CHAPTER 11

MEDICATION PROS AND CONS

It’s just so bizarre how in this world if you have asthma, you take asthma medication. If you have diabetes, you take diabetes medication. But as soon as you have to take medicine for your mind, it’s such a stigma behind it.

—Jennifer Lawrence, actress

Pharmacotherapy (taking medication) is a common treatment for attention-deficit/hyperactivity disorder (ADHD) in both children and adults. In this chapter, I first give you a brief overview of medications, along with a little bit of the history behind the use of prescription drugs. Next, I review the different types or classes of drugs that are commonly used to treat ADHD. You’ll learn about the U.S. Food and Drug Administration (FDA) and why it’s important. I go over both the positive benefits of taking drugs for ADHD and some of the side effects. I explain some important safeguards when taking medications and give you a nontechnical explanation of how drugs work. Finally, I include a case study so that you can see how taking medications can be effectively managed.

WHAT THE EXPERTS SAY

The National Institute of Mental Health has estimated that approximately 50% of children who need medication for ADHD still need it as adults. Remember the core symptoms of ADHD? They are difficulty paying attention, high activity, and impulsivity. These general symptoms can usually be reduced with medication, especially in the short term. It’s estimated that about 70% of children and adolescents who take stimulant medication will show significant improvement. The exact percentage is not yet known for adults, although reports have indicated that it is somewhat less than the effectiveness rates for children.

Those adults who do not show improvement in their ADHD symptoms using drugs are called nonresponders. A nonresponder is defined as someone whose core symptoms do not decrease by at least half or who have such serious side effects that they can’t tolerate the drug. But, as you will read later, many options are available if you happen to be a nonresponder or choose not to take medication.

Hundreds of studies have reported on the effectiveness of medications in children and adolescents with ADHD, but not nearly so many studies in adults. However, there are studies with adults that have shown benefits in alertness, short-term memory, visual memory, and spatial planning. Those adults who do respond well to medication have reported that they are less fidgety and restless, they can focus better, their attention span improves, things seem clearer, they do not interrupt others as much, and/or they are better at finishing tasks.

However, drugs are not a panacea; they won’t magically make you a different person, nor will they undo years of ingrained behavior that you have learned. They won’t change your IQ. They won’t necessarily improve your social skills, organizational abilities, time management skills, and self-confidence. One fairly large study of adults on medication found that almost all of the participants continued to have problems at work, even after taking medication. The second most common area that was not improved by drugs was interpersonal relationships. Many adults continue to struggle in their interactions with their spouse, children, relatives, or friends. That doesn’t mean that these areas won’t improve, only that they won’t improve immediately just because you take medication.

On the positive side, it is believed that medications give people with ADHD the ability to focus and attend, so that they can more easily work on changing these areas of their lives. A good metaphor for this is trying to read a book by candlelight. Candlelight can be very dim, and you may have difficulty seeing the small print reading by it. Taking medication might be compared with turning on a 100-watt lightbulb. All of a sudden, you have the ability to see clearly. The lightbulb won’t make you a good reader or define words that you don’t know; you have to do that yourself. But it will give you an environment that lets you read more easily.

So, what’s the bottom line? If you are an adult, medication alone is probably not going to alleviate all the symptoms and learned behaviors that you have developed over the years as a result of ADHD, but you should also not feel bad about taking medication for a legitimate health issue. We strongly recommend that if you choose to use medication, you combine drugs with some other form of intervention, such as cognitive behavior therapy (CBT) or ADHD coaching. See Chapter 12 for a discussion of good treatments to go along with pharmacotherapy.

TYPES OF ADHD MEDICATION

There are several broad categories of ADHD medication. In this section, I describe them in order of most common to least common. Exhibit 11.1 lists the most common brand names for different categories. Note that some of these medications are FDA approved for ADHD, whereas others do not have FDA approval as an ADHD medication per se but can be used “off label” (see Exhibit 11.2).

