What are the different ADHD medications and their key features? What are the factors to consider when choosing an ADHD medication. A detailed comparison of ADHD drugs including methylphenidate, dexmethylphenidate, and amphetamine formulations.

Methylphenidate Formulations for ADHD

Methylphenidate is one of the most commonly prescribed medications for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). It comes in various formulations, each with its own unique characteristics in terms of duration of action, dosing considerations, and availability of savings programs.

Adhansia XR®

Adhansia XR is an extended-release capsule formulation of methylphenidate, with a 20% immediate-release layer and an 80% controlled-release layer. It provides symptom control for 12 hours or more and the capsule can be opened and the contents swallowed completely with applesauce. It is available in a range of dosages from 25 mg to 85 mg and has a savings program.

Aptensio XR®

Aptensio XR is another extended-release capsule formulation of methylphenidate, with a 40% immediate-release layer and a 60% extended-release layer. It provides symptom control for up to 12 hours and the capsule can also be opened and the contents swallowed with applesauce. It is available in dosages from 10 mg to 60 mg and has a savings program.

Concerta® or Generic*

Concerta is an extended-release tablet formulation of methylphenidate that uses OROS osmotic pump technology. It has a biphasic release pattern, with an initial peak at 1 hour (22% of the dose) and then a gradual release of the remaining 78% over 9 hours. It must be swallowed whole, as the non-absorbable shell may be passed in the stool. It is available in dosages from 18 mg to 54 mg and has a savings program.

Cotempla XRODT™

Cotempla XRODT is an extended-release orally disintegrating tablet formulation of methylphenidate, with 25% immediate-release microparticles and 75% extended-release. It provides symptom control for 12-13 hours and is a grape-flavored tablet that dissolves in the mouth. It is available in dosages from 8.6 mg to 25.9 mg and has a savings program.

Daytrana®

Daytrana is a transdermal patch formulation of methylphenidate, with the drug dispersed in the adhesive layer. It has a 9-hour wear time, and the time the patch is worn can be varied to control the duration of effects. Patients should be monitored for skin rash or sensitivity, and the patches should be discarded properly. Daytrana has a slower onset of medication over the initial six hours. It is available in dosages from 10 mg to 30 mg and has a savings program.

JORNAY PM™

JORNAY PM is a delayed-release, extended-release capsule formulation of methylphenidate. It has a dual-layer delexis delivery system, with an outer layer that delays release for up to 10 hours and an inner layer that controls daytime release. It is taken before going to sleep to provide early morning symptom control and lasts for 12-14 hours. It is available in dosages from 20 mg to 100 mg and has a savings program.

Metadate CD®

Metadate CD is an extended-release capsule formulation of methylphenidate, with a Diffucaps delivery system. It has 30% immediate-release beads and 70% delayed-release beads, providing symptom control for 8-10 hours. The capsule can be opened and the contents swallowed with applesauce. It is available in dosages from 10 mg to 60 mg.

Methylphenidate HCl

Methylphenidate HCl is available in several formulations, including:
– Chewable tablets (2.5 mg, 5 mg, 10 mg) with a grape flavor, providing 3-4 hours of symptom control
– Extended-release tablets (10 mg, 20 mg) that must be swallowed whole and provide 6-8 hours of symptom control
– Oral solution (5 mg/5 mL, 10 mg/5 mL) that is a colorless, grape-flavored liquid providing 3-4 hours of symptom control

Quillichew ER™

Quillichew ER is an extended-release chewable tablet formulation of methylphenidate, with 30% immediate-release and 70% extended-release. It provides symptom control for 8 hours and is available in cherry-flavored 20 mg, 30 mg, and 40 mg dosages. It has a savings program.

Quillivant XR®

Quillivant XR is an extended-release oral suspension formulation of methylphenidate, with 20% immediate-release and 80% extended-release. It provides symptom control for 12 hours and is a fruit-flavored suspension that should be shaken well before use. It has a savings program and can be stored at room temperature.

Ritalin® or Generic

Ritalin is the original short-acting, immediate-release tablet formulation of methylphenidate, providing 3-4 hours of symptom control. It has an abrupt onset and offset, which can increase the number and severity of side effects. It is available in 5 mg, 10 mg, and 20 mg dosages.

Ritalin LA®

Ritalin LA is an extended-release capsule formulation of methylphenidate, using Spheroidal Oral Drug Absorption System (SODA S) technology. It has 50% immediate-release beads and 50% delayed-release beads, providing symptom control for 8-12 hours. The capsule can be opened and the contents swallowed with applesauce. It is available in dosages from 10 mg to 60 mg.

Ritalin SR®

Ritalin SR is a sustained-release tablet formulation of methylphenidate, providing 8 hours of symptom control. The tablets must be swallowed whole and should never be crushed or chewed. It is available in a 20 mg dosage.

Dexmethylphenidate Formulations for ADHD

Dexmethylphenidate is the active dextroisomer of methylphenidate and is available in both immediate-release and extended-release formulations.

Focalin® or Generic

Focalin is the short-acting, immediate-release tablet formulation of dexmethylphenidate, providing 4-6 hours of symptom control. The dosage is approximately half that of methylphenidate, as it is the isolated active dextroisomer. It is available in 2.5 mg, 5 mg, and 10 mg dosages.

Focalin XR® or Generic

Focalin XR is the extended-release capsule formulation of dexmethylphenidate, using SODA S technology. It has 50% immediate-release beads and 50% delayed-release beads, providing symptom control for 8-12 hours. The capsule can be opened and the beads swallowed with applesauce. It is available in dosages from 5 mg to 40 mg and has a savings program.

Amphetamine Formulations for ADHD

Amphetamine-based medications are another class of drugs used to treat ADHD, with different extended-release formulations available.

Adzenys ER™

Adzenys ER is an extended-release oral suspension formulation of amphetamine, with 50% immediate-release and 50% delayed-release particles. It provides symptom control for 10-12 hours, is orange-flavored, and can be taken with or without food. It requires vigorous shaking before use and is available in a 1.25 mg/mL concentration. It has a savings program.

Adzenys XR-ODT™

Adzenys XR-ODT is an extended-release orally disintegrating tablet formulation of amphetamine, with 50% immediate-release and 50% delayed-release. It provides symptom control for 10-12 hours and is available in dosages from 3.1 mg to 18.8 mg. It has a savings program.

Factors to Consider When Choosing an ADHD Medication

When selecting an ADHD medication, healthcare providers should consider several factors, including:
– Desired duration of symptom control
– Dosing considerations (e.g., ability to open capsules, chew tablets, or apply patches)
– Availability of savings programs to help with medication costs
– Individual patient factors, such as age, weight, and response to previous ADHD medications

The wide range of ADHD medication formulations and their unique characteristics allows healthcare providers to tailor the treatment to the individual patient’s needs and preferences.

Key Takeaways

• Methylphenidate, dexmethylphenidate, and amphetamine are the main classes of ADHD medications, each with various extended-release and immediate-release formulations.
• Formulations differ in their duration of action, dosing considerations, and availability of savings programs, allowing for individualized treatment.
• Factors to consider when choosing an ADHD medication include desired duration of symptom control, dosing preferences, medication costs, and individual patient characteristics.
• The comprehensive range of ADHD medication options provides healthcare providers the flexibility to optimize treatment for each patient’s unique needs.

Frequently Asked Questions

What is the difference between immediate-release and extended-release ADHD medications?

Immediate-release ADHD medications, such as Ritalin, have a faster onset of action but a shorter duration of symptom control (typically 3-4 hours). Extended-release formulations, like Concerta or Focalin XR, provide a gradual release of the active ingredient over a longer period, usually 8-12 hours, to maintain symptom control throughout the day.

Can ADHD medications be taken with food?

The dosing instructions for ADHD medications vary. Some, like Quillivant XR and Adzenys ER, can be taken with or without food, while others, like Concerta, must be taken on an empty stomach. Healthcare providers can provide guidance on the specific food restrictions for each ADHD medication.

Are there any savings programs available for ADHD medications?

Yes, many of the ADHD medication formulations mentioned have savings programs or copay assistance available to help patients with the cost of the medication. Examples include the Adhansia XR, Aptensio XR, Concerta, Cotempla XRODT, Daytrana, JORNAY PM, Focalin XR, Adzenys ER, and Adzenys XR-ODT savings programs.

Chart Comparing Guanfacine, Intuniv and More

Ritalin Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Nervousness, trouble sleeping, loss of appetite, weight loss, dizziness, nausea, vomiting, or headache may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor right away if you have any serious side effects, including: signs of blood flow problems in the fingers or toes (such as coldness, numbness, pain, or skin color changes), unusual wounds on the fingers or toes, fast/pounding/irregular heartbeat, mental/mood/behavior changes (such as agitation, aggression, mood swings, abnormal thoughts, thoughts of suicide), uncontrolled muscle movements (such as twitching, shaking), sudden outbursts of words/sounds that are hard to control, vision changes (such as blurred vision).

Get medical help right away if you have any very serious side effects, including: fainting, seizure, symptoms of a heart attack (such as chest/jaw/left arm pain, shortness of breath, unusual sweating), symptoms of a stroke (such as weakness on one side of the body, slurred speech, sudden vision changes, confusion).

