Why Use Medications to Manage ADHD?

This brief video reviews the numerous reasons why clinicians (and patients) would opt to use medication as their first treatment or in combination with starting other psychosocial treatments. it is based on my weekly review of all research on ADHD and on my own books:

Barkley, R. A. (2015). ADHD: A Handbook for Diagnosis and Treatment. New York: Guilford Publications.

Barkley, R. A. (2022). Treating ADHD in Children and Adolescents: What Every Clinician Needs to Know. New York: Guilford Publications.

[jimwilliams]

Thank you for addressing the matter of psychotherapy interventions and side effects. As you note, anything that alters brain functioning can have upsides and downsides, and this includes coping strategies that individuals implement subconsciously and on their own. I eventually realized that I have long leveraged my anxiety to moderate my inattention. It has worked, but at a cost. Being terrified that I will lock my keys in my car keeps it from happening, but at the cost of further strengthening my overactive fear response.

The thing that people often miss regarding psychological modification is that neuroplasticity via behavioral retraining likely works best if problematic neural patterns are a result of learned behaviors in the first place. If an individual has weak executive functioning by design, cognitive interventions are presumably less effective. The “old fart” analogy I sometimes use is trying to get an older auto to start by correct use of the gas pedal. Technique mattered back then, but even so, if there was water in the tank you were unlikely to get the engine to catch, even with impeccable skill. What was needed was to add dry gas to the tank.

So I cannot emphasize this enough: it can be deeply frustrating for those of us with executive dysfunction to try and modify our behavior through cognitive adjustments alone. Sometimes, implementing good technique is difficult or impossible without the ADHD equivalent of dry gas. And the worst thing another person can do when we are struggling is to imply that our difficulties are no different than anyone else’s, and that our problems therefore constitute moral failure. THAT is a cognitive and behavioral modification of the very worst kind.

[chusna.ummusyifa]

7 years taking medication for my 11 yo boy, its really help him to progress as fast as his pace. In this year, he show incredible functional in cognitive, behaviour, communication and social skill 🥰. The key is take the medication as prescribed, discipline behaviour, and family affection. ❤❤
And what dr russell says in this video is totally informative. Can't wait for next video 😍

[LucarioBoricua]

I'd say one overlooked aspect is that, in cases of high severity / greater impairment ADHD, learning skills and adjustment will be oppressively difficult to apply--there's not enough executive function to learn these for this portion of the patient population. In better masked and usually less severe cases, the meds can help counteract exhaustion and frustration related to maladaptive or ineffective coping mechanisms.

Now I do want to see an informed explanation of reasons against the use of medication:
- Intolerable side effects, which may be greater than the gains in executive function for some patients.
- Bad interactions with mental health conditions that can worsen with increased dopamine and/or norepinephrine concentrations in the brain (ex. inducing mania in bipolar disorder, or inducing psychotic episodes).
- Some people experience decreased efficacy as they habituate to their dosage over time.
- ADHD stimulant medications are controlled substances, often subject to very strict regulations. Access to them is subject to shortages, limited amounts prescribed per refill (more executive function challenges to access them), potential occupational or legal problems if detected in drug tests and not justified, or even countries which prohibit the medical use of some or all of them, which can impact people who travel internationally.
- Excess dependence on the medications can lull the patients into a sense of convenience, such that they don't develop healthy adaptations for themselves to do things and behave appropriately when they're not feeling the effects of the medications. It can also lead to bad days if the person skips a dose without meaning to.
- Stimulants tend to have an appetite suppression effect, which can be problematic for growth (in children) and nutrition of people who tend to be more lightweight. It can also lead to insufficient executive function if the person isn't feeding themselves adequately.
- Certain professions discriminate against people who use these medications for their self-management, so it can interfere with occupational opportunities.
- Formulations that use fancy delivery systems can be quite expensive, think of Concerta (OROS pill / osmotic pump pill) or Vyvanse / Elvanse (prodrug that breaks down into the active compound).

