ADHD & Medicines
The episode accompanying this article will be published on Monday November 13th. However, the first two episodes of the Season 6 ADHD trilogy are live already. Click here to listen, click here to read more about ADHD & Women or click here to read more about ADHD & Sex.
Attention Deficit Hyperactivity Disorder, or in short ADHD, is a neurodevelopmental condition which impacts the growth and development of the brain and the nervous system. ADHD can affect one's competence in regards to attention, focus, concentration, memory, impulsivity, hyperactivity, organization, social skills, decision-making, planning, motivation, task-switching and learning from past mistakes.
Neurodivergence is a term used to refer to any and all conditions which impact the functioning of the brain. A diagnosis with ADHD, as well as Autism Spectrum Disorder, dyslexia, dyscalculia and a variety of other conditions make a person "qualify" as neurodivergent. People whose brains function the way a typical brain functions are called neurotypical people.
When it comes to ADHD, there are a variety of treatment strategies. Amongst adults, psychopharmacological treatment is considered the first line of choice. What this entails, you ask? Well, pills.
In order to fully understand what these pills are for, what they do to the brain and how it’s possible they achieve their desired effect, allow me to refresh your memory in regards to how ADHD causes the symptoms it does.
People with ADHD have dopamine - and to a lesser extent noradrenaline - deficiencies in their brain. These two chemicals are neurotransmitters, which play an essential role in filtering the stimuli that enter the brain. Lacking these neurotransmitters leads to the overstimulation, hyperactivity, impulsivity, impaired abilities regarding both focus and concentration and other symptoms associated with ADHD. Chemically interfering with these neurotransmitters people with ADHD lack, may therefore decrease symptoms and improve one’s overall quality of life. But what kinds of medicines are available to do this and how exactly do they impact these neurotransmitters?
Some of the most common medicines used to treat ADHD are:
- Amphetamine;
- Atomoxetine;
- Dexmethylphenidate;
- Lisdexamfetamine;
- Methylphenidate;
- And serdexmethylphenidate.
These meds can be categorized into two main subcategories: stimulants and non-stimulants. As stimulants are considered the first-line treatment option, let's first take a closer look at how exactly stimulants interfere with ADHD.
Stimulants
Admittedly, the term stimulant may be somewhat confusing considering how ADHD is strongly related to hyperactivity and thus stimulants may not be the first thing you think of when looking for a solution against hyperactivity. However, these stimulants stimulate only those areas of the brain which function poorly in people with ADHD.
Stimulants stimulate those brain cells which produce the neurotransmitters norepinephrine, as well as dopamine and its building block dopa. They thereby chemically supplement exactly those neurotransmitters people with ADHD are deficient in. Stimulant medication starts working within approximately 30 to 90 minutes after ingestion. There are two primary types of stimulants:
- Short-acting stimulants
- Work approximately 3-5 hours*
- Long-acting stimulants
- Work approximately 6-8 hours*
*How long both short- and long-acting stimulants work is entirely dependent upon the metabolism of the person ingesting them, therefore these numbers are meant only as rough estimates to give you a general idea.
In most cases, short-acting stimulants are supposed to be taken multiple times a day. People with ADHD may therefore prefer long-acting stimulants, for the simple reason they may otherwise forget to take their short-acting stimulants. No wonder, really, considering memory problems are inherent to ADHD. In result, this may lead to missed doses and fluctuating levels of stimulants, which in turn may cause unpleasant side effects like the infamous rebound.
Rebound
Even though all stimulants can have a so-called rebound-effect, it is short-acting stimulants which are notorious for having a more intense rebound effect than long-acting stimulants. ‘Stimulant medications enter the bloodstream quickly, then are filtered through the kidneys or liver and eliminated from the body fairly quickly. Stimulants work by gradually increasing dopamine and norepinephrine levels and activity in the brain.’ When the body has finished processing these stimulants, the levels thereof drop. This drop in stimulants is what causes the so-called rebound.
Rebound symptoms can differ greatly, but are often described as fatigue and hyperactivity and may result in a bad mood, impatience and / or aggressive behavior. The effects are often similar to regular ADHD symptoms, but then a bit more extreme. Rebound effects last a maximum of approximately an hour.
‘Long-acting stimulants are designed to wear off gradually’ and although they may also result in a rebound effect, generally speaking it is short-acting stimulants which cause the greatest rebound. Although rebound effects are normal to a certain degree, extreme rebound effects can be a sign the stimulant dosage consumed was too high. Make sure to consult a medical professional if you suspect this may be the case for you or your child.
