About 6% — roughly 15.5 million — of American adults live with ADHD. Many aren’t diagnosed until adulthood, and even then they still may not get the treatment they need.
But if you do have adult ADHD, experts say it’s key to get professional help. “Most adults with ADHD will get better with treatment,” says Lenard Adler, MD, a psychiatrist who specializes in adult ADHD at the NYU Langone Medical Center in New York City. “There’s not one treatment that fits everyone. It may take a little trial and error to figure out the best options for you.”
Treatment for adult ADHD usually involves both medication and a type of talk therapy called cognitive behavioral therapy (CBT). “We see the best results when patients do both,” stresses Adler.
All of the treatments for adult ADHD have pros and cons, and they don’t always work for everyone. Your doctor may suggest some of the below options.
Stimulants for Adult ADHD
Stimulants are usually the first treatment for adults with ADHD. Research shows they are more effective than other drugs that are available. “They increase levels of certain brain chemicals such as dopamine and norepinephrine that help you pay attention and concentrate,” says Adler.
Stimulants are considered controlled substances, which means doctors worry there is a chance you could become addicted or misuse them. Many states don’t allow you to get more than a 30-day supply at a time. You’ll have to wait a full 30 days before you refill your prescription, too.
There are two types of stimulants available:
- Amphetamines like dextroamphetamine (Dexedrine) and lisdexamfetamine (Vyvanse). You take both by mouth.
- Methylphenidate stimulants like dexmethylphenidate (Focalin) or methylphenidate (Ritalin). Both come as pills, and methylphenidate is also available as a patch.
Both of these types of drugs work well to treat adult ADHD. Your doctor may prescribe one based on other factors, like what your health insurance will cover, says Adler. Some research suggests that methylphenidate stimulants are more effective than amphetamines to relieve core symptoms of ADHD like trouble with concentration, impulsivity, and hyperactivity. But people in one study were also more likely to stop taking methylphenidate because of side effects.
Stimulant side effects
Most people tolerate these drugs very well. But sometimes, they have side effects like:
- Dry mouth
- Trouble sleeping
- Irritability
- Loss of appetite
- Weight loss
- Headaches
- Changes in blood pressure and heart rate
About 10% of adults with ADHD stop taking these medicines because of side effects. If you do experience any of them, Adler recommends that you talk to your doctor. Side effects may go away if you switch to another type of stimulant or if you decrease the dose.
If you have risk factors for heart disease, your doctor will want to check your blood pressure and heart rate before you start these medications. They may also run a test called an electrocardiogram (EKG) to look at your heart’s electrical rhythms.
Your doctor will warn you to limit alcohol use when you take stimulants entirely. But if you do, drink after the medications have worn off, which is usually in the evening.
Should you take short-acting or long-acting stimulants?
Stimulants for ADHD come in two forms, immediate release (short-acting) or extended-release (long-acting). There are pros and cons to both.
Immediate relief. You take these stimulants as needed, and they last for around four hours. But once the effects wear off, you may experience a “crash,” which includes a big downward spike in your ability to think and concentrate.
Long-acting relief. You take these stimulants once in the morning daily. Their effects usually last six to eight hours, so you are less likely to crash during the day.
Many adults with ADHD combine both forms, says Adler. You may take an extended-release drug in the morning, then switch to an immediate-release dose in the later afternoon so you can continue to power through your day.
Other Types of ADHD Medications
Stimulants are an effective way to treat adult ADHD. But they aren’t for everyone. Your doctor may not want you to take stimulants if you have:
- Past alcohol or drug addiction
- A history of heart disease, including heart attack or stroke
- Other conditions like anxiety or depression
- Intolerable side effects
There are two different types of nonstimulant drugs doctors often use to treat ADHD:
Norepinephrine reuptake inhibitors. These include atomoxetine (Strattera) and viloxazine (Qelbree). They work on the dopamine and norepinephrine levels in your brain to decrease ADHD symptoms. Studies show that they are more effective than a placebo, but they aren’t as effective as stimulant medications to treat ADHD. Side effects include:
- Dry mouth
- Trouble sleeping
- Nausea
- Loss of appetite
- Constipation
- Erection problems
- Low libido
- Dizziness
- Sweating
- Trouble peeing
Rarely, these drugs can cause you to become manic or suicidal. Your doctor will watch you closely to make sure that you don’t show signs of either.
Antidepressants. They aren’t approved to treat adult ADHD, but doctors sometimes prescribe them off-label. They can be used alone or with stimulant medications to make them more effective.
The most commonly used antidepressant is bupropion (Wellbutrin). It usually takes several weeks to work. It’s also the first treatment if you have both depression and adult ADHD. Studies show it’s effective, but not as effective as if you take a stimulant.
Other options include tricyclic antidepressants like desipramine (Norpramin) or nortriptyline (Pamelor). These are also off-label and considered third-line meds if other meds don’t work. Your doctor may recommend these if you have another condition along with your ADHD, like depression.
