Amphetamines (Adderall) vs Methylphenidates (Ritalin) for ADHD Treatment in Adults

Dr. Pagnani of Rittenhouse Psychiatric Associates discusses two categories of controlled stimulant medications used to treat ADHD in adults: amphetamines and methylphenidates. Amphetamines (like adderall, vyvanse and dexedrine) and methylphenidates (like ritalin, concerta and focalin) both increase availability in the extraneuronal space of norepinephrine and dopamine by preventing their reuptake and also increasing their release. These medications have significant abuse potential and patients can develop physiological dependence and tolerance. They can also cause withdrawal, if taken regularly and decreased or stopped abruptly. There are various side effects, some potentially serious, and taking these medications must be under the direct supervision of a medical professional.

Dr. Pagnani discusses that in his clinical experience, he's found that the amphetamine stimulants seem to have a higher likelihood of causing anxiety, irritability, insomnia, restless, tiredness or "crash," between doses or when the medication is wearing off. With that said, these medications may work better for individuals with significant hyperactivity as part of their illness, than the methylphenidates, and there are certainly many patients who tolerate them well. Methylphenidates are often preferred (when medication management with a controlled medication is warranted) for patients who's primary symptom of ADHD is difficulty with focus (mental, as opposed to physical hyperactivity). He discusses that he believes there's a lower abuse potential (although there certainly IS abuse potential) with methylphenidates than amphetamines.

Dr. Pagnani is the founder and medical director of Rittenhouse Psychiatric Associates, an Instructor at The Johns Hopkins Hospital for the Department of Psychiatry, he supervises psychiatric residents at Jefferson Hospital, he serves on the Young Professional Board of Uplift, the Center for Grieving Children and he maintains a private practice of Psychiatry in Philadelphia where he sees patients for one-time psychiatric evaluations and second opinions. He is a licensed physician and surgeon in NJ, PA, NY, MD, DE, FL and CA and can provide consultations to individuals via HIPAA compliant Telehealth visits living in these locations.

Rittenhouse Psychiatric Associates is a private practice of psychiatry consisting of about 25 psychiatrists, psychiatric nurse practitioners and psychotherapists with physical locations in Philadelphia and Paoli, PA and serving all of PA, NJ, NY and FL virtually via HIPAA compliant tele-psychiatry. Individuals seeking not only evaluations but long-term psychiatric care, can contact Rittenhouse Psychiatric Associates directly.

These videos aim to increase awareness and discussion of mental health topics and to encourage struggling individuals to schedule an appointment directly with a mental health provider. Mental health needs to be normalized, and simply speaking about mental health topics openly, is an important first step.

Dr. Pagnani and Rittenhouse Psychiatric Associates are NOT advocating for or against the use of any mentioned psychiatric medications for any specific individual. Additionally, any side effects mentioned are not a complete list of potential side effects or contraindications to taking any mentioned medications, and all risks and benefits of a medication should be discussed with an individual’s provider at an appointment, before starting, stopping or making changes to a medication regimen.

This video is INFORMATIVE ONLY - NOT MEDICAL ADVICE.

If you are researching a specific topic, please view our Youtube channel, click all videos and use the search function. Please also visit and follow us on instagram and FB: @RittenhousePsych.

www.RittenhousePA.com
www.ChrisPagnaniMD.com

[Myperfectshell]

I had listened to another video which stated that research has shown, when used as prescribed in folks with a diagnosis, abuse rates are low and the medications are highly effective

[dltn]

I'm Brazilian, Adderall (dextroamfetamine) is prohibited here, only Vyvanse (Lis-dexamfetamine) is allowed because it has to be broken by the liver, so, theoretically, it's a barrier to limit substance abuse.
Yet I feel that Methylphenidate (allowed as well) is even safer because bcuse it is hard even to tolerate high doses of it .. at least for me, 40 mg a day is the maximum I have ever supported.
I feel that Vyvanse is a bomb to my circadian cycle hahaha... I just can't sleep :/ .. by the other hand Methylphenidate gives me a little bit of anxiety sometimes... Yes ADHD sucks, and without medications and being physically active.. working with spreadsheets, reports and anything that demands attention is near impossible. :(

[staywackzach]

Methylphenidate is actually more structurally similar to crack/cocaine than it is to Methamphetamine. Amphetamines are literally just unmethylated meth, so that one is pretty self explanatory. Methylphenidate made me tweak and get facial ticks as a kid, I always hated how it makes me feel

[jeny]

