Medication for ADHD: What You Need to Know?

Dealing with Attention Deficit Hyperactivity Disorder (ADHD) can be a challenge for both adults living with this diagnosis and parents seeking the best for their children.

Medication is often seen as a promising solution, but it also raises questions and concerns: Is it the right choice? What are the actual benefits and potential risks?

In this article, we clarify the role of medication in ADHD treatment, explore the options available in Portugal, and demonstrate how it can be complemented with other effective approaches.

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The Role of Medication in ADHD Treatment

Medication for ADHD is often viewed as a controversial solution: for some, it’s a true hero, alleviating symptoms and allowing greater focus and productivity 💪; for others, it’s a villain, associated with side effects like insomnia, appetite loss, or mood swings 😞.

The truth lies, as in many cases, somewhere in the middle.

Medication doesn’t cure ADHD, but it can help regulate brain function, enabling individuals to benefit more from other therapies, such as cognitive-behavioral therapy (CBT) and/or neurofeedback.

It’s important to remember that medication for ADHD is not a standalone solution but part of an integrated and personalized treatment plan.

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International Guidelines for ADHD Treatment

⚠️ According to international recommendations, medication is not recommended as a first-line treatment for everyone with this diagnosis.

Prescriptions are generally reserved for moderate to severe symptoms and only when psychological treatment has not produced satisfactory results.

This approach aims to ensure that treatment is as safe and effective as possible, reducing unnecessary risks of side effects.

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Types of Medication for ADHD Available in Portugal

In Portugal, there are several medication options for ADHD, approved and regulated by entities like Infarmed.

These medications are divided into two main categories: Stimulants and Non-stimulants.

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Stimulant Medications for ADHD

Stimulants are the most commonly used approach in treating ADHD.

These substances work by increasing dopamine and norepinephrine levels in the brain — neurotransmitters that help regulate attention and behavior and are also linked to neuroplasticity.

Examples include:

• Ritalin®, Concerta®, Rubifen®: Contain methylphenidate, frequently the first-choice medication for treating ADHD, especially in children.
• Elvanse®: Contains lisdexamfetamine, generally prescribed as a first option for adults and commonly used in children when methylphenidate is not effective.

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👍 Key Advantages of Stimulant Medications:

• Rapid onset of action (around 30 minutes).
• Ease of administration (extended-release tablets require only one dose per day).
• Available in various formulations, allowing greater flexibility in treatment.
• Methylphenidate is covered by the public health system (SNS).

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👎 Key Disadvantages of Stimulant Medications:

• Adaptation period: Finding the right medication and “ideal” dose can be complex and associated with a generalized feeling of discomfort.
• Possible side effects, including:
  • Loss of appetite, insomnia, headaches, abdominal pain, weight loss, emotional instability, nausea, vomiting, and diarrhea.
  • “Crash effect”: Occurs when the effect of the medication begins to wear off, causing the brain to experience a sharp drop in stimulation. This can result in intense fatigue, irritability, loss of focus, or a general decline in well-being, akin to a sudden “letdown” after a period of high productivity and concentration.

⚠️ Important Note: Side effects are not common for most individuals, as each case is unique and requires personalized monitoring.

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Non-Stimulant Medications for ADHD

Non-stimulants are an important alternative for treating ADHD, especially in cases where stimulants are not well-tolerated or do not deliver the expected results.

These substances act more gradually, regulating norepinephrine levels and promoting a stabilizing effect on brain receptors.

Examples include:

• Strattera®: Contains atomoxetine, a potent selective norepinephrine reuptake inhibitor in the brain.
• Intuniv® (not available in Portugal) and Catapresan®: Contain guanfacine and clonidine, respectively. These reduce excessive neurotransmitter release and regulate neural activity.

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👍 Key Advantages of Non-Stimulant Medications:

• They do not cause the “crash effect” associated with stimulant medications and have fewer reports of abuse or misuse.
• They offer additional benefits: atomoxetine is effective for anxiety symptoms and behavioral disorders, while clonidine/guanfacine is useful for treating insomnia.
• Atomoxetine is covered by the SNS (National Health Service).

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👎 Key Disadvantages of Non-Stimulant Medications:

• They are less effective in controlling ADHD and, therefore, are generally used only in cases of therapeutic failure or contraindication to stimulants.
• Possible side effects include headaches, low blood pressure, nausea, vomiting, diarrhea, fatigue, behavioral changes, and irritability.
• They should be used with caution in individuals with heart conditions.

⚠️ Important Note: Side effects are generally not frequent for most individuals, as each case is unique and requires personalized monitoring.

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Complementary Approaches to Medication

It’s important to remember that medication is just one pillar in the treatment of ADHD.

Other therapies can play a fundamental role, especially when combined with medication:

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Final Considerations

Medication for ADHD is not a miraculous solution, but it can be a valuable tool within the context of a personalized and multidisciplinary treatment.

The most important thing is to recognize that each case is unique and that professional support is essential to achieve the best results. 👨‍⚕️

If you believe that you or your child could benefit from a more comprehensive treatment for ADHD, get in touch with us.

At NeuroImprove Clinic, we offer an integrative and targeted approach, which includes an initial evaluation with qEEG, neurofeedback sessions, and specialized psychological support.

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References

National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder Diagnosis and management of ADHD in children, young people and adults. NICE Guideline 2019. Disponível em: https://www.nice.org.uk/guidance/ng87

Medicamentos para a Hiperatividade com Défice de Atenção. GABINETE DE INFORMAÇÃO E PLANEAMENTO ESTRATÉGICO - Infarmed, 2015. Disponível em: https://www.infarmed.pt/documents/15786/17838/Relatorio_ADHD.pdf/d6043d87-561e-4534-a6b1-4969dff93b78 

Mechler K, Banaschewski T, Hohmann S, Häge A. Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology & Therapeutics, Volume 230, 2022. doi: 10.1016/j.pharmthera.2021.107940