ADHD is a Medical Condition that Affects the Functioning of Neurotransmitters in the Brain.
With just a little understanding of how ADHD medications work, many people can enjoy significant improvement in their ADHD symptoms.
The symptoms of ADHD result from the brain not producing enough or utilizing the brain’s neurotransmitters efficiently, dopamine and norepinephrine.
Like any organ in the body – your eyes, pancreas, heart, or lungs – the brain is susceptible to faulty functioning. When there is an imbalance of neurotransmitters in the brain, it cannot operate effectively. This is similar to needing glasses for impaired vision, inhalers for asthma, or insulin for diabetes.
A good analogy to help understand ADHD and how ADHD medications work is what happens with the pancreas and diabetes.
In diabetes, the pancreas does not produce enough insulin. Sometimes 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 diet and foods, and increasing exercise. However, oral medication or an insulin injection is one of the most effective ways to re-balance the body’s insulin.
ADHD is similar.
Balancing the Imbalance
With ADHD, the brain is not producing or utilizing enough of the neurotransmitters dopamine or norepinephrine.
Without sufficient neurotransmitters, there is not enough to activate the brain’s frontal lobe – the area responsible for providing us with the benefit of “executive functions.” Executive functions include our ability to pay attention to things less interesting and filter out environmental stimuli or remember details (You can learn more about executive functions in my course Your Best Year Ever With ADHD or my ADHD Medications Course).
For my son, and many others, confirmation of the need for more active neurotransmitters in his brain came when he started taking ADHD medication, like Ritalin or Adderall, which is designed and formulated to specifically and only activate specific neurotransmitters.
Better Grades in Six Weeks
The difference when my son took the medication was like night and day. Finally, he could hold his attention on reading, and his grade level increased by three grades in six weeks! He wanted to read; the problem was not his motivation but that his brain could not focus on the task because he did not have enough dopamine to help him keep his attention.
ADHD is similar to someone with impaired vision and needs glasses. If you have poor eyesight, you cannot simply force yourself to make your eyes focus. We don’t hesitate to see an eye specialist and, if found needing, provide and wear corrective lenses. Interestingly, we never worry that wearing glasses at a young age will weaken our eyesight later. Imagine if we believed impaired vision should not be corrected or optional!
What we know about people not getting enough dopamine and other neurotransmitters to their frontal lobe is that they often struggle academically, personally, and professionally. They struggle with low self-esteem and lack confidence and are more likely to seek out alternative ways to self-medicate, trying to get their brain to focus or calm down.
When a person takes a stimulant medication such as Ritalin or Adderall that targets specific neurotransmitters, it helps to activate dopamine or norepinephrine so it can be utilized by the brain more effectively.
What ADHD medications do is specifically “simulate” the neurotransmitters in the brain.
How Dopamine Works
Stimulating the dopamine receptors in the brain increases the dopamine available. With an increased dopamine level, the brain is now better balanced and ready to complete the tasks of the day!
Even though this post is about how ADHD medications work, they are just one “tool” available to help you better manage ADHD symptoms. And, of course, medications need to be properly prescribed by your physician.
The prescribed medications need to be the right medication at the correct dose, delivered at the right time, and taken consistently to get maximum benefits with minimal side effects.
And medication is not the whole answer.
ADHD is a 24/7 disorder. While medications work fairly quickly, the best solution is a comprehensive approach that combines medicine with other “tools”—other tools such as using a planner system effectively, creating systems and structures to follow, etc.
Comments? I love reading your comments and replying! Please feel free to leave your comments below.
I hope you enjoyed this article. Here are three more all about managing ADHD in your loved one:
What 10,000 Steps and ADHD Have in Common
Your Top Three Questions About ADHD Medication Answered
And if you’re looking for more in-depth knowledge about ADHD, check out my ADHD Medication Answers series!
This is very helpful to me. I am starting a support group for people with or associated with ADHD. The person who is partnering with me (or me with her??) has a real negative view on meds for ADHD and I have a positive view (experience) with these especially Ritalin. This gives me some back up. I certainly know more than meds are required but she tosses out the meds when so many parents feel they’ve been saved by Ritalin..etc.
Thanks for this article.
My son is 21 and has ADD. I’m just wondering if you’ve started you support group yet and if so how is it going? My son is of a mind set that he can make it without medication anymore.
