Welcome back to "What in the ADHD?" I'm Sydni, and
today's topic is ADHD medication
"Um, but you already talked about that?"
Yes, I know. BUT. I've gotten a lot of really great questions
on previous videos and on social media.
So I wanted to make sure I have all of the information for Frequently Asked Questions
all in one place for everyone.
But, before we get into stimulants and nonstimulants, I wanted to start off with story time.
[music]
Imagine you're walking through the woods. And you're alone.
And it's dark. And maybe a storm is approaching. [thunder]
You're trying to keep your cool, but you can't help but feel a little nervous
when all of a sudden, you hear a noise.
[growls; animal noises]
After the initial "what the [beep] was that?" moment,
what happens?
When we're startled, we have what's called the Fight or Flight Response. [screams]
Since the beginning of time, humans have reacted to threats with this stress response that
prepares our body to either run away or fight whatever the threat is. [punches]
Of course, this response isn't always prompted by something that's dangerous, necessarily.
People commonly have this response to loud noises or every day stressors.
So, odds are, you know what it feels like when your body goes into this mode.
During the Fight or Flight response, the Central Nervous System, or "CNS",
responds to the stimulation by releasing epinephrine, also known as adrenaline.
This causes a few other things to happen in the body.
Increased heart rate, slowed digestion,
alertness, faster breathing, higher blood pressure,
dilated pupils, and a burst of energy.
These things happen because your body is trying to prepare itself to either fight or run.
Side note, and fun fact that I promise has relevance:
your digestive tract slows down its activity because,
during the Fight or Flight response, your body is sending as much blood as it's allowed
to your extremities, or your arms and legs.
You want more blood flow to the extremities because you'll need them to either flee or throw hands.
[boxing bell]
So, what does this have to do with ADHD medication, exactly?
As most of you know, there are two classes of drugs that are commonly used to treat ADHD:
stimulants and nonstimulants.
Stimulants are going to stimulate the Central Nervous System,
while nonstimulants are not.
Wait, wait, wait, wait, wait. Hold up. Play that again?
[rewind]
"stimulants are going to stimulate the central nervous system while nonstimulants are not"
[fast forward]
We JUST talked about what happens to the body when the central nervous system is stimulated.
But, does that same idea apply here, too?
The answer is: yes!
When you take stimulant medication, you're giving your body synthetic forms of CNS stimulants,
that, in turn, increase the production of adrenaline and dopamine.
That's why some people experience the symptoms I mentioned earlier when they take stimulant medication.
An increased heart rate, feeling alert, and feeling energized.
Many people will also have a decreased appetite after taking stimulants.
When the body pulls resources away from the digestive tract,
you're not going to get as many cues for hunger that you normally would without the stimulants.
See? I told you the thing about digestion was relevant.
Ok. So now that we have a general idea of how stimulants work,
Let's go over popular stimulant medications and the types of compounds that are in each of them.
First up: Adderall, since it seems to be the most popular.
Adderall's main compounds are amphetamine and dextroamphetamine.
Not to be confused with methamphetamine, an illegal drug. [buzz]
To put it simply, these compounds increase dopamine and adrenaline levels,
which increase focus.
Next up: Ritalin. The long, sciencey name for this drug is "methylphenidate hydrochloride"
Through a slightly different mechanism than adderall, this also increases dopamine and adrenaline.
And then there's Concerta. This is "methylphenidate" WITHOUT the "hydrochloride".
Even though the name is slightly different from Ritalin, they're essentially the same drug.
The only real difference between the two is that Concerta only has Extended Release,
while Ritalin also has Immediate and an Intermediate Release.
The last stimulant I wanted to talk about is Vyvanse, or "Lisdexamfetamine".
This is also known as "Elvanse" in some countries.
Vyvanse is a special one because it has a different metabolic process in the body than the others.
When you ingest Adderall, Ritalin, Focalin, Dexedrine, and Concerta,
the drugs get absorbed into your bloodstream and act on the central nervous system as they are.
In other words, nothing too drastic is going to change about these drugs after ingesting them.
Vyvanse, however, requires an additional step when being metabolized.
Lisdexamfetamine is what's called a "pro drug",
which means that it's not in its final form just yet.
It first has to be metabolized by the liver.
Once the lisdexamfetamine reaches your liver,
your liver will take a look around at its ingredients that it has in stock and combine them with the Vyvanse.
Some time later, the liver will start to produce Dextroamphetamine.
Which will THEN act on the CNS and increase dopamine and adrenaline.
Because your liver has to metabolize it before it can be useful,
Vyvanse has a lower chance of being abused or causing dependency or addiction.
Once your liver runs out of ingredients, dextroamphetamine can no longer be made that day,
no matter how much lisdexamfetamine goes into your system.
