Attention deficit/hyperactivity disorder is the root of many debates ranging from whether it really exists to how to treat it -- if at all. Current public perceptions indicate that ADHD is over-medicated and over-diagnosed, and despite several studies that find the opposite of these beliefs, many people still hold onto that idea.
Where Does ADHD Come From?
Scientists still aren’t certain what causes ADHD; although, current evidence points toward a genetic cause. Evidence also seems to rule out causes such as watching too much television, eating too much sugar, or instability during childhood. That’s not to say that these factors do not aggravate symptoms of adult ADHD; it only means that they are not likely to cause it.
For the most part, scientists are beginning to view ADHD as a condition that arises from differences in the brain structure development that may or may not be related to chemical differences, particularly a lack of the neurotransmitter, dopamine. Dopamine plays a vital role in motor control, attention and focus, motivation, and reward to name just a few. Basically, what we are left with is the idea that ADHD can arise when the brain structure is affected by the lack of dopamine – and symptoms such as problems with attention follow.
Treating Adult ADHD with Stimulants
Understanding why and how ADHD comes about is key to “treating” it or coping with symptoms. Currently, it's treated with ADHD medication and cognitive behavioral therapy. Many people swear by natural remedies and diet restrictions, but studies are limited on their success.
Prescribing medications, particularly stimulants, often leads to controversy. Adult ADHD is treated with medication or therapy. The stimulants used in ADHD treatment are often misunderstood. Learn the facts about stimulants and ADHD.
In my experience, this controversy is fueled by a misunderstanding of the medication’s purpose. Science has advanced our knowledge and expectations. We now find it harder to fathom that there is nothing we cannot fix without a pill, thus we expect pills to cure us. In reality, medication is merely a tool in our toolbox of health. We run into problems when we misuse the tools or mistake them for the answer to our problems.
Shouldn’t Stimulants “Amp up” Someone With ADHD?
Stimulant medications, such as Adderall, have different effects on the brain of someone diagnosed with ADHD. The medication increases the amount of dopamine available to the brain, which functions in attention and focus. The result is, in effect, an increase in calm and focus. This is the opposite of what one expects to see. However, individuals who already have properly functioning dopamine levels in their brain see the expected effects of hyperactivity, euphoria, and aggression.
Too much dopamine results in psychosis, hearing and seeing things that others cannot, and plays a role in mental disorders such as schizophrenia. That's why someone who takes stimulants, like Adderall, and does not have ADHD (and the presumed lack of dopamine already) can appear to have a mental disorder. Parkinson’s disease is another condition that is associated with a progressive loss of dopamine producing cells in the brain resulting is a chronic lack of dopamine which in turn results in motor dysfunction, depression, and dementia. Interestingly, when it comes to motor coordination, too little and too much dopamine have similar effects, namely, abnormal motor control seen as an inability to move or hold still.
It’s fascinating what simple chemistry means to the brain and how we function. It’s also complicated. My explanation here is bare bones, but I hope it serves to bring some understanding to how stimulant medication helps ADHD symptoms.
Is There a ‘Right Way’ to Approach ADHD Treatment?
To appropriately manage ADHD, it is not only important to find the right treatment regime, but also maintain an open relationship with a qualified healthcare provider. It is not enough to go to any clinic off the street and request medication.
You should look for a provider who has experience treating ADHD in addition to having a good bedside manner. Management of ADHD involves regular appointments (at least every other month, any less is a red flag to consider another provider). Ideally, your provider will want to see you monthly to evaluate how your symptoms are responding to current treatment, evaluate how medication is affecting you, as well as monitor basic vital signs, most importantly your blood pressure and heart rate.
Expect a provider to perform lab testing and EKG at least once a year. Lab tests should include urine testing, as well as blood tests to monitor overall health including liver function.
Jimmy Durham is a board certified registered nurse at Ole Town Med with a background in psychiatric nursing, crisis intervention, and primary & community health care. This article was reviewed and approved by Laura Hill, FNP-C, President of Ole Town Med
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