Amphetamines (Adderall) vs Methylphenidates (Ritalin) for ADHD Treatment in Adults
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- Опубликовано: 29 дек 2022
- Dr. Pagnani of Rittenhouse Psychiatric Associates discusses two categories of controlled stimulant medications used to treat ADHD in adults: amphetamines and methylphenidates. Amphetamines (like adderall, vyvanse and dexedrine) and methylphenidates (like ritalin, concerta and focalin) both increase availability in the extraneuronal space of norepinephrine and dopamine by preventing their reuptake and also increasing their release. These medications have significant abuse potential and patients can develop physiological dependence and tolerance. They can also cause withdrawal, if taken regularly and decreased or stopped abruptly. There are various side effects, some potentially serious, and taking these medications must be under the direct supervision of a medical professional.
Dr. Pagnani discusses that in his clinical experience, he's found that the amphetamine stimulants seem to have a higher likelihood of causing anxiety, irritability, insomnia, restless, tiredness or "crash," between doses or when the medication is wearing off. With that said, these medications may work better for individuals with significant hyperactivity as part of their illness, than the methylphenidates, and there are certainly many patients who tolerate them well. Methylphenidates are often preferred (when medication management with a controlled medication is warranted) for patients who's primary symptom of ADHD is difficulty with focus (mental, as opposed to physical hyperactivity). He discusses that he believes there's a lower abuse potential (although there certainly IS abuse potential) with methylphenidates than amphetamines.
Dr. Pagnani is the founder and medical director of Rittenhouse Psychiatric Associates, an Instructor at The Johns Hopkins Hospital for the Department of Psychiatry, he supervises psychiatric residents at Jefferson Hospital, he serves on the Young Professional Board of Uplift, the Center for Grieving Children and he maintains a private practice of Psychiatry in Philadelphia where he sees patients for one-time psychiatric evaluations and second opinions. He is a licensed physician and surgeon in NJ, PA, NY, MD, DE, FL and CA and can provide consultations to individuals via HIPAA compliant Telehealth visits living in these locations.
Rittenhouse Psychiatric Associates is a private practice of psychiatry consisting of about 25 psychiatrists, psychiatric nurse practitioners and psychotherapists with physical locations in Philadelphia and Paoli, PA and serving all of PA, NJ, NY and FL virtually via HIPAA compliant tele-psychiatry. Individuals seeking not only evaluations but long-term psychiatric care, can contact Rittenhouse Psychiatric Associates directly.
These videos aim to increase awareness and discussion of mental health topics and to encourage struggling individuals to schedule an appointment directly with a mental health provider. Mental health needs to be normalized, and simply speaking about mental health topics openly, is an important first step.
Dr. Pagnani and Rittenhouse Psychiatric Associates are NOT advocating for or against the use of any mentioned psychiatric medications for any specific individual. Additionally, any side effects mentioned are not a complete list of potential side effects or contraindications to taking any mentioned medications, and all risks and benefits of a medication should be discussed with an individual’s provider at an appointment, before starting, stopping or making changes to a medication regimen.
This video is INFORMATIVE ONLY - NOT MEDICAL ADVICE.
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This was very helpful you clearly know a lot about this , thank you
I had listened to another video which stated that research has shown, when used as prescribed in folks with a diagnosis, abuse rates are low and the medications are highly effective
yes, for me, i'm currently looking and in dire need of a psychiatrist/ doctor that will actually listen to me and understand that I depend on my medication and that they have my best interests in mind. consistency is key for me.
I have ADHD with a past history of SUD and marijuana had a way more “drug liking effect” than amphetamines ever did. Personally, I wish CRISPR Cas9 could cure my adhd so I wouldn’t have to take stimulants at all. It blows my mind how people find them euphoric. But I guess we’re all different
@@user-dc3ek1pn1nexactly for me it's just hyper focus and I can get stuff done... Without them I'm wasting away unable to do squat and stare at a wall for hours talking to myself...
