How ADHD Stimulant Medications Work
By Laurie Dupar, PMHNP, RN, PCC, Certified ADHD Coach and Nurse Practitioner, Coaching for ADHD
ADHD is a medical condition where the brain is not producing enough of the 
neurotransmitter Dopamine. The brain is no different than other organs in our body, such as our heart, lungs, kidneys or pancreas. In fact a good analogy to help understand how ADHD medications work is similar to how insulin helps someone with diabetes. In diabetes, the pancreas does not produce enough insulin. Sometime this occurs in childhood…sometimes it happens with aging. Either way, management of diabetes includes learning about the condition of diabetes, making changes in lifestyle habits, such as eating certain foods, and increasing exercise. However, one of the most important ways to re-balance the body’s insulin is with a pill or an injection of insulin.
ADHD is similar. With ADHD, the brain is simply not producing or utilizing enough Dopamine. You see, most of the Dopamine in our brain is made in the middle part of the brain. Without a sufficient amount of Dopamine, there is not enough of it to get to the frontal lobe so it can do all those “executive functions” such as paying attention to things that are less interesting, or filtering out environmental stimuli or pausing to think before we act or say something.
So, when a person takes a stimulant medication such as Ritalin or Adderall, those medicines work directly on the brain to help those Dopamine neurotransmitters either produce more Dopamine or utilize it more effectively. What they are “stimulating” and only simulating is the Dopamine! Voilà! Stimulating the Dopamine receptors increases the Dopamine available in the brain. With an increased Dopamine level the brain is now better balanced and ready to complete the tasks of the day!
Laurie Dupar, Senior Certified ADHD Coach and trained Psychiatric Nurse Practitioner, specializes in working with clients who have been diagnosed with ADD/ADHD and want to finally understand how their brain works, minimize their challenges and get things done! Through individual/group coaching, live speaking, and her writing, she helps clients and their loved ones use effective strategies to minimize their ADHD challenges so they can experience success. She is the co-author and editor of 365 Ways to Succeed with ADHD and author of Brain Surfing and 31 Other Awesome Qualities of ADHD. For more information, please visit http://www.coachingforadhd.com.
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32 Comments on “How ADHD Stimulant Medications Work”
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Thank you for writing this. I have found that many doctors are not entirely sure why the medication works the way it does, they just know what it is supposed to do and (the good docs) know what the side effects are. This is a terrific synopsis and I thank you for writing it!
Hello theforgottenwife. ADHD is very complicated and my hope is that with more research and sharing like this blog, that we will develop a clearer understanding of why the medications work or don’t work, as well as learn and share strategies to succeed and cope with side effects and symptoms. I’m glad you commented and that this post helped!
Laurie,
Thank you for this article. It is a very objective synopsis, and I think it will help other parents to better understand how methylphenidate work.
I do have a question: Do you think drugs like Concerta, Ritalin and Adderall are too easily prescribed when a child is diagnosed with AD(H)D? It’s case by case, I’m sure, but should parents try other treatments before jumping on the meds train?
Le Clown
Hello Le Clown- Great question!
I think they are quickly prescribed because ADHD is a medical diagnosis and the first “tool” most medical practitioners are aware of is a medical approach of which medications top the list. Medications also happen to have the most success, approximately 80% success, in reducing the core symptoms of ADHD such as impulsivity, hyperactivity and distractibility. I think most parents, myself included, put giving their child any medication at the bottom of their list and will try any other solutions such as change in diet, brain training programs, modification of environment, etc. before resorting to medications. My experience has been that medications are only one tool to successfully manage the symptoms of ADHD, but it is not magic and must be combined with several other strategies. Even if someone is taking mediation to manage their ADHD they need to learn all they can about ADHD, diet changes that can help, the benefits of exercise and the importance of consistent sleep. Additionally, children benefit greatly to learn early the strategies for how to do things their brains are not naturally talented in…such as organization, planning, time awareness, managing overwhelm etc. To be honest with you, my concern is not that medications are too easily prescribed, but that there is not enough follow up medically, so that parents and students can fine tune the type, dose and timing of the medication so they are using the lowest dose for them with the highest efficacy.
Laurie Dupar
Coaching for ADHD- http://www.coachingforadhd.com
well, this is an excellent reply. Really, a post on itself.
I particularly like this part ” My experience has been that medications are only one tool to successfully manage the symptoms of ADHD, but it is not magic and must be combined with several other strategies” I can’t emphasize enough how important this is!
And yes, the lack of follow up for the fine-tuning is even more worrying than the liberal prescribing of the medication
There’s little I appreciate more than a medical practitioner explaining to me why things work (or don’t work) the way they do. I think it’s such a mistake to go blindly into a treatment, as many medical practitioners expect us to do.
Thank you for writing this, Laurie, as it clearly explains why medication for AD(H)D is (sometimes) necessary and how it works.
Thank you, Meizac! ADHD itself is so confusing, hence why I think there are so many different medications to counteract the same symptoms, so my passion is to clear up as much of that confusion as possible.
