Stimulant medications

Stimulant medications, like Ritalin and Adderall, are the most common treatment for ADHD (Attention Deficit/ Hyperactivity Disorder). When taken as prescribed by a doctor, they’ve proven to be safe and effective for many people with ADHD. [1]

But they do have side effects, and they can also be abused. For people with mild ADHD, the side effects can sometimes outweigh the benefits. [2]

Stimulants are occasionally used to treat other conditions. Your doctor should be able to explain why they believe this is the right treatment for you. The side effects will be similar, regardless of the reasoning.

Understanding the risks and benefits of stimulant medications can help you make more informed decisions about your health care.

What do stimulants do?

Stimulants work by restoring the balance of the chemicals in your brain. These brain chemicals are called neurotransmitters. They send messages from one brain cell to the next. You can imagine them sending messages like, “I’m bored! It’s time to get up and move around,” or “This is really interesting! I better pay attention!”

Getting too many “I’m bored” signals could lead to symptoms of ADHD, like fidgeting or zoning out. People with ADHD are often understimulated. They often show differences in parts of the brain that deal with attention, behavior, and impulse control.

Different neurotransmitters send different types of messages, but the most important ones for understanding stimulants are: [3]

• Dopamine, which affects motivation, pleasure, and movement. Sometimes called the “feel-good chemical” or the “reward chemical.” Dopamine tells your brain, “Whatever we just did felt good. Let’s try it again!” [4]
• Norepinephrine, which affects your energy level, focus and attention. Related to adrenaline and has similar effects, like increasing your heart rate. Norepinephrine tells your brain, “Wake up! Focus! Something important is happening!” [5]

For people with ADHD, boosting the levels of dopamine and norepinephrine a bit can make it easier to stay engaged in a classroom or a workplace. Even though these medications are called “stimulants”, the right dose can make someone with ADHD feel calmer.

On the other hand, boosting these chemicals too much can make anyone hyperactive. People who take stimulants recreationally can become addicted to them. It’s important to follow your doctor’s advice and take stimulants only as prescribed.

Examples of stimulant medications

Stimulants all have similar effects, but each medication is slightly different. What works for someone else may or may not work for you.

There are two main “families” of stimulants: amphetamines (like Adderall) and methylphenidate (Ritalin). Both are equally effective on average, but one might work better for you. Methylphenidate-based stimulants tend to work a little bit faster, while amphetamines tend to last a little longer. [6]

Here are some examples of stimulant medications:

How quickly do stimulants work?

Unlike antidepressants, stimulants work very quickly. They usually take effect within an hour, and last anywhere from a few hours to most of a day. Many people notice a difference right away. If you take a stimulant daily for a week or so and don’t notice any improvements, talk to your doctor about it—you may need a higher dose, or a different medication.

Stimulants come in two forms: immediate release and extended release.

With immediate release, the whole pill is dissolved in your stomach and is absorbed into your body right away. You’ll feel the positive effects soon after—along with any side effects. The medication will wear off within a few hours. You may need to take multiple doses throughout the day.

Extended release pills dissolve slowly instead of all at once. The effects come on more slowly, but last longer. This can help you feel more stable throughout the day. Sometimes the side effects are less noticeable this way. It’s also easier to remember to take one pill in the morning than to remember to take it 3 times throughout the day! On the other hand, for some people the effects can last too long.

Some meds also come in a “sustained release” form, which is somewhere in between immediate and extended.

What are the side effects?

Although stimulants are considered safe and effective for treating ADHD, they still have side effects. For many people—such as those with milder symptoms—the side effects can outweigh the benefits [2]. Some side effects may get better after you’ve been on the medication for a little while. [7]

Common:

• Loss of appetite
• Upset stomach
• Weight loss
• Trouble sleeping
• Headache
• Increased blood pressure
• Irritability
• Dizziness
• Dry mouth
• Increased anxiety
• A “crash” or sudden loss of energy when the medication wears off

Less Common:

• Blurred vision
• Hallucinations

Are stimulants addictive?

It’s true that stimulants can be abused. However, this mostly happens when people take stimulants recreationally. There’s no evidence that taking stimulants as prescribed will lead to addiction. (If anything, getting effective treatment for ADHD may reduce your risk of becoming addicted to something else.) [7][8][9]

As long as you take the medication as prescribed, the risk of becoming addicted is extremely low.

If you’re worried about becoming addicted to stimulants, your doctor can help you understand and minimize the risks. It’s good to be cautious, especially if you have struggled with addiction in the past, or if addiction runs in your family. Some forms of the medication are harder to abuse. There are also non-stimulant options for treatment. (See the next section for more info.)

If you take stimulants for a long time, you may develop a tolerance. This means that you will need a higher dose of the same medication to get the same effect. Tolerance is not the same thing as addiction—but it can still be a problem. Eventually a medication can stop working, or the side effects can get worse. When this happens, you may need to switch medications.

One way to avoid developing too much of a tolerance is to take a tolerance break every now and then. A tolerance break is when you stop taking a medication for a few days or weeks at a time. (For example: on the weekends, or on vacation.) Not everyone needs tolerance breaks—talk to your doctor about what will work best for you. [10]

What are alternatives to stimulants?

There are also non-stimulant medications for ADHD. These medications still have side-effects, and they’re often less effective than stimulants—but they aren’t as habit-forming. [6][7]

Strattera (or atomoxetine) is the only non-stimulant medication that was developed specifically to treat ADHD. Unlike stimulants, Strattera needs to be taken daily for several weeks before taking full effect.

Other non-stimulant medications for ADHD are experimental and much less common.

In addition to medications, many people with ADHD benefit from therapy, mindfulness, or other lifestyle changes. Some people are able to use these instead of medications. Many others use them alongside medication for added benefit.

• Therapy can help you deal with negative emotions associated with ADHD, like frustration or shame. Therapy takes time, but the benefits are also long-lasting—unlike medication, which stops working if you stop taking it.
• ADHD coaching is less focused on emotions and mostly focused on problem-solving. It’s not covered by health insurance and can be expensive.
• Mindfulness is a practice of actively paying attention to the present moment. Mindfulness can be helpful for ADHD symptoms like zoning out or hyperfocusing on the wrong tasks.
• Sleep, nutrition, and physical activity are all important for keeping your brain healthy and focused.
• Learning time management skills and limiting screen time can also be helpful.

For more information on alternatives to stimulant medication, read How do you treat ADHD?

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