Side-effects & effectiveness of stimulants
Side-effects of stimulants vary, but may include decreased appetite, nausea, headaches, stomach pain and sleep disruptions. Stimulants have been proven to be incredibly effective in the short-term. Their safety profile suffices, however, insufficient research has been conducted looking into the long term effects of using stimulant medication. ‘Current evidence indicates that stimulants show efficacy and safety in studies lasting up to 24 months.’ Nevertheless, no conclusive evidence has been found to indicate that their use is harmful in the long-term, so long as they’re prescribed and used under careful therapeutic supervision.
Stimulant medication has been demonstrated to improve the ADHD symptoms of approximately 70% of adults and 70-80% of children with ADHD.
Non-stimulants
However, that leaves us with the remaining 10-30% of people with ADHD who don’t respond to or tolerate treatment with stimulants. Luckily there are also non-stimulant medicines that can chemically assist individuals with ADHD. Generally speaking, non-stimulant medicines are only prescribed to patients who do not want to take stimulants or to those for whom the use of stimulants doesn’t provide sufficient improvement in regards to their ADHD symptoms.
The primary non-stimulant medicines used to treat individuals with ADHD can be classified into four categories:
- Selective Norepinephrine Reuptake Inhibitors - also known as SNRI’s
Atomoxetine is a Selective Norepinephrine Reuptake Inhibitor (SNRI) which is used in the treatment of ADHD, because it increases both norepinephrine and dopamine concentrations in the prefrontal cortex.
- Norepinephrine and Dopamine Reuptake Inhibitors - also known as NDRI’s
Both the stimulant methylphenidate, as well as the non-stimulant bupropion, are Norepinephrine and Dopamine Reuptake Inhibitors (NDRI) which are used in the treatment of ADHD. As their name suggests, they block the action of both norepinephrine and dopamine transporters, increasing dopamine levels in the prefrontal cortex as a result.
- Tricyclic antidepressants - also known as TCA’s
Amitriptyline is a Tricyclic antidepressant (TCA) used in the treatment of ADHD. Amitriptyline is primarily used as an antidepressant and is used to treat ADHD only in rare cases. Tricyclic antidepressants ‘increase noradrenergic or serotonergic neurotransmission by blocking the norepinephrine or serotonin transporter (NET or SERT) at presynaptic terminals.’
- Alpha 2 Adrenergic Agonists
Both guanfacine and clonidine are Alpha 2 Adrenergic Agonists (α2-agonists) which are used in the treatment for ADHD, as they mimic the effects of norepinephrine in the prefrontal cortex - supplementing exactly those neurotransmitters people with ADHD are deficient in.
Side-effects of non-stimulants
Side-effects of non-stimulants vary as well, but may include decreased appetite and stomach pain - just like with stimulants, but can also be fatigue and nausea. Although side-effects of any and all types of ADHD related medicines can be troublesome, many of them are temporary and will decrease or disappear altogether once your body has been able to adjust to the presence of the chemical compound in question.
Most medication, used in the treatment of individuals with ADHD, have an effect on both blood pressure and heart rate. Thus, the use of these medicines should always be monitored regularly.
So of all these options, what to use?
Medication order of preference
Luckily, you’re not expected to make that choice yourself. Psychopharmacological treatment for adults with ADHD takes place conforming to the medication order of preference which, although slightly different across various geographical locations, boils down to the following order:
- Methylphenidate or dexamphetamine;
- Atomoxetine;
- Bupropion.
Medication for children
In the treatment of adults with ADHD, medication is the first line of choice. Contrary to adults, in the treatment of children with ADHD using medication is not the first line of choice. Alternative methods like psycho education for both the parents and the child, parental advice and behavioral therapy for the child are preferred. Medicines are prescribed to children only when these alternative methods have afforded insufficient improvement, in regards to their ADHD symptoms.
When prescribing medicines to children, the first line of choice - just like with adults - is methylphenidate. The second choice is generally atomoxetine, followed by dexamphetamine. Guanfacine is only administered to a child when stimulating substances aren’t suitable or when other medicines are either ineffective or poorly tolerated.
Off-label
ADHD medication can be, and often is, prescribed to individuals off-label. This means the drug in question is prescribed in a situation that doesn’t adhere to the guidelines created by the organization responsible for approving drugs.
In the United States it is the FDA - short for Food and Drug Administration - which bears responsibility for drug approval. A common misconception is that the FDA - or organizations like it - also regulate drug prescriptions, however, it is doctors who bear responsibility for what it is they prescribe.
So-called off-label prescriptions are used when the benefits of prescribing certain medicines outweigh the possible risk thereof. Off-label prescriptions are both legal and commonplace. In fact, they are far more common than you might think. Research found that in cancer treatment 33% of prescriptions were off-label. A study looking into off-label prescriptions for people with HIV found that 81% ‘of patients received at least one drug off-label.’