I'm Brazilian, Adderall (dextroamfetamine) is prohibited here, only Vyvanse (Lis-dexamfetamine) is allowed because it has to be broken by the liver, so, theoretically, it's a barrier to limit substance abuse.
Yet I feel that Methylphenidate (allowed as well) is even safer because bcuse it is hard even to tolerate high doses of it .. at least for me, 40 mg a day is the maximum I have ever supported.
I feel that Vyvanse is a bomb to my circadian cycle hahaha... I just can't sleep :/ .. by the other hand Methylphenidate gives me a little bit of anxiety sometimes... Yes ADHD sucks, and without medications and being physically active.. working with spreadsheets, reports and anything that demands attention is near impossible. :(
I appreciate your mature delivery.
Thank you for the comment and watching. Best, - Dr. Pagnani
Sorry can’t follow without graphics.
Thank you for your comment! I definitely got a chuckle. - Dr. P
@@RittenhousePsych I am a 54 year old female that wasn’t diagnosed until my late twenties. I took Ritalin for many years. It worked until late afternoon & I would get extremely tired. I’ve been taking adderall for about 15 years & it actually makes me tired & not want to do anything. There are not many good doctors around to treat this problem. Any suggestions? Thank you for your time.
@@RittenhousePsychwhat is the "meth" in methylphenidate and methamphetamine
@@RittenhousePsychis there an association with "meth" in the title
@@MarcKlarkIt’s a methyl group attached to a molecule, I don’t think it universally changes molecules in any one way though.
( Wellbutrin XR 150mg or 300mg can also be effective against adhd, alone, but also in conjunction with Ritalin.
(Only adding this as what seems to be current concensus.)
thank you good sir
I’m currently taking Dexmethylphenidate XR 30Mg once a day. I was up dosed by my doctor from 10Mg once a day. Unfortunately it doesn’t seem to be effective. I do have a 2 hour period where I notice a difference but then it fades and leaves me in a bit of a fog. I’m diagnosed Adult ADHD non hyper active. My doctor is thinking to change me to the immediate release to see if that helps. She did mention possibly Adderall or Concerta if this doesn’t work. I’m new to all of this looking for advice. Thanks
Hello Dr.,what about Desoxyn-generic also, and Cylert (pemoline) ? If You have time to explain.
I just switched from Adderall to Ritalin and it was horrible, made me so nauseous, dizzy and shaky so the oposite of what you described (as far as I understand). Adderall was excellent, for just focus for me
Same!
Thank you for your video. I trust my provider and follow his recommendations but I still like to read up on this stuff. I was extremely disappointed that Ritalin had zero effect on me. Same with bupropion. I wanted to give up on having more clarity, focus, and motivation in my life. Most of my past depression has been from the fact that I feel like a failure and in a fog. Anyway, I'm one week into Adderall feeling some hope. It's just interesting how medication can affect different people so differently
How has it been going ? I am one day in with a methylphenidate and notice no change. Still also have fog, no motivation, clarity or focus.
@@j994xAdderall has been great! I don't get stuck in my head and on my couch as much as I used to. Even started making real dinners. It is subtle but I like that. It still makes me feel like I'm in control. I ran out of medication for a few days but still could function just great other than feeling a little bit more tired.
I'm happy to hear it has been working for you. I have a history of addiction (5 years clean now) so my provider is very hesitant to prescribe adderall. I anticipate a merry-go-round of trying to find what med and dosage works for awhile which is unfortunate but a reality. @@jeny9227
This was a very informative video. I could actually really use your advice from your expertise on these kinds of medications. I've been trying medications to treat my ADHD (inattentive type), but nothing has really worked? More that it's really difficult to tell. For example, I was on vyvanse for a while, and it seemed like it helped, but then it just stopped helping, even after increasing the dosage. After I stopped taking it, I felt so much better after, like I didn't realize how bad I felt until after I wasn't on it anymore. I've tried concerta before the vyvanse where it seemingly had no effect, and I'm currently on straterra.
