Brain Function 101- why medicine helps those with ADHD

Neurotransmitters are the messengers that bring information from one neuron to another. An imbalance in their levels can cause many problems. Medicines can help bring levels back to normal.

There’s a commonly held belief that people with ADHD should just try harder, but this doesn’t usually work. The symptoms of ADHD are caused in part by imbalances of neurotransmitters in the brain. Low norepinephrine levels lead to symptoms of ADHD. More and more evidence is showing the differences in the brains of people with ADHD compared to neurotypical (“normal”) people.

ADHD is real. You can’t just will it away.

Not everything gets better when people just try harder. Some things require a different approach. #adhdkcteen

What if no meds are used for ADHD?

Not everyone with ADHD is treated with medication. There are many reasons.

Some have never been diagnosed. Others don’t like medicine for whatever reason.

Many teens want to come off their medications. Some don’t like side effects. Others don’t want to be different.

Some can manage issues with alternative treatments and accommodations. Or think they can, but suffer from unrecognized complications of undertreated ADHD.

Some people simply forget to take it and then struggle with the consequences of being unmedicated.

Many families have a hard time affording the medicine or taking the time to do the required follow up with their physician.

I’m sure there are many more reasons people stop (or never start) medicine.

Neurotransmitters

Before discussing how the medicines work, it’s important to learn about neurotransmitters.

Our brain is of course very complicated in structure and function. There are millions of neurons that make up our brains. Between each neuron is a synapse, or space. Different areas of the brain serve different functions, and they all interact with each other. They also interact with other parts of our body and the outside world.

There are many pathways or circuits that bring information from one part of our brain to another. Neurotransmitters are the messengers that bring information from one neuron to another. They are made from amino acids.

Neurotransmitters each have a unique function but can be broadly classified into two categories: excitatory and inhibitory. Some neurotransmitters can serve both functions.

Neurotransmitters each have a unique function, but can be broadly classified into two categories: excitatory and inhibitory. Some neurotransmitters can serve both functions. #adhdkcteen

Excitatory neurotransmitters regulate motor movement, thought processes, anxiety, and more.

They can help us stay alert, but when they aren’t moderated by an inhibitory system, things can get out of control.

ADHD is like having a Ferrari engine for a brain with bicycle brakes. Strengthen the brakes and you have a champion. ~ Dr. Edward Hallowell #adhdkcteen

Inhibitory neurotransmitters act like brakes.

We need brakes so we don’t feel restless, irritable, and out of focus. When our brakes work, we can excel! Without brakes, we’re out of control.

Lock and key

Neurotransmitters act as messengers between different neurons. They are released from one neuron into the space between neurons called the synapse. They enter a neuron that has the proper shaped structure for it to fit.

Neurotransmitters are used to communicate from one neuron to another. #adhdkcteen

It works like a lock and key.

Each neurotransmitter is like a different key. They each fit certain locks, and often can fit more than one type of lock.

Neurotransmitter levels and ADHD

When neurotransmitter levels are too high or too low, we can develop anxiety, depression, and executive functioning disruptions.

It is important to understand that to some extent we can control our actions, but neurotransmitters are important in the aspects that are beyond our control. Sometimes we just feel anxious or sad. Focusing can be very difficult. Executive functions, such as time management, working memory, and more, can be hard to manage.

While we can’t simply will ADHD symptoms away, there are things we can do to improve our mood and executive functioning that don’t involve medicines. But medicines are an important treatment.

Norepinephrine

Norepinephrine is an excitatory neurotransmitter. It is primarily made and stored in neurons but is also found in the blood and a small amount is stored in the adrenal glands, which sit on top of our kidneys.

Norepinephrine is involved in focus, emotions, sleeping, dreaming, and learning. Too much norepinephrine can cause anxiety, but too little can lead to problems with focus and motivation.

It can raise our heart rate, increase blood flow to muscles, and increase our blood sugar level – all symptoms we experience in times of anxiety. These are helpful responses when stress is caused by physical danger and we need to run away, but not so much when we worry about a test or other common anxieties.

These symptoms can lead to distraction, self-consciousness, and poor focus and performance. This can look a lot like when norepinephrine levels are too low, which is one reason why anxiety and ADHD can mimic one another as well as exacerbate one another.

Norepinephrine: too much leads to anxiety, too little to poor focus and low motivation. #adhdkcteen

Dopamine

Dopamine makes us feel happy. Getting a bump in dopamine feels good.

