Treatment for Adult ADHD: Medication, Therapy, & Self-Help Strategies

Medication For Adult ADHD

Adult ADHD medications are common, effective, and typically covered by insurance. You will need a prescription from a qualified provider who can prescribe medications. While there is no cure for ADHD, medication is typically the first-line of treatment to help manage ADHD symptoms and signs, increase attention, and reduce hyperactivity or impulsivity.¹

Stephen V. Faraone, PhD and Vice Chair of Research of Psychiatry and Behavioral Sciences at Upstate Medical University, adds that, “Guidelines indicate medication as the first approach to treatment. When that is not sufficient, cognitive behavior therapy (CBT) should be added. Talk therapies (other than CBT), exercise and support groups can be very helpful for improving a person’s well being, but they are unlikely to reduce symptoms of ADHD.”

Stimulants

Adults typically tolerate stimulants well and they are considered a safe treatment option by most providers. Like with any medication, there is always a risk of adverse effects, but the use of stimulants is well-studied and broadly accepted as a first-line of treatment by providers. Stimulants are prescribed to help those struggling with common symptoms like attention, performance, and memory.

Commonly prescribed stimulants for ADHD include:¹

• Ritalin or Concerta (methylphenidate)
• Focalin (dexmethylphenidate)
• Dexedrine (dextroamphetamine sulfate)
• Mixed amphetamine salts like Adderall (amphetamine/dextroamphetamine) and Vyvanse (lisdexamfetamine dimesylate, or LDX).

There are also other forms of stimulant medications like liquid, sprinkle, tablet, capsule or patch.¹ With these medications, you may notice a stark difference in functioning should you miss a dose due to how fast-acting these types of drugs generally are.

While stimulants are effective, they can be misused, intentionally or unintentionally. For people who take stimulants and do not have ADHD, they may experience a euphoric-like high or intense increase in motivation.² There is some stigma associated with the use of stimulant medication due to historical misuse; however, when used as intended, this type of medication can be life-changing for those struggling with ADHD symptoms as an adult.

Some stimulants like Adderall may also affect women with ADHD differently than men with ADHD, so it’s always helpful to be aware of medication options and potential ADHD medication side effects prior to starting a new medication.

Non-stimulants

Certain healthcare providers and individuals may choose not to use a stimulant medication due to adverse effects, comorbid issues, potential for abuse, or simply personal preference. It is estimated as little as 10%-30% of all children and adults with ADHD either do not respond to or do not tolerate stimulants well.³

Common non-stimulant ADHD medications include:³

• Strattera (atomoxetine)
• Intuniv (guanfacine)
• Qelbree (viloxazine)
• Kapvay (clonidine)

Some of the non-stimulant medications that are commonly used for attention deficit/hyperactivity disorder (ADHD) are intended for use with ADHD (such as guanfacine), whereas others were developed for other uses but have been shown to be effective for ADHD, like clonidine, which is commonly used to treat high blood pressure.³

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants (TCAs) are generally not a first line of treatment for ADHD because of potential adverse effects, but they can be helpful when stimulants vs. non-stimulants have not been helpful.^{3, 4, 5}

Adults with ADHD can exhibit some symptoms that look like depression, anxiety, or even a more serious mood or personality disorder disorder. Shared symptoms might be impulsivity, changes in mood, angry outbursts, or feelings of boredom; however, the impulsivity component of ADHD is typically short-lived and not as intense or risky for those with other psychiatric disorders.⁴

Other Medications

Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressants and have been used to treat ADHD. These are typically not prescribed because of known, dangerous interactions with certain foods and and adverse effects like weight gain, sexual dysfunction, and hypertension.⁵ Your doctor may prescribe a MAOI or other type of antidepressant if you are resistant to other forms of treatment.

6 Questions to Ask Before Beginning Adult ADHD Medication

It’s good to bring a list of important questions to ask your provider before taking any medication. If you’ve been diagnosed with ADHD, it’s important to communicate with your provider about whether you have any other mental health or physical health issues or concerns (diagnosed or not). It could take more than one try with medications, and your doctor may switch medications if you have serious adverse effects.

