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- Опубликовано: 7 июн 2024
- The past 10-15 years have witnessed a number of major developments in the medications and delivery systems available for the management of ADHD. Dr. Barkley here discusses the types of medications now available to ADHD management and the various delivery systems developed to extend the effectiveness of the medications across the day. For each medication, he will present the major beneficial effects and side effects. He will also discuss various issues clinicians should consider in selecting particular medications to use with a patient with ADHD, such as those issues related to the social context, the patient’s characteristics, and any comorbid conditions that may exist. What you will learn:
1. Describe the various medication types now available and FDA approved for ADHD management
2. Discuss the different delivery systems that now exist and are FDA approved for extending the effectiveness of medications across the day
3. Briefly review the beneficial effects and potential side effects associated with each medication type
4. Alert clinicians to the various issues that need to be considered in the selection of types of medications and delivery systems for individual ADHD patients (context, patient, comorbidity, etc.).
A list of all current medications for ADHD in the US as of May of 2023 can be found at my website here: www.russellbarkley.org/factsh...
My thanks for Andrew Desman, MD for making this summary sheet available through his own website.
I just wanted to thank you so much for all the work, research, and advocacy you do for ADHD, I was diagnosed about a year and a half ago at 23 and was given stimulant medication. It has been life changing, as a child I was always in honors/advanced classes but as I got older my academics really slipped, as did other areas in my life. Now I’m getting straight As again in university as a biopsychology major and I feel like I can truly live up to all my potential that I’ve been told about my entire life 😂 I want to become a clinical psychologist or a neuropsychologist and also advocate for adhd as you have. You are truly a blessing to this community and I have been able to learn so much from you and also unlearn all the incorrect and stigmatizing information out there. I’d love to get involved in research one day as well!
My son is about to graduate from college. Dr. Barkley's approach certainly worked in his case. It is hard work and supervision is absolutely necessary. I highly recommend his videos and books.
Thank you so much for these videos! My wife and I have started our ADHD treatment journey recently and your work has been a huge help!
You are welcome.
Hi, Dr @russellbarkleyphd2023 do you think you could do a short video on what types of symptom relief can be expected on medication and which symptoms would require other intentions to manage? Thanks!
I have a long list of commentaries to do now but will keep this idea in mind for a later one. Thanks!
I too would be very interested in a video covering this! Or something similar, maybe one on what to look for when trying medication, covering both: the signs of the medication working, and the signs that maybe it isn't working. Oh, and maybe covering some information to help someone in the position where the drugs work but come with side effects, and they are trying to decide whether or not to continue with current medication or look for a different medication that comes with less side effects and/or greater efficacy.
Either way I just wished to throw my name in the hat of those that are interested in such a video.
@russellbarkleyphd2023 I massively appreciate the information you provide, helps me both practically deal with my circumstance, as well as satisfying the part of me that demands a factual and logical understanding of the conditions I'm dealing with and their impact.
Comorbid disorders do not respond unless it is oppositional disorder. So things like Depression require additional treatment. The meds for ADHD won’t affect it much except for that demoralization that arises from the history of difficulties from ADHD. So does moderate or more anxiety if it is not related to the ADHD symptoms. Be well
Reading comments and now I have to go back to the beginning. Dr. @russellbarkelyphd2023 I was diagnosed at 42 at the start of Covid and I am unmedicated. I have all but “hyper” markers, combined type but it’s all internalized now. I was on adderall pills for a few weeks and it did nothing for my brain function but just kept me awake for up to 40 hours at a time. Which med should I next speak to my Dr about in your opinion? And thank you for validating my entire life. I really am trying to follow along and understand this presentation.
I am awaiting assessment with a Psychiatrist in the UK, currently. Thank you for this it was very informative and instructive. I will be able to discuss with the psych potential medications from a more informed position. Cheers!
Well done,thank you!
I've been really scared to start medication, despite thinking it will probably help me. I'm nervous about being reliant on a pill to function properly. And being dependent on something. And long term unknown effects.
This video really helped lay out the evidence and options. I'm giving it all more thought.
wow! the delayed release extended release medication is amazing to hear about. i wish i had that when i was a kid. amazing technology!
Thank you so much for making this videos for us with ADHD. I’m currently taking adderall 20mg IR 3 times a day. Did the FDA approve 40 or 60mg to be safe in clinical studies? The 60 is beneficial for my ADHD but I want to be sure it’s safe long term at that dose on the brain. Thank you for all you have done and continue to do for the ADHD community.
