ADHD: Common Prescribing Myths
Myth 1: Most patients do better with Vyvanse more than Ritalin (or vice versa)
There is no way of predicting which stimulant would work best; however discussions should be held in relation of the potential advantages and disadvantages of each (i.e short-acting for closer monitoring vs long-acting for convenience).
Myth 2: The dose is titrated according to the patient’s weight
Medication dosing is not determined by the patient’s height or weight, but rather based on individual needs, treatment effectiveness, side effect tolerance and/or other comorbidities.
Myth 3: All patients require an ECG before commencing stimulants
An ECG is not needed routinely, unless the patient has specific comorbidities (see guidelines) or a co-occuring condition that is being treated with medications that may pose an increased cardiac risk.
Myth 4: You should see improvements in ADHD symptoms right away
Knowing that stimulants are first-line pharmacological treatment doesn’t mean we can predict how any medication or dosage will affect a particular individual. Regular consultations and observations are important to judge the full effect of the medication.
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A general guideline can be suggested:
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Stimulants: Days - Weeks
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Non-stimulants: Weeks - 1 month
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Atomoxetine: 6 - 8 weeks
Myth 5: If stimulants disrupt the patient’s sleep, it must be switched to a non-stimulant
The causes of sleep disturbances are multi-faceted, and further evaluation is required. Utilising lifestyle management strategies or referring to psychological supports can be highly valuable in complementing medication effects in this instance.
Myth 6: If stimulants stops working, we’ll need to try something else
Take a step back to consider life before your stimulant commencement. Often individuals typically forget how far they’ve come after a few weeks of experiencing the ‘novelty’ of improved functional capacity. This also emphasizes the need to keep a good record of observations from the commencement of medications to appreciate the progress made.