Stimulant BASICS: Ritalin and Adderall

Two BRAND names for medications
known for treating ADD/ADHD
GOOD news or bad?

© Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
in the Diagnosis and Treatment Series – Part I

How much do you really KNOW?

When I first learned about ADD, as it was named when I was diagnosed at 38, years ago now, I was overjoyed to learn that there was a medication reputed to help.  Tearfully so.

Still, it took me over a year to give psychostimulants a trial – the first-line medications for ADD.

Meanwhile, I did my research, and continue to do so.

I am dismayed (often appalled!) by how much myth and misinformation I found and continue to find today — in the media, on the web, and even out of the mouths of doctors, sourcing so much needless fear and struggle.

SO, I have always been inspired to share what I learned
with as many people who are willing to listen
with an open mind.

Stimulant Basics

While I endeavor to share some important overview information in this particular article in the Diagnosis and Treatment Series, I’m going to hit the highlights, and save a great many of the specifics for another time and format.

Let’s begin here by going over the similarities between two medications you hear about most often: Ritalin and Adderall.

The Related Links at the very bottom of this article are there for those of you who want more specifics about the differences NOW.

On to those basics . . .

The psychostimulants you hear about most often (also called stimulants), are amphetamines (ex., Adderall & Dexedrine) and methylphenidates (ex., Ritalin, Concerta, Metadate & Methylin).

They are similar in chemical structure, and ALL can have different effects – including side-effects (true with any substance).

Psychostimulants are a broad class of drugs reported to reduce fatigue, promote alertness and wakefulness, with possible mood-enhancing properties (Orr 2007).

Don’t let that term scare you. Caffeine, nicotine and some of the non-drowsy allergy medications are also psychostimulants.

Since the early 1930s, doctors have prescribed either amphetamines or methylphenidate to treat various health-related conditions and disorders, among them obesity, depression & other mood disorders, impulse control disorders, asthma, chronic fatigue, and sleep disorders characterized by excessive sleep or excessive daytime sleepiness (hypersomnolence).

Addiction and Abuse

According to Wikipedia and despite what you frequently read: it is estimated that the percentage of the population that has abused amphetamines, cocaine and MDMA combined is between .8% and 2.1%.^[4]

A study published in the Journal Pediatrics*, showed that individuals with ADD/HD who were treated with stimulant medication had a lower risk of drug abuse than ADD/HD individuals who had not taken medication, and subsequent studies have returned similar findings.

* Biederman et al, Pharmacotherapy of Attention Deficit/Hyperactivity Disorder Reduces Risk for Substance Abuse Disorder, Pediatrics, Vol 104, No 2, Aug.’99.

How they are the same?

Both drugs are in the same medication class: psychostimulants, and it is said that they both work in two ways.  While not exactly accurate, this is basically how they work:

1. They make neurotransmitters last longer in the parts of the brain that control attention and alertness, and
2. They increase the concentration of neurotransmitters in areas of the brain believed to be under-aroused or otherwise under-performing.

In other words, stimulant medications increase the release or block the reabsorption of dopamine and norepinephrine, increasing transmission between certain neurons. Each stimulant has a slightly different mechanism of action, and each may have similar or different effects on the ADD/HD symptoms of any given individual.

For anyone new to the blog, neurotransmitters are chemical messengers that send signals from one neuron (brain cell) to another, increasing the activity in certain parts of the brain, in this case helping to focus attention.

WHY they might be necessary

Contrary to what might seem logical if you’ve ever spent much time around a diagnostic Hyperactive Harry or Chatty Cathy, an ADDer’s unmedicated brain is less active than a neurotypical brain in the conscious “supervisory” areas that FOCUS behavior — in particular, the prefrontal cortex [PFC]. 

That leads to an under-performance of the brain-based mechanisms that make it possible for human beings to observe the environment and supervise responses, guiding decision-making and directing subsequent action effectively.

Basically, in a person with an ADD diagnosis, the brain’s filtering & focusing areas are not operating well, so its “juggling ability” is limited by the number of “attentional balls” it is forced to juggle already.  These are elements filtered out automatically by neurotypical brains.

Regular readers of this blog may recall that the PFC has “regulation responsibility” for what we term the brain’s executive functions, which include planning, organization, and critical thinking as well as time management, effective judgment, and impulse control.

The “normal” human ability to sift through options, plan ahead, use time wisely, focus on goals, maintain social responsibility and communicate effectively is heavily dependent on a PFC that is up to the task.

Stimulants do just what they sound like they’d do, and seem to work particularly well on the area that most needs it: they stimulate sluggish neuro-perfomance, waking up the PFC so that it can do its job.

Connecting the Brakes

Found HERE

While ALL stimulants are activating for certain parts of the brain, they often seem to help calm a person with ADHD.

That is frequently referred to as the “paradoxical effect” — leading to erroneous claims that ADD meds are “sedating” kids into compliance.

NOT SO – that’s not how they work!

Whenever the PFC under performs, other areas of the brain, effectively, step up to compensate. You can see the difference on a brain scan.

So the filtering and focusing areas are, essentially, down for the count, and there’s suddenly more activity that needs filtering and focusing.

• See the problem when the PFC’s “offline”?

No filters, MORE to filter = BRAIN CHATTER, distractibility or hyperactivity, problems with short-term memory – swimming upstream!

• Once the PFC is stimulated to come back on line, the rest of the brain can relax (filters working better – less to filter). Suddenly, we can get things done – swimming WITH the current!

As soon as the PFC is stimulated into action, the rest of the brain can calm down – leading to a calmer individual.

A study reported in the Jan. 1999 issue of Science* suggested that methylphenidate also elevates levels of serotonin, which may account for some of its calming effects as well. Methylphenidate has never worked that way in my own brain, however, it makes me jittery.

* Gainetdov et al., Role of Serotonin in the Paradoxical Calming Effect of Psychostimulants on Hyperactivity, Science, Jan. 15, 1999: 397-410.

So WHICH medication is better?
Read more of this post