Need Finetuning and Tiltration advince not the basics personally, but obviously its solid information. Thx.
🎯 Key Takeaways for quick navigation:
00:26 📚 *Importance and Evidence Base of ADHD Medications*
- ADHD medications are supported by a substantial evidence base that demonstrates their effectiveness.
- This evidence base includes hundreds, if not thousands, of controlled trials comparing medications to placebos over various intervals.
- ADHD medications have shown a higher effectiveness rate compared to other psychiatric medications.
01:47 🛡️ *Safety Profile of ADHD Medications*
- ADHD medications are considered to be the safest in psychiatry due to extensive evidence indicating minimal long-term physical or emotional harm.
- Most side effects associated with these medications are manageable and not life-threatening.
- Large population studies and longitudinal research support the safety and efficacy of ADHD medications.
02:40 💊 *Efficacy and Normalization with ADHD Medications*
- 70 to 90 percent of clinical cases show positive responses to one or more ADHD medications.
- Approximately 50 to 60 percent of cases achieve normalization in behavior related to ADHD symptoms.
- The degree of improvement and normalization with ADHD medications surpasses that seen with other psychiatric drugs.
03:48 🏢 *Convenience and Cost-effectiveness of ADHD Medications*
- ADHD medications offer convenience in administration and are often more cost-effective than other intervention methods.
- These medications can be used across various stages of life, providing a prolonged window of influence.
- They offer consistent effects across community settings, ensuring treatment continuity even in unsupervised scenarios.
06:29 🧠 *Neural Protection and Enhancement with ADHD Medications*
- Long-term use of ADHD medications has been associated with brain growth and normalization in areas affected by ADHD.
- The term "neural protection" may be a misnomer; evidence suggests ADHD medications might enhance neural growth in underdeveloped brain regions.
- Multiple studies have indicated that individuals on ADHD medications show more brain growth than those not on medication.
27:03 🧪 *Development of Pro-drug Delivery System*
- Exploration of a pro-drug delivery system designed to mitigate amphetamine diversion and abuse.
- This system, unlike typical consumption methods, aims to deter misuse by altering its chemical form when consumed orally.
- The extended release nature of this system provides a more gradual onset and offset, potentially resulting in fewer side effects and better therapeutic efficacy.
29:07 🧒 *Stimulants' Safety with Preschoolers*
- Examination of the safety and effectiveness of stimulants, specifically methylphenidate, in preschool-aged children diagnosed with ADHD.
- The PAT study, involving 303 preschoolers, revealed that while stimulants are effective, they might not be as potent in this age group as in older children.
- Despite being less effective, stimulants were deemed safe for use in preschoolers, albeit with a slightly higher incidence of side effects compared to older age groups.
33:18 📚 *Documented Effects of Stimulants*
- Compilation of various documented improvements observed in individuals using stimulants for ADHD management.
- These effects span across social relationships, sports participation, reduction in punishments at home and school, improved handwriting, and enhanced working memory.
- Moreover, stimulants have shown benefits even when ADHD is comorbid with other disorders like autism spectrum disorder and bipolar disorder.
35:16 🌙 *Common Side Effects of Stimulants*
- Discussion on the prevalent side effects associated with stimulant medications used for ADHD management.
- Notable side effects include insomnia, loss of appetite, headaches, and stomach aches, with varying intensities across age groups.
- While some side effects might diminish over time or with dose adjustments, clinicians must consider these when prescribing to ensure the patient's well-being.
54:25 🌿 *Atomoxetine and its benefits in ADHD treatment.*
- Discussion on atomoxetine as a norepinephrine inhibitor beneficial for ADHD kids with enuresis.
- Highlights on the lack of significant insomnia effects compared to other medications.
- Insights on emotional effects, like emotional blunting, being less common with atomoxetine.
56:01 📊 *Side effects and considerations of Atomoxetine.*
- Overview of side effects, including minimal impact on heart rate and blood pressure.
- Insights on growth-related concerns but less dramatic compared to stimulants.
- Addressing concerns like hepatotoxicity and the disproven link with atomoxetine.
57:25 🚫 *Debunking concerns about suicidal ideation with ADHD medication.*
- Dissecting the black box warning and its origins.
- Providing evidence that suggests reduced risks rather than increased suicidal tendencies.
- Emphasizing the low percentage risk in the context of untreated ADHD children and teens.
59:25 🌙 *Antihypertensive drugs: Guanfacine and Clonidine in ADHD treatment.*
- Discussion on the effectiveness of antihypertensive drugs as third choice medications.
