ADHD: Methylphenidates, Amphetamines, and Non-Stimulants

In my coaching practice, I’m often faced with questions concerning ADHD medications, particularly stimulants and what they do. This is an important issue, because many individuals complain that the medications didn’t seem to work or caused negative side effects. But managing these medications is an art form. It requires time-tested dosing, and it requires the patient to communicate with the physician to help arrive at the right dose at the right time.

To learn more about the meds and how they work, I had a conversation with Dr. Carolyn Lentzsch-Parcells. She explained that the primary way these meds work is by increasing available dopamine, which is the main neurotransmitter the brain needs for cells to communicate effectively.

In no case, however, are the stimulants addictive but, in fact, are the opposite. With ADHD, attention is not on a dimmer switch. With ADHD, it’s all or nothing. It’s possible that there is a need for higher levels of dopamine than other people would need to flip that switch to get the focus and have those signals flow the way they should.

In an oversimplified illustration of how dopamine works in the brain, hold a pen and imagine it’s a neuron. When dopamine gets one of these guys excited, an electrical charge travels down the neuron like a wave of electricity. When it gets to the end, it releases neurotransmitters into the gap, kind of like hairspray, so the electricity jumps from one neuron to the next. The receiving neuron sucks in those neurotransmitters and cascades throughout the attention network, manifesting in feelings, thoughts, or behaviors.

We know that dopamine is the reward neurotransmitter, but to put it into context, it’s almost like a dopamine addiction. Everything we are addicted to actually increases the release of dopamine, as with caffeine, cocaine, nicotine, alcohol, gambling, risk-taking, and others. The more dopamine is released, the more reward there is.

When I hear someone say that the medication isn’t working, I ask them if, before the meds, they couldn’t read four chapters of a book but now with the meds, they can, then the medication is working. They are able to sustain focus longer.

For doctors to know what is the optimal treatment, they have to compare ADHD without medicine. It can be very tricky to figure out whether it’s working or working efficiently.

To learn more about the process doctors use when prescribing and what medications are available, how they work, and why one medication over another might be more effective for you, check out my podcast with Dr. Carolyn Lentzsch-Parcells on Attention Talk Radio. Here’s the link:

2 thoughts on “ADHD: Methylphenidates, Amphetamines, and Non-Stimulants

  1. I have arrhythmia so can’t tolerate any of the stimulant medications for ADHD. I am taking Strattera and would appreciate your discussing this medication’s efficacy.

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