Areas › Focus, starting, and ADHD › Medication and how it works
People usually stop for one of three reasons: the side effects are not worth it, the price is too high, or the dose was never raised far enough to do anything. The last one is the saddest, because it makes a workable medicine look useless.
If a trial ended with the words nothing happened, it is worth going back over what dose was actually reached and for how long it was held there. A dose that was never pushed towards an effect can leave a family convinced that an entire class of medicine failed them, and that belief lasts years. Cost is worth saying out loud too, because there is often a generic or a different formulation at a fraction of the price.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
Qur’an and Sunnah
'Give full measure when you measure, and weigh with accurate scales' (Quran 17:35). Full measure applies to the care someone is given as much as to what is sold to them.
وَأَوۡفُواْ ٱلۡكَيۡلَ إِذَا كِلۡتُمۡ وَزِنُواْ بِٱلۡقِسۡطَاسِ ٱلۡمُسۡتَقِيمِۚ ذَٰلِكَ خَيۡرࣱ وَأَحۡسَنُ تَأۡوِيلࣰ ا
Give full measure when you measure, and weigh with accurate scales: that is better and fairer in the end
Qur’an 17:35read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
Dose matters more than people expect. A review of medications for adults found that effect sizes for stimulants approach those seen in school aged children when adequate doses are used, with atomoxetine and bupropion as second line options. On the money, a systematic review of economic evaluations generally found these medicines cost effective, while noting wide variation in the assumptions those models rest on.
Santosh PJ, Sattar S, Canagaratnam M. (2011). Efficacy and tolerability of pharmacotherapies for attention-deficit hyperactivity disorder in adults.. CNS drugs doi
Wu EQ, Hodgkins P, Ben-Hamadi R, Setyawan J, Xie J, Sikirica V, Du EX, Yan SY, Erder MH. (2012). Cost effectiveness of pharmacotherapies for attention-deficit hyperactivity disorder: a systematic literature review.. CNS drugs doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
A dose too small to do anything gives you all the inconvenience of treatment and none of the benefit.
This one is still a draft. It is waiting on a scholar and a clinician to read it before it is published.
Near this one
A short acting dose lasts around four to six hours in most people, and bodies vary a great deal around that. Some clear it quickly and feel almost nothing, some clear it slowly and feel every side effect at a small dose.
For someone who cannot swallow tablets, or whose mornings fall apart long before the tablet gets taken, patches exist that release medicine slowly through the skin over hours.
Conversations about alcohol and cannabis tend to be timed for the child you expect to have at fourteen. With an attention difficulty in the picture, start them earlier and keep them light.