Stimulants are usually the first choice of medications in both children and adults due to their high rate of effectiveness in all but a few cases and because they are so well tolerated in most people. There have been many studies showing the effectiveness of stimulants in the treatment of ADHD in children, adolescents and adults. In fact, stimulants effectively decrease inattention, distractibility and impulsivity in over 70 percent of individuals with ADHD. Stimulant medications increase the release, or block the reabsorption of dopamine and norepinephrine, two brain neurotransmitters. This increases the transmission between certain neurons. Since each stimulant achieves this slightly differently, a medication that is effective for one individual with ADHD may not be as effective for another. The first two are, by far, the most commonly prescribed.
Methylphenidate (Ritalin, Concerta, Metadate, Riphenidate, Methylin) is the most commonly prescribed stimulant and is approved for patients as young as six years old. Research on mice suggests that methylphenidate elevates levels of serotonin, and that this may account for some of its calming effects. It usually starts to work about 15 to 30 minutes after it is taken. It peaks an average of 90-120 minutes after it is taken. This can vary from person to person. The effect of dose can be from 2.5 to 4 hours.
Amphetamine (Dexedrine, Adderall) is one of the standard treatments of ADHD and is available as a once daily preparation. It is approved for ages three and older. It is also short acting but usually lasts an hour or so longer than methylphenidate. DeAmphetamine and dextroamphetamine are used in combination to treat ADHD.
Pemoline (Cylert) is given once a day. It is not a first-line drug because it carries a risk for liver failure. There have been 15 deaths due to liver failure associated with pemoline. It is used rarely, perhaps if other drugs fail to produce results, and liver function levels must be monitored every 2 weeks during treatment. It is approved for ages 6 and older. It takes about one or two hours to take effect and lasts up to eight hours. Pemoline may take days to build up enough to have an effect. It should be given seven days a week.
Methamphetamine (Desoxyn) is the medication most effective at enhancing concentration and decreasing distractibility, with the least occurrence of side effects. However, since it has a higher potential for abuse than the other stimulants, Desoxyn is often used as a second-line medication when the first-line medications have been found deficient. The greater primary effectiveness of Desoxyn is believed to be caused by the extra methyl group of methamphetamine, which basic amphetamine does not have. This may increase the solubility of methamphetamine and therefore be more thoroughly and deeply absorbed into the brain. Generally, the recommended uses of Desoxyn are similar to the other amphetamine-class stimulants. Used carefully in selected patients, it can be an effective treatment for ADHD.