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

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?

Remember that you can always check out the sidebar
for a reminder of how links work on this site, they’re subtle ==>

HOVER before clicking – often a box will appear to tell you what to expect

NEITHER Medication Is Better for everybody!

And some people can’t take them at all. Everything depends on how each particular brain and body responds.

While there are certainly a few situations where trying either of these stimulants is contra-indicated, a percentage of people are what they call “non-responders,” meaning that none of the stimulants seem to work for them.

However, according to a review of 40 years of studies, stimulant medications are effective in treating 70 to 80 percent of individuals with ADD/HD. When a second medication is tried, the success rates can be even higher.

The old saw applies: different strokes for different folks!

The other advice I want to insert here is: if you don’t need ’em, don’t take ’em. And if you DO need them, don’t be afraid to take them – always under a doctor’s supervision.

For Medication Responders

Although there are some effectively minor differences between dexedrin and methylphenidate, the safety or side-effects profiles and efficacy (effectiveness) of both are essentially similar. Differences include how quickly they work, how many times a day you must take them to keep medication levels consistent, how many different choices of dosage and delivery type are available, etc.

To determine which is most effective for YOU, your doctor may put you (or your loved one) on a trial of one medication, then suggest a switch to the other.

If s/he doesn’t suggest it, I DO, btw.
“Good enough” functioning is seldom good enough.
I believe that Optimal Functioning™ is our birthright.

For example, in addition to discovering that one or the other only provides minimal assistance or doesn’t work very well for you at all, you may find that you get different kinds of help from each of them.

Your ability to direct your attention and follow through on tasks might be better with one medication, while the other may give you better activation or short-term memory recall. You may also have side effects with one drug that you don’t have with the other.

You will usually be able to tell within several days of starting a new stimulant medication whether it’s likely to be effective and how well you tolerate any side effects (which frequently go away entirely once your body gets used to it).

Most people find they can work with and around most lingering side-effects.

  • I drink a lot of fluids to work around dry mouth, for example.
  • Mothers wait until after meals to give medication to children who lose their appetites, and
  • Most adults can learn to eat whether they actually feel hungry or not.

Unless you have more patience with the process than most ADD/EFDers I’ve met, take notes (specifically – like a school-girl diary of her day).  In a few weeks a pattern will emerge, and you’ll have documentation to review to compare how each affects your functioning.  That’s the point, right?

The Differences you’ll read about

Keep this in mind as you read any information about medications:

ANYTHING you read on the web – and even what the best doctor in the world might tell you – can only be a guestimate of how you or your loved one will respond to stimulant medication.  Every brain is different.

For every person you can find who will say, “Yes, that’s exactly how it works!”  I’m sure I can locate TWO who will disagree (one vehemently).

Composite statistics are useful as targets – to give you a place to begin.  But YOU are an individual and may respond in a totally different manner — even if you are the only person on the planet who responds as you do.

Do I have to add a reminder that you really don’t want to try any medication without being overseen by a doctor?

  • That’s especially true with medication for your brain, right?
  • You might get lucky “trying” a pill or two from a friend or relative.
  • Then again, you might NOT. The safest advice came from Polonius in William Shakespeare’s play, Hamlet: neither a borrower nor a lender be.

Brand Names and Generics

Adderall and Ritalin are both brand-name drugs that are also available as generic drugs. Generic forms tend to be cheaper than the brand-name versions, but that may not always be the case with your insurance carrier – so call to find out the specifics of your plan.  Some plans only cover the generic versions of the certain drugs, so be sure to check.

Costs vary by pharmacy as well – and sometimes the “big-box” stores like Sam’s etc. will be much cheaper for one medication and twice as expensive as anywhere else for another.  It’s well worth your time to call around to compare prices.

Despite what you’ll read on many sites, they are NOT exactly the same.

The amount of active medication in the generic version of either medication is equal to what you’ll find in the equivalent Brand because it is regulated. However, the binders that form Brand Names are proprietary, and are almost always different in the generic version.  Most people won’t be able to tell much of a difference, but some people run into trouble they never anticipated.