Medications Used to Treat ADHD

EXHIBIT 11.1. Common Brand Names

Long-Acting Methylphenidate

Adhansia XR

Concerta

Aptensio XR

Focalin XR

Quillivant XR

Quillichew ER (cherry flavor)

Metadate ER

Methylphenidate Pro-Drug Formulation—Long Acting

Azstarys

Methylphenidate—Delayed Onset

Jornay PM (take in evening)

Methylphenidate Short Acting

Ritalin

Methylphenidate chewable (grape flavor)

Methylin Solution (grape flavor)

Amphetamine—Long Acting

Mydayis

Dyanavel XR

Adzenys XR – ODT (orange flavor)

Adzenys ER (orange flavor)

Adderall XR

Amphetamine Pro-Drug Long Acting

Vyvanse (capsule or chewable/strawberry flavor)

Nonstimulant

Strattera

EXHIBIT 11.2. Understanding FDA Approval and Drugs Your Doctor Might Prescribe

The U.S. Food and Drug Administration (FDA) approves drugs for attention-deficit/hyperactivity disorder (ADHD). However, most of the drugs that have been approved have been for children and adolescents, not for adults. The only ADHD drugs approved by the FDA for adults (as of June 2010) are Vyvanse (lisdexamfetamine, a stimulant), Adderall XR (amphetamine and dextroamphetamine, a stimulant), Azstarys (serdexmethylphenidate and dexmethylphenidate, a stimulant), and Strattera (atomexitine, an antidepressant). Just because an ADHD drug hasn’t been approved by the FDA for adults doesn’t mean that you can’t take it. A physician can legally prescribe a drug off-label. That means they can write you a prescription, and you can take that drug. However, it is illegal for the drug manufacturer to advertise or in any way promote a drug for a specific use that has not been approved by the FDA. For example, Effexor (venlafaxine) has been approved by the FDA as an antidepressant. Therefore, the company that makes Effexor can only advertise it as an antidepressant. However, your doctor can legally prescribe it for you as a treatment for ADHD. Generally, physicians only do this when there are scientific studies showing that the drug works for ADHD. It can take many years to get FDA approval, so it commonly happens that the evidence for a drug exists a long time before the FDA actually approves it.

Stimulants

The original treatment of choice for ADHD, amphetamine, was identified as early as the 1930s. Since that time, amphetamine has been repeatedly shown to produce a significant improvement in all three symptom areas and works well regardless of your diagnostic subtype (primarily inattentive, primarily hyperactive-impulsive, or combined type). Thus, amphetamines remained the primary treatment for over 50 years.

In 1968, another stimulant, methylphenidate, was approved by the FDA, and it has since replaced amphetamines as the drug of choice. Technically, amphetamine and methylphenidate refer to two different molecules, both of which are stimulants, and most of the trade names you have probably heard of are just variants of one of these two molecules. Today, stimulants continue to be the most commonly used class of drugs for the treatment of ADHD. Although methylphenidate remains the gold standard for children with ADHD, a recent meta-analysis of the efficacy and tolerability of medications in children, adolescents, and adults found that amphetamine-based medications are the more effective first-choice for adults with ADHD (Cortese et al., 2018). Trade names for methylphenidate-based stimulants that you might be familiar with include Ritalin, Focalin, and Concerta, among others. Common trade names for amphetamine-based stimulants include Adderall, Mydayis, and Vyvanse. Because the two molecules have different effects on the body, some individuals tolerate and respond better to amphetamine(s), and others respond better to methylphenidate; however, if neither of the stimulants is effective, there are other classes of drugs that can be tried.

Nonstimulant Antidepressants

The second most popular class of drugs, after the stimulants, are the nonstimulant-based antidepressants. Dr. Thomas Spencer, who is affiliated with both Massachusetts General Hospital and Harvard Medical School, has written extensively about antidepressant medications for ADHD. He summarized four types commonly used: tricyclics, bupropion, monoamine oxidase inhibitors (MAOIs), and both selective and specific reuptake inhibitors (selective serotonin reuptake inhibitors [SSRIs] and serotonin and norepinephrine reuptake inhibitors [SNRIs]). According to Dr. Spencer, tricyclics are beneficial because they are longer lasting, they do not have a high abuse potential, and they tend not to cause insomnia. They can be especially useful for someone who has symptoms of anxiety and depression along with ADHD symptoms. Bupropion is a nonstimulant antidepressant commonly used to treat major depression. MAOIs are used less frequently in treating ADHD, and there is some evidence that they can negatively interact with food (such as cheese). There is also concern that they should not be used in combination with stimulants. SSRIs and SNRIs are undergoing more widespread research trials, and further study is needed. Strattera (in the class atomoxetine, which is one type of SNRI) is currently the only antidepressant approved by the FDA for adult use as an ADHD drug, although those approved for children are sometimes used off-label for adults (i.e., Qelbree [viloxazine]).

