Areas › Focus, starting, and ADHD › Medication and how it works
Most people who try do find something that helps, but often not the first thing they try. Not responding to one class of stimulant says surprisingly little about the other.
The high response figures you may have read come from people who worked through more than one option, not from one prescription going well. Response there also means clearly better and heading the right way, not everything fixed. If the first attempt did nothing much, or did something unpleasant, the usual next step is the other class rather than closing the door on medication altogether.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
Qur’an and Sunnah
'You will not be blamed if you make a mistake, only for what your hearts deliberately intend' (Quran 33:5). Finding the right one by trying and adjusting is not a failure of judgement.
ٱدۡعُوهُمۡ لِأٓبَآئِهِمۡ هُوَ أَقۡسَطُ عِندَ ٱللَّهِۚ فَإِن لَّمۡ تَعۡلَمُوٓاْ ءَابَآءَهُمۡ فَإِخۡوَٰنُكُمۡ فِي ٱلدِّينِ وَمَوَٰلِيكُمۡۚ وَلَيۡسَ عَلَيۡكُمۡ جُنَاحࣱ فِيمَآ أَخۡطَأۡتُم بِهِۦ وَلَٰكِن مَّا تَعَمَّدَتۡ قُلُوبُكُمۡۚ وَكَانَ ٱللَّهُ غَفُورࣰ ا رَّحِيمًا
Name your adopted sons after their real fathers: this is more equitable in God’s eyes––if you do not know who their fathers are [they are your] ‘brothers-in-religion’ and proteges. You will not be blamed if you make a mistake, only for what your hearts deliberately intend; God is most forgiving and merciful
Qur’an 33:5read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
A review of drug treatment in adults found that when doses are taken up to an adequate level, stimulant effect sizes come close to those seen in school aged children, with atomoxetine and bupropion sitting behind them as second line options. Adequate dose is carrying real weight in that sentence. A trial that stopped at the starting dose has not really tested anything yet.
Santosh PJ, Sattar S, Canagaratnam M. (2011). Efficacy and tolerability of pharmacotherapies for attention-deficit hyperactivity disorder in adults.. CNS drugs doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
The two families of stimulant work slightly differently, so one can suit a person the other did not.
When not to
Changing class or dose is a prescriber's decision, so bring them what happened rather than adjusting things yourself.
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 swimming float keeps you at the surface. It does not decide which end of the pool you are heading for, and medication is much the same.
Wanting to try everything else first is a normal instinct and worth taking seriously. It is still fair to ask why we would have a child squint for a year before trying glasses.
When somebody decides against medication, respect the decision and then say the rest plainly. Some of the struggle will stay, and no amount of therapy or another clever app will fully close that gap.