Faraone also notes that, “There is no total cure for adult ADHD. Treatments help a lot with the management of symptoms and improve quality of life but some residual problems typically remain.”

Here are six questions to ask your doctor/prescriber before beginning a new medication:

1. What side effects are the least and most common?
2. What is the likelihood this medication will produce an adverse effect?
3. How do I know if the medication is helping?
4. How long does it take to see results?
5. What should I do if I think I am experiencing an adverse side effect?
6. What can we do if this medication doesn’t help?

Most Common & Effective Therapies For Adult ADHD

The most common and effective therapies for adults living with ADHD are cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and acceptance and commitment therapy (ACT). Working with a psychotherapist is a great way to look at what you can and cannot control on your own, with or without the aid of medications. Psychotherapy is more intensive and specific to individual needs than what prescribing doctors can do with ADHD medications.

That said, Faraone suggests speaking with your doctor about their recommendation for therapy if they don’t also prescribe medication for treatment. He suggests saying, “I heard that medications for ADHD were the first line treatment, why did you only prescribe therapy?”

For adults with ADHD and comorbid mental health issues like ADHD depression, anxiety, PTSD, or mood disorders, psychotherapy is typically recommended in addition to medications as they are not a simple “fix-all.” It’s important to find a knowledgeable therapist who you trust. Sometimes people go into therapy thinking they want to address one issue but find there’s a lot to examine in different areas of their lives.

Cognitive Behavioral Therapy (CBT)

CBT analyzes the relationship between thoughts, emotions, and behaviors. It’s a common, evidence-based talk therapy that typically aims to help people identify automatic negative thoughts and “thinking mistakes” to improve mood. CBT can help those with ADHD develop skills to improve focus, planning/organizing, and self-image by practicing self-control.⁶

Length of CBT treatment will vary based on past experience in therapy, level of management of current ADHD symptoms, and other factors, but you can expect at least six sessions or more, depending on specific needs.

Dialectical Behavioral Therapy (DBT)

DBT is a skills-based therapy designed to help those who struggle with self-soothing. A hallmark of DBT includes mindfulness and distress tolerance, which have more weight in this type of therapy than other modalities. It’s highly structured and teaches people to use specific skills to alleviate symptoms affecting their ability to organize, plan, self-motivate, regulate emotions, and examine interpersonal effectiveness.⁷

For someone who struggles with conflict in their relationship due to ADHD symptoms, DBT could help them take better control over their impulses and examine what their words or body language communicate to their partner. DBT can help anyone with or without the aid of medications, but true DBT is longer term (several months), including individual and group therapy.

Acceptance & Commitment Therapy (ACT)

Like with any mental health diagnoses, the ability to accept and tolerate varying levels of distress can be achieved through practicing mindfulness and being present. ACT is a therapeutic approach that emphasizes mindfulness, acceptance, defusion, self-as-context, committed action, and values.⁸

A therapist who uses ACT might help you explore your values and examine whether your behavior is aligned. Although ADHD is a neurocognitive disorder, conscious and unconscious avoidance can make difficulties with attention even more severe. The length of ACT is typically at least 12 sessions, but it can be longer depending on the individual needs of a client.

Other Types of Therapy

There are many schools of thought on which treatment approach is best for any particular disorder, but it depends on a combination of personal comfort and commitment. Like with medication, it may take more than one try or approach to find the right treatment for you. It’s important to address your concerns with your therapist and ask for feedback.

Other types of adult ADHD therapy you may encounter include:

• Strengths-based coaching: a strengths-based approach to therapy concentrates on the client’s problems and goals, uses psychoeducation to reinforce certain competencies in order to reach those goals, and relies on the coach’s use of self-disclosure and life experience to support the client.⁹ This type of coaching incorporates many modalities of psychotherapy but is not practiced by a licensed professional or covered by insurance.
• Neurofeedback (NF): with neurofeedback, a computer reads brain activity and a special software challenges areas of the brain that need to be addressed like inattention and mood balance.¹⁰ Neurofeedback is covered by some insurance companies and can be discussed with your doctor or therapist for a referral.

