The stimulants most often prescribed for ADHD represent several different types of agents that help control attention and behavior. These include methylphenidate (like Ritalin and Concerta) and mixed salt amphetamines (like Adderall and Vyvanse). Each of these has a specific effect on the body’s neurotransmitters, or the chemical compounds that help transmit signals within the nervous system. The exact mechanisms by which these chemicals interact are very complex, but essentially, if levels of these chemicals are too low or their activity is blocked, the transmission of messages within the nervous system decreases, corresponding to a state of inattention or impulsivity. Specific medications aimed at targeting attention-deficit and hyperactivity symptoms help increase levels of neurotransmitters and their activity. For example, methylphenidate-based medications like Ritalin increase the activity of the neurotransmitters dopamine and noradrenaline in the parts of the brain that help to control attention and behavior. Adderall also increases dopamine’s effects, but in a more gradual way than Ritalin and similar agents do.
So let’s back up a moment. If stimulants can increase one’s attention span and reduce impulsivity, why shouldn’t we use them? Furthermore, even if we’re masking another underlying condition, aren’t we at least solving the problems of inattention and impulsivity in the patient? The answer to both of these questions is a resounding NO. While stimulants can help people with a variety of symptoms in the short term, they have multiple damaging effects in the short- and long-term. The most common short-term side effects associated with stimulants involve overstimulation, such as loss of appetite and sleep disturbance, but perhaps more troubling are the longer-term effects of stimulant use, which include unhealthy weight loss, poor concentration and memory, and even reduced life expectancy in some cases. Long-term, patients also face the development of tolerance, which exacerbates these side-effects. After a while, the body adjusts its natural production of these same chemicals in the brain, and the temporary improvements in attention and behavior begin to disappear. This is why we see doctors prescribing higher and higher doses of the stimulant to achieve the same effect in the patient as time wears on—a dangerous pattern.