ADHD, what medications are actually useful?

ADHD is primarily a problem getting the enough Dopamine in your prefrontal cortex so that it can work efficiently. Most “natural” dopamine “aids” don’t do anything for ADHD. If they did, they’d be medicine. However, there are some diet and exercise things we can look at to minimise ADHD symptoms and ensure we aren’t making ADHD worse before we look at medication. It is important to note, that if the non-medication solutions work, you don’t have ADHD, you have a different problem. For ADHD, you really do need ADHD Medications.

Understanding the natural process for making dopamine, it is important to balance diet and possibly exercise. The precursor ingredient for Dopamine is tyrosine. To extract it from protein takes Oestradiol (E2), and Vitamin B6. Oestradiol is a break down ingredient from your primary sex hormones. Sex hormones are made from LDL cholesterol. To convert Tyrosine all the way into Dopamine in the brain requires Ferritin, more Vitamin B6 and Vitamin C. Oestradiol regulates how much Dopamine you make and release (more oestradiol, more Dopamine). Low oestradiol means low dopamine. Any of these can be a bottle neck for your brain making enough Dopamine. Ensuring you have enough of the basic ingredient in your daily diet is essential to avoid that happening.

Be careful about when you get your Vit C. Natural non-sour Vit C in your average meal is fine. Concentrated Vit C, such as a tablet, fortified blackcurrant juice or citrus fruit, is enough to disable your ability to metabolise many other medications for around 2 hours.

Let us take a look at ADHD Medications. Tier 1 medication is Ampehtamine and Methylphenidate. Other edications are considered to be Tier 2, 3 or even 4. I won’t define those other tiers. Often GP’s can prescribe the other tiers.

Amphetamine and Sertraline increase the homeostatic level that your brain is trying to make, so long as it has the base ingredients. That is, if your brain isn’t making enough according to that level, it tries to make more. When it hits that level, it stops producing Dopamine.

Amphetamine and methylphenidate (Ritalin) act as DRI, Dopamine Reuptake Inhibitor. This is quasi understood, but in a nutshell, not as much used Dopamine is cleared away and the number of Dopamine receptors needed to trigger the signal is reduced, reducing how much Dopamine needs to be used to do the same job. Effectively making the Dopamine more efficient, – that is, less goes further.

About 2/3 of people find that exercise helps raise background adrenaline, which helps reduce anxiety and depression, and also reduces the start up energy requirements for a task. Similar to the chemistry concept of activation energy. For the other 1/3, you just get tired. Effectively, exercise reduces some of the symptoms of ADHD.

Caffeine and caffeine clones such as taurine, ginseng and guarana, don’t directly increase dopamine. However, they do stimulate additional heart beats per minute, and increase blood pressure, which indirectly triggers your brain to release additional adrenaline and noradrenaline, which then helps with that activation energy. The sugar can act as a dopamine clone, facilitating thoughts and actions, easing mood. In the absence of supplied sugar, your body increases the BSL to match the adrenaline’s needs that the caffeine et al triggered.

There are three more medications worth mentioning here as helpful to ADHD. If a person experiences increased anxiety and or aggression due to amphetamine / methylphenidate, then clonidine is your friend. It will reduce your systems sudden adrenaline lift, dulling the anxiety and anger responses back to a manageable level. It has a secondary effect that increases available dopamine in the prefrontal cortex. Guanfacine does a similar and more targeted action. These can be taken in the absence of the direct dopamine medications and still have a positive effect (great for PTSD).

Agomelatine is quite helpful too. It can help people to sleep, and the following day indirectly increases their dopamine. It has a targeted serotonin benefit, but not a sweeping one (versus SSRI, which is all serotonin (ish) experiences reuptake inhibition). Sertraline has a secondary effect of increasing dopamine for the 16 hours after you take it. Good for helping the afternoon/evening.

Lastly, very important to mention: antipsychotics block dopamine receptors. This is useful for people who struggles with psychosis too. You want that D2 dopamine receptor blocked or dulled – but you don’t want the rest done too! Antipsychotics will trump the other medications trying to help your ADHD, by blocking the target that the Dopamine goes to. Some antipsychotics are very targeted and allow other Dopamine receptors free access to Dopamine (not blocked), while blocking D2 and at least one other Dopamine receptor. ADHDers taking antipsychotics need to be careful in the selection of antipsychotics.