- Insights on how these drugs can help in reducing specific ADHD symptoms like hyperactivity and impulsivity.
- Addressing potential combinations with stimulants and their off-label usage considerations.
01:03:10 🧠 *Importance and benefits of early ADHD identification and intervention.*
- Highlighting reasons for early identification and treatment, including improved executive functioning.
- Addressing health-related risks like accidental injuries and potential suicide attempts.
- Discussing potential benefits related to brain growth and development with stimulant medication usage.
01:19:46 🧠 *ADHD Medication Responses Based on Etiology*
- Medication response varies based on the cause or etiology of ADHD.
- Patients with ADHD due to specific causes like head trauma or fetal alcohol syndrome show a lower likelihood of positive response to stimulant medications.
- The familial/genetic onset of ADHD tends to respond better to stimulant medication compared to acquired forms.
01:21:05 🚺 *Gender Differences in ADHD Medication Response*
- Females with ADHD may have a different peak response to stimulant medications like methylphenidate compared to males.
- The timing and efficacy of stimulant medication may vary between genders, suggesting tailored treatments may be necessary.
- Attention should be given to specific ADHD subtypes, like SCT, that may not respond well to stimulant medications.
01:21:58 🌡️ *Comorbidities and Their Influence on ADHD Medication Choices*
- Various comorbid conditions can impact the choice of medication for ADHD treatment.
- Factors like pre-existing sleep problems, anxiety disorders, tic disorders, and math disorders may necessitate alternative medications or approaches.
- Some medications may exacerbate certain comorbid conditions, requiring careful consideration during treatment planning.
01:24:26 🎯 *Efficacy and Challenges of ADHD Medications*
- ADHD medications are generally effective for managing the disorder, with a majority of patients responding positively.
- These medications offer significant improvement and safety compared to other psychiatric treatments.
- Challenges in medication adherence arise due to concerns about side effects, cost, and changing needs as children grow into adults.
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Dr. Russell you’re an amazing scientist and very generous sharing your experience with public in this platform. Thanks for your time and effort to educate patients and families.
I have a question regarding supporting and/or alternative treatments of ADHD such as (specifically) cerebellum training excercises. In his new book ADHD 2.0 Dr. Ned Halloway mentions this treatment and mentions this can help children. What is your experience and intake on these cerebellum activating/training excercises to treat ADHD in children and adults.
Thanks
The therapy does not work and has no convincing evidence for it. The author also has a conflict of interest with that therapy as I recall. Worse yet, the treatment developer went bankrupt in Australia keeping the deposits of families awaiting treatment, if recall serves me correctly.
Is there any alternattive treatments that you believe could possibly support treatment? Meditation, mindfullness, yoga, neurofeedback training, probiotics, fish oil supplements etc. There are multiple alternative treatments suggested by different doctors and we can find research papers supporting these but it’s very hard for a regular person t eliminate noise from facts. Would be great to hear your perspective on these alternatives and recent scientific views. Thanks again.
My wife and I both have ADHD. We actually found information about two years ago that Atomoxetine didn't work in most individuals, and have therefore stayed away from this medication. I see that this information doesn't appear to be true after all. Thank you for this video!
It’s very hit or miss compared to stimulants. It either works or it doesn’t for most people.
I was just diagnosed yesterday at age 43. My dr prescribed atomoxetine to start. Guess we’ll see…
Wellbutrin (as far as non-stimulants go) has a higher success rate and Qelbree even better, but the best is Adderall, at least of common options, Amphetamine Sulphate also seems to be effective but I'm just guessing that it might be even more competitive. But really it is all individual, but the more you are willing to ty the higher the odds.
If I am understanding correctly it sounds like usually one starts with stimulants and then switches to atomoxotine if the combinations of delivery etc with stimulants don't work. Is that accurate? Or is it more a case by case decision where some people might want to start with atomoxotine? (E.g. if they already have anxiety or high blood pressure).
Also, thank you for the wonderful high quality information you are providing. I am an early career tenure track non medical researcher trying to educate myself on ADHD for a possible grant proposal and this channel has been very helpful in guiding my understanding of the state of the art.
I was just diagnosed yesterday and my dr is starting me on atomoxetine.
My 15yo daughter has her apt on Monday to get diagnosed and started on tmt…
Thank you for your precise presentation. Very simply described. Unfortunately here in Nepal, many medicines are not easily available. We have recently access to Atomoxetine.
What is the earliest age that we can use Atomoxetine?
The package insert with the medication in your county will have the recommended lower age limit but some research has shown it can be used in 4-5 year olds.