Instead of feeling we’re being insulted when someone tells us what is lacking in the dopamine department, let’s think about how blessed we are to have these medications which can help most of us.
When I look back at my family history and recognize that the alcoholism, rampant anxiety and depression were caused by undiagnosed mental illnesses, which today can be treated at least to some extent, I feel so sorry for those people.
I know what it was like to have undiagnosed ADHD, and how much of a failure I have felt in my 50 yr life…how much worse for those who always thought they were just bad, weak people?
Hi Patricia! I am glad you found the blog post helpful. I would love to hear more about the support group your are starting!
Medications are just one “tool” available to help better manage ADHD symptoms. And…it needs to be the right medication at the right dose…at the right time and taken consistently to get maximum benefits with minimal side effects. This seems to be why most people have not had a good experience with medications…and you are right…medication is not the whole answer. For one most only work for part of the day and ADHD is a 24/7 disorder. It is most useful for people to combine medication with other “tools” such as learning to use a planner system effectively for themselves…create systems and structures to follow, etc. Thanks again for your sharing your thoughts…let me know more about your group and keep in touch! ~Laurie
I understand and appreciate the information…I just can’t help but wonder what are the long term effects this has on the brain. I know I am in true need of this type med…it just scares me. I do also come from a family of All Natural believers. They poo-poo it. I just want to get better.
Hi Debbie! Stimulant medications are one of the longest and most studied types of medicaitions. They have been used in treating ADHD type symptoms for over 50 years and studied over and over again due to the high degree of concern surrounding their use. Very few substances, manufactured or “natural” have been studied over generations and as rigorously to determine their positive benefits and minimize negative side effects…short or long term. I am always amazed that we wouldn’t think of not giving insulin to someone with diabetes or offer glasses to someone who has vision problems…both “un natural” solutions to these very natural disorders. But for some reason, we think that we can just will our brains to work differently, produce neurotransmitters while we struggle. Your thoughts?
This is very good information, thanks for offering it to everyone. I am a college student studying Neuroscience and would just add the following (it may help people when trying to maneuver through medications–I know that when I was diagnosed this was all very interesting to me):
Some medications, such as Adderall actually produce increased levels of brain dopamine by causing the neurons that synthesize this neurotransmitter to release it. Other medications such as Methylphenidate (Ritalin, other generics), produce their effects not by causing neurons to expel more neurotransmitter, but by keeping it around in the brain longer (i.e. by blocking the breakdown of Dopamine). Some studies have also shown that amphetamine-derived medications such as Adderall also have this effect of blocking Dopamine breakdown in addition to causing extra release of the neurotransmitter. Hence, its important to know a little about the drug you’re going to try (and discuss this with your doctor) in order to determine what would be the proper dose–since, clearly, 5mg of Ritalin and 5mg of Adderall are not the same thing!
So is determining which medication works a process of trial and error?
Danly, Thanks for your comment…by reading your post you obviously have a great handle on the way ADHD medication works and will be a great asset to the neuroscience field. I hope you will stay active in the treatment of ADHD…you are spot on!!!! Keep in touch. ~ Laurie
I question the idea that folks with add have a defective brain. It is my understanding that there is no evidence of dopamine or other deficiency in adhd or add brains, and that this idea comes from the drug company marketing. See “Anatomy of an epidemic” by Whitaker. Can you share more about your source for this idea of a dopamine deficiency please Laurie?
Hi Cassandra. I always love questions like this because it gives us a great opportunity to continue the conversation. It’s also timely, since one such study “came across my computer” today! The understanding that the symptoms of ADHD are partially caused by the “inefficient” or “insufficient” production of Dopamine in the brain is science based, not just an idea.
The study I saw today that you might be interested in is called, “Gene Variants Predict Response to ADHD Treatment”. It is in the J Am Acad Child Adolesc Psychiatry. 2011;50:1129-1139. Another study is in the journal, Neuropsychopharmacology (2002) 27 607-619.10.1038/S0893-133X(02)00315-9, called “Dopaminergic System Genes in ADHD: Toward a Biological Hypothesis”.
I agree…”defective” is a harsh word and has a very negative flavor. I think the terms “ineffective” or “insufficient” are more appropriate when describing the way the ADHD brain works. Maybe it is only semantics…but I think it leaves a very different impression when we frame it in this way.