Rarely, males (including young boys and teens) may have a painful or prolonged erection lasting 4 or more hours while using this medication. Caregivers/parents should also be watchful for this serious side effect in boys. If a painful or prolonged erection occurs, stop using this drug and get medical help right away, or permanent problems could occur. Ask your doctor or pharmacist for more details.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US –

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Types, Side Effects, and More

Stimulant drugs are the treatment most often used for ADHD. They can help you manage symptoms, such as:

• Short attention span
• Impulsive behavior
• Hyperactivity

They may be the only treatment you use, or you can try them along with behavior therapy.

These drugs ease ADHD symptoms in about 70% of adults and 70% to 80% of children. They tend to cut down on hyperactivity, interrupting, and fidgeting. They can also help a person finish tasks and improve relationships.

As long as the medication is taken, people have a better attention span and better behavior. Even though there is some debate about whether social skills or performance at school gets better, there are many people who benefit from them.

What Do Stimulant Drugs Do?

For someone with ADHD, these medications boost the levels of certain brain chemicals, like dopamine and norepinephrine. They help nerves in your brain talk to one another. They’re also created in response to pleasant activities. If you take them for ADHD, you’ll get slow and steady doses, just like your brain would create them naturally. That helps boost your energy, helps you pay better attention, and keeps you alert.

Common Stimulants for ADHD

There are many stimulants available to treat ADHD: short-acting, intermediate-acting, and long-acting forms.

The short-acting forms are usually taken two or three times a day, and the long-acting ones just once a day. The benefit of short-acting is that you have more control over when you have medication in your system. The downside is you have to remember to take them often.

A positive of the long-acting type is that you don’t have to remember to take them as often, usually just first thing in the morning. They may also cut down on some side effects. But it may be harder to wind down at night until you get your medication dose and timing right.

Short-acting stimulants include:

Intermediate-acting stimulants include:

Long-acting stimulants include:

Most are pills, but sometimes medication can be in a patch that is put on the skin or in a liquid.

Who Should Not Take a Stimulant Drug?

You should not take stimulants if you have:

• Underlying heart problems
• Glaucoma (a buildup of pressure in your eyes)
• Severe anxiety, tension, agitation, or nervousness
• Tics (body movements you can’t control that happen over and over)
• Tourette’s syndrome, or someone in your family has it
• A history of psychosis or are psychotic
• Taken a type of medication called a monoamine oxidase inhibitor within 14 days of when you start taking the stimulant. Examples of this type of medication include phenelzine (Nardil) and tranylcypromine (Parnate).

What Are the Side Effects of Stimulants?

Common side effects include:

These often go away after a few weeks of taking these medicines. That’s because your body can adjust to the medication. But if they don’t get better, let your doctor know.

Other side effects include:

• Less of an appetite
• Weight loss (Sometimes taking your medication after meals can help avoid this. Or you can add high-calorie snacks or shakes to what you eat.)
• Nervousness
• Insomnia (you have a hard time sleeping)
• Tics

Continued

The side effects may go away if your doctor changes your dose or if you try a different type of stimulant.

Some kids and teens who take stimulants grow slower than those who don’t. But it doesn’t affect their final height. If your child is taking stimulants, their doctor should keep an eye on their weight and height.

Sometimes stimulants can cause allergic reactions. In the case of patches such as Daytrana, permanent loss of skin pigmentation can happen where the patch is put on. A skin rash can be one of the signs. In general, it’s best to call your doctor if you vhave any new or unusual symptoms.

Are Stimulants Addictive?

Stimulants aren’t habit-forming in the doses used to treat ADHD in children and teens. And there is no evidence that taking them leads to drug abuse. In fact, studies have shown that people with ADHD who are treated with medication have lower rates of substance abuse than people with ADHD who are not treated.

Still, there is a potential for abuse and addiction with any stimulant medication. This is especially true if the person taking them has a history of substance abuse and addiction. It’s something you may want to take into consideration.

Before You Take a Stimulant

When you talk to your doctor, be sure to tell them if you:

• Are nursing, pregnant, or plan to become pregnant
• Take or plan to take any dietary supplements, herbal medicines, or nonprescription medications
• Have any past or present medical problems, including high blood pressure, seizures, heart disease, glaucoma, or liver or kidney disease
• Have a history of drug or alcohol abuse or dependency
• Have had mental health problems, including depression, manic depression, or psychosis

Tips for Parents

The following are useful guidelines to keep in mind if your child is going to take stimulants for ADHD:

• Always give the medication exactly as prescribed. If there are any problems or questions, call your doctor.
• When starting a stimulant, do it on a weekend. Then you will have a chance to see how the child does on it.
• Your doctor will probably want to start your child on a low dose of medication. Then they can up the amount slowly until symptoms are controlled.
• Try to stick to a regular schedule. To make sure they take the medicine at the same time every day, children may need teachers, nurses, or other caregivers to give the medicine.
• If a dose is missed, take the next dose at the regular time. Don’t try to catch up by taking additional doses and try not to take them later in the day.

What About ‘Medication Vacations’?

Some children do better if they take medication regularly. But if you want your child to take a “vacation” from the medication, plan to do it on a day when they may not need concentration, like a weekend in the summer.

Side Effects, Types, Drug Interactions, Warning & Uses

References

Reviewed by:

Marina Katz, MD

American Board of Psychiatry & Neurology


REFERENCES:


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DiPiro, Joseph T., et al. “Chapter 46. Attention Deficit/Hyperactivity Disorder.”
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Kessler, R.C., et al “The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication.”
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Expert Rev Neurother 11.10 (2011): 1443-1465.

List of 53 ADHD (Attention Deficit Hyperactivity Disorder) Medications Compared

Non-Stimulant Medications Available for ADHD Treatment

​Some non-stimulant medications may be appropriate for children who have been diagnosed with Attention Deficient Hyperactivity Disorder (ADHD) and certain coexisting conditions—such as ADHD with accompanying tic disorders (such as Tourette Syndrome)—because they can in some cases treat both conditions simultaneously. Proven alternate choices to stimulant medications include Atomoxetine, Guanfacine XR, Clonidine XR, and Bupropion.

Note: The first three are newer FDA approved medications that have not been ​used as long as stimulants. Bupropion is not FDA approved but has had several small trials for ADHD. Atomoxetine, guanfacine XR and clonidine XR are considered second-line (second-choice) treatments. Bupropion is a third line agent.

Atomoxetine

Atomoxetine (Strattera) is a non-stimulant approved by the FDA for the treatment of ADHD. It is in the class of medications known as selective norepinephrine reuptake inhibitors. Because atomoxetine does not have a potential for abuse, it is not classified as a controlled substance.

Atomoxetine is a newer medication and the evidence supporting its use is more limited than for stimulants. Atomoxetine, unlike stimulants, is active around the clock. However, atomoxetine has been found to be only about two-thirds as effective as stimulant medications. After starting atomoxetine it may take up to 6 weeks before it reaches its maximum effectiveness.

Possible side effects

Atomoxetine has a warning on it that it may, in a very small number of cases, have some potential for causing suicidal thoughts in the first few weeks of treatment. Atomoxetine may be helpful in the treatment of children who have both ADHD and anxiety, since stimulants may worsen anxiety symptoms. Side effects are generally mild but can include decreased appetite, upset stomach, nausea or vomiting, tiredness, problems sleeping, and dizziness. Jaundice (turning yellow) is mentioned in a warning on the medication, but is extremely rare. Taking atomoxetine with food can help avoid nausea and stomachaches. Atomoxetine should be used in lower doses in children also taking certain antidepressants like fluoxetine (Prozac) or paroxetine (Paxil), because they can raise the atomoxetine levels in the bloodstream.

Atomoxetine is now considered an option for first-line therapy for ADHD, and is the first non-stimulant to fall into the first-line category. Parents concerned about the possibility that stimulants may be used for substance abuse may choose atomoxetine as the first-line agent for their child. It is often used for children who have had unsuccessful trials of stimulants.

Long-Acting Guanfacine

Long-acting guanfacine (Intuniv) is in the group of medications known as alpha agonists. These medications were developed for the treatment of high blood pressure but have also been used to treat children with ADHD who have tics, sleep problems, and/or aggression. It has recently been approved by the FDA for the treatment of children with ADHD.

Long-acting guanfacine is a pill, but it cannot be crushed, chewed, or broken and must be swallowed whole. Like atomoxetine, it is not a controlled substance.

Possible side effects

It does not cause much appetite suppression, so may be a good choice for children who lost a significant amount of weight when taking a stimulant. Side effects can include sleepiness, headaches, fatigue, stomachaches, nausea, lethargy, dizziness, irritability, decreased blood pressure, and decreased appetite. Although sleepiness occurs in a large number of children when children start taking long-acting guanfacine, it seems to get better as they continue to take it. It may take 3 to 4 weeks to see medication benefit.

Long-Acting Clonidine

Long-acting clonidine (Kapvay) is also FDA approved for the treatment of ADHD. It is taken twice a day while long acting guanfacine is once a day.  Both long acting alpha agonists have been studied for use alone or as an add-on to stimulants when the stimulant alone does not eliminate all the symptoms of ADHD.