I have had clients who have developed unusual adverse reactions switching from the brand to the generic: scalp hives, for one, dry, itchy skin for another, increased “hay fever” symptoms for several others, etc.

Their problems went away once they switched back, despite the fact that only one of their doctors believed that the binder difference in the medication change was behind their symptoms.

Sometimes reactions show up immediately, and sometimes they creep up slowly enough that it’s difficult to figure out what’s wrong. It’s unusual, but not rare – so pay attention and keep a log of changes any time you switch.

Costs and Availability

Dosage variations between the two types of stimulants means that the cost of an individual pill for one may be more than another but, in general, Adderall and Ritalin cost about the same to remain medicated effectively for an entire month.

Difference can sometimes be seen in the monthly costs for generics, however.

By law in America, you will need to get a new prescription every single month – in person or by mail.  Your doctor can’t call or fax a prescription to your pharmacy as with other medications.  A future article will go into more detail about why, but it has to do with how drugs are classified: stimulants are Schedule II medications — in other words, Controlled Substances.

Adderall and Ritalin – brand or generic – are usually available at most pharmacies. However, one of the problems with the current laws in the U.S. means that Controlled Substances experience shortages, frequently toward the end of the year.

As a result, the medication you rely on may not be available at all times in all locations, depending on how many customers they have, how long they’ve been in business and how well they generally keep them in stock. Older pharmacies generally get first dibs during meds shortages.

Be sure to call your pharmacy ahead of time to find out if your medication is available – and start calling around immediately to find it if the answer is no.

Before Part I of this article concludes, I am going to risk lengthening it with some information for parents who are reading particularly for information about medication for their children.

A little advice from a prior article: ADD Meds Info for Moms

Statistically, the percentage of people who are “medication responders” increases when a second medication is tried.

Now, if we have this statistic at all, what does that tell you about how easy (or common) it is to hit it out of the ballpark with the first pitch?

See Can I Get My Medication Well Done?
for another meds-trial analogy from a doctor
who treats ADD (and related) disorders.

This does not mean that it *always* takes two tries to “get it right.” Sometimes you get lucky.
(Those are the ones you hear about most often — what I call the EUREKA! responders.)

  • Other times you get the right medication (for example, methylphenidate vs. dexedrin) but not the formulation — for example, Concerta vs. Ritalin (methylphenidate based), or Adderall vs. Vyvanse (dexedrin-based).
  • Sometimes you need to titrate the dosage, sometimes the timing needs tweaking (which includes whether short acting or long acting meds work best for your child) — and this is just to find out if the FIRST medication is going to work.

So don’t start “doctor shopping” the minute that you hear that your friend Karen’s doctor turned her Wild Indians into little angels practically over night, thinking there must be something wrong with the doctor working with YOUR kids because they are having problems adjusting to their medication.

  • It’s okay to talk to your doctor about Karen’s kids, but don’t assume that Karen’s doctor is “better.”  Maybe so, maybe not.
  • If your friend had gone to your doctor and you to hers, the result might still have been exactly the same.
  • Don’t fall into the trap of blaming your doctor because the medication doesn’t work “out of the box” – they’re doctors, not magicians!

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About Madelyn Griffith-Haynie, MCC, SCAC
Award-winning ADD Coach Training Field founder; ADD Coaching field co-founder; [life] Coaching pioneer -- Neurodiversity Advocate, Coach, Mentor & Poster Girl -- Multi-Certified -- 25 years working with EFD [Executive Functioning disorders] and struggles in hundreds of people from all walks of life. I developed and delivered the world's first ADD-specific coach training curriculum: multi-year, brain-based, and ICF Certification tracked. In addition to my expertise in ADD/EF Systems Development Coaching, I am known for training and mentoring globally well-informed ADD Coach LEADERS with the vision to innovate, many of the most visible, knowledgeable and successful ADD Coaches in the field today (several of whom now deliver highly visible ADD coach trainings themselves). For almost a decade, I personally sponsored and facilitated seven monthly, virtual and global, no-charge support and information groups The ADD Hours™ - including The ADD Expert Speakers Series, hosting well-known ADD Professionals who were generous with their information and expertise, joining me in my belief that "It takes a village to educate a world." I am committed to being a thorn in the side of ADD-ignorance in service of changing the way neurodiversity is thought about and treated - seeing "a world that works for everyone" in my lifetime. Get in touch when you're ready to have a life that works BECAUSE of who you are, building on strengths to step off that frustrating treadmill "when 'wanting to' just doesn't get it DONE!"