It's like, I think I see positive signs, but overall feel the same, or like, I keep experiencing problems from ADHD that the medication was supposed to stop from happening. How do you know if the medication is actually doing what it's supposed to? The only consistent change I've noticed from the straterra is how light my sleep is (waking up from something happening in a dream, or when family members are making noise in the morning), when normally I'm a very heavy sleeper (almost always sleep through the entire night, could sleep through people going into and out of my room while making noise, I've been told).
Thank you for sharing your experiences and your questions. I'm sorry to hear that you've been having so much difficulty with medication trials - specifically, sorting out exactly how these medications are affecting you, while you're engaged in trials (and compared to your baseline). Sometimes journaling each day on symptoms (sleep, energy, focus, anxiety, overall mood, irritability, libido etc) can be very helpful. When individuals journal like this, it's important to add information on whether one's taking a medication, what dose, extenuating circumstances or stressors, timing with monthly cycles, alcohol or substance use etc to look for patterns. There are apps that can also be used to record this type of data as well.
With all that being said, if someone's taking a medication to help them with their focus, and they are not noticing a significant improvement in symptoms, it's very important that they discuss this directly with their provider, as if someone takes a medication, it's important that it is indeed helping them. Sometimes a dose just needs to be adjusted, or sometimes it may just not be the right medication, but all of this should be discussed directly with the person's provider.
Thank you again for sharing!
- Dr. Pagnani
Could've mentioned that extended release and prodrug versions dont have as much abuse potential as instant release.
if i had to scratch my head and had multiple random thoughts and looked at the background frames and couldnt focus on half things what he said, is it likely i have adhd ?
I don't understand others who say "I need visuals" to focus on the video. I find seeing his face soothing and it get straight into the point. Maybe I've grown tired of being overstimulated by the perversion of media that everyone is just too addicted to visual aid a situation like this should not call for it.....Anyways, I've switched over from Adderall XR to Concerta XR at lowest strength and well....there are side effects, but whether that's a price to pay or not.
I live outside the US . I was diagnosed with ADHD at 14 and I have been taking methylphenidate hydrochloride(Ritalin or Rubifen) since. In my personal experience my psychiatrists have been unwilling to prescribe Adderall due to its potential to be addictive. For me that has not been the case with methylphenidate hydrochloride, I struggle to remember to take the pill everyday.
had trouble paying attention to the vid
what do you think of modafinil for off label treatment of adhd? there are some studies showing it's effective in adhd although not as much as traditional stimulants. if it does work though it's not addictive and doesn't have the withdrawals or crash.
Thank you for watching and your question. Provigil (Modafinil) and Nuvigil (Armodafinil) are medications which inhibit dopamine reuptake and used in narcolepsy, obstructive sleep apnea, shift work sleep disorder and other conditions. I have had patients utilize these medications for ADHD, although not first line. They may be helpful for some individuals, but I do want to comment that they are not without potential for abuse/ dependence. There actually are individuals that abuse these medications as well. All the more reason to be sure to discuss directly with a mental health professional, if someone's considering treatment. Best, - Dr. Pagnani
Do you need modafinil 200mg??
I hear dexedrine and vyvanse make you less jittery than adderall and that for many its the levoamphetimine that causes lots of side effects and the dextroamphetimine seems to be more tolerable
Thank you for your comment! There is a great deal of variability with patient responses and side effects with these medications, and some may certainly be more or less tolerable (with side effects that you mention) for some. However, as mentioned, this is not consistent and I always recommend that patients work with their providers to start slowly with any medication trials, and slowly titrate (monitoring effect and any side effects). Thank you again! - Dr. Pagnani
@@RittenhousePsych Doctor,if i can ask,pemoline and d-metamphetamine r now very rarely prescriped?
I tried methylphenidate and I’m not sure if there’s a loading period but I felt very odd on them and my fingers would swell and I would have other odd things happening.
