Home What is Adult ADD? Does ADD Exist? ADD Questionnaire How I treat ADD Questions / Answers Psych/Neuro Tests Vyvanse Adderall vs Ritalin High Dose Stimulants Coaching Gems Research on ADD Reminder System ADD and Psychotherapy Getting Help Nick Schwartz, MD Marc Schwartz, MD Info for Clinicians
A Comparison of the Effects
(Adderall etc.) and Methylphenidate (Ritalin etc.)
on Symptoms of Adult ADD
Clinicians treating patients with ADD often have to decide which type of stimulant medication to prescribe, amphetamines (like Adderall, Dexedrine, and others) or methylphenidate (like Ritalin, Concerta, Focalin, and others. Vyvanse is an amphetamine type stimulant, but was not on the market when this study was done.) I created a questionnaire designed to see if there is a difference between the effects of these two types of medications on ADD symptoms and had 37 of my adult patients who benefited from treatment complete it.
All patients had taken one or both kinds of medication and had achieved optimal treatment results with at least one of them. Optimal results were defined as those achieved by slowly increasing the dose of the medication to the point where there was definite improvement in a patient's ADD symptoms but where a higher dose either did not achieve a better effect or caused unacceptable side effects. Patients who benefited from neither amphetamines or methylphenidate were not asked to complete questionnaires.
Each item in the questionnaire contained a statement about the effect of the medications, for example, helps you focus on details, reduces hyperactivity, etc. Patients scored items on a 6 point scale where 0 indicated the medication had no effect, 3 a moderate effect, and 5 a strong effect.
Thirty seven patients completed 50 questionnaires. Twenty four had achieved optimal results after taking one type of medication: for twenty, this was AMP, for four it was MPH. These patients took the questionnaire once.
Thirteen had been treated first with one medication, failed to achieve optimal results, then were switched to the other and did achieve such results. They completed a questionnaire for both medications after achieving optimal results with the second. One patient found neither medication on its own to be optimal and was treated with both simultaneously.
The Overall Effects of the Stimulants on Patient Who
Benefited from Treatment
An analysis was first carried out on all subjects' questionnaires, regardless of which stimulant or stimulants they had taken. The symptoms found to be most affected by the stimulants were those which involved executive functioning such as concentration, focus, task initiation, and others (Table 1). A lesser beneficial effect was seen for hyperactivity and impulsivity. Changes resulting from side effects, such as loss of sleep, loss of appetite, and anxiety, were rated smaller.
Average Effect of Stimulants ( Scale: 0 = No Effect to 5 =
Strong Effect )
37 patients, 50 questionnaires
It should be kept in mind that these overall impressive results were obtained from patients who had, for the most part, benefited from using stimulants. Patients who benefited neither from AMP or MPH were not given the questionnaire. Still, a third of the questionnaires (13 of 37) were scored by patients who had not achieved an optimal result from one of the medications then had taken the other medication and had only then completed questionnaires for both medications.