I often joke that we get a dopamine hit every time we check social media or win a game. One of the reasons depressed people overeat comfort foods is that eating rises our dopamine levels, which makes us feel better. (At least until the heartburn sets in or we notice we’ve gained a few too many pounds to be healthy.)

Dopamine is one of the neurotransmitters that can be both excitatory and inhibitory.

Drugs like nicotine (yes, even from electronic cigarettes), opiates, and alcohol all increase dopamine levels. Eating foods can have the same dopamine increase, as can winning a game or doing anything else pleasurable.

We can all choose healthy options to get dopamine hits. Exercise. Playing games. Enjoying the company of friends and family. Helping others. All of these are healthy things that bring us happiness.

Negative things, such as drugs and alcohol or too much screen time, can lead to more problems than they’re worth. Even though they bring temporary feelings of happiness, they cause more problems in the end. Avoid these dopamine hits.

Drugs, alcohol, exercise, foods and any pleasurable activity can increase our dopamine level and make us feel happy. Not all are healthy ways to get a dopamine hit. #adhdkcteen

Dopamine can increase our alertness and help with memory and motor control in addition to giving us pleasure.

Dopamine can be converted into norepinephrine and epinephrine.

Low dopamine

Low levels of dopamine are associated with problems focusing, depression, the inclination to abuse drugs and alcohol, excessively playing games online or gambling , and overeating.

If the levels are low in motor areas of the brain, it can lead to the tremors commonly seen in Parkinson’s disease.

Low levels in other parts of the brain can lead to learning and memory problems, lack of energy and motivation, and a loss of happiness and interest in things that used to bring pleasure.

Low levels in the prefrontal cortex are associated with ADHD.

High Dopamine

High levels of dopamine can cause overexcitement and disrupted thoughts. They can even lead to anxiety and paranoia.

Serotonin

Serotonin is important in the regulation of anger and aggression, body temperature, mood, sleep, sexuality, appetite and metabolism. It can help us relax when serotonin is available in proper amounts. Stress can lower our serotonin levels as we use it up trying to relax.

About 80-90% of the body’s total serotonin is found in the gut. It is made by bacteria that live in our gastrointestinal tract. There are ongoing studies using probiotics (healthy bacteria) to alter the level of serotonin to help anxiety and depression. Unfortunately, as of now studies show mixed results, and at best only a minor benefit.

Low serotonin

Low levels of serotonin can result in depression, anxiety, anger, panic attacks, low energy, migraines, insomnia, obsessions, irritability, craving sweets or loss of appetite, focus and memory problems, aggressive behavior, slowed muscle movement and speech, and having a decreased interest in sex.

High Serotonin

High levels of serotonin cause diarrhea, headache, confusion, sweatiness, twitching muscles or stiff muscles, fever, high heart rate and blood pressure, seizures, and even death.

How do ADHD medicines work?

Stimulant medicines are considered the first line medical treatment for ADHD. The two types of stimulants are methylphenidates and amphetamines.

The differences in how these two groups of stimulant types work may explain why some people with ADHD respond to one type better than another.

Methylphenidates

Methylphenidates include prescription medicines such as Ritalin, Metadate, Concerta, Focalin, Aptensio, Quillivant and others.

The methylphenidates block the reuptake of dopamine and norepinephrine. This leaves more of these neurotransmitters in the synapse. Methylphenidates also help release these neurotransmitters from the neuron, again allowing more to be in the synapse.

Amphetamines

Amphetamines include Adderall and Vyvanse. They increase the release of dopamine and norepinephrine from their storage sites into the synapse. They also slow the reuptake of the neurotransmitters, but not to a large extent.

How do medicines affect neurotransmitters?

Medicines that affect neurotransmitters are used to treat ADHD, anxiety, depression, and low blood pressure.

  • Stimulant medicines (methylphenidates and amphetamines) increase norepinephrine and dopamine.
  • Atomoxetine (Strattera) affects only norepinephrine.
  • Serotonin norepinephrine reuptake inhibitors (SNRIs) are antidepressants that work by increasing serotonin and norepinephrine.
  • Tricyclic antidepressants also increase norepinephrine and serotonin, but are not often used anymore since there are many safer options available.
  • Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat anxiety and depression. They block the reabsorption of serotonin, which leaves more available in the synapse.
  • MAOIs prevent the breakdown of serotonin (and other neurotransmitters) but are rarely used due to significant adverse reactions.

For more:

In addition to the resources hyperlinked throughout this post, check out the following:

For more on the basics of the medicines used to treat ADHD, see ADHD Medications: Types and side effects.