Historically, it is common that a pharmacological treatment will be discovered or created for one disorder, and then a correlating observation occurs that the medication has positive benefits for other symptoms, totally unexpected. Ritalin was one of these pharmacological treatments. Ritalin was first developed in 1944 by the Ciba Corporation and used to treat chronic fatigue, depression and narcolepsy. “ADHD” or at least what we recognize today as the symptoms of ADHD, had been around for generations before the release Ritalin. Considering statistics it would have been much more profitable for Ciba pharmaceuticals to pursue marketing Ritalin for depression or low mood since it’s estimated that more people suffer from depression than ADHD.
Thanks for the recommendation of the article. I have not read it and will look forward to reading about different perspectives.
From a non-technical, users, standpoint I can contribute with my experiences. Last, Feb, after serious struggles with anxiety and depression, I started on Celexa. I helped, but after 6 months I had a feeling it could get better – I wasn’t happy. Switched to Zoloft; much better.
Now, I realized my focus and motivation needed a lot of work. Did some research and recognized the need for dopamine. Got on a small 10-20 mg daily dosage, and it has made a world of difference. Still need to work on my discipline traits so as to get better at planning, and resisting the infinite distractions of the internet.
I’m 60 and expect to be on these medications until I punch-out. Thank God for modern pharmaceuticals.
PS: Tried Straterra – scary stuff!!!
Hi Gary! Thanks for your comment and sharing your story! It is all too common that ADHD is last to be considered. Like you, many struggle for years with anxiety and depression, not aware that ADHD is the underlying cause of these other disorders. Medication is not for everyone and I can tell that you were very conscioutions about taking any medication. We are lucky to live in an era when we have multiple choices for treatment. PS If you are still struggling with distractability and having difficulty ignoring “the call of the internet” you may want to share these symmptoms with your doctor and discuss adjusting medication. Keep in touch..let me know how things are going. Sincerely, Laurie
Love the article. I had to adjust the dosage twice of Straterra because I became unemotional on the recommended daily dosage. Fortunately my neurologist listened and was willing to fine tune the medication to the way my body worked. Thank you Laurie for a good article. I was also helped to understand and fine tune by Dr. Amen’s book, Change Your Brain. I have alcoholism in my family history which affected the impulsivity and compulsivity issues of ADHD in my brain so both needed to be treated.
Thank you for your comment. I am glad you enjoyed the article and have taken the steps to fine tune your medication so that it works best for you. Keep in touch.
Wow! Thank you for this write up on ADHD stimulants, Laurie. I must admit that I’ve had this webpage open for about 20 minutes with the intention of reading it after I surfed other pages (and got distracted with other pages as well).
The analogy you gave painted a much clearer picture for me than what others have verbally tried to teach me in the past.
Currently I have been “off” medication this week due to a severe head cold, and have been made to realise (once again) how stimulants can benefit my personal relationship. Although it can be challenging for me to keep to my prescriptions, I am fully aware how my ADHD symptoms can affects my life and those around me.
HI Shelly! Thanks for your comment! I am glad you liked the article and found the analogy helpful. Yep…the hardest thing about ADHD medications is often remembering to take them! Keep in touch! ~Laurie Dupar
My daughter was recently diagnosed with hyperactivity/impulsivity adhd. She is twice exceptional. My husband and I are currently trying to research medication. I want to point out our “cons” in hopes of someone clarifying them for us or pointing us in the direction of some good literature. I keep hearing the use of medication for adhd being compared to insulin for a diabetic. With a diabetic, you can check their blood sugar, see an actual number, and justify the use of insulin and the proper dosage. I have a had time with the idea of medicating my child because there is no test to prove to me she is in need. If someone could show me that my child was actually lacking dopamine or had a problem with absorption, I would be more comfortable with the idea of medicating her. I just feel like there is not enough proof. My other concern is this… At her age her brain is still developing. Is there enough research to prove that these drugs are not effecting her long term? I just don’t want to hurt her. I am scared and new to all of this. If anyone has any advice or stories, I would love to hear. My husband and I have been playing devils advocate trying to make sure we have answered every possible argument. Thanks in advance.