62 Responses to Stimulant BASICS: Ritalin and Adderall

  1. Pingback: Flashback: Can This ADDer Be Saved? – Part 3 | ADD . . . and-so-much-more

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  3. Pingback: Top Ten Questions about ADD meds | ADD . . . and-so-much-more

  4. I am so glad I read this post Madelyn. It is so full of excellent information. I also think that a lot of your insights are useful for other medications – particularly the difference in binders in generic drugs and keeping a diary of your response to new medication. I also empathise with doctors and the fact they are not magicians.

    Liked by 1 person

  5. dgkaye says:

    Stunning revelations my friend! I have shared this article to my new Flipboard magazine – Health and Wellness. ❤ 🙂

    Liked by 1 person

  6. Finally, that’s what I’m talking about 👍
    Excellent, to the point and referenced, academic Nirvana.
    But I’ll start with the beginning and get by again, as I get by…
    Thanks MGH 💐

    Liked by 1 person

  7. This is such an informative article, Madelyn. I was also interested to read that you need a new script every month for this medication in the US. In South Africa you can get a script for 6 months – one month seems a bit ridiculous. It makes if very difficult for people if you have to keep visiting a doctor.

    Liked by 1 person

  8. So love the way you started out this post with personal passion and testimony both of which are ingredients for wisdom. Wow and Wow again Madelyn for an article that is so extremely packed with information that has obviously been researched with great attention to detail and broken down for us to understand. You continue to amaze us. Keep up the great work which must at times be exhausting.

    Liked by 1 person

  9. -Eugenia says:

    Excellent post and very useful information. Thank you for sharing, Madelyn. 🌼

    Liked by 1 person

  10. mistermuse says:

    I’m glad you pointed out the difference binders can make in generics compared with name brands. My wife and youngest daughter both experienced bad side effects when being switched from a brand name to a generic, and had to revert back to the brand name despite the latter being much more expensive.

    Unfortunately, some insurance companies refuse to recognize this possibility and won’t pay for the brand name, even when the patient’s doctor vouches for the patient’s need for the brand name.

    Fortunately, we can afford to pay the higher price out of our own pocket, but I feel sorry for those who can’t. Shame on cynical insurance companies!
    mgh added white space for readability for those who struggle with longer strings of text; words unchanged

    Liked by 1 person

    • Don’t get me started on the insurance industry!! Hateful business, IMHO – hide bound by rules and tables with sometimes tragic results for individual sufferers of many types.

      Thanks for underscoring the binder information – I’ve been surprised at how many doctors are unaware of the issue, and MOST people have no idea there is any difference at all between brands and generics (beyond price). I’m glad to read that you can afford the brand name medications your wife and daughter need, and sorry they had to go through side-effects after being forced to switch.

      Liked by 1 person

  11. Bernadette says:

    I hope anyone who is contemplating taking these medications or giving them to their children read this post slowly and thoroughly.

    • Thanks, Bernadette. I would hope that anyone contemplating mental health medication would do their research. I always say that medications for neuro-focus are like glasses for visual focus – if you need them, you NEED them, and if you don’t they won’t help and are likely to give you a big headache!

      The wrong prescription can be worse than nothing at all – and they do nothing in and of themselves. You still have work to do, in the same manner that a child who can’t focus on the page won’t suddenly be able to read just because s/he can suddenly focus clearly.

      Thanks always for taking the time to ring in.

