How ADHD Medication Works

by Dr. Thor Bergersen

In recent blog posts, I’ve written copiously about dopamine, the neurotransmitter primarily responsible for our ability to sustain attention, organize our environment, prioritize tasks and resist our impulses. Excess dopamine recycling in the prefrontal cortex results in relatively low levels of this chemical messenger’s “availability” for nerve cell communication in that part of the brain, resulting in deficient executive functioning.

Last time, I wrote about ways in which we can naturally increase our dopamine levels through exercise, good sleep habits and a stimulating environment. Although I discuss changes in lifestyle, therapy and coaching with all of my patients, I also prescribe medications, most of which affect neurotransmitter levels. Of the medications used to treat ADHD, all except one increase available dopamine by inhibiting its recycle rate. The outlier, atomoxetine (brand name Strattera), boosts levels of norepinephrine, a neurotransmitter that shares many characteristics with dopamine.

The dopamine boosting medications, also referred to as stimulants, are tightly regulated by the DEA and are categorized as “controlled substances” because people sometimes abuse or become addicted to them. During my 16 years of clinical practice, I have encountered patients who, as a result of misdiagnosis and, more often than not, “doctor shopping,” manage to game the system in order to obtain medication that is actually hurting more than helping them. These patients, however, represent rare exceptions. For the vast majority of people with ADHD who have been properly diagnosed, stimulant medications are far from addictive. In fact, many people prefer not to take their medication when they are not at work or school.

When dopamine boosting medications like methylphenidate (brand names Ritalin, Concerta, Daytrana) or amphetamine (brand names Adderall, Vyvanse, Dexedrine) are prescribed to treat ADHD, the effects can be dramatic. The ability to initiate and complete tasks, sustain attention and resist distraction can markedly improve. This is due, of course, to the prefrontal cortex, or coach of the brain, waking up. People who have procrastinated their entire lives can suddenly get stuff done. They can read a book or the newspaper. They can fix the fence, remember their kids’ sports schedules, take out the trash and be on time.

As we all know, medications can have side effects. Stimulants can decrease appetite, interfere with sleep, cause dry mouth and anxiety among other things. Rarely, they cause increased heart rate or blood pressure. When well tolerated, however, they’re among the most effective treatments for ADHD. Next time, I’ll discuss non-stimulant medication options.