Antidepressants are generally thought to be better for treating mild to moderate ADHD. They become effective in 2 to 3 days, but it can be 8 to 10 weeks before full benefits are seen. The rate of nonresponders is thought to be higher for the antidepressants than for the stimulants. Also, antidepressants sometimes lose their effectiveness after a year or two. Antidepressants might be a particularly good choice if you have symptoms of depression or anxiety along with your symptoms of ADHD. In many cases, antidepressants are prescribed in conjunction with a stimulant; however, this should be done very carefully on the advice of your doctor, as some stimulants and antidepressants (particularly MAOIs) should not be combined.

Less Common Medications

You might consider drugs other than stimulants or antidepressants if you are a nonresponder to those medications; if you have serious side effects; if you have a history of drug abuse; if you develop a tolerance to your current prescription medication; or if you have a worrisome history of heart problems, bipolar disorder, schizophrenia, or other disorders. Alpha agonists are drugs commonly used for high blood pressure and other vasculatory issues. However, two of these drugs have been FDA approved for the treatment of ADHD in children (Kapvay [clonidine] and Intuniv [guanfacine ER]). Other drugs that are not approved but are sometimes used off-label to treat ADHD include Provigil (modafinil, normally used for sleep disorders), Risperdal (risperidone, normally used for schizophrenia or bipolar disorder), and Tegretol (carbamazepine, normally used to control seizures).

IMMEDIATE RELEASE VERSUS EXTENDED RELEASE

For many of the ADHD medications, you will have the choice of a short-acting, intermediate-acting, or long-acting form of the drug. The short-acting forms are usually taken two or three times a day and the long-acting ones just once a day. For those who can’t remember to take their drugs, or if your work or school day makes it difficult to take drugs during the day, the long-acting drugs can be a good choice. These are called extended release (usually indicated by an XR after the name), and their effects usually last 8 to 12 hours. The immediate-release drugs often need to be taken every 3 to 5 hours but have the benefit of quick effects that can be targeted to specific situations (such as studying for an exam or attending a meeting).

WHY MEDICATIONS WORK

Scientists don’t know the exact reason why ADHD medications work. It is suspected that ADHD can be caused by both genetic factors and predisposing environmental events (such as low birth weight, maternal smoking during pregnancy, or prenatal exposure to toxins). Both genetics and the prenatal environment seem to cause difficulties in the way the brain works.

Neurotransmitters are chemicals that help the different parts of the brain communicate by transmitting signals between nerves. These chemicals don’t seem to be released correctly in someone with ADHD. Neurotransmitters thought to be important in ADHD are epinephrine, norepinephrine, dopamine, and serotonin. Drugs such as stimulants and antidepressants regulate impulsive behavior and improve attention span and focus by regulating the levels of these chemicals.

The stimulants increase the ability of the brain to be vigilant, to focus, and to inhibit unwanted behaviors. They do so by “stimulating” the production of the neurotransmitter chemicals like dopamine, enabling networks for nerve cells in the brain to work more effectively with each other. As a result, the stimulant is stimulating, or increasing, your ability to focus, self-regulate, and inhibit your behaviors, which looks to outside observers as if you are decreasing your inattentiveness, impulsivity, and hyperactivity.

As you might guess, it’s difficult to know exactly what’s going on in your brain unless you can actually open it up and examine it. So, scientists have to rely on noninvasive procedures that, fortunately, are becoming much more sophisticated. These techniques usually include some sort of neuroimaging procedure. Newer research has suggested that the two types of stimulants, amphetamines and methylphenidate, work a bit differently in the way they release and block the transmission of dopamine and norepinephrine. They also work differently in the way they metabolize in the body. This is why it is suggested that if you are a nonresponder to one of these drug types, you should try the other one. Exhibit 11.3 lists the things that you should mention to your doctor before starting or changing your medication regimen.

EXHIBIT 11.3. Tell Your Physician if Any of the Following Conditions Apply

• If you are nursing, pregnant, or plan to become pregnant
• If you are taking any other medications, either prescription or over-the-counter
• If you have a history of any medical problems, particularly high blood pressure, seizures, heart disease, glaucoma, or liver or kidney disease
• If you have a history of drug or alcohol problems
• If you have ever had problems with depression, bipolar disorder, anxiety, or thought disorders
• If you become agitated or irritable, or develop suicidal thoughts
• If you develop irregular heartbeats or fainting spells

COMMON SIDE EFFECTS OF MEDICATIONS

The good news is that medications are very effective for many adults in reducing the symptoms of ADHD. The bad news is that many people experience some level of side effects. Because these side effects tend to be similar for drugs in the same class, I have summarized them by class. However, keep in mind that your particular drug (or response to a drug) might be different, and you should read the medication guide carefully (see Exhibit 11.4).