About 4-5 based on a few studies of preschoolers.
the presence of math disorder lowering MPH response that much is very interesting, does AMPH suffer from the same effect?
We don’t know. Only methylphenidate was studied.
I extend my gratitude for the informative video. I am 36 and aiming to have our second child. Research suggests Methayphenadate could impact sperm quality. Should I pause my 15 mg daily dose while trying to conceive? Your advice on alternatives like Alfa 2 agonists or Atomexotine is also appreciated.
watching to see if you get an answer.
Dr Barkley. What is your opinion on adderall compare to other medication? Does it have more adverse side effects? Thanks
Because amphetamines are more powerful than methylphenidate based drugs, they may have more side effects but they also produce greater improvements, too. Be well.
I have adenoma tumors that attack my thyroid and pituitary gland. In other words, I now have chronic autoimmune disease because of non cancerous tumors that drain me, physically, mentally. My frontal part of my brain swells due to chronic inflammation from my autoimmune disease. I need adhd medication to actually get out of bed. Vyvanse worked great. I was working and even riding my bike. I could clean my home and read with ease. Ritalin makes my hip hurt. I can't be limping and feeling agitated. Im not working or doing anything anymore. Not having Vyvanse for over a year, makes my life very challenging. I really wish the government would stop interfering with our medications.
Dr. Barkley i was diagnosed with subtype Innattentive adhd at 33 , i have also been diagnosed with depression and anxiety. I was prescribed adderal , although it’s helping me focus . It has made my anxiety worse . Do you have any recommendation on best medication for innatentive type and best medication that may not make anxiety worse?
i’ve also read from a lot people that Vyvance is amazing , particularly in women . However currently too expensive for me .
Vyvanse got generics approved by the FDA just this month! They should be widely available and cheap very soon
@@daniellec6337 that’s amazing news! It has been on patent so costly for so long!!
My daughter (22) is currently waiting for a diagnosis. Her friend who is already on medication - Elvanse - gave her a couple of the tablets to try. The effect was very good. She felt motivated and energetic, she got on with a lot of things that she'd been putting off for a while. She also found that despite feeling so energetic that when it came to bedtime she just fell asleep no bother which is something she normally struggles with.
Why would a stimulant medication actually help her sleep?
We don't know for sure but about 20% of people have a paradoxical response to a stimulant where it increases sleepiness.
I have frequently the huge problem that i have an endless loop of songs or bits of music that wont shut up.
I am tired, but just cant let it go.
Elvanse helps a great deal with that.
Aks your daughter if she has problems shutting her head off when it is time to actually do that.
Hello dr. Barkely, I was wondering if you've ever stumbled upon patients with ADHD who didn't respond to ANY of the ADHD medications. I've been on methylphenidate, dextroamphetamine, Wellbutrin and Atomoxetine, and tney were all terrible. What do you prescribe in such situations?
Yes, it’s about 7-10% or so of adults.
@@russellbarkleyphd2023 Thank you so much for your answer. May I ask what your approach would be then to control symptoms, especially in combination with GAD/SAD? Any antidepressants?
Is psychodelics being studied in relation to their effects on adhd?
And what is your personal thoughts on this?
Is Vortioxetine used for ADHD?
9😅😅😅😅
Not in the US.
Any thoughts on NAC for ADHD?
I am not aware of any but you can use Google Scholar to search the journals for that term + ADHD and see if there is anything recent.
My 11+ with ADHD needs methylphenidate SR but he never eats lunch as a result. It really helps him at school though.
Then by the evening it's worn off and he can't focus on homework.
Any advise??? 3 short acting versions throughout the day so he can eat lunch and dinner and focus in the evenings????
If he literally won’t eat anything at lunch, then he is likely being overmedicated. Appetite suppression is normal, but he should still be able to eat.
@@johnmoore1495 he isn't on a high dose for his weight and lesser doses are ineffective for his ADHD. He eats about 20% of his lunch.
@@creativesource3514 smaller shorter acting methylphenidate may be a better option. While the SR and EX meds release longer and slower they still result in a larger peak concentration due to all the medication being taken at once which as a result can mean more side effects ie. worse appetite suppression.
Maybe he could drink a "weight gainer" (kind of like a protein shake or ensure) that way his appetite won't be as much of a factor since it's just a glass of a drink
@@oysterchampion8998 thank you for your reply. I am giving him shakes. By the time he sleeps i get his calories in but its difficult and takes persistence.
What do you think of Qelbree?
wondering this too!