Thank you for your video. I trust my provider and follow his recommendations but I still like to read up on this stuff. I was extremely disappointed that Ritalin had zero effect on me. Same with bupropion. I wanted to give up on having more clarity, focus, and motivation in my life. Most of my past depression has been from the fact that I feel like a failure and in a fog. Anyway, I'm one week into Adderall feeling some hope. It's just interesting how medication can affect different people so differently

[mrk]

I just switched from Adderall to Ritalin and it was horrible, made me so nauseous, dizzy and shaky so the oposite of what you described (as far as I understand). Adderall was excellent, for just focus for me

[harrisoncrenshaw]

This was very helpful you clearly know a lot about this, thank you

[hawklegs]

This was a very informative video. I could actually really use your advice from your expertise on these kinds of medications. I've been trying medications to treat my ADHD (inattentive type), but nothing has really worked? More that it's really difficult to tell. For example, I was on vyvanse for a while, and it seemed like it helped, but then it just stopped helping, even after increasing the dosage. After I stopped taking it, I felt so much better after, like I didn't realize how bad I felt until after I wasn't on it anymore. I've tried concerta before the vyvanse where it seemingly had no effect, and I'm currently on straterra.

It's like, I think I see positive signs, but overall feel the same, or like, I keep experiencing problems from ADHD that the medication was supposed to stop from happening. How do you know if the medication is actually doing what it's supposed to? The only consistent change I've noticed from the straterra is how light my sleep is (waking up from something happening in a dream, or when family members are making noise in the morning), when normally I'm a very heavy sleeper (almost always sleep through the entire night, could sleep through people going into and out of my room while making noise, I've been told).

[VirtualBFFs]

Yes dependency is a thing... However, you would not say that to a cancer patient.. They too are dependant on their medication...

The dependency depends on how it affects the person because medications for me are life-changing so yes i too am dependent... Because without them I cannot function... I cannot do simple tasks things and spiral into terrible depression

[Nurr]

Thanks this is a helpful, concise summary. I hadn't realised until today that Ritalin *wasn't* amphetamine based. Interesting!

[Farambul]

I’m currently taking Dexmethylphenidate XR 30Mg once a day. I was up dosed by my doctor from 10Mg once a day. Unfortunately it doesn’t seem to be effective. I do have a 2 hour period where I notice a difference but then it fades and leaves me in a bit of a fog. I’m diagnosed Adult ADHD non hyper active. My doctor is thinking to change me to the immediate release to see if that helps. She did mention possibly Adderall or Concerta if this doesn’t work. I’m new to all of this looking for advice. Thanks

[AR-vfvg]

( Wellbutrin XR 150mg or 300mg can also be effective against adhd, alone, but also in conjunction with Ritalin.
(Only adding this as what seems to be current concensus.)

[MarcKlark]

I take methylphenidate. It worked well. After a while I relied on it to get up and go. My get up and go kinda got up and went. I really essentially begged my doctor for refill. It improves mood. It has a ceiling so taking more is a waste. It does come down. I used caffiene tablets until my doctor finally refill me so at first I had caffeine lingering. I will try go two days w/o either then take ritalin and give you an update 2/14/24 today is 2/11/24 I took a tablet already and yesterday. I will skip Mon and Tue All stimulating drugs 💉 and let you know how it workes

[perun]

there is no such thing as abuse of drugs
they are used for the effects that they can give.Thats it

[sdfjsd]

I remember my doctor prescribed me Concerta for ADHD a couple years back just to have me try it out, and it was very bad. It made me feel REALLY jittery, it would severely decrease my appetite, it made me feel like throwing up especially when I worked out, but most importantly, it didn't really help me focus. Eventually, just looking at the pill made me nauseous lol. I started calling it "the death medicine" because it felt like poison. Interestingly, however, Adderall does not do this to me. Yes, it does make me feel a little jittery and a little anxious, but it really helps me focus.

[CynicAtheist]

Could've mentioned that extended release and prodrug versions dont have as much abuse potential as instant release.

[SuperTurtlemandude]

Stop taking meds when I was 12 now as 35 I think I need to take it again

[SwyvCrux]

I hear dexedrine and vyvanse make you less jittery than adderall and that for many its the levoamphetimine that causes lots of side effects and the dextroamphetimine seems to be more tolerable

[satisfiedvideosberry]

I tried methylphenidate and I’m not sure if there’s a loading period but I felt very odd on them and my fingers would swell and I would have other odd things happening.

No problems with dextroamphetamine tho. And I have non hyper active, mostly need it for focus

[kite]

what do you think of modafinil for off label treatment of adhd? there are some studies showing it's effective in adhd although not as much as traditional stimulants. if it does work though it's not addictive and doesn't have the withdrawals or crash.

[richardleetbluesharmonicac]

I almost died from adderol. I developed MAP, which is methamphetamine abuse psychosis