ADHD and Other Coexisting Conditions
About 70% of people with adult ADHD sometimes have other mental health conditions like depression, anxiety, or a substance use disorder. Here’s how doctors often treat the two together:
Depression. Your doctor may start you on bupropion alone. It’s been shown to treat both conditions. If that doesn’t work, they may suggest that you try a stimulant and another antidepressant medication such as an SSRI like sertraline (Zoloft).
Anxiety. Your doctor may recommend a stimulant and an SSRI together. They usually start the SSRI first, and when the anxiety improves, add the stimulant. “Otherwise, a stimulant can make you too jittery,” says Adler.
Substance use disorder. If you’re in active treatment for drug or alcohol use disorder, your doctor won’t want you to start ADHD medication until you’ve finished. After that, they’ll recommend a norepinephrine reuptake inhibitor like atomoxetine or viloxazine. They don’t carry the same risk of misuse and addiction that stimulants do.
Therapy for ADHD
Therapy often goes hand in hand with ADHD. “They are like yin and yang — both treatments are most effective when they’re paired together,” says Adler.
When it comes to talk therapy for ADHD, don’t expect to lie on a couch and tell your counselor about your past life history. “Adults with ADHD respond well to a specific type of therapy, called cognitive behavioral therapy, where we teach them how to reshape negative beliefs into positive ones,” says Justin Barterian, PhD, a psychologist at the Ohio State University-Wexner Medical Center in Columbus, Ohio.
Research shows CBT works well for most adults with ADHD. Studies show it improves symptoms and increases self-esteem and overall quality of life. “Many of my patients have gone undiagnosed and untreated for much of their life, so they come into therapy fully believing that they’re incompetent,” explains Barterian. Here are some ways CBT for ADHD can help:
Reframe negative thoughts. “If you miss a work deadline, instead of thinking, ‘I’m incompetent, and I never do anything right,’ switch it to ‘how can I break a task down into manageable chunks so I get it done in time in the future,’” says Barterian. “We want to teach you to be proactive rather than be reactive and blame yourself.”
Teach ways to manage executive dysfunction. These are behaviors that disrupt your ability to manage your own thoughts and emotions. You may notice that you hyperfocus on only one thing, for example, get distracted easily, find it difficult to start tough or boring tasks. A therapist will help you focus on strategies that include:
- Task breakdown. “Big tasks are often overwhelming for adults with ADHD, which can lead to avoidance and procrastination,” explains Barterian. Your therapist can work with you to break large tasks into smaller, manageable ones.
- Ways to combat ADHD paralysis. “Sometimes, if you commit to working on a task for just five minutes, you get momentum and power through,” says Barterian.
- Time management strategies. These include time blocking and alternating between focused work intervals and quick breaks.
- Distraction delays. “When a distraction pops up, write it down and then return to your task,” advises Barterian. “After 30 minutes, take a pause and deal with it.”
- Impulse control. Since people with ADHD sometimes find it hard to control emotions, your therapist can work with you on strategies like deep breathing to help you calm down.
Unlike other forms of talk therapy, CBT for ADHD usually only involves about 15 sessions, says Adler. You’ll meet with your therapist, either virtually or in-person, once a week for about 45 minutes. They may use symptom checklists to gauge your response to treatment. “If you don’t see significant improvement after that, talk to your doctor: You may need a medication or therapist switch, or both,” he explains.
Lifestyle Strategies to Treat ADHD
There are things you can do on your own to help you better manage your ADHD while you undergo treatment. They include:
- Exercise. Research shows that adults who are physically active along with their regular ADHD treatment see more improvements in symptoms.
- Get enough sleep. “If you’re tired, it makes it even harder to concentrate,” says Barteriean.
- Eat a healthy diet. One study found that kids with ADHD who ate more fruits and vegetables showed fewer symptoms like inattention.
- Organize your home and workspace. Try to keep things in the same place. Create a place where you store important items, and use checklists and reminders as needed.
- Reduce stress. While some people with ADHD thrive during short periods of stress, too much can make it even more difficult to concentrate, says Barteriean. Mindfulness techniques like deep breathing or yoga have been shown to help adults with ADHD.
Though it can sometimes be stressful to live with adult ADHD, there are plenty of treatments available to help you. “It’s often a relief for adults who have lived with symptoms all of their lives to find relief with a combination of medication and therapy,” says Adler. “They often say, ‘why didn’t I try this earlier?’ There’s no reason if you have adult ADHD that you can’t live a full, productive, happy life.”
Show Sources
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SOURCES:
Lenard Adler, MD, psychiatrist who specializes in adult ADHD, NYU Langone Medical Center, New York City.
Justin Barterian, PhD, psychologist, Ohio State University-Wexner Medical Center, Columbus, Ohio.
CDC: “Data on ADHD in Adults | Attention-Deficit / Hyperactivity Disorder (ADHD).”
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Cleveland Clinic: “Executive Dysfunction: What It Is, Symptoms & Treatment.”
Nutritional Neuroscience: “Fruit and vegetable intake is inversely associated with severity of inattention in a pediatric population with ADHD symptoms: the MADDY Study.”
European Psychiatry: “Adult ADHD and the use of mindfulness-based practice: A pilot study.”
