ADHD Medications: Amphetamines vs. Methylphenidates - Efficacy, Risks, and Best Practices
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- Опубликовано: 13 сен 2024
- A thorough comparison of amphetamines and methylphenidate, focusing on efficacy, tolerability, psychiatric risks, and adult ADHD diagnosis.
Content written by: Chris Aiken, MD
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A 30-minute webinar for CME credit by Chris Aiken, MD, Editor-in-Chief of The Carlat Psychiatry Report. Dr. Aiken is a practicing psychiatrist in Winston-Salem, NC; director of the Mood Treatment Center in North Carolina; and Assistant Professor NYU Langone Department of Psychiatry.
Highlights
🧠 Mechanism: Amphetamines release dopamine, while methylphenidate blocks its reuptake.
📊 Efficacy: Meta-analyses show amphetamines generally have a greater effect size than methylphenidate.
💊 Tolerability: Methylphenidate is better tolerated with fewer side effects compared to amphetamines.
⚠️ Psychiatric Risks: Amphetamines may pose higher risks for psychosis and mania, especially in vulnerable populations.
🔍 Diagnosis: Adult ADHD diagnosis is complex; symptoms can overlap with other psychiatric disorders.
🏥 Treatment: Methylphenidate is often preferred as first-line treatment in adults due to its safety profile.
📈 Trends: Historical data shows a shift in stimulant prescriptions from amphetamines to methylphenidate in adults.
Key Insights
⚙️ Mechanism of Action: Understanding the differing mechanisms of amphetamines and methylphenidate is crucial for effective treatment choices. Amphetamines provide a more immediate increase in dopamine, which may lead to stronger effects but also a higher potential for side effects. 🧠
📈 Efficacy Differences: While amphetamines generally demonstrate a larger effect size, individual responses vary. Some patients may find methylphenidate more effective, emphasizing the need for personalized treatment approaches. 📊
😌 Tolerability and Side Effects: Methylphenidate tends to be better tolerated than amphetamines, suggesting it may be a safer option for patients, particularly those with complex comorbidities. 💊
⚠️ Psychiatric Risks: The risk of developing psychosis or mania is a significant concern, particularly with amphetamines. This highlights the importance of closely monitoring patients with a history of psychiatric disorders. ⚠️
🧩 Complex Diagnosis: The diagnosis of adult ADHD can be challenging due to overlapping symptoms with other conditions like PTSD or bipolar disorder, necessitating thorough assessments. 🔍
🏥 First-Line Treatment: Methylphenidate is often recommended as the first-line treatment in adults due to its favorable side effect profile, reflecting a shift in prescribing practices. 🏥
📜 Historical Context: Understanding the historical prescribing trends of stimulants can inform current practices and help avoid potential biases towards amphetamines. 📈
This is what a doctor should do. People should be selected and trained to practice like Dr. Aiken.
This is exactly what I was looking for. I wanted to see which stimulant helps with GAD and social anxiety. Learned a lot more than I expected. Thank you for your detailed analysis
This was fantastic. Exactly the kind of information I was looking for but is so hard to find. Thank you!
This is a very detailed report I use dexmethylphenidate and while it may not be as effective or euphoric it still does make a big difference in everyday life and I recommend it to people who want a safe stimulant that’s not gonna lead to any erratic behaviors.
Very well done report. Best regards
Thank you! I’ve been looking for information comparing methylphenidate vs amphetamine for a couple of years. I am a late middle aged adult female who has definitely had ADHD (yes little girls can be hyper active!) since early childhood. I am meeting with my psychiatrist this afternoon and I definitely want to explore switching to a Ritalin type product.
an animal model is gonna give him paws
Ritaline is like adderral, but without the smile.
The quality-of-life improvements I've got from methylphenidate certainly makes me smile.
@@ToveriJuri4 days in, life changing. Not sure what more you could want and I’m only on 1/4 the dose
I think amphetamines are a problem for me...methy i was much happier and productive...amps i became a miserable sob addict. Problem is if they gave me the option today..I'm go with amps!! :)
Wilson Nancy Martin Linda Walker Gary
This looks biased. Where are the studies ?
Here are the studies used to provide the information from this webinar!
Arnold LE, J Atten Disord 2000;3(4)200-211
Wolraich ML et al, Pediatrics 2019;144(4):e20192528
Cortese S et al, Lancet Psychiatry 2018;5(9):727-738
Moran LV et al, J Psychiatr Res 2015;71:41-47
Curran C et al, Br J Psychiatry 2004;185:196-204
Hegerl U et al, Eur Neuropsychopharmacol 2018;28(1):185-194.
Farrell M et al, Lancet 2019;394(10209):1652-1667
Korn L et al, Med Sci Monit 2019;25:3778-3787
Li P et al, Hum Exp Toxicol 2021;40(9):1422-1433