The drug therapy of ADHD

• Synonyms in a broader sense
• definition
• Why medication at all for ADHD?
• Different groups of drugs used to treat ADHD
• Drug treatment for ADHD in children
• Drug therapy for ADHD in adults
• Other forms of therapy

Synonyms in a broader sense

Attention Deficit Hyperactivity Syndrome, Fidget - Philipp Syndrome, Fidgety Philipp, Psycho-Organic Syndrome (POS), Hyperactivity Syndrome, Hyperkinetic Syndrome (HKS), Attention Deficit Hyperactivity Disorder, ADHD, Attention - Deficit - Hyperactivity - Disorder (ADHD), minimal brain syndrome, behavioral disorder with attention and concentration disorder, Fidgety Phil, ADS, Attention Deficit Disorder, ADD.

definition

The Attention Deficit Hyperactivity Syndrome includes a pronounced inattentive, impulsive behavior that manifests itself over a longer period of time (around six months) in several areas of life (kindergarten / school, at home, leisure time).

Due to the changeable and sometimes below average ability to build attention, other areas (German and / or mathematics) are often affected by school problems. Many ADHD children develop one LRS (= Reading and spelling weaknesses) and or Arithmetic weakness. In addition, ADHD children can also be gifted. However, it can be much more difficult to express the first “suspicions” in this regard, because - due to the symptoms of ADHD - the symptoms of giftedness may not be correctly interpreted and therefore not really recognized.

Drug therapy is supposed to relieve symptoms and enable the child to live and learn adequately.

Further information on this topic can be found at: ADHD

Drug therapy for ADHD

Drug therapy in the area of ​​ADHD therapy is probably the most controversial form of therapy in this area. There are two different opinions about this that oppose each other:

• Those who refuse drug therapy in any case and
• those who advocate it.

We believe that an ADHD never exclusively medicinal should be treated, but always embedded should be into a multimodal (= multi-layered) and therefore individually tailored therapy.

One should not see a panacea in drug therapy, but rather it is important to recognize that this is only a contribution to alleviating the symptoms of ADHD on several levels. Of course, the support of the family is particularly important. In addition to love, affection and security, a consistent upbringing with rights and obligations, with adherence to rules, will help improve symptoms.

Drug therapy should not be started until the age of 6 at the earliest. Medicines are used that regulate the imbalance of the messenger substances in the brain. In addition to the drugs of first choice, the so-called stimulants, there are also drugs Antidepressants for use. They aim to increase the concentration as well as the stamina and attention of an affected child. Through this strengthening of the impulses with their accompanying symptoms, the child then appears calmer and more orderly as such.

In the case of a decision in favor of drug therapy for ADHD, the attending physician must first discuss the individual dose and the right time to take it being found. Depending on the drug, the effect is immediate and lasts differently. Some medications have to be taken several times a day, while others release the active ingredient gradually so that a single dose per day is sufficient (“retard medication”).

Every drug has its own individual side effects. In the case of drugs used in ADHD therapy, these are often loss of appetite, headaches and abdominal pain, sleep disorders, depression, etc. It is not always said that a child responds immediately to drugs. In addition, it is important to know that drug therapy does not “cure” ADHD. It relieves symptoms for as long as the medication is taken. However, this does not mean that an ADHD child is dependent on drug therapy for the rest of his life. The more complex and individually tailored a therapy is, it can improve the symptoms. Drug therapy often provides the basis for making further forms of therapy possible in the first place. Through this multi-layered therapy, negative behaviors can be positively influenced and replaced by other behaviors. The declared goal is to strengthen the child's behavior in such a way that it learns to use these positive behaviors itself (self-management), so that at some point, with the agreement of the treating doctor, the medication can possibly be reduced or completely discontinued.

More recent research results and studies show that medication generally does not lead to dependence if ADHD has been clearly proven and the dosage is appropriate for the individual. Unfortunately, especially with newer drugs, there are no long-term studies that can confirm or refute such a result in the long term. At this point we want to state that the dangers that can arise from drug therapy vary in individual cases and that no general statements can be made here.

Also read our topic: Psychotherapy for ADHD and ADHD and curative education

Why medication at all for ADHD?