HI Jessica! Thanks for your comment and thoughtful questions. We do live in an age when we have come to expect to see physical “evidence” of a diagnoses. We are blessed that science has made possible for us to “see” many things concretely that for generations we would treat based on physical symptoms or behavior. For instance, before we had the ability to test blood sugar or urine for ketones, diabetes was detected through behaviors such as frequent urination, thirst or fruity odor on peoples breath. Doctors still diagnose many conditions based solely on behavior, either reported or observed. For instance doctors determine the difference between a simple head cold or the flu, based on your overall symptoms. I think it is easy to forget that medical or mental disorders have been around and have been treated long before we understood everything about them. Having said that, I do hope in my lifetime that there is a “physical” test for disorders such as depression, anxiety, or ADHD. It will make it easier for people to believe it exists, I think. It is especially difficult to do any direct measurement of neurotransmitter in the brain because the brain protects itself so well with it’s “blood brain barrier”. In the meantime, the diagnosis is based on behaviors, personal history and reports of our internal experience to our diagnosticians. LIke you, most people, inluding myself, struggled with the thought of mediating their child with something that might not be necessary. I spent years doing anything I could to help my child succeed without medication(including a diet consisting of about 5 staples) and only resorted to trying a small dose of stimulant in desperation as I saw him withdraw socially, emotionally and academically. As parents are job is to keep our kids safe and your hesitation is completely understood by so many parents. For my son, and for many, the evidence of the need for more dopamine in his brain came when he started taking medication, like Ritalin or Adderall, that specifically and only stimulates that neurotransmitter. For him, and for many, the difference was like night and day. Finally he was able to hold his attention on reading and his grade level increased 3 grades in six weeks. He wanted to read, his brain was just not able to focus on it. Similar to someone who needs glasses. We can’t will them to focus, and we certainly don’t hesitate to give them glasses worrying that wearing glasses at a young age will weaken their eyesight later. Imagain if we had that belief! But it is very much the same. What we know about kids with ADHD that are not getting enough dopamine to their frontal lobe, is that they more often than not struggle in school, academically, socially or both, have low self-esteem and are more likely to seek out alternative ways to self-medicate, trying to get their brain to focus or calm down. Most undiagnosed and struggling kids with ADHD will try and find or do something to get their dopamine going if their bodies are not getting enough on it’s own. I also encourage people to learn as much as possible about ADHD medications so you can make the right choice for you and your child. Remember also, that using medication as a management strategy now, does not set in stone the need for your child to take the medication for the rest of her life. YOU are at choice. With regards to her developing brain. The stimulant medications actually increase the brains activity and allow our brain the use of more neurons…which is good in the long term. Keep in touch, I would love to hear from you again. Sincerely,Laurie
We are also in a similar situation right now. I see your post was from a few tear back. Did you make any final decisions?
I have similar concerns to Jessica’s. In the final analysis, ADHD is not a diagnosis but a statistical categorization of the person as “too distracted”. If a person is in 99.99 percentile of the population he may be categorized has having ADHD or may be that the threshold is 90.00 percentile. In the second case 10% of the population will be categorized as affected by ADHD which would be a huge number. In future generations to come, people will value concentration so much that a person who is average today will be categorized as “abnormally distracted” by then. Secondly, I wonder if drugs like Ritalin have regressive effect of dependence. Because of the positive feedback signals, brain cells would think they have enough dopamine so let me reduce my own manufacturing activity a little. In the long run the brain might stop manufacturing any dopamine at all.
Hi Panna! Thank you for your comment. As far as I know, there is no statistical quota in the diagnosis of ADHD. However, you are right that we are approaching the reality that approximately 8% of the world’s population does have symmptoms consistant to what we currently call ADHD. Instead, the diagnosis is based on a persons level of impairment in at least six or more categories that would be consistent for others at their age level. Whether we like it or not, we have evolved to a social style where the ability to concentrate for longer periods of time, to think linearly and plan is valued highly in most of our academic and professional worlds. What a great question about the downregulation of dopamine receptors! Research seems to show that there is an initial down regulation. Sort of scary since the initial challenge with ADHD is related to having an insufficient or ineffecient amount of dopamine getting to the frontal lobe to begin with! This is often why there is an initial adjustment of medication dose needed to find the lowest effective dose. I don’t know for sure, but based on observations of people who decided to stop using ADHD medications for whatever reason typically returned to previous executive functioning levels. Thanks again for your great comment and questions…love to have a chance to ponder the answers!
I have just been diagnosed w add. I have petit_mal epilepsy. What drugs would be good? My psychiatrist knows about my epilepsy, but has nit given me an Rx yet. Do you know any folks w/ epilepsy who are doing well on a drug?