EXHIBIT 11.4. Medication Alert—Serious Side Effects

In 2007, the U.S. Food and Drug Administration (FDA) began requiring all manufacturers of attention-deficit/hyperactivity disorder (ADHD) drugs to develop patient guidelines that warn consumers about possible cardiovascular risks as well as risks of possible psychiatric side effects. All patients must be given these guidelines any time they receive their ADHD medication. The FDA cautioned that there have been reports of sudden death in patients with underlying serious heart problems or defects and reports of stroke and heart attack in adults with certain risk factors. The FDA also warned that ADHD medicines revealed a slight increased risk (about one per 1,000) for psychiatric adverse events, such as hearing voices, becoming suspicious for no reason, or becoming manic, even in patients who did not have previous psychiatric problems. The ADHD drugs that are included in this warning are only those drugs that are approved by the FDA for the treatment of ADHD. The only drugs approved by the FDA for the treatment of ADHD are stimulants and the nonstimulant atomoxetine.

Stimulants

Loss of appetite, dry mouth, insomnia, nausea, and headaches are all common side effects of ADHD stimulant medications (Parikh & Baker, 2016). A rise in blood pressure can also occur as a result of a stimulant medication. Often, the effects are mild and last only a few weeks, but this is not always the case. One key to minimizing side effects is to make sure you are on the optimal dose of the medication. There is a delicate balance between getting enough of the drug to alleviate your symptoms and not getting so much that your side effects are unmanageable. Signs of exceeding an optimal dose are similar to having too much caffeine: mild depression, jitters, literally feeling your heart beating, headache, irritability, hand tremor, and loss of appetite. Some individuals have noticed that when they take too much of a stimulant, they have a reverse effect, popularly described as the “zombie syndrome.” They feel slow and lethargic, as if their thoughts and feelings have been slowed down. This has sometimes been reported, even with the correct dosage, during the first day or two that the drug is started.

Another term you will want to remember is the dosing rebound. This can be a bit confusing because the same symptoms have been linked to two very different causes. In the first instance, you have probably taken too high a dose and feel the typical high-dose side effects just described. In the second instance, you have the same side effects but only when the medicine is wearing off; in this case, the cause can be a dosing rebound. This means the level of medication in your blood is dropping too quickly, which causes you to crash. You can work with your doctor to prevent dosing rebound by taking a very small dose of the immediate-release version of the same medication shortly before the time of day when rebound occurs, smoothing out the effects so the drop-off is more gradual. Again, be sure to consult your doctor and try this only under their guidance.

There have been concerns that taking stimulants can lead to abuse and that they can become addictive. Research by several leaders in the field has suggested that the use of stimulants does not lead to substance abuse or dependence. In fact, a group of researchers led by Dr. Timothy Wilens of Harvard Medical School found that teens with ADHD who took stimulant medications were less likely to abuse drugs than those who did not take stimulant medications (Wilens et al., 2008). Stimulants could be a concern primarily for someone who is already abusing drugs. Someone who currently has a history of drug abuse should probably not take a stimulant medication for ADHD.

Antidepressants

Antidepressants can also have side effects. The most common ones seem to be loss of appetite, upset stomach, nausea, headache, dizziness, mood swings, and tiredness or sleepiness. The drug Strattera (atomoxetine) includes an FDA-required warning that it has been associated with suicidal thoughts in children and adolescents. However, according to the FDA, studies with adults have shown no risk of suicidal ideation in adults who take Strattera.

Several websites offer advice on how to deal with common side effects. One of those (https://www.webmd.com) lists the following suggestions. Many of these suggestions have been tried primarily in children and adolescents; however, you may still find them helpful.

• Stomach upset: Take your medication with food. Eat healthy snacks during the day. If you can take your dose a little later in the morning, this could decrease chances of stomach upset.
• Headaches: Take your medication with food; without food, the medication is absorbed more quickly, which causes blood levels of the medication to rise, which can lead to headaches. Try switching to a long-acting medication; sometimes headaches can be due to the rebound effect when your short-acting medication is wearing off.
• Sleep difficulties: Try to maintain a consistent time to go to sleep and wake up. Develop bedtime rituals. Avoid caffeinated beverages in the afternoon or evening. Dedicate the bedroom to sleep only, not to work or entertainment. Use relaxation techniques at bedtime.
• Dizziness: This often results from a medication dosage that is too high. Check your blood pressure and consult your physician if it’s higher than normal.