Are there any supplements known to help children with ADHD?
It at this time.
Your chart and video don't mention Desoxyn?
Because most or nearly all pharmacies here won’t stock it and most physicians won’t prescribe it because it’s methamphetamine and is highly likely to be stolen, sold, abused etc. But it does work for ADHD.
@@russellbarkleyphd2023 Makes sense. How about Cylert?
It was taken off the market several decades ago due to some rare cases of liver failure in children. @@thx1136
@russellbarkleyphd2023 I'm not sure if this is covered in another video, and if so, could you point me towards it, but can you do a talk on developing a tolerance to stimulants? If that is common, how common and if so, the best ways to manage that.
I'm 39, I got diagnosed 9 months ago, have been on Methylphenidate for the last 8 weeks, and this is mostly down to listening to yours and other professionals research, so thank you so much for everything you do. Its changed my life.
Do my brain parts still improve if I am only diagnosed at 21,5 years old and just start taking medication like in the figures?
There is just one study of adults with ADHD and it did show such an effect in some of the participants. There is more research on children.
The info from 1:20:00 to 1:26:00 is helpful
Three things stood out to me in this video:
1. Preschoolers where tested on in one particular study
2. Coming off the medication could potentially lead to suicide (in your own words)
3. He claims the medications are not addictive but then says the patients can develop a dependency on them 🤨
Didnt it ever occur to all these super smart people that preschool is too soon to diagnose children with ADHD? Also, why do doctors think taking medicines lifelong is okay? Nobody wants that. If coming off the medication could potentially lead to serious consequences then it seems smart to stay away from them in the first place.
💚🙏🙏🙏
Dr Barkley how can medication be controlled? My son overuses it and I can’t control it while he’s in college
What do you mean by "overuse"?
If he is prescribed it how is he overusing it? Do you mean he's using it more than you'd like him too or more than he's prescribed?
Instead of twice a day , he takes it 4 times a day , that’s overuse
@@user-df1cy7sl7f The number of times a day doesn't dictate over- or under-use. The question is the effect it has on his ability to function. Is he taking so much that he totally zones out, his functioning declines, is dangerously increasing his blood pressure or some other negative side-effects?
A diabetic isn't overusing their insulin just because they need it more often than their doctor anticipated, but they might be if they're taking so much insulin that they constantly need sugar to avoid dizziness, a racing heart or other negative side-effects of too much insulin in their system.
@@user-df1cy7sl7f That certainly is more than is normally prescribed. If he's taking twice a much does that mean he's going half the time with no meds?
Assuming it's one of the short acting types they do only cover around 3-4 hours so taking 4 would just cover 16 hours where he's awake. Adhd doesn't go away when you leave school or work so maybe he finds he needs it all day to function? . Maybe you could speak with his clinician about moving him to a long release instead? If it's long release and he's taking more without side effects then maybe he actually needs a higher dose.
It's generally very unusual for the drug to be misused as it doesn't really provide any benefit when it's too much. Definitely speak to his clinician about it though.
1:24, mass disorder? Maths disorder?
My daughter was diagnosed with dyslexia and dyscalculia in 6th grade and should be diagnosed with adhd in a few days so I’m interested in info regarding the relationship and if there are meds that would help all…
She is 15.5yo and I was just diagnosed at age 43. Wish I would’ve been diagnosed decades ago. My life could’ve been so different with proper treatment!
The cursory acknowledgement of delayed/impaired physical growth is concerning. Dr. Barkley is attentive to the cognitive benefits of stimulant intervention, which is reasonable as the clinical data supports his position. However, the physical developmental delays in children are not inconsequential or trivial. It seems as though the negative impact on growth is behavioral and not physiological ( the medication, methylphenidate, does not seem to have a systemic effect on the microbiome's ability to absorb nutrients; although, that would be an interesting experiment). In malnourished children, they do not feel compelled to eat whilst medicated, and subsequently do not meet macro and/or micro nutrient requirements. The alarm bells should be ringing whenever development delays are reported due to poor nutrition. Ultimately, I am disappointed that Dr. Barkley minimized that side effect. The tandem of malnutrition and preexisting nuero-divergence is a cocktail of disaster. Like most secular clinicians, Dr. Barkley fixates on the drug and disregards nutrition-- incredibly disappointing.
I want it
How can I buy doc
you have to have a diagnosis for adhd lmfao
You need a diagnosis then a prescription.
It's best to take the medication with milk to neutralise the nasty acidic effects.
I never had any acidic effects whatsoever.