Before starting medications, a few crucial points should be explained to patients:
1) Medications only manage symptoms of ADHD and do not cure it. The symptoms recur after treatment is stopped.
2) Like any other treatment, response to treatment varies from patient to patient. Some patients respond better, and some may not see much benefit.
3) There is always a possibility that patients experience side effects although side effects are usually mild and limited to the first few days of treatment. Even if side effects persist, they will disappear when treatment is discontinued.
4) Patients with ADHD have problems with organisation, time management and keeping deadlines as long as they can remember. ADHD medications will enable them to change their lifestyle and habits, but mediations will not automatically modify those habits. It is up to patients to make effort in order to establish new habits.
5) It is important to diagnose and treat comorbid conditions alongside ADHD (sometimes even before ADHD) in order to provide a better quality of life for patients.
6) ADHD medications can interact dangerously with alcohol and some illicit drugs. It is vital that patients address the harmful use of those substances before starting ADHD medications.
Stimulants: (e.g. Concerta XL, Medikinet, Elvanse)They are the first line of treatment for ADHD. They are generally well-tolerated and effective. Stimulant medications are from two main groups of amphetamine (e.g. Elvanse) and methylphenidate (e.g. Concerta XL). Patients respond very individually to each group in terms of therapeutic benefits and side effects. Both groups are available in immediate-release and slow-release forms. It is strongly advised to treat adults with ADHD using slow-release preparations because i) they do not induce euphoria and less potential for abuse ii) they need to be taken only once a day and iii) they provide a rather steady level in the brain which causes steady feeling for the patient. Side effects are usually mild and limited to the first few days of treatment and include poor appetite, headache, feeling of heaviness in the chest, and poor sleep. However, they can have ongoing side effects which are mainly poor appetite (which can lead to weight loss and physical weakness) and poor sleep (usually if medication is taken late in the morning). In a very small minority of patients, stimulant medications can cause irritability and anxiety. Stimulant medications leave the body rather quickly and hence, any side effect is expected to disappear within a day or two after stopping the medication. It is of note that (in contrasts to a general belief), stimulant medications are not addictive because they do not induce tolerance (no need to constantly increase the dose), they do not cause withdrawal symptoms (they can be stopped immediately and patients only notice a return of ADHD symptoms) and they do not cause craving.
Non-stimulants: There is only one medication in this category, Atomoxetine. Atomoxetine is similar in the molecule to one of the new antidepressants (Vortioxetine) and acts differently from stimulants, therefore, it can be used if a patient is unable to take stimulants due to their pre-existing medical conditions of side effects. Unlike stimulants, Atomoxetine has a more gradual and build up effects. It is also well-tolerated by most patients. The side effects are uncommon; the main ones are reduction in appetite, fatigue, anxiety and low mood, menstrual irregularities and sexual dysfunction.