      Liked by 1 person

  12. John Fioravanti says:

    Bless you, for your efforts, Madelyn. I wish I could get off my medications… not happening anytime soon.

    Liked by 1 person

  13. Extremely interesting and important. Thank you.

    Liked by 1 person

  14. Lucy Brazier says:

    Wow, this is a very interesting and informative post – even for someone like me who has no experience of medications. It has actually made me much more aware of the problems facing friends with ADHD – the condition itself is fairly well documented these days and relatively easy to grasp (if not understand, as a non-sufferer) but I had no idea how complex the situation concerning the medication is. As if you haven’t got enough to contend with! These posts are very important – not just for those with the condition but for others so that these things can be better understood. Thank you once again for educating me!

    Liked by 1 person

    • What a compassionate and well considered comment, Lucy. Thank you.

      There is a lot of documentation about ADD/EFD these days, thankfully, and fewer people who “don’t believe it is a ‘real’ disorder.” But still far too many people swallow what they read in the popular press, etc. – most of which is not accurate and a great deal of which is down-right WRONG, especially where medication is involved. With the advent of the interwebs, misinformation spreads like wildfire!

      That’s why I do what I do – but you’d be surprised how many people refuse to listen or read credible studies first-hand and how many people are struggle needlessly for years as a result.

      Thanks always for ringing in – and I’m excited that your next book in the PorterGirl Series is just about to be available.

      Liked by 1 person

  15. thanks, that was very interesting… and what you wrote counts for a lot of meds (or for all?)… and I will keep it in my mind the next time that we all respond in a different matter… and there is probably no “one size fits all”… that works not even at the clothing front :o)

    Liked by 1 person

    • Right! It’s a bit more straight-forward for the medications that most people take for physical ailments, but mental health and pain meds are often person-specific. DAILY patient documentation until you’ve got things under control is not only important to know what’s working and to what extent, but also to get your doctors to take you seriously.


  16. Thanks for taking the time to put this very useful and thoroughly researched information together.

    Liked by 1 person

  17. Another excellent and very much needed article! There are so many misconceptions floating around multiplied by denial that every bit of objective information helps!

    Liked by 1 person

  18. John Fioravanti says:

    Wow! This is a very impressive article, Madelyn! Thanks for sharing your due diligence about these treatments!

    Liked by 1 person

    • Thank you so much, John. I’m hoping I’ve built enough content credibility that I’ll change a few paradigms as people spread the word to their friends and loved ones. I hate it that so many people are struggling needlessly, knowing what I know.

      A client of a colleague spent MANY years resisting medication – the entire time the client coached with my colleague. Recently my colleague received a phone call from this former client, practically in tears over the difference FINALLY trying medication has make in everything attempted – wishing there had not been so many wasted years.

      That’s why I do the treatment series – to share information to remove the fear.

      Liked by 1 person

  19. robjodiefilogomo says:

    I love the comment about blame and that they are doctor’s, not magicians.
    Because that’s so true. Most doctors are out there to help people. And the hardest part is that every person reacts differently because each person’s body is so, so different.
    And doctors only know what they know.

    Liked by 1 person

    • Thanks Jodie. There is a lot of mistrust of doctors (much of it earned, unfortunately, especially with adjustments to the input of the insurance regulations and limitations, and the advent of 15-minute appointments). But even the most patient-focused doctor in the universe can only apply his or her experience to treatment, and response can be very different from patient to patient. The newer the medication, the greater the number of potential problems.

      That’s why its important to document symptoms and ALL other substances ingested, feedback carefully, and self-advocate. For most patients, they’ll get better treatment communicating effectively with the same *well-informed* doctor than jumping around when the first or second treatment approach is not sufficient.

      The main reason I advise changing doctors is when the one you have seems ill-informed and doesn’t take the time to keep up, and/or “doesn’t believe” in current medication approaches (more often than you’d believe in the ADD/EFD field, Jodie), or refuses to adjust medication to feedback (which doesn’t always mean immediately).

      Liked by 1 person

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