Many people with attention deficit hyperactivity disorder (ADHD) don’t know they have it until they’re adults. It was there all along, but they never got tested for it. Others have known they had it since childhood. But the symptoms -- and the stress it adds to life -- can change with age.
For example, you might be less hyperactive as an adult. But there’s a good chance you still have symptoms that affect your quality of life. Adults can have problems with paying attention, controlling impulses, and staying organized. These issues can affect your work, relationships, and self-esteem.
The same treatments used for kids with ADHD also treat adults. For most people, it’s a combination of medicine, behavior strategies, life skills training, and therapy. This is called multimodal treatment.
Sometimes, the meds you took as a child may work differently because your brain, body, and symptoms may have changed. As an adult, you also might need different skills to stay organized and manage your time. And you may need treatment for other issues like depression or anxiety.
To get the most from any treatment, it’s good to know specifically how ADHD affects you. Does it make it hard to meet deadlines at work? Are you struggling in relationships with your spouse or child? If you know, you can better seek care that’s tailored for you. And you’ll be better able to tell if it’s working.
Which Meds Work?
Drugs are the main treatment for ADHD. But finding the one that works best for you may take some trial and error, and what works at first may not do so well over time. Also, while many drugs work for both children and adults with ADHD, clonidine (Catapres, Jenloga, Kapvay), guanfacine (Intuniv, Tenex), and modafinil (Provigil) haven’t been well-researched for adults and aren’t prescribed much.
Stimulants. These are often the first choice for ADHD, and they tend to work the best. Usually, you start at a low dose. You then increase it every 7 days until you get to where the medication controls your symptoms without too many side effects.
Stimulants commonly prescribed for ADHD include these drugs, sometimes in combination:
- Amphetamine (Adzenys, Dyvanel)
- Dextroamphetamine (Dexadrine, ProCentra, Zenzedi)
- Dexmethylphenidate (Focalin)
- Lisdexamfetamine (Vyvanse)
For most adults, long-acting stimulants work best. They last 10-14 hours, so you don’t have to remember to take as many pills. Once you get the dosage right, you’ll have regular follow-ups to make sure the drug keeps working and any side effects are minor. Most adults with ADHD will need to keep taking medications, but some will be able to stop. Your doctor may suggest:
- Going off the meds once a year to see if you still need them.
- Taking a drug holiday so your body doesn’t get too used to it. Otherwise, you might need a higher dose.
You may be able to manage your side effects by changing the dose or time of day you take it. Common side effects include:
- Anorexia or loss of appetite
- Anxiety or panic
- Dry mouth
- Slight increase in blood pressure and pulse
- Trouble sleeping
Stimulants are effective, but they’re not for everyone. For some, the side effects are too much. And you want to avoid stimulants if you have certain conditions, such as:
- Bipolar disorder
- Heartbeat that’s faster than normal or whose rhythm is off
- High blood pressure
- Severe anorexia
- Substance use disorder
- Tourette's syndrome
Nonstimulants. When stimulants aren’t an option, other choices are atomoxetine (Strattera) and viloxazine (Qelbree). The full effects of these drugs don’t kick in quite as fast as with stimulants, but some people find they work well for them.
You start with a low dose and typically raise it every 5-14 days until you find the right balance. The side effects are similar to stimulants and may also include constipation, lower sex drive, and an upset stomach.
Antidepressants. Antidepressant drugs raise your brain's levels of chemicals such as dopamine and norepinephrine. They aren't usually the first choice for treating ADHD, but doctors have found they can improve attention span in some people with the condition. They also help keep a lid on behavior like being impulsive, hyperactive, or aggressive.
Although doctors prescribe antidepressants to treat ADHD, the FDA hasn't specifically approved them for that purpose. Your doctor may suggest one of four types:
- Bupropion (Wellbutrin)
- Monoamine oxidase inhibitors (MAOIs)
- Tricyclic antidepressants like desipramine (Norpramin) and imipramine (Tofranil)
- Venlafaxine (Effexor)
The right antidepressant for you depends on your symptoms and other health problems. Some adults with ADHD also have depression and anxiety. Antidepressants might be an option if that's your situation, since they can treat these conditions as well as ADHD.
Can Talk Therapy Help?
Yes. The right medicine, along with a good therapist, is a powerful combo. Talk therapy can help you and your family members learn more about how ADHD works and how to better deal with the problems it can create.
There are many types of talk therapy. Two common ones for ADHD are:
Cognitive behavioral therapy. You learn to change your thoughts and actions in a way that gives you more control over your life. It can help with challenges in school, work, and relationships. And it’s used to address issues like substance abuse and depression.
Marriage counseling and family therapy. You and your family members learn how to communicate better and spot patterns that may cause issues. The counseling can help loved ones understand that the problems aren’t simply about your being messy or forgetful.
E-therapy may be a solution if you can't afford a traditional therapist, you feel uncomfortable visiting a doctor in person, or you can't find qualified help in your area. Counselors can reach people in different ways:
Phone calls. Counseling over the phone is hardly a new idea. Many therapists have reported positive results for their clients using this growing option.
Some of the pluses include:
- Lower costs
- More convenience
- A better sense of control for the person seeking help.
Video conferencing. This may be especially valuable for people who live in rural areas, where travel is difficult, or where there may not be many counselors with the needed skills. Usually people using this method have more sessions than they would in person.
Text-based communication. Whether it's email, chat rooms, or direct messages, text communication makes it easy for people to reach out to a therapist. It can also support more direct counseling. Research on this newer trend is ongoing. Generally, it's found to be effective and helpful. Still, there's some evidence that a chat feature is more effective than email alone.
What About an ADHD Coach?
You can learn practical skills, including how to make plans, set goals, manage time, and stay organized. A coach can share suggestions and tips and keep you focused and motivated to make the changes you want. Studies show that coaching can help you reach goals, manage stress, and achieve more in your life.
What About an ADHD Online Community?
It can help to connect with other people who have ADHD or know someone with it. A support group is one way to do this. To find an ADHD support group, check the website of CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder). This nonprofit organization has chapters throughout the U.S. At CHADD’s web site, use the “Get Support” tab to find support and local chapters.
What if I Have Other Conditions, Too?
For example, some stimulant medications for ADHD can make anxiety symptoms worse. So if you have both conditions, your doctor will look at which one is causing the most problems when deciding on your treatment plan.
On the flip side, research has found that treating ADHD with stimulants can help people who also have a substance use disorder stay in addiction treatment programs.
Other times, your doctor can safely combine treatments for more than one condition. A mix of antidepressants and stimulants may help if you have depression along with ADHD.
Some ADHD symptoms can also be signs of other conditions, such as behavior disorders or depression. Or ADHD medications might have side effects that look like different mental health problems. That’s why it’s important to talk with your doctor when you notice changes in yourself or a loved one. If you’re in treatment, keep them updated on any new concerns.