A 2009 study found that ‘approximately 96% of cardiovascular-renal, 86% of pain, 80% of gastrointestinal, and 67% of pulmonary and dermatologic medication prescriptions were off label.’ Experts have estimated that nearly all pediatric patients (80 to 90 percent) are prescribed drugs off-label.’
When looking into statistics regarding the prescription of off-label drugs, in the treatment of individuals with ADHD, we find that ‘among children ages 3 to 5 years, 91.4% of prescriptions were off-label. After the age of 5 years, the percentage of off-label prescriptions dropped notably to 21%, reflecting the increase in availability of approved medications for the treatment of ADHD starting at age 6.’
In Australia, Canada, Germany and the United States, as well as a variety of other countries, stimulant medication is registered for the treatment of adults with ADHD. In The Netherlands methylphenidate, dexamphetamine and atomoxetine are registered for the treatment of both children and adolescents with ADHD. Interestingly, however, for the treatment of adults with ADHD only atomoxetine is registered. As a result, those medicines which aren’t registered for the cause or demographic at hand, are prescribed off-label.
Although different rules apply, in different jurisdictions, in the Netherlands doctors are obliged to inform their patients when they want to prescribe them medicines off-label. A patient needs to agree with such off-label treatment and their compliance must be documented in their medical record. This is called ‘informed consent’.
Did you know ADHD also impacts the way you experience sex? Click here to read the full article about it.
Off-label - good or bad?
Whether or not prescribing medicines off-label is an incredibly good idea, an absolutely miserable one or somewhere in between is up for debate. Opponents argue that such practices are risky and unethical, claiming it lacks scientific substantiation, increases the risk of unwanted side-effects and may thus lead to a surge in unwinnable lawsuits.
Advocates for off-label prescriptions prefer highlighting the benefits, claiming off-label treatment is inevitable at times, considering doctors are required to offer patients personalized treatment. Moreover, emphasizing how off-label prescriptions may allow for otherwise prohibited, yet life-saving treatment.
The benefits of using medication, as a way of treating ADHD, are evident. Yet it is both psychoeducation and behavioral interventions, like cognitive behavioral therapy (CBT), that play a pivotal role in generating progress of executive functioning and organizational skills in the long-term.
Important to note is that starting medicinal treatment for ADHD should only be done under guidance of a healthcare professional, however, when it comes to medication there’s no one size fits all kind of solution. Figuring out which type of medication works best for you is a process which might take more time than you initially anticipated for. Especially in those cases it’s a matter of patience. Considering how exactly that is something that doesn’t come natural to many people with ADHD, that process may be frustrating at times.
When I (@byellenmoore) first took the right dose of meds, I didn’t know what happened to me. I was more productive in a day than I had been in years. I was able to focus in a way I didn’t know was humanly possible. For me, these medicines allow me to use my ADHD to my advantage. They allow me to remain calm in situations which used to drive me absolutely nuts. They have given me the sense of peace for which I had been looking in the wrong places for years and years.
Considering the many scientifically proven benefits medicines for ADHD can result in, my personal advice would be to try and see for yourself if medicines can help you with what it is you're looking for. However, regardless of what it is you choose to do, make sure to do it under supervision of a healthcare professional.
Be safe and you do you.
For a full list of ADHD symptoms & diagnostic criteria, click here :)
Interested in hearing more? Check out the full episode of The Slut Show on your favorite podcast platform, by clicking here! Or head over to our Instagram @TheSlutShowWithEllenMoore for your daily dose of intersectional feminism. Want to send in questions for our mail-segment? Want to be on the show yourself? Know someone who should or want to request an episode about a particular subject? Don’t be a stranger. Our DM’s are always open ❤
We hope to see you on our socials and for now, sluts out!
Lots of love,
Sources
- Abdel-Hamid, Mona, Miriam Basilowski, Barbara Schönfeld, Claudia Bartels, Heike Anderson-Schmidt, Philipp Hessmann, Melanie Kownatka, et al. 2021. “Sexual Dysfunction in Patients with Adult Attention Deficit Hyperactivity Disorder: A Pilot Study.” The Canadian Journal of Human Sexuality 30 (1): 106–13. https://doi.org/10.3138/cjhs.2020-0036.
- “ADHD Brain vs. Normal Brain: Function, Differences, and More.” 2021. August 13, 2021. https://www.medicalnewstoday.com/articles/adhd-brain-vs-normal-brain.