HOW TO MAKE YOUR MEDICATION WORK FOR YOU

Some sources estimate that up to half of adults who start a medication stop taking it after 4 to 6 months. They may be frustrated with the side effects, or they may feel that the benefits are just not worth the side effects. It’s vitally important that you work with your doctor to find the right drug and the right dose so that you can benefit from pharmacotherapy. Studies have shown that the way a stimulant works for you is not consistently related to age, weight, or symptom severity. Rather, it depends on your individual body chemistry, which is genetically determined. Individuals absorb different amounts of stimulants into their bloodstream, and the amount can vary widely. That’s why you should start with a low dose and then carefully increase it under your doctor’s supervision to find out what works best for you. You may take the same dose as your friend who weighs the same as you, but you may absorb twice as much of it. Individuals also have different rates of metabolism. This means that after you absorb the drug into your bloodstream, you metabolize it through your liver and kidneys and out through your urine. The rate at which you metabolize the drug determines how long it has an effect on your symptoms.

Many experts recommend that if you have no other conditions to deal with (such as depression, anxiety, drug dependence, or bipolar disorder), you should always start with a stimulant because stimulants tend to have the best results. Try both an amphetamine and a methylphenidate (both are stimulants) if one or the other doesn’t work. If stimulants are not effective for you, then you should consider an antidepressant and, finally, one of the drugs commonly used for other disorders (sleep disorders, high blood pressure, thought disorders, and seizures).

Alternatively, if you have symptoms of depression, you might want to start with an antidepressant. Antidepressants seem to be different from stimulants in that the proper dose is based more on weight than on body chemistry. A benefit of the nonstimulant medications is that they are not a controlled substance, and so they can be used more safely by someone who has an ongoing substance abuse problem. They also tend not to cause insomnia, which can be common with stimulants.

The first weeks and months of taking a new drug are critical. You need to carefully monitor your side effects. Keep a daily journal if possible, so that when you meet with your doctor, you can give a detailed report of your eating habits, sleep, side effects, and benefits. Keep track of how the drug works during different activities (such as work, exercise, relaxing, or reading).

It is also very important to work with your doctor to determine if you have conditions other than ADHD that may interfere with your ADHD medication. Many adults with ADHD will have at least one other mental health disorder during their lifetime. These other disorders include anxiety disorders, depressive disorders, bipolar disorder, and substance use disorders. Be sure to read Chapter 8 of this book if you think you have one of these other disorders. If this is the case, then you may need to work with your doctor to adjust your medication to make certain that you are controlling all of your symptoms. You may need to decide which condition is most distressing to your overall quality of life and treat that one first. Sometimes the medication for your other disorder can help your ADHD symptoms; unfortunately, sometimes, that medication can make your ADHD symptoms worse (see Exhibit 11.5). You will need to work with your doctor to select a drug or combination of drugs to manage your particular symptoms.

EXHIBIT 11.5. Drug Interactions

If you are taking a stimulant medication for attention-deficit/hyperactivity disorder (ADHD), check with your physician before taking any medications for colds or allergies. Common over-the-counter decongestants, such as Sudafed, contain pseudoephedrine, which can increase the side effects of your ADHD stimulant medication, perhaps causing increased heart or pulse rate. You might want to consider using a nasal spray rather than a decongestant, skipping your ADHD medication temporarily, or making sure that your cold medicine does not contain pseudoephedrine.

CAN YOU RELATE TO THIS?

Mike was a junior in college, majoring in business. He aspired to work with his father one day in his father’s real estate office; however, he was beginning to despair of this happening. Mike’s father had insisted that he obtain his college degree, and Mike was barely maintaining a 2.0 average. He sought help at the university mental health clinic on the advice of his advisor and was evaluated and diagnosed with ADHD, combined type.

During his evaluation, Mike related that he had experienced difficulty in school for as long as he could remember but managed to get by with help from his parents and teachers. He reported that his difficulties “skyrocketed” when he left home to attend college. He lost his student ID six times during his freshman year and accumulated more than a dozen parking tickets. He had tried working part-time but was fired from three different “menial” jobs as a waiter for poor performance. Mike had pledged a fraternity his freshman year and was devastated when he was kicked out the fall of his junior year. He claimed to have no idea why he was kicked out, saying that the official reason—missed meetings—could not have been the real reason. Mike seemed to have little insight into his difficulties. He had failed or withdrawn from several courses, primarily for missing too many classes or not being able to keep up with assignments. He reported partying and drinking more than he knew was good for him and feeling that his life was “totally out of control.”