No problems with dextroamphetamine tho. And I have non hyper active , mostly need it for focus
Thank you for sharing! There's not necessarily a "loading" period, but sometimes it takes someone several doses (or even a couple weeks) to fully adjust to medications like this. As an example, if someone doesn't drink coffee, and they have one, they may feel significant anxiety, jittery, be more easily distracted and have insomnia. If they continue to drink a coffee a day for a couple weeks, these side effects of the caffeine in the coffee, may go away, or diminish significantly. If someone has side effects (like swelling) it's very important to talk to their provider about it directly. Thank you again, - Dr. Pagnani
I take methylphenidate. It worked well. After a while I relied on it to get up and go. My get up and go kinda got up and went. I really essentially begged my doctor for refill. It improves mood. It has a ceiling so taking more is a waste. It does come down. I used caffiene tablets until my doctor finally refill me so at first I had caffeine lingering. I will try go two days w/o either then take ritalin and give you an update 2/14/24 today is 2/11/24 I took a tablet already and yesterday. I will skip Mon and Tue All stimulating drugs 💉 and let you know how it workes
how did it go?
Ritalin makes me moody and anxious. Adderall is not available in my country
@@r1reis it's hard to stop because it definitely releases dopamine
@r1reis thanks for asking. I be dragging when I run out
Stop taking meds when I was 12 now as 35 I think I need to take it again
Yes dependency is a thing... However, you would not say that to a cancer patient.. They too are dependant on their medication...
The dependency depends on how it affects the person because medications for me are life-changing so yes i too am dependent... Because without them I cannot function... I cannot do simple tasks things and spiral into terrible depression
It’s kind of funny how you walk into a doctor’s office in ruin with ADD & GAD and their first thought is “ah yes… Meth”
Lol it's not meth😂
that’s like saying ah diazepam.. pentobarbital/alchohol
My problem is adderall works great for me... but I like it way too much , and I overtake, same with many other meds..
what solutions are there for ppl in this predicament?
Thank you for watching and your question. It's incredibly important to only take medication as prescribed. If someone is on a medication (even if it's helpful) and they're unable to take it according to the directions from their provider, it's not safe. There are potential serious adverse effects from taking adderall (heart arrhythmias, unstable vitals and others). It can lead to psychosis, seizure, stroke and even death. I would recommend discussing directly with your provider.
There are several non-addictive medications that can be extremely helpful for ADHD. They typically are once daily, and need to build up in one's system. If it's clear that treatment is helpful for you, it may be incredibly helpful to really give other options a full trial.
Thank you again for your openness and honesty!
- Dr. Pagnani
Having taken Concerta for about 15 years at this point and still going through the process (always pay attention to how your medication affects you. I ended up going down from 54mg to 45mg 3 years ago due to headaches!), I agree with Pagnani.
If you are getting addicted to your medication, you should talk with your doctor or specialist (depends on the healthcare system) about your issues and try out other medication. Again, if you ever end up experiencing side effects, you may want to talk with your doc about lowering the dosage or even try out other medication.
Non-stimulants might work better for you. As Pagnani said, it takes a while for it to take effect as it has to build up in your system.
Communication with your doctor is *important* when it comes to ADHD medication and I really can't stress this enough. If you feel something is off when on medication, talk with your doctor.
If your dosage is still within prescribable dosages, you could be undermedicated. Also, Vyvanse is less up and down than Adderall. It's smoother and lasts longer.
my problem with adhd meds in general is that it makes me feel good for a little bit but feel like shit for twice as long as the good effects. i still use them but shit lowkey sucks.
@@delsymdrinker100%
I almost died from adderol. I developed MAP, which is methamphetamine abuse psychosis
For real???? From Adderall? Wow
Thank you for your comment and sharing. Individuals often do not realize that psychosis can be a side effect of stimulants like adderall. It's incredibly important that this is treated quickly.
Were you actually abusing it or did your brain just spazz?
i take take pretty high doses of focalin ir, for example i snorted 40mg ir, 30mg orally, and a 15mg adderall xr throughout today. i get a awful hangover everytime but never have gone conpletly insane. im kinda worried about getting phychosis but dont have enough self control to stop what im doing :( anyway does anyone know the max dose of focalin IR i can take without getting a heartattack because i dont know much about dosing with it comes to focalin
@@delsymdrinkerGoogle it or don't abuse the damn drug. Go to AA, get help. Abusing those drugs WILL get to you sooner or later.