- “ADHD Medication Rebound | When ADHD Medication Wears Off.” n.d. Understood. Accessed June 2, 2023. https://www.understood.org/en/articles/adhd-medication-rebound-what-you-need-to-know.
- “ADHD Medications: How They Work & Side Effects.” n.d. Cleveland Clinic. Accessed June 2, 2023. https://my.clevelandclinic.org/health/treatments/11766-adhd-medication.
- Advokat, Claire, and Mindy Scheithauer. 2013. “Attention-Deficit Hyperactivity Disorder (ADHD) Stimulant Medications as Cognitive Enhancers.” Frontiers in Neuroscience 7 (May): 82. https://doi.org/10.3389/fnins.2013.00082.
- Amani Jabalkandi, Samaneh, Firoozeh Raisi, Zahra Shahrivar, Abolfazl Mohammadi, Alipasha Meysamie, Reihaneh Firoozikhojastefar, and Fatemeh Irani. 2020. “A Study on Sexual Functioning in Adults with Attention-Deficit/Hyperactivity Disorder.” Perspectives in Psychiatric Care 56 (3): 642–48. https://doi.org/10.1111/ppc.12480.
- Arnett, Anne B., Bruce F. Pennington, Erik G. Willcutt, John C. DeFries, and Richard K. Olson. 2015. “Sex Differences in ADHD Symptom Severity.” Journal of Child Psychology and Psychiatry 56 (6): 632–39. https://doi.org/10.1111/jcpp.12337.
- Arnold, L. Eugene. 1996. “Sex Differences in ADHD: Conference Summary.” Journal of Abnormal Child Psychology 24 (5): 555–69. https://doi.org/10.1007/BF01670100.
- Arruda, Marco A., Vincenzo Guidetti, Federica Galli, Regina C. A. P. Albuquerque, and Marcelo E. Bigal. 2010. “Migraine, Tension-Type Headache, and Attention-Deficit/Hyperactivity Disorder in Childhood: A Population-Based Study.” Postgraduate Medicine 122 (5): 18–26. https://doi.org/10.3810/pgm.2010.09.2197.
- Arruda, Marco Antônio, Renato Arruda, Vincenzo Guidetti, and Marcelo Eduardo Bigal. 2020. “ADHD Is Comorbid to Migraine in Childhood: A Population-Based Study.” Journal of Attention Disorders 24 (7): 990–1001. https://doi.org/10.1177/1087054717710767.
- B, Bőthe, Koós M, Tóth-Király I, Orosz G, and Demetrovics Z. 2019. “Investigating the Associations Of Adult ADHD Symptoms, Hypersexuality, and Problematic Pornography Use Among Men and Women on a Largescale, Non-Clinical Sample.” The Journal of Sexual Medicine 16 (4). https://doi.org/10.1016/j.jsxm.2019.01.312.
- Banaschewski, T., V. Roessner, R. W. Dittmann, P. Janardhanan Santosh, and A. Rothenberger. 2004. “Non–Stimulant Medications in Thetreatment of ADHD.” European Child & Adolescent Psychiatry 13 (1): i102–16. https://doi.org/10.1007/s00787-004-1010-x.
- Bazzano, Alicia T. F., Rita Mangione-Smith, Matthias Schonlau, Marika J. Suttorp, and Robert H. Brook. 2009. “Off-Label Prescribing to Children in the United States Outpatient Setting.” Academic Pediatrics 9 (2): 81–88. https://doi.org/10.1016/j.acap.2008.11.010.
- Bellini, Benedetta, Marco Arruda, Alessandra Cescut, Cosetta Saulle, Antonello Persico, Marco Carotenuto, Michela Gatta, et al. 2013. “Headache and Comorbidity in Children and Adolescents.” The Journal of Headache and Pain 14 (1): 79. https://doi.org/10.1186/1129-2377-14-79.
- Bidwell, L. Cinnamon, Rachel E. Dew, and Scott H. Kollins. 2010. “Alpha-2 Adrenergic Receptors and Attention—Deficit/Hyperactivity Disorder.” Current Psychiatry Reports 12 (5): 366–73. https://doi.org/10.1007/s11920-010-0136-4.
- Biederman, Joseph, and Thomas Spencer. 2000. “Non-Stimulant Treatments for ADHD.” European Child & Adolescent Psychiatry 9 (1): S51–59. https://doi.org/10.1007/s007870070019.
- Bijlenga, D., J. A. Vroege, A. J. M. Stammen, M. Breuk, A. M. Boonstra, K. van der Rhee, and J. J. S. Kooij. 2018. “Prevalence of Sexual Dysfunctions and Other Sexual Disorders in Adults with Attention-Deficit/Hyperactivity Disorder Compared to the General Population.” ADHD Attention Deficit and Hyperactivity Disorders 10 (1): 87–96. https://doi.org/10.1007/s12402-017-0237-6.