Two other shorter-acting alpha agonists are available for use, but not approved by the FDA for ADHD. These are clonidine (Catapres) and short-acting guanfacine (Tenex). These can be used as adjunctive medications, or if FDA-approved medications are not helpful.

If no FDA-approved medication has been found helpful for your child, you should also consider whether ADHD is the correct diagnosis, and whether additional coexisting conditions might be present.

Bupropion

Bupropion is a unique type of antidepressant that has been less frequently studied as a treatment for ADHD. It is also not FDA approved for ADHD or as an antidepressant in people under the age of 18. Some research indicates that bupropion is effective in reducing ADHD symptoms in some children, but it seems to have less effect than stimulants or atomoxetine. Its use in ADHD is not widespread.

Possible side effects

The side effects, though usually minimal, can include irritability, decreased appetite, insomnia, and a worsening of existing tics. It is important to note that at higher doses, bupropion may make some individuals more prone to seizures and cause hallucinations, so it should be used cautiously in children who have seizure disorders.

Additional Information from HealthyChildren.org:

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Generic Medications to Treat Your ADHD at Lower Cost

Most commonly, attention-deficit/hyperactivity disorder (ADHD) is diagnosed in children, and it often persists through adolescence and later adulthood. The medications that are most commonly prescribed to treat ADHD are stimulants, though non-stimulants are available as well. While many are brand-name drugs, lower-cost generic alternatives may be more affordable—if they’re not already required by your insurance provider.

Common Medications

Children with ADHD fall into three categories:

• Primarily hyperactive-impulsive
• Primarily inattentive
• A combination of the two

Although some people with ADHD “outgrow” the disease, it’s estimated that as many as 80% of people carry the condition through adulthood. Adults with ADHD are by and large not hyperactive and instead inattentive.

The majority of ADHD medications can be purchased as generic versions, which are the names in parentheses in the lists below.

Medications are a big part of treatment for both adults and children. The stimulants your doctor may prescribe include:

• Adderall and Adderall XR (amphetamine and dextroamphetamine)
• Concerta (methylphenidate)
• Daytrana (methylphenidate)
• Dexedrine (dextroamphetamine)
• Focalin and Focalin XR (dexmethylphenidate)
• Metadate CD (methylphenidate)
• Methylin and Methylin ER (methylphenidate)
• Ritalin and Ritalin LA (methylphenidate)
• Quillivant XR (methylphenidate)
• Vyvanse (lisdexamfetamine)

The following non-stimulant medications may also be prescribed for ADHD treatment when an individual does not respond well to stimulants:

• Intuniv (guanfacine)
• Kapvay (clonidine)
• Strattera (atomoxetine)
• Qelbree (viloxazine)

Of note, the XR, ER, and LA designations indicate extended-release preparations.

Cost Differences

Brand-name drugs are typically expensive. Generic medications are often low-cost alternatives that, for most people, work just as well as brand-name drugs. In fact, according to the FDA, the cost of generic medications is typically around 85% less than brand-name drugs when there are multiple generics for the same drug on the market.  

Keep in mind that medication costs can vary over time and be dependent on your pharmacy and insurance coverage. And some insurance companies only authorize brand-name drugs or vice versa.

While this doesn’t reflect the potential savings for every generic medication, particularly when there are fewer generic competitors, in many instances, switching to generic medications can save you hundreds or thousands of dollars on ADHD treatment each year.

Compared with generic versions of shorter-acting drugs, it can cost several times more to purchase extended-release preparations. Although it may be more convenient to take extended-release versions because fewer doses are needed, you may be able to save lots of money by switching to shorter-acting alternatives.

Effectiveness

Some people are concerned about the effectiveness of generic medications versus brand-name options. Each generic medication goes through the same level of scrutiny and approval process by the Food and Drug Administration (FDA).

The FDA states, “A generic medicine works in the same way and provides the same clinical benefit as its brand-name version.” In order to be approved for use, it has to have the same safety, strength, quality, performance, and intended use.

Notably, the FDA withdrew approval of two generic versions of Concerta (methylphenidate hydrochloride) extended-release (ER) capsules, as they failed to demonstrate the same therapeutic effect as the brand-name drug.

Changing Medications

Just as switching from any medication to another, some people will not have the same reaction to a generic drug as they would to the brand-name equivalent (and vice versa). Whenever you and your doctor decide to change to a different medication, it’s important that you monitor yourself or your child for any changes.

When you change a medication, bring up anything you notice—including side effects—to your doctor so they can make adjustments as needed. This may include a dosage change or trying a different medication until you find the right one for you. ADHD is a very individual condition and requires individualized treatments.

Payment Support

If you’re having trouble paying for ADHD medications, inform the prescribing physician and ask about generic alternatives. The physician can offer you options and alternatives that may lower the cost of ADHD medications.

For example, many large pharmacy retailers offer a value formulary, a list of medications that can be prescribed for less cost. Moreover, patient assistance programs are also available in many communities and can subsidize the cost of treatment.

A Word From Verywell

Treating ADHD with medications often requires patience and open conversations with your doctor. If you have concerns over the cost of medications, bring these up during your appointments, along with any questions you have about side effects. By working together, you can find a treatment that will help.

90,000 💊 Drug List aDHD – 2021

Treatment of attention deficit hyperactivity disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a mental disorder. This causes a number of symptoms. include:

• concentration problems
• forgetfulness
• hyperactivity
• inability to complete tasks

Medication can help reduce symptoms of ADHD in children and adults. Treatment approaches can vary between children and adults, and not everyone with ADHD takes the same medications.

In fact, many drugs are available to treat ADHD. The following list of ADHD medications can help you talk to your doctor about which option might be right for you.

Stimulants Stimulants

Stimulants are the most commonly prescribed medications for ADHD. They are often the first course of drugs used to treat ADHD. can hear this class of drugs called central nervous system (CNS) stimulants. They work by increasing the amount of hormones called dopamine and norepinephrine in the brain.This effect improves concentration and reduces the fatigue that is common with ADHD.

Many branded stimulants are now only available as generic versions that cost less and may be preferred over some insurance companies. However, other drugs are only available as brand name products.

Amphetamines

Amphetamines are stimulants used for ADHD. These include amphetamine, dextroamphetamine, or lisdexamphetamine. They come in immediate release (a drug that goes straight into your body) and extended release (a drug that is slowly released into your body).Brand names of these drugs include:

• Adderall XR (general access)
• Dexedrine (public)
• Dyanavel XR
• Evekeo
• ProCentra (Public)
• Vyvanse

Methamphetamine (Desoxyn)

Methamphetamine is linked to ephedrine and amphetamine. It also works by stimulating the central nervous system. It is not known exactly how this drug works to help the symptoms of ADHD. It can decrease appetite and increase blood pressure.This drug comes in the form of an oral tablet, taken once or twice a day.

Methylphenidate

Methylphenidate works by helping the reabsorption of norepinephrine and dopamine in your brain. It is also a mild stimulant. It comes in immediate-release, extended-release, and controlled-release oral forms. It also comes in the form of a transdermal patch under the Daytrana brand name. Brand names include:

• Aptensio XR
• Metadate ER
• Concert (general access)
• Daytrana
• Ritalin (general access)
• Ritalin L.A. (general access)
• Methyline (general available)
• QuilliChew
• Quillivant
• Focalin (public access)

Non-stimulants Nonsteroids

Non-stimulants affect the brain in different ways than stimulants. These drugs also affect neurotransmitters, but they do not increase dopamine levels; in general, these drugs take longer to get results than stimulants.

These drugs fall into several classes.A doctor may prescribe them if stimulants are not safe or ineffective. They can also prescribe them if the person wants to avoid the side effects of stimulants.

Atomoxetine (Strattera)

Atomoxetine (Strattera) allows norepinephrine to work longer in the brain. The drug is long acting, so you need to take it once a day. This drug is also available generic.

Atomoxetine has caused liver damage in a small number of people. If you have signs of liver problems while taking this drug, your doctor will check your liver function.Signs of liver problems include a tender or swollen belly, yellowing of your skin or whites of your eyes, or tiredness.

Clonidine (Kapvay)

Clonidine (Kapvay) is used to reduce hyperactivity, impulsivity, and distraction in people with ADHD. This medication is also used to treat high blood pressure. Because it also lowers blood pressure, people taking it for ADHD may feel lightheaded.

This drug is available generic.

Guanfacine (Intuniv)

Guanfacine (Intuniv) is usually prescribed for high blood pressure in adults. This drug is available as a generic drug, but only a time-off version and generics are approved for use in children with ADHD.

This drug may help with memory and behavior problems. It can also help improve aggression and hyperactivity.

TakeawayTalk with your doctor

Your doctor may suggest other treatments for ADHD along with medications.

For example, an article in the journal Pediatrics says changing your diet can relieve ADHD symptoms. A study in the Clinical Psychology Review found that taking omega-3 supplements may also slightly improve symptoms in children with ADHD. Talk to your doctor about your medication options, as well as alternatives like these six natural remedies. For best results, it is important to discuss all your ADHD treatment options with your doctor.