Vyvanse is also unique in the sense that you can take it with food
and still experience its full effect.
This is because of the liver metabolism aspect.
When you take Adderall or any of the stimulant drugs I listed,
it's really important to time your meals around it.
If you eat too soon before or after you take your Adderall, or Concerta, or Ritalin,
there's a chance that it won't be as effective.
So, think about the capsule of stimulant meds going down into your stomach.
The potency and efficacy of the drug
depends on how quickly and efficiently your body can absorb it into your bloodstream.
If you throw Adderall down with a cheeseburger and fries, it's going to get lost in there and be of little use to you.
Citric acid and ascorbic acid (also known as Vitamin C) are important to watch for for all of the stimulant medications.
These act as a sort of magnet for amphetamines.
The amphetamines will be drawn out of the body if citric acid and ascorbic acid are there,
and sent to the kidneys to be filtered and excreted.
[toilet flush]
Because of this, it's best to wait at least an hour to have anything with citric acid or vitamin C after taking your medicine.
Now let's move on to the nonstimulants.
Unlike stimulants, these do NOT stimulate the central nervous system.
Nonstimulants, then, are a great option for people with severe anxiety
and/or people that are very sensitive to stimulant medication.
There are four nonstimulants that I wanted to touch on for this video.
The most popular nonstimulant is Wellbutrin or "Bupropion".
Which is a norepinephrine-dopamine reuptake inhibitor, a type of antidepressant.
Another popular nonstimulant/antidepressant is Strattera or "Atomoxetine".
A selective norepinephrine reuptake inhibitor.
And then there are two other popular nonstimulants that are referred to as "cognition-enhancing medications",
rather than being full-blown antidepressants like Strattera and Wellbutrin.
The first is Guanfacine,
which is a centrally acting alpha 2 a adrenergic receptor agonist,
whatever that means.
And then there's clonidine, a centrally acting alpha agonist hypotensive agent,
whatever THAT means.
Side note: I'm joking, of course.
If someone really wants to know the science behind these drug classes, I don't mind researching it and getting back to you.
But, for simplicity's sake, we're just going to move forward for this video.
Now that we have the big words out of the way, let's talk about dosage.
Nonstimulants need to be taken every day to notice them working.
While stimulants can be taken every few days or however often you want to take them,
and still have full efficacy each time,
nonstimulants need time to build up in the system before they really start to make a difference.
This can take anywhere between two to six weeks.
Some people SWEAR that they can feel the nonstimulants working immediately,
But this is more likely a general reaction from your body because something new is in your system.
Or, you know, it could just be good ol Placebo Effect.
I've had a few people ask me why certain ADHD medications work for them and others don't,
and if there's a way to determine which one is best for you without having to try ALL THE DRUGS
First, let's think back to when I mentioned the different compounds in each of the medications.
Everyone's body is different, and that applies to how we metabolize drugs, too.
Here's a personal example:
Adderall works really well for me.
But I've also tried Wellbutrin and Vyvanse. Neither of them worked.
Wellbutrin made me feel depressed and Vyvanse made me kinda tired and made my armpits smell weird.
Yes, that's a whole thing, and I have an entire blog post on my website explaining the science
behind body odor and medication.
On the other hand, I know people who hate Adderall
because it makes them jittery or nauseous.
Or it just doesn't work for them.
Those same people swear by Vyvanse or Wellbutrin.
It all comes down to how your body processes and metabolizes certain drugs and compounds.
Lucky for you, there is a way to find out which drugs would work best with your body's metabolism process.
All it takes is a quick cheek swab or blood test.
These are called "Pharmacogenetic Tests".
Pharmacogenetic tests can be ordered by your doctor.
When your samples are sent off to a lab, the scientists extract your DNA
and determine your body's specific drug preferences based on your genotype for different metabolism genes.
I'll link a website for more information on these tests if you're interested in learning more about genetic testing for medication.
Lastly, I wanted to go over side effects, things to watch out for,
and what to do if you're concerned about your medication.
Some of the super common side effects experienced by people taking ADHD medication are:
decrease in appetite, dry mouth, headaches,
insomnia, diarrhea, increased sweating and body odor,
and tachycardia, which is when your heart beats faster.
Other side effects to watch out for that are far more serious:
extreme weight loss, heart palpitations,
severe nausea or vomiting,
seizures, panic attacks,
and a sharp increase in blood pressure.
If at any time you're concerned about your medication
whether you're bothered by the side effects or you don't feel the medication working,
It's always a good idea to talk to your doctor about it.
They could change your dosage or switch medication brands altogether.
If your doctor is unavailable, pharmacists are also helpful professionals to talk to.
Alright, that is all I have for you on ADHD medication today. [Outro song; Electric Heart by Anevo]
If you have any additional comments or questions, feel free to leave them in the comment section below.
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