- Boorady, Roy. n.d. “Side Effects of ADHD Medication.” Child Mind Institute. Accessed June 2, 2023. https://childmind.org/article/side-effects-of-adhd-medication/.
- Braüner, Julie Vestergaard, Lily Manzello Johansen, Troels Roesbjerg, and Anne Katrine Pagsberg. 2016. “Off-Label Prescription of Psychopharmacological Drugs in Child and Adolescent Psychiatry.” Journal of Clinical Psychopharmacology 36 (5): 500. https://doi.org/10.1097/JCP.0000000000000559.
- Brosgart, C. L., T. Mitchell, E. Charlebois, R. Coleman, S. Mehalko, J. Young, and D. I. Abrams. 1996. “Off-Label Drug Use in Human Immunodeficiency Virus Disease.” Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology: Official Publication of the International Retrovirology Association 12 (1): 56–62. https://doi.org/10.1097/00042560-199605010-00008.
- Brzezińska, Agnieszka, Monika Borowiecka, Marlena Zając, Konrad Warchoł, and Wiktor Michniak. 2021. “ADHD in Women - a Review.” Journal of Education, Health and Sport 11 (9): 491–96. https://doi.org/10.12775/JEHS.2021.11.09.063.
- Carlson, Gabrielle A., and Kevin L. Kelly. 2003. “Stimulant Rebound: How Common Is It and What Does It Mean?” Journal of Child and Adolescent Psychopharmacology 13 (2): 137–42. https://doi.org/10.1089/104454603322163853.
- Commissioner, Office of the. 2021. “What We Do.” FDA. FDA. June 28, 2021. https://www.fda.gov/about-fda/what-we-do.
- ———. 2022. “What Does FDA Regulate?” FDA, October. https://www.fda.gov/about-fda/fda-basics/what-does-fda-regulate.
- Dorani, Farangis, Denise Bijlenga, Aartjan T. F. Beekman, Eus J. W. van Someren, and J. J. Sandra Kooij. 2021. “Prevalence of Hormone-Related Mood Disorder Symptoms in Women with ADHD.” Journal of Psychiatric Research 133 (January): 10–15. https://doi.org/10.1016/j.jpsychires.2020.12.005.
- Epstein, Jeffery N, and Richard Ea Loren. 2013. “Changes in the Definition of ADHD in DSM-5: Subtle but Important.” Neuropsychiatry 3 (5): 455–58. https://doi.org/10.2217/npy.13.59.
- “Explainer: What Is Neurodivergence? Here’s What You Need to Know.” 2022. World Economic Forum. October 10, 2022. https://www.weforum.org/agenda/2022/10/explainer-neurodivergence-mental-health/.
- Faraone, Stephen V. 2009. “Using Meta-Analysis to Compare the Efficacy of Medications for Attention-Deficit/Hyperactivity Disorder in Youths.” Pharmacy and Therapeutics 34 (12): 678–94.
- Faraone, Stephen V, Joseph Biederman, Thomas J Spencer, and Megan Aleardi. 2006. “Comparing the Efficacy of Medications for ADHD Using Meta-Analysis.” Medscape General Medicine 8 (4): 4.
- Fasmer, Ole Bernt, Anne Halmøy, Ketil Joachim Oedegaard, and Jan Haavik. 2011. “Adult Attention Deficit Hyperactivity Disorder Is Associated with Migraine Headaches.” European Archives of Psychiatry and Clinical Neuroscience 261 (8): 595–602. https://doi.org/10.1007/s00406-011-0203-9.
- Flory, Kate, Brooke S. G. Molina, Jr. Pelham William E., Elizabeth Gnagy, and Bradley Smith. 2006. “Childhood ADHD Predicts Risky Sexual Behavior in Young Adulthood.” Journal of Clinical Child & Adolescent Psychology 35 (4): 571–77. https://doi.org/10.1207/s15374424jccp3504_8.
- Geneesmiddelen, College ter Beoordeling van. 2019. “Het Agentschap - College ter Beoordeling van Geneesmiddelen.” Onderwerp. College ter Beoordeling van Geneesmiddelen. June 27, 2019. https://www.cbg-meb.nl/onderwerpen/over-cbg-het-agentschap.
- Greenhill, LAURENCE L., JEFFREY M. Halperin, and HOWARD Abikoff. 1999. “Stimulant Medications.” Journal of the American Academy of Child & Adolescent Psychiatry 38 (5): 503–12. https://doi.org/10.1097/00004583-199905000-00011.