Q:

Are the same drugs used to treat ADHD in children as used to treat adult ADHD?

A:

Yes.However, the doses of many of these drugs are different for children than for adults. In addition, the side effects of these drugs are different in adults than in children. Your medical history may limit your treatment options. It is important to talk to your doctor about your medical history to understand which of these drugs is most likely to work best for you.

Healthline Medical TeamAnswers represents the opinions of our medical experts. All content is strictly informative and should not be construed as medical advice.90,000 How is attention deficit hyperactivity disorder treated in Russia

Since Kirill moved to work as a back-end worker in New Zealand, he has no problem accessing medicines. Ever since school, reviews from teachers as a talented child were surprisingly combined with extremely poor studies. Having entered the budgetary department of the Faculty of Computational Mathematics and Cybernetics at Moscow State University, Kirill flew out from the very first year. Then he recovered and, at the very least, with constant retakes and commissions, finished his studies.He changes jobs on average once a year: “Programming can captivate me, but my attention quickly switches – that means I’m not interested, why am I suffering then? Each time I decide that it will be better at another job, but at another it turns out the same. ”

Difficulties arise not only at a long distance, but also in the work process itself: “I first open one tab for work, then I find myself reading everything instead of working, being distracted by anything.For example, I can get up and start walking in circles around the office. When they ask why I am doing this, I say that I need to think – I cannot think when I am not walking. At meetings, I try to speak briefly and concisely ”. Cyril does not remember the last time he finished reading the book, and watching the film to the end is a volitional act for him.

Moving to Auckland did not change anything – according to Cyril, now he is “not interested in anything at all, this also applies to his personal life.” Therefore, he went to the local psychiatrist complaining not of scattered attention, but of depression: “I have such a feature – when talking with a person I stop paying attention to what he is saying after about a minute.I try very hard, but my attention still jumps. Even here, at the doctor’s, not that I’m not interested in listening, I paid $ 400 for an appointment, of course, I’m interested. But it always happens that I lose concentration, even in interviews. ” After an hour’s conversation, during which it became clear that Cyril, moreover, had a bad dream all his life, the doctor told him about ADHD and wrote out a prescription for Rubifen, a New Zealand trademark of the same methylphenidate.

On the pills, Kirill’s performance immediately jumped up; he almost ceased to be distracted, his emotional state also improved.So much so that just a week later there was a conflict – “Rubifen” made him energetic and self-confident, but did not solve the problems with sleep, Kirill reacted sharply to comments about being late and quit his job without regret. But after two months, he stopped taking medication: “I started using these pills for other purposes, because, in fact, it is a free bag of amphetamines, they can be crushed and sniffed. I had a fairly stable system – there, in addition to Ritalin, there was also alcohol and quetiapine, which I was prescribed for insomnia.I lived alone, I had money and no job. I got drunk on a mixture of Ritalin and booze until three or five in the morning, took a pill of quetiapine and slept for eight hours, woke up, did some business and repeated the same thing in the evening.

More and more children are taking medication for mental disorders – Russian parents often do not receive the necessary help and do not know what to do | Yle Uutiset

Photo: Derrick Frilund / Yle

Olga’s son takes pills containing methylphenidate, a drug banned in Russia, and Sergei’s son was prescribed the most popular antipsychotic in Finland – risperidone.Parents often do not know how to help their child and find professional help difficult to obtain. Meanwhile, the number of children diagnosed with mental illness is constantly growing.

There is a growing number of antipsychotic drugs for children and adolescents in Finland.

According to the data of Leena Saastamoinen , who researches the problems of using drugs of this group at the Kela social department, if in 2012 6135 Finnish children used antipsychotics, then in 2018 – already 9370 people.Data for 2019 will be released in late spring, but overall, according to Saastamoinen’s forecast, the number of prescriptions for such pills is increasing by an average of 10% per year. Such pills are used to treat, in particular, schizophrenia, psychotic conditions, Tourette’s syndrome, aggressive behavior, etc. , also increased significantly.In 2018, more than 20,000 children aged 6-17 years received pills to relieve symptoms of the disease.

Drug statistics, however, do not reflect the depth of the problem. Obviously, there are many more children who are not included in the statistics on prescribed prescriptions and drug reimbursements.

“We cannot wait, we are dying”

Sergey is a programmer, IT entrepreneur and father of two children with Tourette’s syndrome. He asked not to give his last name.Sergei’s son, let’s call him Igor , was born in Finland. The child’s problems began with a delay in speech: at 3.5 years old, Igor spoke only 10 words. The parents saw that the boy was behaving strangely:

“You dress him, but he seems to be drunk,” says dad. – Euphoria gave way to irritability. We did not understand what to do with it, and how to explain it to the doctors.

In the kindergarten, the teachers questioned the fears of the parents, saying that “the child is good, he is happy.”Despite this, the speech therapist saw Igor’s sensitivity disorders – the boy freaked out when his hands were wet – and immediately sent the patient to the Autism Center at the Helsinki and Uusimaa Health District HUS.

– Here we got scared, – Sergey continues. – What autism, we have a completely healthy child, he has no problems with intelligence. As a result, we were diagnosed with Developmental Disorder for an Unknown Reason, and then autism. Here I made a mistake, thinking that they were taking care of us, you just have to wait.

Igor’s parents waited for a year, only an electroencephalogram was made from the analyzes. The boy was getting worse: he became even more irritable, there were unusual fears of shiny and reflective surfaces. At this time, a younger brother was born, and the family attributed the elder’s behavioral problems to banal jealousy.

– At some point I woke up and realized that a year had passed and nothing had happened. Then I myself went with the child to private doctors, but I soon realized that our diagnosis was our sentence.Professionals give up when they see the word “autism”. The diagnosis is only good for receiving benefits, but it is a real stopper in research into the causes of the disease. I decided to act. The simplest thing turned out to be to do a genetic analysis.

Sergei fights for the welfare of his son himself. After a full working day as the owner of an IT company and a difficult evening with two children at home, Sergei sits down to medical literature and reads scientific research on Igor’s illness every day for 5-6 hours on websites for specialists.

Sergey made more than 15 hypotheses of the child’s illness, which he worked on independently and with the help of doctors. He highlights the progress in research, and says he has long since moved away from autism towards neurometabolic diagnosis. At the same time, Igor “sits” on the most popular antipsychotic in Finland – risperidone, which relieves irritability and aggression in children.

– Risperidone was prescribed to us not because the doctor advised him, but because at some point I began to build a hypothesis about Tourette’s syndrome, I saw that there are many coincidences, I learned that in the States this disease is often diagnosed as autism, and went to a private neurologist who prescribed this medication for us.

Recently Sergey sent a formal complaint to the Helsinki and Uusimaa Health District HUS, formulating a list of complaints against the Finnish health care system, from the banal “to see a doctor is a great success” to the rhetorical question “Why do doctors not want to examine a patient?”

– The problem of such families is daily, you can’t wait here, we are dying, – dad shares. – If you look at Finnish groups on Facebook about Tourette’s syndrome or autism, there is a complete howl, I read and I want to cry.One mother recently sent her child to an orphanage for a week now, because she ran out of strength. The doctors did not want to understand his problem, did not want to understand why he was like that. Perhaps this is a problem with the regulation of the system, when the doctor works strictly according to the instructions: if something happens, the Valvira supervisory service will come in.

Sergei continues:

– I believe that if a family has the means, one of the parents should leave work and begin to understand the disease on their own, possibly involving other countries.I don’t believe in the Finnish healthcare system, it doesn’t work. Postponing diagnostics “for later”, the family draws more funds from the budget, for example, for the same benefits. And the problem often does not go away, in 20 years we will also be looking for specialists. Not us, but a child. But in Finland being disabled is ok, and in Russia being disabled is a disaster. Therefore, we do not want this status for our children and are fighting the disease.

“Nobody forced us to take pills”

Olga Mironova has two children, and the older boy is diagnosed with ADHD.Visiting doctors in this family began with the same speech delay problems. A wide range of specialists was passed: from a phoniatrist to a psychiatrist, who helped to launch the speech.

By the age of six, when the boy went to school, speech problems were gone, and behavioral problems worsened. Mom and Dad literally took turns on duty at the school, because the teachers could not cope. At the next appointment with a psychiatrist, they started talking about pills containing the substance methylphenidate. It is the most widely used drug for hyperactivity in Europe and the USA.In Russia, drugs with this substance are prohibited; their storage is subject to criminal punishment. Therefore, all Russian parents of special children in Finland make a difficult choice: to give or not to give. Olga emphasizes that no one pressed her, the decision to take the pills was made by the parents themselves.

After switching to medication, the family exhaled: the boy has become assiduous, he studies in a regular class, at the end of this school year, the teacher plans to remove the child’s watch for individual support.

As soon as the drug was selected, Olga’s son was removed from observation from all narrow specialists, transferred to the Vantaa district polyclinic, where every six months his mother renews the prescription with a therapist.

“I am happy with how the Finnish healthcare system reacted in our case,” Olga said by phone. – One “but”: once I started with the little one and forgot to give the older one pills, he went to school without them. Two hours later, I received a note in Wilma’s school diary about the child’s misbehavior.At that moment, I realized that the pill only relieves the symptoms, unfortunately, it does not cure the cause. We receive no other help.