[projectpiano]

My takeaways: "Behavioral therapies don't generalize across environments, medications do" "Behavioral therapy depends on when, where, and by whom they're implemented (e.g. a teacher implementing, caregiver, ...)" "Medications work when caregivers aren't present" "Stimulants in some cases may improve brain growth in areas affected by ADHD" "It's cheaper across the same span of time [caveit being that medication may be used for years and therapy may be used for only weeks or months]" (sorry if I misparaphrased anything)

[lizsaskia]

I've been on Elvanse for about a year now, and I've found it incredibly helpful - basically I always wake up with a brain fog and within an hour of taking it my head clears like the fog has lifted. My attention is better, my memory had improved, and I am much more motivated to do things. The main problems I have had are supply, as if I run out, I have now lost my ability to compensate for not having it. So where I used to manage to think fairly well because of extreme anxiety helping me to remember things or motivate me to do things, I now have a complete brain fog and lack of motivation all day if I don't have it. I have also had some side effects when taking it - insomnia improved after a few weeks, dry mouth improved by taking electrolytes, but I've had awful constipation which I can't seem to fix despite several lifestyle and diet changes. I really don't want to have to reduce my dosage as it works so well for me, but I might have to if I don't want to spend the rest of my life taking laxatives!

[mariannaark]

I feel very lucky that of all the things I was diagnosed with it's ADHD that stuck/caused them. As u say it's very treatable and medication makes a day and night difference in ways I cannot yet put into words and doesn't compare to treatments for other conditions I had/was told I had.

[issy]

Thank you very much for your videos, Dr Barkley (and, of course, all of your many years of research conducted since way before I was born!). You feel like my mentor and guide in helping me understand my new identity of having ADHD (and accepting the death of my old identity as neurotypical). It's also reassuring and relieving to watch online content about ADHD that is factual and based on science, rather than misinformation.

[HowndsOfDoom]

Actually, my psychiatrist has said the very same thing about brain connection repair after several years of stimulant use! Cool.

[Magicme]

I’ve been on European Ritalin since January. I was diagnosed at 44, and had no idea that I had ADHD or even what ADHD really was for most of my life. It’s working great, but it dries out my mouth so I take a week off, here and there, when I get tired of dealing with that. I’m noticing that me au natural isn’t as bad as it was before medication. I can still get things done. It does require extra mental effort, so I do start to feel much more tired after a while. Then I know that my medication break is over 😊

[mohamedelfatih]

Thank you for the dedication you put on this issue.
Waiting for the next part

[amandadeoliveira]

Thanks for so much doc ❤ After years of studying and talking to different professonals, you were the only one with the detailed information that o need

[pauljb]

So far Adderall and Wellbutrin combo has helped so much

[Haydezzz]

Incredibly informative as always, thank you

[samlee]

I wish I could take medication fpr my ADHD. I had to stop because a medical illness got way worse and left me with horrible side effects. I feel robbed of a real chance to manage my life better, especially because my neurologists told me, therapy (pscychotherapy) would be pointless without medication. I don't know if it is true but I guess I can see his point. Changing ADHD caused behaviour without medication is incredibly hard, if not impossible.

[MeadowgreenStudio]

As always, very informative, useful, and interesting...thank you!

[ashleyboots]

I've done CBT, DBT, talk therapy, organization planning, stimulant medication, etc etc etc

And nothing

NOTHING

Has worked anywhere near as effectively as the Strattera I started just over a month ago

[ay_U_K_Buddy]

Thanks for great video. Also thanks for the transparency!

[QuantPsychNZ]

Hi Russell, Is there any research that suggests stimulants can make symptoms (e.g., processing speed/working memory) worse for some people? Perhaps if the dose is too high? - I have heard this in clinical settings but not found research to support as yet. Thank you

[HowndsOfDoom]

Incredibly interesting!!! Side effects of psycho therapy!! A video please???

[NummyScrum]

I got prescribed adderal and it took a year from my life to being a zombie in high school. Ruined relationships ect. Scared to try another.