- Guardiola, A., A. R. Terra, L. T. Ferreira, and R. G. Londero. 1999. “[Use of amitriptyline in attention deficit hyperactivity disorder].” Arquivos De Neuro-Psiquiatria 57 (3A): 599–605. https://doi.org/10.1590/s0004-282x1999000400010.
- Hagerty, Katelyn. n.d. “Full Antidepressants List: SSRIs, SNRIs, TCAs & Others.” Hers. Accessed June 2, 2023. https://www.forhers.com/blog/full-list-antidepressants-ssri-snri.
- Hamza, Abdul AL-Kareem. 2020. “The Children with Attention-Deficit/Hyperactivity Disorder (ADHD) More Likely Creates to Irritable Bowel Syndrome.” Indian Journal of Forensic Medicine & Toxicology 14 (3): 919–24. https://doi.org/10.37506/ijfmt.v14i3.10488.
- Hansen, Thomas Folkmann, Louise K. Hoeffding, Lisette Kogelman, Thilde Marie Haspang, Henrik Ullum, Erik Sørensen, Christian Erikstrup, et al. 2018. “Comorbidity of Migraine with ADHD in Adults.” BMC Neurology 18 (1): 147. https://doi.org/10.1186/s12883-018-1149-6.
- Hennissen, Leonie, Mireille J. Bakker, Tobias Banaschewski, Sara Carucci, David Coghill, Marina Danckaerts, Ralf W. Dittmann, et al. 2017. “Cardiovascular Effects of Stimulant and Non-Stimulant Medication for Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Trials of Methylphenidate, Amphetamines and Atomoxetine.” CNS Drugs 31 (3): 199–215. https://doi.org/10.1007/s40263-017-0410-7.
- Henry, Erin, and Sally Hill Jones. 2011. “Experiences of Older Adult Women Diagnosed with Attention Deficit Hyperactivity Disorder.” Journal of Women & Aging 23 (3): 246–62. https://doi.org/10.1080/08952841.2011.589285.
- Hertz, Priscilla Gregório, Daniel Turner, Steffen Barra, Laura Biedermann, Petra Retz-Junginger, Daniel Schöttle, and Wolfgang Retz. 2022. “Sexuality in Adults With ADHD: Results of an Online Survey.” Frontiers in Psychiatry 13 (May): 868278. https://doi.org/10.3389/fpsyt.2022.868278.
- Holthe, Mira Elise Glaser, and Eva Langvik. 2017. “The Strives, Struggles, and Successes of Women Diagnosed With ADHD as Adults.” SAGE Open 7 (1): 215824401770179. https://doi.org/10.1177/2158244017701799.
- Margherio, Samantha M., Elizabeth R. Capps, John W. Monopoli, Steven W. Evans, Melissa Hernandez-Rodriguez, Julie Sarno Owens, and George J. DuPaul. 2021. “Romantic Relationships and Sexual Behavior Among Adolescents With ADHD.” Journal of Attention Disorders 25 (10): 1466–78. https://doi.org/10.1177/1087054720914371.
- Matlen, Terry. n.d. “ADHD Medication Side Effects and Their Fixes.” ADDitude (blog). Accessed June 2, 2023. https://www.additudemag.com/adhd-medication-side-effects/?src=embed_link.
- “Medicamenteuze Behandeling ADHD - Richtlijn - Richtlijnendatabase.” n.d. Federatie Medisch Specialisten. Accessed June 2, 2023. https://richtlijnendatabase.nl/richtlijn/adhd_bij_volwassenen/medicamenteuze_behandeling_adhd.html.
- “Medication.” n.d. ADHDcentraal (blog). Accessed June 2, 2023. https://adhdcentraal.nl/en/treatment/medication/.
- Miller, Kelli. n.d. “Off-Label Prescription Drugs Use: Benefits and Risks.” WebMD. Accessed June 2, 2023. https://www.webmd.com/a-to-z-guides/features/off-label-drug-use-what-you-need-to-know.
- Nederland, Zorginstituut. n.d. “bupropion.” Webcontent. Zorginstituut Nederland. Accessed June 2, 2023a. https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/b/bupropion.
- ———. n.d. “clonidine (bij migraine).” Webcontent. Zorginstituut Nederland. Accessed June 2, 2023b. https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/c/clonidine__bij_migraine_.
- ———. n.d. “Farmacotherapeutisch Kompas.” Webcontent. Zorginstituut Nederland. Accessed June 2, 2023c. https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/d/dexamfetamine.
- ———. n.d. “Farmacotherapeutisch Kompas.” Webcontent. Zorginstituut Nederland. Accessed June 2, 2023d. https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/l/lisdexamfetamine.