Specialist: “I know the families where the decision to leave Finland was made”

Yle News editors asked the specialists for comments. Evgeniya Uglova is a psychiatrist with experience in psychiatry in Russia and Finland. Eugenia’s main patients are adolescents in the capital region of Finland. Ganna Oikkonen is a Russian-speaking psychologist who has official permission to test children with suspected autism. Olga Yuntunen is a special teacher familiar to many parents of special children. She works in the field of remedial education at the Maria Family Center in Helsinki. Olga specializes in behavioral problems of special children.

– Do you think that diagnosis of mental disorders in Finland is insufficient?

Evgeniya Uglova:

– Finland has a good system for the detection and diagnosis of mental disorders that meets European standards.We use modern international methods, many of which have been developed in America or Europe, they have been translated and adapted for Finland. Their use requires special training for nurses, psychologists, doctors. There are national Käypä hoito guidelines that are updated frequently. Specialization in psychiatry lasts 6 years, includes a large number of hours of both university seminars and a minimum of 40 hours of participation in conferences, many doctors have advanced degrees. Of course, psychiatry is a very young field of medicine, and many questions remain unanswered.We don’t have effective treatments for all disorders, we don’t have biomarkers. We work at the intersection of related fields (neuroscience, psychology), we need more research, initiatives and funding. But a huge plus in Finland is the system for the early detection of mental disorders and the provision of versatile help and support (family counseling centers, preschool observation system, health maintenance system for schoolchildren and students).

Olga Juntunen:

– My work experience shows that the diagnostics are carried out relatively competently, but they are often late in terms of time.Those problems that can be diagnosed in early childhood before the age of three are recorded only at an older age. Due to the queues and shortcomings of specialists, children find themselves in work over four or even six years old. That is, the most sensitive periods for development are missed, and the existing problems are exacerbated many times over. I am not talking about the burnout of parents by that time.

– Why is the number of children with ASD in Finland increasing?

Evgeniya Uglova:

– An increase in the number of diagnoses of ASD (Autism Spectrum Disorders – Approx.ed.) are partly related to better diagnostics. We began to identify milder forms without intellectual disabilities, which also changed the idea of ​​the percentage of intellectual disabilities in children with ASD. Previously, it was thought that this is about 75%, now it is about 50%.

Ganna Oikkonen:

– The number of children with autism is growing rapidly worldwide. But I would like to note that often after psychological examination, children with ASD showed only one problem — the insufficient level of the Finnish language.I want to emphasize that a double load, for example, in school, goes to children born in the fall, whose both parents are Russian-speaking. They do not understand the Finnish language well enough, and physically and mentally lag behind children born at the beginning of the year. Remember that by law in Finland, parents of children born in the fall have the right to leave their child for a two-year stay in a kindergarten preparatory group (eskari), for this only a psychologist’s opinion is required.

Olga Juntunen:

– This question worries researchers around the world, the growth of these problems is observed not only in Finland.The answer to it includes two directions: the first is the improvement of the diagnostic system. The second is the real increase in children with developmental problems. This is caused by various factors: ecology, illiterate use of drugs and vaccines, unhealthy diet, stress, advances in modern medicine in artificial insemination, reduction of perinatal mortality, etc. here are completely different medicines for the same diseases.For example, the Finnish popular drug for ADHD is banned in Russia. What should parents do in such cases?

Evgenia Uglova:

– In Russia, most drugs that are prescribed to children with developmental disorders, for example, nootropics, do not have any evidence base, therefore they are not available in Europe. At the same time, drugs for the treatment of ADHD, the effectiveness of which should not be doubted, are prohibited. In Finland, drugs are not prescribed that have not been tested for efficacy in multiple studies.It is important to remember that the doctor puts his signature on the prescription, bears full legal responsibility for his prescriptions, and Kela in Finland monitors each prescription.

What to do? It is up to the parents to decide. Each situation is unique and should be discussed with your doctor. I trust evidence-based medicine and I know that the insurance will not cover drugs that cost several thousand euros per patient per year if the drug has not been shown to be effective and safe in research.

Olga Juntunen:

– I know families where a decision was made to leave Finland in the hope of finding the most optimal rehabilitation option, and, as practice has shown, their choice was justified.

– Are Finnish psychiatrists aware of parental distrust of the health care system? How do specialists react to this?

Evgeniya Uglova:

– We often discuss transcultural issues, including the distrust of foreigners in psychiatry in general.We know that foreigners on a higher threshold are seeking psychiatric help. Not because they don’t need help, it’s just that the language barrier often prevents them from understanding how the system works. Cultural characteristics, poor integration into the life of Finnish society also hinder. Someone believes in spirits, someone simply does not know where to turn. It is important to remember that in Russia people still do not have the same trust in psychiatrists as Finns do. For many, psychiatric treatment means the end of life, a death sentence.

ASD is not a disorder for which there is a pill, he gave it and the development of the child’s brain took a different path. And it’s hard to accept. Parents may have their own expectations in relation to their son or daughter.

Help for a parent

In the course of preparing this material, a journalist from the Yle Novosti editorial office spoke with many Russian parents who have children with mental illness. Many of them complain about burnout. Living with a special child is a big challenge.Recently, the problem of special children has become so aggravated that in eastern Helsinki they were forced to respond at the level of public organizations. There are separate meetings in Russian for parents of children diagnosed with autism and ADHD.

“The problem of Russian families is that they are not well integrated into the Finnish system,” says Lena Markova – Coordinator of the “Together to Health” project at the organization “Russian Speakers of Finland”. – All over the country there are many community structures for completely different diseases, including ADHD and autism.They have created various support groups, courses, camps, but our parents are not there. Therefore, we decided to tackle this issue within the framework of the three-year project “Towards health together”. Together with Finnish partners, we are recruiting and training volunteers to support people with different diseases: from allergies to oncology. In the future, our people volunteer to supervise support groups for Russian-speaking parents, including for psychiatric diseases.

Support for parents who find themselves on the path of special parenting is certainly important.After all, mom or dad who are faced with the diagnosis of their child often lose their resources. They are forced to solve difficult issues: from banal complaints from a neighbor about a too loud boy, accusations of poor upbringing to “How to send a child on vacation to his grandmother in Russia, if such necessary pills are prohibited there?” At some point, they lose faith in the fact that help will come and slide into severe depression. This is especially difficult within the framework of a new country and banal linguistic isolation.

90,000 Foreign athletes are doping and are not caught.How do they manage it ?: Summer sports: Sport: Lenta.ru

Recently, doping is the number one problem for Russian sports. Meldonium scandal, numerous disqualifications, selected medals … It came to the removal of the national team from the Olympics. At the same time, athletes from other countries have been legally using prohibited substances for years and won prizes. “Lenta.ru” figured out what the Russians should do in order not to get caught.

Athletes have always used doping. For example, the ancient Greeks dabbled in hallucinogenic mushroom extracts before the start.Prohibited substances became a global problem for sports by the 1970s, when pharmacology reached its peak. The athletes took steroids to increase power, erythropoietin to improve endurance, and beta blockers to relieve tremors.

Fighting for fair sport, the International Olympic Committee has banned a number of drugs. However, for athletes with disabilities, a therapeutic exclusion system (TUE) was invented and introduced in 2004. Thanks to this system, athletes have the right to use substances from the prohibited list of the World Anti-Doping Agency (WADA).

However, obtaining permission was not so easy. To do this, a medical board accredited by the local anti-doping agency or sports federation must establish that:

• the athlete’s health will suffer without the necessary medication;
• the medicine is not being used to obtain additional benefits;
• the athlete does not have an approved alternative drug;
• An athlete would be prescribed the same drug even without competitive practice.

It is not possible to obtain permission retroactively.And WADA has the right to refuse to issue a TUE at the last moment. The system strictly controls their quantity and allows the use of prohibited substances only in a certain amount. According to the head of the International Tennis Federation, Stuart Miller, out of 100 annual applications from tennis players, only half receive approval.

Related materials

00:04 – February 9, 2018

Catch your breath

Why the Norwegians are bringing powerful drugs to the Olympics

But even if the athlete has permission, this does not give him an indulgence for excessive use of prohibited drugs.Norwegian skier, two-time Olympic champion Martin Jonsrud Sundby, having a TUE for the asthma drug Ventolin, went too far with his intake, for which he was disqualified, lost victories and fees.

It is impossible to say which of the athletes has a TUE: WADA does not disclose the list of athletes with permits. However, in 2016 and 2017, the hacker group Fancy Bear published the names of those who legally use doping. The list includes American tennis players Venus and Serena Williams, gymnast Simone Biles, British cyclists Chris Froome and Bradley Wiggins, German disco ballist Robert Harting and several Norwegian skiers and biathletes.The leaked data sparked controversy over the legality of therapeutic exceptions.