Did you know that while stimulants that are used to treat ADHD can help people with ADHD, they can cause imbalances to neurotransmitters to those without ADHD? Learn how stimulants can make focus, attention, mood and more worse in Stimulants decrease brain function. Say What?

Dr. Russell Barkley has studied ADHD extensively and mentions neurotransmitters in his paper, What Causes ADHD?

What is ADHD? Why do some develop it?

ADHD was first recognized as a behavior problem, but now we know it’s a developmental disorder. Don’t worry though. Having a developmental disorder doesn’t make you stupid or damaged. It simply means that brain development is a bit different. We’ll tackle details here.

Typical Brain Development

Our brains have billions of nerve cells called neurons that start developing a few weeks after conception. Within 6 months after conception, there are even more neurons than are found in an adult brain. As we develop, neurons grow and make connections with one another. The number of brain cells decrease as unneeded neurons are pruned away.

Neurotransmitters help to communicate from one neuron to another. For more see adhdkcteen.com. #adhd #whatisadhd #braindevelopment

A network of fibers develops to connect the brain cells in order to interact with other parts of the brain and to perform complex functions. Neurotransmitters help send messages between nerve cells.

We’ll tackle neurotransmitters more in future posts. They’re important!

How long does it take for the brain to fully develop?

We might look pretty mature by our teen years, but our brain is still growing!

The first 3-4 years of life is a time of rapid brain development, but it continues for more than 20 years.

Brains don't stop growing when we do. Learn more at www.adhdkcteen.com. #adhd #adhdkcteen

Prefrontal cortex

The prefrontal cortex is especially interesting. It helps us plan, organize, make decisions, and maintain self control. These are considered executive functions and are often problematic for those with ADHD.

The prefrontal cortex typically doesn’t finish full development until mid-20s. That means our brains are still developing key areas into our early adult years!

For a fun interactive way to see all areas of the brain, visit Brainfacts.org.
For a fun interactive way to see all areas of the brain, visit Brainfacts.org.

How does ADHD develop?

There are many things that affect our brain development that can lead to symptoms of ADHD.

At this point we don’t diagnose the cause of the ADHD since treatment is geared toward addressing the symptoms, but it can be helpful to know that there are many reasons a person develops ADHD.

Genetics

Like many things, brain development is affected by our genetics. Genetics affects how we look, how tall we should grow, our intelligence, and risks of certain health problems – such as cancer or heart disease. Of course our genetics are only the blueprint. Our environment, nutrition, experiences, and much more also affect how we grow and develop.

If one parent has ADHD, a child is more likely to have ADHD. If both parents have ADHD, their child is much more likely to have ADHD.

Genes can affect whether or not we develop ADHD. Learn more at www.adhdkcteen.com. #adhd #adhdkcteen

Prenatal development

While a baby is still in its mother’s womb, it is considered a fetus. This is considered the prenatal time of development.

Many things can affect development during the prenatal time. Drugs and alcohol, illness, and other stressors affecting the mother can affect the baby.

Prematurity (being born before the due date) and being small at birth can increase the risk of developmental disorders, including ADHD.

Our brains develop for months before we're born. Learn more at www.adhdkcteen.com. #adhd #adhdkcteen #development

Illness, injury, toxins and more… oh, my!

The first few years of a child’s life can be complicated by illness, injury, nutritional deficiencies, and toxins. These can all affect brain development.

Even after the critical developmental years, injuries and toxins to the brain can change our brain function. Think of a teen or adult who has had a concussion. Their brain function can be severely altered. They might suffer from mental fogginess, fatigue, irritability, and more after the injury. In fact, sometimes people will be treated with medications commonly used for ADHD temporarily after a concussion. 

What it’s NOT:

ADHD is not due to bad parenting, poor discipline, or bad schools. 

ADHD is not from bad parenting. It is based in our brains and is neurological. For more see adhdkcteen.com. #adhd #whatisadhd #braindevelopment

Yes, those things can worsen a child’s behavior, but they don’t cause ADHD.

What about sugar?

ADHD also isn’t from too much sugar.

Studies have even shown that even when a parent perceives worsening of behavior after sugar, independent observers see no real change. For more on that and how diets affect ADHD, see Special Diets for ADHD.

There are many myths about why ADHD exists - and some even deny its existance. Learn the real cause of ADHD. #adhdkcteen #adhd

Coming up…

Tune in next week for information on brain imaging in ADHD that shows specific differences in the ADHD brain and then for information on what we know about the genetics of ADHD!