- ———. n.d. “Farmacotherapeutisch Kompas.” Webcontent. Zorginstituut Nederland. Accessed June 2, 2023e. https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/a/atomoxetine.
- ———. n.d. “Farmacotherapeutisch Kompas.” Webcontent. Zorginstituut Nederland. Accessed June 2, 2023f. https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/g/guanfacine.
- ———. n.d. “Farmacotherapeutisch Kompas.” Webcontent. Zorginstituut Nederland. Accessed June 2, 2023g. https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/a/amitriptyline.
- ———. n.d. “methylfenidaat.” Webcontent. Zorginstituut Nederland. Accessed June 2, 2023h. https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/m/methylfenidaat#groepsinformatie.
- ———. n.d. “modafinil.” Webcontent. Zorginstituut Nederland. Accessed June 2, 2023i. https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/m/modafinil.
- Nussbaum, Nancy L. 2012. “ADHD and Female Specific Concerns: A Review of the Literature and Clinical Implications.” Journal of Attention Disorders 16 (2): 87–100. https://doi.org/10.1177/1087054711416909.
- “Offlabelgebruik van geneesmiddelen.” n.d. Farmaceutisch Kompas. Zorginstituut Nederland. Accessed June 5, 2023. https://www.farmacotherapeutischkompas.nl/algemeen/offlabel-gebruik-van-geneesmiddelen.
- Panther, Shannon G., Alice M. Knotts, Tamara Odom-Maryon, Kenneth Daratha, Teri Woo, and Tracy A. Klein. 2017. “Off-Label Prescribing Trends for ADHD Medications in Very Young Children.” The Journal of Pediatric Pharmacology and Therapeutics 22 (6): 423–29. https://doi.org/10.5863/1551-6776-22.6.423.
- Pham, Minh N., Matthew T. Hudnall, Richard J. Fantus, Jeremy D. Lai, Siddhant S. Ambulkar, James M. Wren, Nelson E. Bennett, et al. 2022. “The Adverse Association between Stimulant Use for Attention Deficit Hyperactivity Disorder (ADHD) and Semen Parameters.” Andrologia 54 (2): e14315. https://doi.org/10.1111/and.14315.
- Ph.D, Justin J. Lehmiller. n.d. “How ADHD Influences Your Sex Life and Intimate Relationships | Psychology Today.” Accessed May 9, 2023. https://www.psychologytoday.com/intl/blog/sex-esteem/202210/how-adhd-influences-your-sex-life-and-intimate-relationships.
- “Prescription Stimulants DrugFacts.” 2018. National Institute on Drug Abuse. June 6, 2018. https://nida.nih.gov/publications/drugfacts/prescription-stimulants.
- Quinn, Patricia O. 2005. “Treating Adolescent Girls and Women with ADHD: Gender-Specific Issues.” Journal of Clinical Psychology 61 (5): 579–87. https://doi.org/10.1002/jclp.20121.
- Quinn, Patricia O., and Manisha Madhoo. 2014. “A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis.” The Primary Care Companion for CNS Disorders 16 (3): 27250. https://doi.org/10.4088/PCC.13r01596.
- Rajeh, Adnan, Shabbir Amanullah, K. Shivakumar, and Julie Cole. 2017. “Interventions in ADHD: A Comparative Review of Stimulant Medications and Behavioral Therapies.” Asian Journal of Psychiatry 25 (February): 131–35. https://doi.org/10.1016/j.ajp.2016.09.005.
- “Rebound Effect.” 2023. In Wikipedia. https://en.wikipedia.org/w/index.php?title=Rebound_effect&oldid=1157210117.
- Riccio, Cynthia A., Jeniffer J.M. Waldrop, Cecil R. Reynolds, and Patricia Lowe. 2012. “PsychiatryOnline | The Journal of Neuropsychiatry and Clinical Neuros….” Archive.Ph. July 14, 2012. https://archive.ph/k9Xi.
- Rodden, Janice. n.d. “ADHD Medication Rebound: What to Do When a Prescription Wears Off.” ADDitude (blog). Accessed June 2, 2023. https://www.additudemag.com/adhd-medication-rebound/.
- Salem, Haitham, David Vivas, Fei Cao, Iram F. Kazimi, Antonio L. Teixeira, and Cristian P. Zeni. 2018. “ADHD Is Associated with Migraine: A Systematic Review and Meta-Analysis.” European Child & Adolescent Psychiatry 27 (3): 267–77. https://doi.org/10.1007/s00787-017-1045-4.