8 Questions to Ask Before Beginning Therapy

It is a good idea to have a consultation with your potential provider before beginning treatment so that the two of you know you are on the same page. Additionally, consultations allow you to know that your potential provider has the skills necessary to work with you.

Here are eight questions to ask before beginning therapy for ADHD:

1. I think I might have ADHD — Can you work with me on this to figure out if this is true?
2. Have you ever treated ADHD before?
3. What treatments are helpful for ADHD?
4. How does therapy for ADHD, difficulty with attention or feeling hyper all the time work?
5. How long do you think I should be in therapy?
6. Does anyone else need to come to therapy with me?
7. How long will it take for me to get results?
8. Can you provide a referral to a physical if you think I need medication?

5 Lifestyle Changes & Self Help Strategies For Adult ADHD

Whether you experience several or just one symptom of ADHD, there are many strategies you can try on your own to help improve functioning. If you struggle to find relief or notice these things aren’t working for you, you may want to consider seeing a professional.

Here are five lifestyle changes and self-help techniques:

1. Getting Regular Exercise

Physical exercise has a multitude of positive effects for our physical and mental health. Exercise has been shown to reduce stress, anxiety, and depression, as well as improve impulse control, executive functioning, and working memory.^{11, 12} Activity-based exercise like martial arts, group cycling, or dance are healthy ways for adults with ADHD to exert energy and stay focused.

2. Practicing Healthy Sleep Hygiene

Healthy sleep hygiene and routines can alleviate symptoms of ADHD and common comorbid disorders like anxiety. For people with ADHD, it is important to turn off phones and other distracting electronic devices while trying to sleep.

If you find yourself scrolling through social media frequently in the middle of the night, that is a good sign that behavior changes may need to happen to retrain your brain. Some things to consider for healthy sleep include creating a nighttime routine, removing distractions, setting a comfortable temperature, and finding activities that help wind you down.

3. Work-Life Balance

Performance pressure is a common trigger for people with ADHD. Consider making changes to your work-life balance if you feel like your career is consuming your energy, causing anxiety, or affecting your overall performance. It’s normal to want to excel at work but for those who struggle with organization, attention, and managing emotions, it’s wise to consider what performance and productivity may be costing you in your personal life.

4. Consider Your Boundaries

People with ADHD commonly report feeling like they have a hard time with boundaries, saying “no” instead of “yes” or vice versa. Keep in mind that boundaries can exist between you and others and within yourself. Learning about your boundaries includes learning your own limits and triggers. You can do this on your own by making a list of what you know is and isn’t helpful in regards to the symptoms that you experience.

5. Find Support

If you have a mental health diagnosis, you could feel worried that you will be judged, misunderstood, or blamed, and as a result feel guilt and shame. You are not alone in having those feelings. It is important to recognize them and feel them for what they are.

If you aren’t ready to enter therapy, finding a supportive group to help you navigate your diagnosis could help you prepare to share this with your loved ones. There are many adult ADHD support groups online and on social media.

Do some research before joining, know what the purpose of the group is and who it is led by, and decide what your limits are so that you can determine whether or not it is a good use of your time.

4 Questions to Ask About Lifestyle & Self Helps

It’s important to talk to your care team, which may include your doctor and therapist, about implementing self-help strategies or supposed “natural remedies” for adult ADHD. What sounds good on paper might not be the best option for you depending on life circumstances and physical or emotional capabilities. You get to decide, but it may help to review options before making major life decisions.

Four questions to ask your health team about implementing self-help strategies are:

1. What can lifestyle changes do that medication cannot and vice versa?
2. How can I talk to my friends and family about supporting me?
3. What if I try and it doesn’t work? How long does it take?
4. Are there any potential risks or other ways my health can be impacted if I make changes?

Final Thoughts On Treatment For Adult ADHD

If you think you may have ADHD, getting a proper diagnosis may lead to a better, healthier experience. Sometimes putting a name to what you’re experiencing can be validating and helpful in and of itself. Talking to a neurodiverse affirming therapist and finding the right treatments can make a big difference in how you feel and impact your overall functioning. Most importantly, consider changes in behavior and perspective.