As already mentioned in the causes section on the superordinate ADHD side, according to the latest research, the main cause is assumed to be one altered functioning of the brain out. This changed mode of functioning describes a complex disturbance of the so-called catecholamine balance, which one has to imagine as follows.

• There are three different ones related to ADHD Catecholamines (Messenger substances) important: Norepinephrine, Serotonin, Dopamine.
• All of the catecholamines mentioned have a specific function: norepinephrine drive, serotonin impulsivity, dopamine drive.
• Usually these substances are in equilibrium
• The interaction results in further effects. The interaction of norepinephrine and serotonin is responsible for the development of anxiety, for example, while serotonin and dopamine are responsible for appetite, but also for aggression and desire. Norepinephrine and dopamine regulate motivation, all three together have an impact on mood, emotionality and cognitive abilities.

If there is a proven ADHD and thus a correctly made diagnosis there is an imbalance of the messenger substances mentioned above. This imbalance disrupts the forwarding of information between the individual nerve cells in the area of ​​individual brain areas. If this balance is disturbed, stimuli cannot be passed on in the usual way. Since the messenger substances have a significant influence on human behavior due to their properties, an imbalance in the messenger substances means behavior deviating from the norm. Now some messenger substances may be sufficiently available, while others may be insufficient. This ultimately results in the different symptoms of ADHD. Now it is also understandable why not every symptom has to be present and why a catalog of criteria can never be complete.

Different groups of drugs used to treat ADHD

Due to the different imbalance of the messenger substances in individual cases, different drug groups are required that are targeted.

In principle, a distinction is made mainly between

1. Stimulants, including drugs with the main active ingredient methylphenidate (e.g. Ritalin®).
2. Antidepressants

When it comes to antidepressants, a distinction is made between:

1. NARI (Selective Norepinephrine Reuptake Inhibitor)
2. SNRI (Serotonin - norepinephrine - reuptake inhibitor)
3. MAO inhibitors
4. SSRI (selective serotonin reuptake inhibitor)
5. RIMA (Reversible Monoamine Oxidase Inhibitor

Ritalin

The active ingredient methylphenidate is sold under the trade name Ritalin®. The main area of ​​application of this drug is the treatment of attention deficit hyperactivity syndrome.
Ritalin® belongs to the group of stimulants.

It is not known why it has exactly the opposite effect in patients suffering from ADHD. The active ingredient was developed back in 1944. At that time it was used as a performance-enhancing substance.

In addition to its stimulating effect, the drug also has a concentration-increasing effect. It also reduces fatigue. Performance kinks and exhaustion are reduced by taking the drug, but also the appetite. After taking methylphenidate, it builds up in the blood plasma. The highest concentration is measured after about 2 hours.

Today, methylphenidate is used in children with ADHD from the age of 6. Due to the high prescriptions, however, guidelines have been developed that make it clear that methylphenidate can only be prescribed after a very reliable diagnosis of ADHD has been made.
Furthermore, Ritalin® should not be used as the sole treatment for ADHD, but should be used as part of a multimodal treatment concept that also consists of psychotherapy.

After an extensive diagnosis, Ritalin® is then used in children in a dose between 2.5 and 5 mg. The dose can then be further adjusted, increased and reduced depending on the success.

Patients who take Ritalin® regularly appear more balanced. However, Ritalin® is by no means calming. The use of methylphenidate can also lead to undesirable side effects.

A very common loss of appetite should be mentioned here. Patients are less hungry while taking Ritalin®, and this can sometimes lead to unwanted weight loss. Furthermore, there are reports of increased problems falling asleep and staying asleep. These are greatest when the drug is being dosed and can then be reduced if the Ritalin® is taken for a long time.
Sometimes Ritalin® leads to gastrointestinal complaints. Patients complain of nausea, stomach pressure and sometimes vomiting.
In rare cases, Ritalin® can also have a negative impact on the psyche. Increased suicide attempts under Ritalin® were observed.
Sometimes the use of methylphenidate can also cause palpitations and high blood pressure.

Since Ritalin® can also lead to fatigue, special care should be taken when driving and working with machines.