- Sarver, Dustin E., Michael R. McCart, Ashli J. Sheidow, and Elizabeth J. Letourneau. 2014. “ADHD and Risky Sexual Behavior in Adolescents: Conduct Problems and Substance Use as Mediators of Risk.” Journal of Child Psychology and Psychiatry 55 (12): 1345–53. https://doi.org/10.1111/jcpp.12249.
- Silver, Larry M.D. n.d. “ADHD Medication Options: Stimulants, Nonstimulants & More.” ADDitude (blog). https://www.additudemag.com/adhd-medication-for-adults-and-children/.
- Soldati, Lorenzo, Francesco Bianchi-Demicheli, Pauline Schockaert, John Köhl, Mylène Bolmont, Roland Hasler, and Nader Perroud. 2020. “Sexual Function, Sexual Dysfunctions, and ADHD: A Systematic Literature Review.” The Journal of Sexual Medicine 17 (9): 1653–64. https://doi.org/10.1016/j.jsxm.2020.03.019.
- ———. 2021. “Association of ADHD and Hypersexuality and Paraphilias.” Psychiatry Research 295 (January): 113638. https://doi.org/10.1016/j.psychres.2020.113638.
- Swanson, James M., Keith McBurnett, Tim Wigal, Linda J. Pfiffner, Marc A. Lerner, Lillie Williams, Diane L. Christian, et al. 1993. “Effect of Stimulant Medication on Children with Attention Deficit Disorder: A ‘Review of Reviews.’” Exceptional Children 60 (2): 154–62. https://doi.org/10.1177/001440299306000209.
- Tabarrok, Alexander T. 2000. “Assessing the FDA via the Anomaly of Off-Label Drug Prescribing” V (1).
- Thour, Amit, and Raman Marwaha. 2023. “Amitriptyline.” In StatPearls. Treasure Island (FL): StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK537225/.
- “Tricyclic Antidepressants (TCAs).” n.d. Mayo Clinic (blog). Accessed June 2, 2023. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983.
- Volkow, N. D., G.-J. Wang, J. H. Newcorn, S. H. Kollins, T. L. Wigal, F. Telang, J. S. Fowler, et al. 2011. “Motivation Deficit in ADHD Is Associated with Dysfunction of the Dopamine Reward Pathway.” Molecular Psychiatry 16 (11): 1147–54. https://doi.org/10.1038/mp.2010.97.
- Waite, Roberta. 2007. “Women and Attention Deficit Disorders: A Great Burden Overlooked.” Journal of the American Academy of Nurse Practitioners 19 (3): 116–25. https://doi.org/10.1111/j.1745-7599.2006.00203.x.
- ———. 2010. “Women With ADHD: It Is an Explanation, Not the Excuse Du Jour.” Perspectives in Psychiatric Care 46 (3): 182–96. https://doi.org/10.1111/j.1744-6163.2010.00254.x.
- Wigal, Tim, James M. Swanson, Roland Regino, Marc A. Lerner, Ihab Soliman, Ken Steinhoff, Suresh Gurbani, and Sharon B. Wigal. 1999. “Stimulant Medications for the Treatment of ADHD: Efficacy and Limitations.” Mental Retardation and Developmental Disabilities Research Reviews 5 (3): 215–24. https://doi.org/10.1002/(SICI)1098-2779(1999)5:3<215::AID-MRDD8>3.0.CO;2-K.
- Wilens, Timothy E., Joseph Biederman, Stephen V. Faraone, MaryKate Martelon, Diana Westerberg, and Thomas J. Spencer. 2009. “Presenting ADHD Symptoms, Subtypes, and Comorbid Disorders in Clinically Referred Adults With ADHD.” The Journal of Clinical Psychiatry 70 (11): 15333. https://doi.org/10.4088/JCP.08m04785pur.
- Wilens, TIMOTHY E., JOSEPH Biederman, DAVID E. Geist, RONALD Steingard, and THOMAS Spencer. 1993. “Nortriptyline in the Treatment of ADHD: A Chart Review of 58 Cases.” Journal of the American Academy of Child & Adolescent Psychiatry 32 (2): 343–49. https://doi.org/10.1097/00004583-199303000-00015.
- Young, Susan, Nicoletta Adamo, Bryndís Björk Ásgeirsdóttir, Polly Branney, Michelle Beckett, William Colley, Sally Cubbin, et al. 2020. “Females with ADHD: An Expert Consensus Statement Taking a Lifespan Approach Providing Guidance for the Identification and Treatment of Attention-Deficit/ Hyperactivity Disorder in Girls and Women.” BMC Psychiatry 20 (1): 404. https://doi.org/10.1186/s12888-020-02707-9.