After his evaluation and diagnosis, Mike scheduled an appointment with the psychiatrist at the student counseling center on campus. He also continued to meet weekly with a counselor. The psychiatrist initially started Mike with 20 mg, twice per day, of immediate-release Adderall. Mike soon reported a significant loss of appetite. He stated that he would go all day and “totally forget to eat.” After losing 10 pounds, he began setting his phone alarm twice a day to remind him to eat. He also left notes for himself at home to remind himself to take a snack with him to classes. Mike also noted difficulty sleeping, saying that his body was exhausted, but his mind just kept going and going. The more he tried to will himself to sleep, the more frustrated he got, which resulted in hours of lying awake. By the time he finally fell asleep, he would be so exhausted that he would often sleep through his alarm clock in the morning, missing class as a result. Then, he would take his initial dose of medication too late, which often contributed to another sleepless night.

Mike also described “crashes” that occurred as the drug was wearing off. He would feel depressed, irritable, and tired and would often take an additional dose of the drug when he felt a crash coming on. The crashes were so aversive that Mike would overmedicate regardless of the time of day or consequences of the extra dose. Mike was extremely discouraged at the end of his first month on Adderall but continued to work with both his counselor and psychiatrist. After 3 months of careful experimentation, Mike found that his best regimen consisted of 30 mg of extended-release Adderall once in the morning, followed by 10 mg of immediate-release Adderall in the afternoon.

After finding the best dosage of his medication, Mike reported that “my life changed forever; I feel like I have a future.” He was grateful that he had stuck it out and worked with his doctor and counselor because he had felt several times like giving up. Mike was excited to report that he was passing all his courses with at least a B average and that he had already been promised a summer job working with his father, which was “my ultimate reward, to have my father proud of me.” He reported that he was able to focus, finish tasks, and actually think through the consequences of his actions. He had not had a parking ticket in 3 months, partly because he was riding his bike more, which had the added benefit of helping him stay in shape. Mike lamented that “it breaks my heart to think there are people out there like me, trapped in the prison of ADHD. I’m really glad I had a great team who worked with me to turn things around.”

It should be clear from this case study that it is extremely important that you work with your doctor and/or clinician to make sure that you are on the best medication for you and at the best dosage for you. Remember, everyone is different, and there is no way to know how your body will react. You may benefit from a stimulant, an antidepressant, or even a drug normally used for high blood pressure or sleep disorders. The key is to keep your spirits up, realize up front that you will probably need to make adjustments before you find the best drug regimen for you, and know that it will very likely pay off with positive results in the end.

QUICK TIP: CHECK THE FDA MEDICATION GUIDES

Don’t despair if this chapter seems a bit overwhelming. There are many drugs available for ADHD, and it’s difficult to keep them straight. Keep in mind that your doctor is the expert, and you don’t have to know all the facts. (Just make sure your doctor has experience in treating patients with ADHD.) It can be especially daunting to read the medication guide that comes with your ADHD drug. The FDA recently standardized and shortened these guides and provides a handy website where you can easily review the drug you might be considering. Keep in mind that you can find a lot of information on the Internet; if you put in the name of a drug, you are likely to get thousands of hits, and there is no way to know whether what you are reading is accurate. The medication guides put out by the FDA have all been carefully scrutinized and approved by the FDA, so you can be sure they are accurate. Each guide will have the following information:

• problems associated with the drug
• precautions, such as when and what to tell your doctor
• how to take the drug (dosage, can you chew or crush it)
• side effects
• who should not take the drug
• whether the drug can be taken with other medicines
• how to store the drug
• ingredients in the drug

To find the FDA guide, do an internet search for “FDA guide” and the name of the specific drug.

SUMMARY

Here are the important points you will want to take away from this chapter. Use the following checklist to note the areas you have thoroughly studied. Leave the box empty if it is an area you would like to come back to and review further.

• I understand ways to tell if I am a nonresponder to medication.
• I understand that medication might help some, but not all, ADHD symptoms.
• I have considered using medication in combination with a psychological intervention.
• I have learned about the most common types of ADHD medications and the way they work.
• I understand that many medications produce unwanted side effects.
• I have learned how to make my medications work for me.
• I have checked the FDA guidelines for my medication.