The most criticized anti-asthma drugs – bronchodilator sprays with ephedrine, terbutaline or salbutamol. The drugs expand the bronchi, however, when the therapeutic dose is exceeded, they acquire a psychostimulating effect: they increase the contractile ability of the muscles, making the athlete more enduring, and increase fat burning. They also have a side effect – the drugs cause severe hand tremors. Perhaps that is why the number of asthmatics in biathlon is several times less than in cross-country skiing.

According to a study by the US Olympic Committee, today 60 percent of top skiers are asthmatic. The sports community explains this by the fact that increased stress, especially in cold air, increases the risk of developing asthma. Therefore, the disease is so common among professional athletes, which means that the overwhelming amount of TUE is justified.

Photo: AI Project / Reuters

If an explanation was found for the total spread of anti-asthma drugs, then the situation with psychosomatic drugs is more complicated.The most common medications for attention deficit disorder (ADHD). This is a disease in which it is difficult for a person to concentrate, he is hyperactive and impulsive. Most often, the syndrome develops in children and disappears with age. It is difficult to recognize it, but it is completely impossible to cure it with medicines. According to psychiatrist Elisey Osin, drugs are substitution therapy that simply helps to restrain oneself.

However, three Olympic champions from the United States – gymnast Biles, shot thrower Michelle Carter and swimmer Michael Phelps – found permits for an anti-ADHD drug, methylphenidate, which stimulates physical activity and fights fatigue.In Russia, the drug is known as Ritalin and is banned as a drug.

Speaking of drugs. Biles had a TUE for amphetamine from 2012 to 2014, a drug that increases performance, physical activity and gives a burst of energy. According to the gymnast’s doctor, she needs opiate to fight ADHD, because amphetamine increases attention. The same permission was received by the American basketball player, Olympic champion-2016 Elena Delle Donne. The athlete did not go into details, briefly explaining the use of the drug by a certain disease.

The case was not limited to amphetamine. The Williams sisters found a TUE for oxycodone and hydromorphone – the strongest pain relievers, relatives of morphine and heroin. They are used to treat severe pain and cancer. According to the former head of the Russian Anti-Doping Agency (RUSADA) Nikolai Durmanov, in Russia these are drugs with a particularly regulated circulation, for which you can go to jail.

Last on the list are gluosteroids. The ones that buy to increase muscle mass.The list of therapeutic exceptions includes prednisone, prednisolone, methylprednisolone, and triamcinolone. These drugs affect metabolic processes, allowing the body to produce more energy, improve performance and muscle mass. The drugs on this list were taken by the Williams sisters, Olympic swimmer Madison Wilson and bronze medalist slalom rower Jessica Fox.

Photo: Issei Kato / Reuters

According to the athletes, they used glucosteroids as anti-inflammatory drugs to treat muscle injuries.The athletes insisted that they did not take them all the time, and their permissions were strictly valid from four days to a year. Everyone had an explanation.

In Russia with TUE everything is much worse. After RUSADA’s license was revoked, domestic athletes received TUEs with the help of foreign anti-doping agencies. In 2016, they were issued only 15 therapeutic exceptions, in 2017 – 22. For comparison: in the USA there are 398, in Italy – 372, and in France – 207.

“Therapeutic exceptions in Russia are used ten times less often than competitors, ”said the secretary of the presidential council for the development of physical culture and sports Alexei Kulakovsky.And while foreign athletes are legally entitled to use prohibited substances, Russians continue to be disqualified for doping.

According to the former head Ramil Khabriev, the small number of applications for TUE is associated with excessive paperwork, too long processing procedures and unwillingness to provide documents that are complex in form and content. Which once again confirms: in Russia they have not learned how to protect the rights of athletes.

“We have few competent sports lawyers, as well as knowledgeable sports doctors who could work with the WADA list.And this is a question of the development of the sports industry within the country ”, – says the associate professor of the Department of Management and Marketing of the Sports Industry of the PRUE. G.V. Plekhanov Alexey Kylasov.

After WADA reinstated RUSADA’s rights in September 2018, the Russian side acquired the right to independently issue permits for therapeutic exceptions. This means that it is quite possible that the situation will change.

And while the ethical side of the TUE application leaves a lot of questions – whether the competition is fair under such a scheme, how to equalize the opportunities of sick athletes with permits and healthy athletes – one thing is clear: the inability to protect their rights legally leaves athletes behind the finish line.

Event Related Potentials (ERPs) and other EEG Based Methods for Extracting Biomarkers of Brain Dysfunction: Examples from Pediatric Attention Deficit / Hyperactivity Disorder (ADHD)

Prediction of drug response in pediatric ADHD 90 130
ADHD 903 . It is characterized by symptoms of inattention, accompanied by symptoms of hyperactivity and impulsivity. Disruptions in school, home, and leisure activities are common.In school-aged children, the prevalence is estimated to be between 5% and 7%. Comorbids are common. Treatment with stimulants based on methylphenidate (MPH) or dextroamphetamine (DEX) is widely used. The positive effects of stimulant drugs (reducing restlessness, hyperactivity and impulsivity and improving attention) are reported in 70% of patients. Switching from drugs based on MPH to DEX can increase the beneficial effect by up to 80% ^{37 , 38} .Frontal striatal circuits appear to be activated by stimulants ³⁹ .

There is no generally accepted definition of a drug response that is clinically significant. The use of rating scales, comparing baseline scores with drug scores, is the most commonly used method. In some studies, a 25% or 50% reduction in scores is used as a definition of a response. In other studies, estimates not exceeding 1 SD above the population average are used ^{40 , 41} .A generic solution based on all relevant available data is used clinically. To evaluate side effects such as loss of appetite, insomnia, increased irritability, or anxiety, ^{37 , 42} are important.

The use of rating scales can be criticized for several reasons. Small correlations (0.30-0.50) between teaching and parenting scores have been reported in several studies ⁴⁸ . The search for clinically useful predictors of response is motivated by a large number of nonresponders, whistleblowers who disagree, and the fact that each may have some modest attention-improving effects when small doses of stimulants are used.Published studies on predictors of response include ADHD subtype, demographic, comorbid disorders, gene variables, rating scale scores, neuropsychological test scores, and EEG / ERP variables ^{43, , 44 , 45 , 46} . Our publication 2016 ⁴⁷ summarizes studies that have applied ERPs to predict drug response.

In previous studies, we analyze the d data from the cued visual GO / NOGO problem (i.e.(i.e. attention test data, EEG spectra and ERPs). In one study, we found 3 variables significantly predictive of side effects. These variables were combined with an index considered clinically significant ⁴² . In a clinical effects study using the same methods, a prediction index was also considered clinically useful ⁴⁸ . The effect of a single dose of stimulant medication on drug responders (REs) and non-responders (non-REs) was investigated in a third study ⁴⁷ .The testing procedure was completed twice, the first test without drugs, and the second test one hour after receiving the trial dose. Based on rating scales and interviews after a 4-week drug trial, patients were classified as REs or non-REs. Our focus has been on changes in cognitive ERPs and attention assessment tests. We found that the effect on the P3 component of NOGO was significantly different in the two groups, with a large effect size (d 1.76). A significant increase in the amplitude of the components was observed in RIZ, but not in non-RIZ.Response predictions based on the two tests have been improved over those based on test 1 alone.

In our latest study, we developed two global indices, one for predicting clinical achievement and one for predicting side effects. As described above, we pooled variables that discriminated significantly when compared to a group with a modest or large effect size. Each variable was weighted according to the size of the effect.We looked at variables from all three WinEEG domains: EEG spectra, ERPs, and behavior. The following variables were pooled: Test 1: P3NOGO amplitude and theta / alpha ratio; Differences between Test 2 and Test 1: inactivity errors, response time variability, conditional negative changes (CNV), and P3NOGO amplitude. The size of the global scale effect was € 1.86 . The accuracy was 0.92. Prediction of side effects was based on 4 variables: Test 1: RT, Test 2: novelty component, alpha peak frequency and changes in response time (Test 2 – Test 1).The global scale d was 1.08, and the accuracy was 0.78 ^49.

Some preliminary findings
In an ongoing study, we compare a group of 61 ADHD patients aged 9-12 years with a group of 67 age-related healthy controls (HC). The final statistical analysis has not yet been completed. Preliminary results from the WinEEG evaluation are presented below.

Behavioral, the ADHD group showed a pattern of inattention with a statistically (at p’lt; 0.001), more errors of omissions compared with the healthy control group (HC) (13.7% versus 4.8%) are accompanied by a regularity of neglect, expressed in statistically higher (p’lt; 0.001) variability in response time (151 ms versus 125 ms).

The main results of comparing ERP waves between the two groups are shown in Figure 5 and Figure 6. Figure 5 demonstrates ERP correlates dysfunction of active cognitive control in the ADHD group.Two indices of anticipatory cognitive control (P3 cue waves and CNV waves) are reduced in the ADHD group compared to the HC group. Figure 6 demonstrates ERP correlates with reactive cognitive control dysfunction in the ADHD group. Two indices of reactive cognitive control (N2 NOGO and P3 NOGO) are reduced in the ADHD group compared to the HC group.