Read more on the subject at:

• Methylphenidate
  and
• Ritalin®

Medikinet®

Like Ritalin®, Medikinet® is also a substance with the active ingredient Methylphenidate. It is used in the treatment of attention deficit hyperactivity disorder.

children from the age of 6 can be treated with the drug if a definite diagnosis of ADHD has been made and other forms of treatment have not helped.
The treatment should take place over a longer period of time. If there has been an improvement in the symptoms over several months, an attempt to reduce the medication can be made under certain circumstances and after careful consideration.

Medicinet® should not be taken if the person concerned is allergic to the active ingredient methylphenidate, if they are under strong conditions high blood pressure or Heart problems suffer when Liver or kidney damage are available and if there is already to severe depression has come.
If a suicide attempt has already occurred, then Medikinet® must not be used, as taking it can increase the risk of suicide.

The dose of Medikinet® should initially be low and, if necessary, the dose should be increased depending on the success. The maximum daily dose is 60 mg per day.

Strattera®

The active ingredient is sold under the trade name Strattera® Atomoxetine expelled.
It is mainly used for the treatment of ADHD and is one of the newer substances for the treatment of this disease.

Strattera® is available in the form of hard capsules and in the form of a solution. Atomoxetine was approved for the treatment of ADHD in children and adolescents in 2005. Originally, the drug was developed for the treatment of depression.

The structure of the active ingredient is very similar to the group of Serotonin reuptake inhibitorsthat are successfully used in the treatment of depression. However, atomoxetine is less of an inhibitor Serotonin, than NorepinephrineAs a result, this messenger substance is increasingly available in the synaptic cleft of the nerve cell.

The exact effect, why Strattera® works successfully in the treatment of ADHD, has not yet been fully clarified.

As with the other drugs that are used in the treatment of ADHD, Strattera® is also suspected of leading to possible psychological transgressions when taken. It has been reported that it increased under treatment Suicide attempts has come.
A possible Liver damage overdosage and improper use has also been reported.

Drug treatment for ADHD in children

There are two extreme opinions about the use of drugs in the case of ADHD:

• Rejection
• Believes that this is the only effective way to take appropriate account of the changed functioning of the brain described above.

In general, it should also be said here that it always depends on the individual case. However, it is important that no doubts about the diagnosisl exist because, as already mentioned, not every child with behavioral problems is also an ADHD child.
There are very many studies that examined the effects and side effects of methylphenidate (active ingredient in Ritalin®), for example. It could - provided that the diagnosis and indication have been made correctly - In none of the studies has a dependency on the active substance been demonstrated. If the diagnosis is clear, it is assumed that the imbalance of the messenger substances really exists and that medication is used to restore the balance to the children that they lack.

The following can be stated:

• Drug therapy only in clear cases.
• Drug therapy not in preschool children (<6 years)
• Side effects can occur - depending on the drug
• The dose varies from person to person and has to be “tested” in a certain way. Dosage recommendations based on body weight are available to the attending physician.

Drug therapy for ADHD in adults

There is also one in adults drug therapy possible, however, choosing the right drug is much more difficult. The main problem in adults is that the metabolism works faster than with a child, for example. It is precisely in this respect that the Hormones, which is not or only marginally given with the children, plays a major role. Since this varies from person to person, the method of calculating the dosage based on body weight also lags. In adults, too, is usually up Stimulants resorted to. But it can also happen that medication with so-called tricyclic antidepressants is treated, or a combination of both is prescribed. The attending physician will help here.
Experience reports from adults also show that the stimulants only take effect after several months - here, too, there is a decisive difference compared to children.
The experience reports on drug therapy in adults are also not as numerous as in children.
The studies also show different and by no means uniform results.
As with children, the success of drug therapy is likely to be mainly attributable to those adults whose ADHD is clearly established and who have no other personality disorders (Borderline, depressions, Tourette - syndrome, ...).

Other forms of therapy

1. General information on ADHD and family
2. Information on the therapy of ADHD through psychotherapy
3. Information on therapy of ADHD through curative education
4. Information on specific diets for ADHD
5. Information on ADHD and homeopathy

The additionally mentioned forms of therapy are not superfluous even with drug therapy. The medication should always be used as part of an overall therapeutic strategy - as a combination with home therapy, psychotherapeutic and curative education therapy and / or nutritional therapy.

Read more: Therapy and help for children and adolescents with behavioral problems