Hi Maggie! Thank you for your comment. Having been diagnosed with petit_mal epilepsy I highly encourage you to work closely with your psychiatrist to find the best medication for you. Whatever your psychiatrist recommends, I encourage you to keep close records of the effectiveness of your medication. Feel free to download my medcation log at https://iactcenter.com/medicationlog/
Keep in touch. Let me know how things are going. ~Laurie Dupar
Very informative. I have been taking medication for some time now but this explination says everything. Some times we need a good way to explain it to our families that dont think this is real. Really need your coaching since Iam newly diognosed (last dec)at age 38 and am still trying to figure things out. After my son was diognosed it explained a lot about my shortfalls in life. Now I want to get a workable system for myself as well as my 8 year old son. I also have a 21 month old daughter and already see some of the signs in her. Really need help… Also I really enjoyed your presentation at the last sacramento CHADD meeting. 🙂
HI Kathy! Thank you for your comment! I am glad that you found the article helpful in explaining medications. I would love to be able to talk with you about the possibility of coaching. Please feel free to contact me through my website. I hope to hear from you soon. ~Laurie Dupar
My son was diagnosed with ADHD at 5 years old. He took Adderall at its max dose for the severity of his ADHD until he was 16. Because of financial problems and no insurance, I could not provide him with the medication. But, as a parent you do what you have to do, so we left to my home country, my son continued studying, he graduated from high school with both diplomas; my home country and USA diploma. His schooling overseas was in English except one class of Spanish every day. Today he is 18 years old; He took the national high school test in my home country, in Spanish with excellent results, applied to college and was accepted in all. Now he is studying in Spanish to become a mechatronic engineer. Yes, he still has issues with executive functions. He still is not taking medication. But the dedication and persistence during the years of treatment (multimodal) taught him that he had to advocate for himself.
I want to point out two things:
-Studies about children with ADHD in situations like my son have not been done? It will be interesting to know about.
– In USA, you are accepted to college based on your GPA among other considerations. But, these kids have always struggle at school; therefore school grades can be somehow subjective. I observed that in other countries you put more emphasis in some of the strengths of the student toward the career of choice. Something to think about……
I can certainly understand the concerns of parents being advised to give their children psychotropic drugs, but I see the issue from the other side. I am ADD inattentive and was not diagnosed as a child. I am 66 now and was only diagnosed 4 years ago. It was simply shocking, stunning, it explained my life, all the troubles and disappointments I had lived through and still experience daily. Grief and anger were my most common feelings. I wish I had been diagnosed and treated earlier.
One last thing. I have learned that what I have is not a disorder, it’s simply a difference. Yes, while I’m emotional and easily distracted, I’m also really smart, funny and creative. I think of things, make connections, others don’t. That’s the positive side of my difference and is not something I would ever give up.
Another thing (Hey, I’ve got ADD, remember), I tried stimulants a few years ago and they helped, but, unfortunately, side effects (chest pains) made me give them up. I wish I could take them. But stimulants are only one way to deal with ADD, the others being external supports (calendars, coaches, friends, family) and the other being internal (learning mindfulness). I’m working on those.
Best wishes to all.
I have been diagnosed with ADHD and am on 30mg of Adderall IR 3X a day, so 90mg/day total. When I first started taking this medication, it really seemed to help me function like I haven’t been able to in a very long time. I was able to focus and get things done at work more quickly, and it also helped with my depression quite a bit. I’ve only been on this medication for about three months, and I’m at the maximum dosage, but it doesn’t seem to be working quite as well as it used to. Every time I take it, I feel extremely drowsy with no energy, and I lack motivation/focus again. Also, my depression seems to be coming back. Should I switch medications, or is there something I should do to help the Adderall be more effective? What other medications do you recommend?
I have two sons, both recently diagnosed with ADHD-inattentive subset. Both are on medication, and I have seen vast improvement in overall mood, impulse control and school behavior when they are on medication. They are both functioning better, and self-esteem has risen. Here’s what confuses me about the medication: if the ADHD brain isn’t manufacturing enough of a particular neurotransmitter, and medication helps balance this out, why do they try to “wean” you off meds when you become an adult? To use your analogy — no insulin-dependent diabetic is going to be weaned off insulin. It is a lifelong journey. Yet, I’m being told by pediatricians that once they learn certain skills relating to executive function, they won’t need medication anymore. Since a big piece of ADHD for both my children seems to be mood regulation (which is not an executive function skill), how is this justified?