Figure 5: Grand mean ERP wave patterns (a) and corresponding maps (b) in predictive cognitive control in ADHD and Healthy Control (HC) Groups. ( a a) ERPs are measured at P3 in the ADHD group (green line) and HC group (red line) and their difference (ADHD-HC) waves (blue line). Blue vertical bars below the curves indicate the level of statistical significance of the difference (small bars – pp / l; 0.05, medium bars – pp / t; 0.01, large bars – pp / t; 0.001). Arrows indicate classic waves – P3 cue and CNV (contingent of negative variations). (b) Maps of the maximum amplitudes of P3 and CNV waves for two groups. Please click here to view a larger version of this figure.

Figure 6: Grand mean ERP wave patterns (a) and corresponding maps (b) in reactive cognitive control in ADHD and Healthy Control (HC) Groups. ( a a) ERPs are measured in Group Fz and Cz ADHD (green line) and HC groups (red line) and their difference (ADHD-HC) waves (blue line). Blue vertical bars below the curves indicate the level of statistical significance of the difference (small bars – pp; 0.05, middle bars – pp; 0.01, large bars – pp / t; 0.001).The arrows point to the classic waves – N2 NOGO and P3 NOGO. (b) Maps of the maximum amplitudes of N2 NOGO and P3 NOGO waves for two groups. Please click here to view a larger version of this figure.

As can be seen the ADHD group shows hypo-functioning of several cognitive control operations. These operations take place in different time windows and in different spatial locations. A particular patient can have only one hypofunctional one, indicating the source of the individual disorder and ways of correcting it.

Clinical significance
To calculate a clinically useful biomarker for a heterogeneous diagnosis such as ADHD, several variables that differ significantly between ADHD and control must be pooled. The size of the effect of the (d) index must be higher than d .8. An important next step will be the application of this index when ADHD is compared with clinical controls.

how ADHD is (not) treated in Russia

Attention deficit hyperactivity disorder occurs during childhood and interferes with learning and socialization.It can carry over into adulthood and transform into even more serious problems – with the psyche, behavior and addictions.

Attention deficit hyperactivity disorder occurs during childhood and interferes with learning and socialization. It can carry over into adulthood and transform into even more serious problems – with the psyche, behavior and addictions.

There are no statistics on people with ADHD in Russia.The Ministry of Health of Russia, based on the research of doctors, can name only an approximate percentage of people with attention deficit hyperactivity disorder in relation to the population of the country.

While this feature of mental development is being successfully treated in the USA and European countries, patients with ADHD in Russia are still not provided with systemic assistance, and often they are not correctly diagnosed, mistaking neurological symptoms for poor upbringing.

Thin crust and the problem of self-control

Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric developmental disorder in which a person lags behind peers in the formation of self-control skills.It is difficult for him to endure, plan, postpone rewards until results are achieved, and much more. The disease is usually observed from childhood, but it is detected in adults.

It is difficult for a person with ADHD to concentrate on one thing – his attention is distracted / Illustrations: Anya Michurova for “To be honest”

The reason is especially the structure of the cortex of the brain regions that are responsible for attention and cognitive control. In people with ADHD, the cortex in these regions is thinner than in others. Because of this, less dopamine is produced, which helps the brain switch between tasks and focus.

The exact causes of the development of the disease have not yet been established, but heredity is called the main one. The likelihood that a person with ADHD has at least one relative in a family with the same diagnosis reaches 80%. It is also known that the risk of developing the disease can increase problems during the development of the fetus in the womb. For example, if the mother used alcohol or drugs during pregnancy.

Symptoms of ADHD significantly affect the quality of life of a child: they interfere with social adaptation, learning, increase the risk of injuries, for example, bruises or accidental poisoning due to hyperactivity.In addition, the disease is accompanied by sleep disorders, early alcohol and drug addiction, as well as the risks of developing other mental disorders.

Statistics

According to some reports, ADHD suffers from 2 to 12% of modern children. Considering that in 2019 almost 1.5 million children were born in Russia, it turns out that about 180 thousand of this number may have attention deficit hyperactivity disorder.

There may be quite a few people with ADHD in Russia, but we do not know about this, because official statistics are not kept / Illustrations: Anya Michurova for “To be honest”

Attention deficit disorder in adults has been widely recognized only in the last ten years, therefore, to date, there are no reliable studies on how aging affects disease symptoms.However, it turned out that up to 70% of children with ADHD carry the problems associated with the disease into adulthood. This can make it difficult for an adult to work in one place for a long time, complete tasks on time, control addictions, and build healthy relationships with others.

Diagnosis of ADHD in Russia

In the ICD-10 (International Classification of Diseases), there are three types of ADHD

• Primarily Hyperactive-Impulsive ADHD type ADHD .Patients in this category feel the need for constant movement, cannot listen to speech addressed to them and perform various impulsive actions;
• Primarily Inattentive ADHD, formerly ADD . This type is characterized by difficulty concentrating, forgetfulness, constant distraction to external stimuli, and frequent loss of things. Until the late 1980s, ADD was recognized as a separate attention disorder, but eventually it was accepted as a type of ADHD;
• Combined Type ADHD (Combined Type ADHD).In this case, the person with ADHD shows six signs of the hyperactive and inattentive types each.

The same classification must be adhered to in Russia, however, for various reasons, the majority of Russian doctors still have problems with the diagnosis of ADHD. These problems can be roughly divided into two large categories: overdiagnosis and neurological diagnoses, to which the syndrome does not belong.

In addition, Russia still does not maintain official statistics on patients with ADHD, and this makes it difficult to see the overall picture of the disease detection rate.

Doctors often cannot make the correct diagnosis / Illustrations: Anya Michurova for “To be honest”

According to the expert of the Vykhod Foundation on early diagnosis of autism, child psychiatrist Elisei Osin, now the successful diagnosis of ADHD in Russia is not easy on the competence of the doctor, but also on his goodwill and experience. Elisey Osin notes that the number of incorrect diagnoses has begun to decline. He draws such conclusions based on what patients say about other doctors, as well as on the experience of colleagues.However, as before, the correct diagnosis is made less often than the wrong one. In particular, neurological abnormalities such as minimal brain dysfunction (MMD) are often diagnosed instead of ADHD.

“The term MMD was popular among American doctors in the 60s of the XX century. It was used to describe children with behavioral difficulties, but no obvious mental disorders, explains the psychiatrist. “Then the USA refused to use MMD, but in Russia they continue to use it.”

Also, children with ADHD are often diagnosed with an organic disorder, in other words, brain damage – the same dubious term as MMD, according to Elisei Osin, a term.Such diagnoses suggest that ADHD is just a consequence of another health problem, rather than a disease in its own right that needs to be treated. In rare cases, both schizophrenia and autism may be detected instead of attention deficit hyperactivity disorder.

“There is simply no data on detecting ADHD in Russia,” says Elisey Osin. – But individual studies suggest that the rate of diagnosis of the disease is low. Our figure is slightly higher than, for example, in England or Belgium with similar studies.And out of dozens of children, literally a few receive any help in connection with their disorders. ”

In a review of the situation with ADHD in Russia, which was presented by professors of the Department of Nervous Diseases of the Pediatric Faculty of the Russian State Medical University Andrey Petrukhin and Nikolai Zavadenko, the prevalence of ADHD in Russia is 7.6%. They obtained such a result during a local medical and psychological examination among 537 Moscow schoolchildren of 7-10 years old. According to the survey results, 11.2% of boys and 2.5% of girls have ADHD.

In addition to the diagnostic problems identified by Elisey Osin – for example, the identification of ADHD with MMD – Petrukhin and Zavadenko also call overdiagnosis. In their opinion, the ICD-10 and DSM-IV diagnostic criteria for ADHD often create the illusion that the syndrome is easy to detect. This leads to the fact that doctors do not make a differential diagnosis with a wide range of other conditions and immediately diagnose ADHD.

No support and one drug

In addition to children, the syndrome is also treated in adults all over the world: “adult” ADHD is recognized in 18 European countries.One of the most popular drugs for patient support in the United States and Europe, methylphenidate, is prohibited by law as a psychostimulant in Russia.

Medicines that are recognized in Europe and the United States as effective in treating ADHD are prohibited in Russia / Illustrations: Anya Michurova for “To be honest”

Buying medicines with another active ingredient – bupropion, which is prescribed for ADHD and depression criminal prosecution under article for drug smuggling. This was the case, for example, with Olga Kalinovskaya from Volgograd, who ordered bupropion by mail.

Prescribing stimulants for children is one of the main issues in the controversy around ADHD and the main reason for the actual lack of differentiated treatment of the disease in Russia. For drug therapy for ADHD, only one drug is available in Russia – Strattera. It is an inhibitor of the reuptake of norepinephrine, a neurotransmitter that plays an important role in various brain processes and, in particular, in the process of selective inhibition.

The human nervous system is designed in such a way that it reacts immediately to a large number of different things, but at this time it can concentrate on one thing.This is possible due to the fact that the internal cancellation system “reduces the volume” of other signals and helps to concentrate on one more important one.

The drug “Strattera” increases the concentration of norepinephrine in the brain, and it becomes easier to “inhibit” the nervous system. This should help ADHD patients stay focused on a specific task and be less distracted.