This is far to difficultl to focus on without visuals
I have personal experience with Ritalin/Methlyphetamine. The slow release version provided a very good base rate dose to keep releasing throught the day. The quick release version was also instantly effective. Remember that each person is different but I had a massive instant libido high times 20-30. I can see how your first initial dose could produce orgasm or imulsive sexual behaviour patterns. I loved that element and had both benefits and minuses. Both dopaminic drugs. Your reaction could be completely different ofc!
Thats weird cause methylphenidate had the worst side effects for me and dexamphetamine works much better.
But im 30 and i know amphetamines work slightly better for adults then children and young adults
@TerminalCreed youre a pharmstain
Good information, but is there no way to just say it based on bullet points, instead of reading verbatim? It is only a three-minute video.
Thank you for your comment and I'll work on this with future videos. Best, - Dr. Pagnani
I found that zenzedi is WAY smoother than adderall. Even though the levorotatory isomer is only 25% it causes nasty peripheral side effects. Dexedrine is way better than Adderall at least for me.
This video kinda sucked you didnt really say anything. It helps you focus? Thats it? How will it improve my life?
audio level in mastering is too low
The sound guy went to lunch. Otherwise he would be all over the master.
Thank you for your comment! I will definitely keep this in mind for future videos! Thanks again, - Dr. Pagnani
A blah blah blah
If im not mistaken, amphetamines are good at releasing dopamine and MPH at blocking the reuptake, very little studies on this but it seems a combination is the best treatment?
I have been thinking about getting on medication for ADD. I feel like I have a pretty bad short term memory, since I've started smoking pot heavily and daily about 5 years ago. I started smoking for my social anxiety and found that it really helped calm my anxiety but gave me a lot of brain fog after constant use. prior to smoking I became "addicted" to pornography at a very young age, consuming a lot daily. does pot and marijuana affect dopamine receptors? do you think medication would be beneficial to me?
I find my long term memory also being affected, I find it hard to recall knowledge from high school and college classes like important years in history. I don't want to be on medication forever and just want to use it to get myself on the right path
Thank you for your question and such personal information. Whenever I evaluate a patient for ADHD or treatment for this condition, I always recommend that they stop any marijuana use. Marijuana can absolutely affect cognition, focus, energy, motivation and cause other symptoms that are commonly seen in ADHD (so someone could be misdiagnosed with ADHD or end up on more medication than they need for ADHD, if their symptoms are complicated by MJ use). Sometimes less is more, so if someone can decrease MJ use, then that may actually be all that they need for symptom control. With all of this being said, I understand that MJ (particularly medical marijuana) is controversial and there are many opinions about it. I do think it's important to note, that there are possible side effects. I hope that you do not mind me being so direct, and I wish you the best, and hope that your symptoms improve, Sincerely, - Dr. Pagnani
@@GloomyNate Porn addiction absolutely fries your brain. Smoking weed at a young age and onward for a long time- if you've done it- has possibly permanently decreased your intelligence somewhat, IQ if you want to call it that
Why not methamphedaminea
I love the motivation (instant) from Ritalin but HATE with a passion feeling like a ZOMBIE even at 10MG or Less. Horrible vibe. ROBOT, can't feel a thing. I wish there was something that allowed me to feel how I do without meds but got me moving so I don't want to sleep every chance I get. Is there something like this? I need focus AND motivation, not hyper at all. ADD I guess but all these labels are just labels IMO.
And yes I have prescribing physician who diagnosed me as ADD, but he doesn't seem to have any answers.. Mild anxiety as well. Kind of need both, to relax and motivated at the same time! : ) Thanks for any suggestions that I may pass on to my doctor.
@phonemail1367 I am the same have anxiety I think have autistic too with adhd combined and bpd . I was on adderall but increase my heart rate and lost my taste bud . I am also on st john worth. I don't feel any difference. Did you up my meds?
same here