Attention-deficit/hyperactivity disorder (ADHD) is treated with both stimulant and nonstimulant medications. Choosing the right medication and dose to manage the disorder is an important decision made between patient and prescriber. Like other medications, though, ADHD medications can produce side effects that range from mild discomfort to severe problems. People should understand the risks before beginning treatment.
What Are ADHD Medications?
An ADHD medication is any prescription drug used to address, reduce, and treat symptoms of ADHD. Medications for ADHD vary greatly, producing very different results.
Whatever the medicine, the goal of ADHD medications is to:1
- Improve attention and concentration
- Limit careless mistakes
- Increase organization skills
- Reducing fidgeting
- Improving patience
- Increase judgment and decision-making skills
Though psychotherapy is important, medications are at the center of ADHD treatment for adults and children. These medications tend to be separated into two categories: stimulants and nonstimulants.
Stimulants are a large group of medications. They work by regulating certain neurotransmitters in the brain to decrease impulsivity and boost attention span.
Common stimulant medications for ADHD include:2
- Adderall XR (amphetamine)
- Concerta (methylphenidate)
- Dexedrine (amphetamine)
- Focalin XR (dexmethylphenidate)
- Quillivant XR (methylphenidate)
- Ritalin (methylphenidate)
- Vyvanse (lisdexamfetamine dimesylate)
Non-stimulants are a more diverse group of medications. They include medications originally developed for blood pressure and certain antidepressants.3 The most common nonstimulant is Strattera (atomoxetine), a medication that works like an antidepressant by regulating levels of norepinephrine in the brain.
Other non-stimulant ADHD medications include:3
- Tricyclic antidepressants, such as Pamelor (nortriptyline), Tofranil (imipramine), and Norpramin (desipramine)
- Wellbutrin (bupropion)
- Effexor (venlafaxine)
- Kapvay (extended-release clonidine)
- Intuniv (extended-release guanfacine)
Clonidine and guanfacine are medications often prescribed to treat high blood pressure.
Side Effects of Stimulants
Though stimulant medications for ADHD have different names and dosing, the way they work in the brain is very similar. Because of this, they are likely to produce a consistent group of side effects involving lower appetite, nervousness, and stomach complaints.1,2
Common stimulant side effects of ADHD medication include:1,2
- Decreased appetite that can lead to unwanted weight loss in adults or poor weight gain in children
- Dry mouth
- Nausea, vomiting, and diarrhea
- Mood swings with agitation, anger, and aggression
- Increased blood pressure and heart rate
- Trouble falling asleep and staying asleep
- Anxiety and physical tension
Another side effect comes from the stimulant medication’s mechanism of action. Stimulants are designed to begin working each day after the morning’s dose is taken. It will then wear off at different times of the day depending on how long-acting the medication is designed to be.
When blood levels are low, the person could have a return of symptoms. At times, the reemerging symptoms could be more intense than their normal presentation.
Called the rebound effect, people could see their hyperactivity, attention, sleep, and appetite shift in dramatic ways as the medication leaves their system. Prescribers, parents, and patients should always work together to minimize the rebound effect, while finding a medication that provides adequate symptom relief.5
Side Effects of Non-Stimulants
People may think that using a non-stimulant will help them avoid all unwanted side effects of ADHD medication, but non-stimulants can create their own set of undesirable side effects. Still, there is plenty of overlap with all ADHD medications and their side effects. Like with other side effects, these may only last for a few weeks as the body adjusts.
Common side effects of nonstimulant ADHD medication include:1,3
- Upset stomach with nausea, vomiting, and constipation
- Worsening depression, agitation, or anxiety
- Sleep problems
- Lower appetite
- Feeling tired and fatigued
- Dry mouth
- Liver damage
- Blood pressure and heart rate increases
- Sexual dysfunction or pain while urinating
Other Changes Linked to ADHD Medication
Some of the larger issues linked to ADHD medications side effects include effects on personality, height and weight, and sleep. There is also a link between ADHD and sex for some people.
Effects on Personality
Some effects on personality will be a desired goal of the medication. If someone’s personality centers on being hyperactive, impulsive, and prone to poor decision-making, the medication should change their personality for the better, calming their hyperactivity, boosting their focus, and improving their judgment. Other effects may not be so desirable, though. When some people take ADHD medication, it may affect their moods and anxiety levels.
Medication may also spark these emotions:1,2,3
- Mood swings: the depression or “lows” may be strong enough to produce suicidal thoughts or actions
- Increased irritability, anger, and aggression: this could end in violence or harm to others
- Increased worry, anxiety, and physical tension
Some combination of these changes can significantly alter the way a person interacts with others at home, work, or school. They could change how relationships are formed and maintained. The risks are greater for people with preexisting mental health conditions like depression and anxiety. The medications may create new or exacerbate established symptoms.