“There are two impressions about Strattera,” says Elisey Osin. – On the one hand, research says it is an effective drug.Thanks to these studies, we prescribe it often enough. On the other hand, patient reviews and medical opinions suggest that the effectiveness is still not enough. ”

As an alternative to Strattera, which can cause side effects, drugs that are not specifically approved are used to treat ADHD. These are, for example, some antidepressants or drugs for the cardiovascular system.

“He’s just ill-mannered”

Eight-year-old Lyona Zvyagintsev from Yekaterinburg was diagnosed with ADHD about four years ago.His father Ivan says that his son was restless from birth, but at first this did not raise suspicion – after all, all children are like that.

“He also never slept well with us. This problem persisted after three years, so we went to a neurologist, says Ivan. – At the reception, Lenya behaved too noisily: he pulled the cabinet handles, was capricious, walked around the office in circles. The doctor said: “He’s just ill-mannered” and prescribed “Stugeron” and “Glycine” “.

The active ingredient of “Stugeron” is cinnarizine, it reduces the excitability of the vestibular apparatus.This drug is often given to infants to improve the blood supply to the brain. The effectiveness of “Glycine” has not been proven.
Lenya had sleep problems, but the first attempts to solve them with medication did not lead to anything / Illustrations: Anya Michurova for “To be honest”

When it became clear that the prescribed drugs did not help, Lenya’s parents turned to another neurologist, who prescribed course “Atarax”.

Thanks to Atarax, Lenya began to sleep normally. The active ingredient of the drug – hydroxyzine – has a sedative effect, normalizes sleep, improves memory and attention.However, the body gets used to hydroxyzine rather quickly, so the problem with sleep soon returned. The boy was again taken to a neurologist, where the doctor finally announced the obvious diagnosis and prescribed Stratter.

“The first drug intake was scary. The child cried and asked: “Dad, why don’t I want anything?” – Ivan recalls. – Then he was constantly in a dazed state with us, he began to sleep a lot during the day. Lost appetite, started to lose some weight and became irritable. At the same time, the drug did not remove the problem of inability to concentrate ”.

After some time, the effect of the Stratters began to wane altogether. After consulting with a neurologist, the Zvyagintsevs first increased the dose, and then decided to cancel the drug.

While schools are on distance learning, Lena’s parents devote 90% of their time – there is no other way. To complete his homework, he needs a whole day with constant breaks. The boy regularly collides with his peers, because sometimes he frightens them with his excessive activity.Tantrums for no apparent reason, tears, outbursts of aggression – an incomplete list of symptoms that make Lena’s life difficult.

For a year now, he has not taken any medications and has not attended special classes for children with ADHD: the Spectrum-A correctional pedagogy center, where Lenya studied last year, was closed due to a conflict with the Ministry of Social Policy. There are no other specialized places in Yekaterinburg.

President of the fund for helping children with autism “I am special”, of which the Spectrum-A center was a part, Aleksandrina Khaitova believes that the social and educational sphere in Russia is designed to “extinguish” the disease, and not provide support.Children with ADHD still cannot get specific help.
People with ADHD need not only medication support, but also classes with specialists – they help to maintain skills that are difficult to develop on their own / Illustrations: Anya Michurova for “To be honest”

certain conditions for socialization and learning: classes with psychologists, defectologists, experienced teachers, says Alexandrina. – They need to develop their abilities – and many of them are very capable children with mathematical and creative inclinations – in a comfortable environment.There are no such conditions in Russia. Firstly, all this – drugs and educational centers – not every parent can afford. Secondly, everything depends on the will of chance – on what hands the child will fall into in kindergarten, at school, how adequate his parents will be ”.

Since 2014, the fund’s specialists have been striving to create a support system for children with autism spectrum disorders, and only this year they were able to come up with an initiative to the State Duma. ADHD is even more difficult: it is not considered a serious illness, no one educates parents, and medicine and social services in the country have too many weak points.

“In Russia, the structure that should create conditions for supporting children with ADHD is stalling,” says Alexandrina. – The layer between the government and the people, this bureaucratic apparatus, it is too fat and, unfortunately, “extinguishes” most of the initiatives. Therefore, there is no reason to hope for the emergence of systemic assistance to these children in the near future ”.

Obsessive-Compulsive Disorder (OCD) – key facts in Russian

What is Obsessive-Compulsive Disorder?

At times we can all get hung up on some things, but if:

Horrible thoughts come to your mind, even if you try to get rid of them,

You are forced to count or touch some things over and over again , or repeating actions, such as washing your hands,

You may have obsessive-compulsive disorder (OCD).

Who gets OCD?

About one in 50 people may develop OCD at some point in their life. Equally, it can be men and women. In Great Britain, their number is about 1 million. OCD usually begins in adolescence or early adulthood. Over time, OCD symptoms can worsen or diminish, but often people do not seek help for years.

What are the signs and symptoms of obsessive-compulsive disorder?

• Repetitive thoughts that make you feel anxious – “compulsion” or “obsession”.These can be unpleasant words or phrases, mental pictures or doubts.
• Actions you do over and over that make you feel less anxious are “compulsions.” You can try to correct or “neutralize” thoughts by counting over and over again, speaking a special word, or performing certain rituals.

What are the causes of OCD?

Many factors can play a role in OCD. One or more of the following may explain why you or someone you know has OCD.

• In some cases, OCD is inherited, so sometimes the disorder can recur in the family.
• Stressful life events cause OCD in about a third of cases.
• Life changes in which you have to take on more responsibility, such as puberty, having a baby or a new job.
• If you have OCD and it lasts for some time, an imbalance in serotonin (also known as 5HT), a brain neurotransmitter, may develop.
• You are a neat, pedantic, methodical person – but you go too far in this.
• If you have extremely high standards of morality and responsibility, you may feel particularly uncomfortable with unpleasant thoughts. To the point where you start to be wary and watch them closely, and this will make them even more likely to appear.

How to help yourself

• If you regularly force yourself to think about the thoughts that bother you, you can better control them.You can record them – on a dictaphone or on paper, and then listen to or re-read. You should do this regularly, about half an hour every day. At the same time, try to resist compulsive behavior.
• Do not use alcohol to control your anxiety.
• If obsessive thoughts involve issues of your faith or religion, discuss them with your religious leader to help you understand if it is an OCD problem.
• Try using a self-help book.

Professional help Various types of psychotherapy

Exposure and response prevention

Helps stop the mutual reinforcement of compulsive behavior and anxiety.

We know that if you stay in a stressful situation long enough, you gradually get used to it, and the anxiety goes away. Thus, you gradually come across a situation that you fear (exposure), but stop yourself from performing your usual compulsive rituals – checking or clearing (preventing a response) and waiting for your anxiety to go away.

Cognitive Therapy

Instead of getting rid of your thoughts, cognitive therapy helps you change how you respond to them. It specifically targets unrealistic, self-critical thoughts. Useful if you have obsessive thoughts but do not perform any rituals or actions to reduce anxiety. Can be used with Exposure and Response Avoidance.

Antidepressant treatment

Even if you are not depressed, SSRI antidepressants (Selective Serotonin Reuptake Inhibitors) can help you.They can be used alone or with cognitive behavioral therapy for moderate to severe OCD. If the medicine hasn’t worked at all after three months of taking it, you can change it to another SSRI antidepressant or to a medicine called Clomipramine (Anafranil).

How effective is the treatment?

Exposure and response prevention

Approximately three out of four people who completed such therapy worked well, but one in four will return symptoms and need additional treatment.About one in four people refuse to try this type of CBT or do not finish it – they think it is too difficult for them.

Medicines

About six out of 10 people feel better with their medication, and their symptoms are reduced by about half. Medication does help prevent OCD from coming back as long as it is taken, even years later. Unfortunately, in about half of those who stop taking the drug, symptoms return within a few months afterwards.This is less likely when drug treatment is combined with cognitive behavioral therapy.

Which approach is best for me?

Mild OKR

Exposure and response prevention can be done without professional help. This method is effective and has no side effects, but you will feel more anxious for a while. You must be motivated and ready to do the hard work. Cognitive therapy and medication are equally effective.

Moderate or severe OCD

• At first, you can choose either CBT (up to 10 hours in contact with a psychotherapist) or medication (for 12 weeks).If you do not feel better, you should try both treatments together.
• If you have severe OCD, it is best to combine medication and CBT right from the start.
• Taking medication alone will help you if you feel unable to deal with the anxiety caused by exposure and prevention of response, but the chances of OCD re-occurring are higher – about 1 in 2 compared to 1 in 4 with psychotherapy treatment.The medication should be taken for about a year and is obviously not ideal during pregnancy or breastfeeding.

The original page produced by the RCPsych Public Education Editorial Board. Series Editor: Dr Philip Timms.

Information about treatments can change rapidly and the College updates its mental health information pages regularly.

Translated by: Maria Kadmenskaya

Translation date: August 2011

(c) February 2013.Royal College of Psychiatrists. This booklet may be downloaded, printed, copied and redistributed free of charge, provided that no profit is derived from its use and the Royal College of Psychiatrists is named and acknowledged as the author. Permission to reproduce this booklet in any other form must be obtained from the Director of Publications. The College does not allow the transfer and reprint of this booklet to any other site, but does allow a direct link.

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