That’s probably the clearest explanation for this I’ve ever seen.
(As a diabetic, I found the analogy quite illuminating.)
Great job, Laurie!
El Guapo, much appreciation for the compliment. I will make sure to continue to use this analogy since it’s been so helpful! So glad for that feedback.
Just one little addition if you don’t mind… Diabetes is not always the result of lack of production of insulin. In some cases, enough insulin is produced, but there’s something wrong with the Insulin receptors and therefore insulin cannot be internalized and it just keeps going around in the blood system. This is why, taking an insulin pill does nothing for this kind of patients cause what they need is better receptors
Thank you very much for this explanation, Laurie–it’s really helpful! I do have a question about these meds, sort of along the lines of what Le Clown asked. Stimulant drugs that act at the dopamine pathway are serious business, even when they can provide a good benefit. Have you had much experience with patients, or parents of patients, who choose a more conservative route first before exploring meds? How have they fared?
I’m curious about this because I know the neurologic (among others) adverse event profiles for stimulants, as well as other drugs like dopamine agonists (for Parkinson’s, etc), can be quite intense, and I know a lot of people want to avoid them when/if possible. So I’d love to know your thoughts on this since you see this first-hand. Thanks!
HI Madame! Thanks for your question. Yes, any medication or for that matter substance that we take to alter the way our neurotransmitters work in the brain is serious business and needs to be approached with caution and a great deal of information. Even though my specialty is in psychopharmacology and the neurology of the brain and I understood how the medications worked, I personally tried nearly everything before that step. I find most parents do this also and that always, medication is a last resort. For whatever reason, medications (the right medication, at the right dose, and taken at the right time) are the most effective way that has been found to minimize the core symptoms of ADHD including hyperactivity, impulsivity and distractibility. Other routes have a much less initial success rate or don’t have the long term effectiveness compared to medications. For many parents or adults for that matter, the negative effects of not being able to remain focused, reduce distractibility or refrain from impulsive behavior is far more impactful than taking a medication. I hope this helps. Keep in touch! ~Laurie Dupar
Thanks so much for this, Laurie! Yes, for people who suffer from extreme cases, I can imagine that any side effect from the medication is preferable to what they’ve endured already. But I’m glad to know that your experience has been that “medication first” hasn’t been the go-to strategy for everyone. Thanks for your reply!
If these drugs are “stimulating and ONLY (my emphasis) simulating (sic) the dopamine, why all the side effects?
HI! Thanks for your great question! The short answer to this is that there are currently, five known types or subtypes of dopamine receptors in the human body; they are found in the brain, peripheral nervous system, blood vessels, gastrointestinal tract and the kidney. The stimulants for ADHD are designed to specifically target the type of dopamine receptors in the brain, but due to a person’s unique genetics or metabolism, the other types of dopamine receptors might be activated. This is why the most common “side effects” a person experiences with taking a psychostimulant include side effects common to those body systems such as nausea, lack of appetite, headache, etc.
Thanks for the enlightening response! Could this possibly mean that, in the future, when everyone’s genes have been enumerated and categorized and personalized, I could go to the pharmacist with an RX for, say, venlafaxine and bring along my gene study and get some venlafaxine that would only target the correct gene? Wouldn’t that be something!
Hi! Yes…it would be something! I dream that in my lifetime we might be able to understand our brains enough to target specific subtypes of receptors for optimal treatment!
Thank you Laurie. My (possibly flawed) understanding is that there are no longitudinal studies assessing the effects of methylphenidate. What is your view on the possible health risks of long-term treatment? Thanks.
HI David! Your understanding is not flawed. Despite the fact that methylphenidate has been around now for nearly 60 years, we have relatively few longitudinal studies that show what the “long term” effects are of taking methylphenidate consistently as a management tool for ADHD over say a lifetime. Realistically, I would say this is true for most “chronic” conditions. My opinion is that this lack of data is due to the only relatively recent understanding that we do not outgrow ADHD and the overall minimizing about how impactful ADHD can be to a person’s life. What we do know is that short term, children who are diagnosed and treated for ADHD with medication, overall do better in their academics, social life, family life and are less likely to abuse recreational drugs. And in my work with adults who have been recently diagnosed, whether they are 26 or 66, they overall wish that they had known earlier about ADHD and its available treatments as they look back and grieve for years lost, dreams destroyed and opportunities missed.
Again, great reply. Wish it were included in the post as I think that most people won’t see it here.
Very nicely done.. clear, concise and I know so much more now about ADHD.. Great guest blog post!!!!
Thank you so very much, Free Penny Press!
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GREAT article, Laurie!! I will be back-linking to some of the meds content on my main blog — I’ll ping you as I get to them.
Madelyn Griffith-Haynie, CMC, SCAC, MCC
- cofounder of the ADD Coaching field -
(blogging at ADDandSoMuchMore and ADDerWorld – dot com!)
“It takes a village to educate a world!”
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Hi,
I’m late to the game with this question – but does the brain change over time – or is it once ADHD always ADHD and the brain doesn’t increase production of the neurotransmitter Dopamine?