Effects on Sexual Health & Functioning
Some people who use ADHD medications will note an unwanted impact on their sexual health. These seem more common with the nonstimulant medication options. One major concern is erectile dysfunction in men, either from an inability to have an erection or having too frequent erections. Women may experience other forms of sexual problems affecting functioning or desire.3
Effects on Height & Weight
About 80% of people who use stimulant medications for ADHD will experience a reduced appetite.2 The level of decreased appetite experienced can vary greatly amongst people taking stimulants. Although some people find this a welcomed result from the medication, the changed diet can cause new issues or worsen old ones.
Children who need proper nutrition to maintain their normal development may struggle to achieve height and weight expectations. When children are prescribed stimulant medications, they’re at risk for being underweight or shorter than their peers, especially if treatment continues for extended periods of time.
Adults who are already underweight or who have a history of eating disorders may want to avoid ADHD medications to preserve safety. Taking the medication after eating and changing diet to include more protein and more frequent, small snacks can prove helpful to lessen the effects.2
Effects on Sleep
Both types of medication for ADHD can affect sleep in unwanted ways. For stimulants, many people report sleeplessness and insomnia. They note having a hard time falling asleep and staying asleep throughout the night.2,4 Other medications may result in people feeling sleepy and drowsy during the day. They could note being tired after a full night’s sleep and feel an overriding sensation of fatigue.1,3
Experimenting with the dose and timing of the medications may help reduce the unwanted side effects. Like with other sleep and energy issues, a person could reduce the impact by changing diet and physical activity levels to promote desired energy during the day and healthy, restorative sleep at night.
Long Term Effects of ADHD Medication
ADHD is not a mental health condition that tends to resolve quickly. Symptoms, and the treatment used to resolve these symptoms, typically last for years. Because of this, it is imperative to recognize the risks that develop from using ADHD medications over the long-term. Fortunately, there is little evidence to support the notion that there is any long-term risk from ADHD medications.6
Some feared long term effects of ADHD medications are:6
- Lower height and weight
- Substance use problems
- Issues with brain development
In reality, there is no real risk of any of these concerns. Children using stimulants will catch up to their peers’ height and weight over time. There is no association between medication use and future substance use, and any brain changes have no negative effect on the person.6 It seems that adults and children should feel comfortable taking ADHD medications over the long-term.
ADHD Medication Side Effects in Children
Many people who use ADHD medications are children. They are not immune to certain problems with the medication, including problems with height and weight.
Side effects of ADHD medication for children include:4
- Problems with weight gain
- Delay in growing taller
- Emotional changes
ADHD Medication Side Effects in Teens
Teens with ADHD may have experience unique medication side effects. If they are using non-stimulants or antidepressants, they could face a higher risk of anxiety, aggression, and mood changes. In the worst situations, these side effects could escalate towards suicidality.
Side effects of ADHD medication in teens include:1,2,3
- Worsening tics
- Sleeping problems
ADHD Medication Side Effects in Women
Women experience the same risks of ADHD medications as men. Not only that, but they may note additional side effects that are unlikely or impossible for men to endure. Women should take special care to consult with their prescriber to learn about their unique risks.
Side effects of ADHD medications in women include:3
- Urinary tract problems
- Painful menstruation
- Hot flashes
Pregnant & Breastfeeding Women
Any person who is nursing, pregnant, or plans to become pregnant should discuss their treatment options with a medical professional. Some medications may be appropriate to start or continue through pregnancies, while others should be stopped immediately.
A study found that the rates of women taking ADHD medications during pregnancy have been rising, and although rare, there is a risk of complications and birth defects.7 More research is needed to better understand the connection between ADHD medications, pregnancy, and breastfeeding.
Potential complications and birth defects include:
- Gastroschisis: the intestines growing outside of the belly
- Omphalocele: infant’s intestines, liver, or other organs grow outside of the belly in a thin sac
- Transverse limb deficiency: part of the infant’s arm, leg, hand, or foot do not form fully
Risks of Taking ADHD Medication
Whether interested in stimulants or nonstimulants, people should seriously consider their options if they have medical or mental health issues that could increase the risk of dangerous outcomes. Improving one condition could inadvertently worsen another. A person should always explain all of their health conditions with the prescriber before arriving at a medication.
Conditions that may limit the use of ADHD medications include:2,3
- Anxiety, depression, or psychosis
- Tourette’s syndrome
- Thyroid issues
- Cardiac concerns
- Substance use disorders
- Liver problems
- Seizure disorder
Questions to Ask Your Health Team About ADHD Medication Side Effects
ADHD medications, like many other drugs used to treat a condition, may lead to unwanted side effects. You should always feel comfortable enough to ask your treatment team about the risks and benefits to each medication to maintain safety as symptoms reduce.
Questions to ask your care team about ADHD medications are:
- Would I do better with a stimulant or non-stimulant?
- How do they work?
- When will I notice the medication is working?
- How will this medication impact my overall physical and mental health?
- What side effects should I expect?
- Should I be patient with side effects or let you know which ones present?
- Are there any long-term issues that present from this medication?
- Can this medication help address any other conditions or symptoms?
- Do I have to take this medication everyday?
- What happens if I miss a dose?
Not all ADHD medications are a good fit for all people. It’s important to know the side effects of ADHD medications in order to determine your best option with your care team.