The best cure for ADHD inattentive (ADHD-PI) or inattentive ADD is probably not Ritalin. There are some psychiatrists who believe that inattentive ADD or ADHD-PI generally cannot have ADHD, and that patients with this subtype of ADHD may react quite differently than other subtypes to stimulant medications.
Dr. Russell Barkley, ADHD Chief Specialist, wrote this on the treatment of an inattentive ADHD subtype: “These children do not respond to stimulants anywhere near, as well as with hyperactive, impulsive children AD / HD, will show a sufficient therapeutic response to keep them on treatment initial titration period. Ninety-two percent of AD / HD children respond to stimulants. Twenty percent of these children respond to stimulants, and AD is HD. with very light doses, small doses. "
However, many people with ADHD-PI successfully use a stimulant. For some people, even a small improvement is reason enough to stay on treatment. The best medicine always depends on each person, but there is evidence that Ritalin works less effectively for ADHD-PI than Adderall. It would be great, I think, to have an easy and quick reference to the medications used to treat inattentive ADHD. To better understand the available treatments, a very simple lesson in the biology of ADHD is convenient.
All types of ADHD are believed to be the result of a problem with the neurotransmitters in our brain. The two neurotransmitters that cause the main symptoms of ADHD are dopamine and adrenaline (norepinephrine). It is very simply said that a small amount of dopamine in our brain will cause hyperactivity and impulsivity. Low levels of adrenaline will cause a lack of focus, lethargy and mental fatigue. Serotonin, another neurotransmitter, is secreted and depleted in tandem with dopamine and adrenaline. Low serotonin levels make us irritable, tired and depressed. The level of circulating serotonin is related to the levels of these two other neurotransmitters and vice versa.
All treatments for ADHD are aimed at optimizing the function of the neurotransmitter in the brain. The Ritalin (Methylphenidate) family works by increasing brain dopamine and epinephrine. The Adderall family (amphetamine) works by increasing the brain's epinaphrine and dopamine, but this family of drugs increases dopamine by about half less than methylphenidate. Strattera (atomoxetine) works by increasing norepinephrine. Guanfacine (Intuniv) regulates the flow and efficiency of neurotransmitter receptors in the brain in a way that reduces hyperactivity, improves working memory and decreases impulsiveness and distractibility.
So what is the best cure for ADHD-PI? Some doctors believe that the Adderall family works better than the Ritalin family for inattentive people, since the effect of drugs on norepinephrine is greater than the effect on dopamine. All stimulants may cause concern in some patients, but patients with ADHD-PI seem to tolerate amphetamines better than they tolerate the Ritalin family.
It would seem that using this very simple understanding of the biology of ADHD, Strattera should work best for ADHD-PI. The reality is that Strattera only works for some patients with ADHD-PI. We do not know why this is so. It would seem that Intuniv would not work well in people with ADHD-PI, since its main effect would be associated with hyperactivity. The reality is that some doctors have found that Intuniv works well for patients with ADHD-PI.
Because some people with ADHD also have problems with depression and anxiety, sometimes they prescribe antidepressants, such as tricyclics (Elavil, Norpramin, Tofranil), which work on norepinephrine and serotonin. There are many patients who report relief from their inattentive symptoms when they are treated with tricyclics. SSRIs, selective serotonin reuptake inhibitors (Prozac, Paxil, Celexa) work only on serotonin and are sometimes used with stimulants to treat ADHD-PI with depression, but can also help inattention.
All of these medicines can have side effects. Stimulants can cause weight loss, anxiety and sleep problems. Intuniv can cause a decrease in blood pressure and drowsiness, Strattera can cause sexual dysfunction and has as a SSRI a warning for pediatric patients regarding an increased risk of agitation, irritability and suicidal thinking. Usually, the side effects of the drug are mild or rare, but when they are not there, they will unfortunately dictate which treatment can be used.
Some researchers believe that once we compare the genetic problems associated with ADHD, we will be able to tailor individual procedures for everyone with ADHD. This is a high order since the actions of the neurotransmitter in the brain are complex and none of the neurotransmitters work independently. The many symptoms of ADHD are also interrelated and complex.
Given the individual and unique manifestation of ADHD symptoms, as well as differences in the occurrence and tolerance of drug side effects, the treatment of ADHD-PI will always be to some extent a process of individual trial and error.
