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Adult ADHD: Pharmacotherapy

Medical treatment

Medical treatment for adults who have ADHD is outlined in CADDRA Guide to ADHD Pharmacological Treatments in Canada--2015.

General treatment principles

  • Start with a very low dose. Increase the dose and stop when the target symptoms are better.
  • Resist the urge to "see if a little more makes a difference."
  • Use long-acting agents over short-acting ones because they produce better compliance and better effect.
  • If another family member is being treated for ADHD, use the medication that the first family member has been successfully treated with because it will likely have a positive effect on the subsequent patient.
  • Combining ADHD medications with antidepressants, mood stabilizers or other psychiatric medications is common. Review any potential drug interactions.
  • Always ensure the patient is medically stable before starting ADHD medications because they pose a risk to the cardiovascular system by increasing blood pressure and heart rate. Review the product monograph. It is not necessary to do a pre-treatment ECG. However, patients with any of the following risk factors should be referred for assessment before treatment begins:
    • a history of unresolved structural cardiac problems
    • a family history of known cardiac conduction problems
    • an unexplained syncope

Medical treatment of adults for simple ADHD 

  • Treat the ADHD symptoms first and see what remains. The exception might be in cases of suspected bipolar I disorder where the mood stabilizer should come first.
  • While long-acting agents are preferred, augmentation of short-acting psychostimulants could be used to account for variations in day-to-day attention loads.
  • Do pre- and post-reviews of medication efficacy and side-effects. Use the Side-Effect Rating Scale in the Canadian ADHD Practice Guidelines.
  • Monitor patients bimonthly until they are at their correct dose,vb and every three months after that.

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Frequently asked questions

Clinical guidelines

Canadian ADHD practice guidelines (CADDRA, 2011)

Attention deficit hyperactivity disorder: diagnosis and management (NICE guideline CG72, 2008)