Comparing Adderall vs. Ritalin: Treatment Options for Adult ADHD
Comparing Adderall vs. Ritalin: Treatment Options for Adult ADHD
Attention deficit hyperactivity disorder (ADHD) is a disorder that can greatly affect the functionality of an individual carrying the diagnosis. According to The Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition (DSM-5), ADHD is considered a neurodevelopmental disorder. This means that it manifests early in development (often before grade school) and produces impairments to a person’s social, academic, personal, or occupational functioning. ADHD impairs one’s level of inattention, disorganization, and/or hyperactivity-impulsivity. Having impairments in these regions leads to an individual having trouble with staying on task, difficulty waiting, intrusiveness, fidgeting, and seeming not to listen at levels that are inconsistent with age or developmental level. Having such difficulties as a child can create difficulties, yet an important consideration is how having ADHD can affect an adult trying to provide for themselves and their families. According to Boland et al. (2022) the predominant symptoms of ADHD noted carrying through into adulthood are inattention and impulsivity. Untreated ADHD can affect an individual’s ability to keep a job, accomplish necessary chores in the home, and/or even interact with peers. Self-esteem is often affected (Boland et al., 2022). It is the focus of this article to address some of the different treatment options available to adults with ADHD (American Psychiatric Association, 2013).
Adderall and Ritalin are two common medications that are used to treat ADHD. They are both classified as stimulants and dopamine, norepinephrine reuptake inhibitor and releaser (DN-RIRe) agents. Adderall, known generically as amphetamine-dextroamphetamine, is a medication that increases the availability of norepinephrine and dopamine actions by blocking their reuptake and inhibiting their release. Enhancing the effects of dopamine and norepinephrine has been shown to improve attention, concentration, executive function, wakefulness, hyperactivity, depression, and fatigue. Ritalin, known generically as methylphenidate, acts in a similar fashion by both releasing and inhibiting the reuptake of dopamine and norepinephrine. It is important to determine which medication is the best choice for a given patient based upon a patient’s unique traits and lifestyle (Stahl, 2021).
One might ask - What is the difference between Adderall and Ritalin? The predominant difference is that amphetamine-based medications are considered to be twice as potent as methylphenidate-based medications. The increase in potency can increase the likelihood of efficacy but can also increase the likelihood of adverse effects. Faraone et al. (2002) found that for a single morning dose of Adderall, patients would experience clinical improvement throughout an entire day, whereas patients who took methylphenidate would require two doses to achieve a similar level of functioning. Adverse effects can include insomnia, headache, nervousness, irritability, tremor, dizziness, anorexia, constipation, and dry mouth (Stahl, 2021).
Adderall and Ritalin both come in several forms, and a key determinant for choosing the best form is to know the medication’s half-life. According to Wilson et al. (2013), the half-life of a drug is the time required for the concentration of a drug to decrease by 50% in the body. It can also represent the time necessary to reach steady state or decline from steady state after a change. In other words, half-life is the amount of time a patient has after taking a medication until it drops to half-strength and begins to lose its optimal effect on the patient’s brain and body. Half-life can be affected by a disease state or the age of the drug user. For some patients, a medication with a longer half-life might be ideal because that patient needs consistent concentration for a long period of time, such as if they have a career where they need to have optimal concentration for long hours. With a longer half-life, on has less peaks and troughs throughout the day and can maintain a comfortable medication level without having to take multiple pills throughout the day. For other patients, a medication with a shorter half-life could prove optimal because the patient may feel that they only need bursts of functionality during specific parts of her day or week. These various facets of a patient’s life need to be considered when a provider selects the best formulation.
Different Forms Available
Adderall comes in several forms which each have unique benefits and drawbacks. Adderall, Adderall XR, Adzenys-XR, and Mydayis will be the four foci of comparison for the purposes of this article.
Adderall is also sometimes known as Adderall IR. There are several abbreviations from the medical community noted above. XR stands for extended release, IR stands for immediate release, and ODT stands for oral disintegrating tablet. Adderall, or Adderall IR, has a half-life of 4-6 hours. This means that, to achieve optimal effect, the patient would want to take a dose upon waking and take another dose every 4-6 hours throughout the day, taking the last one 6 or more hours before bed to ensure that the medication has dropped to half strength or less by the time the patient is ready to go to sleep. Adderall, a stimulant medication, is known for promoting wakefulness and can therefore lead to insomnia if taken in conjunction with bedtime. Adderall XR has a half-life of 8-10 hours, meaning that, due to the extended-release formulation, it can last for a longer period of time. Adzenys XR-ODT has a half-life of 8-10 hours as well, but because it is an oral disintegrating tablet, it can bypass the first pass effect of the liver. This means that when the drug is absorbed within the mouth, it enters the bloodstream directly. This can lead to a more rapid onset of action and reduce the amount of side-effect causing metabolites that the liver might form during the first pass of a medication through its system (Grother et al., 2017). And, finally, Mydayis has a half-life of 12-16 hours. This makes Mydayis an ideal formulation for those who benefit best from an amphetamine-based selection who require consistent coverage for a lengthy amount of time.
Ritalin comes in several forms as well. Methylphenidate formulations are considered highly effective with relatively few adverse effects (Boland et al., 2022). Ritalin, Ritalin LA (long-acting), Concerta, and Contempla XR-ODT will be the four foci of comparison for the purposes of this article.
Ritalin has a half-life of 3-4 hours, meaning it will require frequent re-dosing throughout the day to maintain optimal focus. This could be of benefit for patients who want improvement in their focus in small bursts with minimal associated side-effects. For days where a patient only needs to achieve optimal functioning for a few hours during their day, this could prove a valuable resource. Ritalin LA, by comparison, has a half-life of 6-8 hours, doubling its window of efficacy. Concerta and Contempla XR-ODT have the same half-life (8-10 hours) with the primary difference being that Contempla XR-ODT is an orally dissolving tablet. This, again, means that the medication will be absorbed more quickly and with less metabolites produced. This could prove very helpful for an older patient with known liver issues who requires coverage for a significant portion of her day (National Resource on ADHD, 2018).
Overall, adults with ADHD have multiple proven treatment options that could allow for the management of their disorder. Pharmacotherapy is a proven and effective approach to treating adult ADHD, and each of the agents above are first-line choices that a provider might use to help a patient (Boland et al., 2022). It is important for those with adult ADHD to manage their symptoms so that they do not experience occupational or social disadvantages. Adults with ADHD demonstrate higher rates of mood disorders, anxiety disorders, and substance use disorders compared with the general population (Boland et al., 2022). By selecting a formulation that best fits a given patient’s needs, the patient can achieve optimal functioning. That optimal functioning could prove crucial to achieving success and fulfillment in one’s occupational life, social life, and beyond.
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