Why would a stimulant be used to treat hyperactivity? Explain the medicinal treatment for Attention Deficit/Hyperactivity Syndrome. Be sure to include any side effects.

Question

What will be an ideal response?

Answer 1

Stimulant drugs are prescribed primarily for elementary-school-age children diagnosed as unable to maintain sufficient attention levels and impulse control in school or hyperactive. These symptoms are collectively referred to as attention deficit/hyperactivity disorder (ADHD).
Commonly prescribed stimulant medications for the treatment of ADHD include oral administrations of an amphetamine-like drug, methylphenidate (Ritalin), a combination of dextroamphetamine and amphetamine (Adderall), and a combination of dextroamphetamine and the amino acid lysine, lisdexfamine (Vyvanse). 
Ritalin dominated the market in prescriptions written for ADHD. While a growing number of alternative medications are now available for this purpose, Ritalin remains the most recognizable "brand" with respect to ADHD treatment. The rapid onset and short duration of Ritalin requires two administrations during a school day: one at breakfast and another at lunchtime, supervised by a school nurse. 
Adderall has a longer duration of action, making it possible to administer a single dose and avoiding school involvement in treatment. In comparative studies, Ritalin and Adderall have been found to be equivalent in effectiveness. 
New drug treatments for ADHD have become available that are essentially variations of methylphenidate medication. They include a sustained-release formulation (Concerta), a formulation that produces an initial rapid dose of methylphenidate followed by a second sustained-release phase and a chemical variation of methylphenidate that allows for a longer duration of action. A methylphenidate patch was approved in 2006.
One side effect of stimulant medications is a suppression of height and weight gains during these formative years, reducing growth to about 80 to 90 percent normal levels. Fortunately, growth spurts during the summer, when children are typically no longer taking medication (referred to as "drug holidays"), usually compensate for this problem. Discontinuance of medication, however, has to be carefully monitored. Symptoms such as lethargy, lack of motivation, and, in some cases, depression can occur during this time. A more serious concern is the increased risk of cardiovascular disease due to the effects of stimulant drugs. 
In 2006, the FDA recommended a "black box" warning on ADHD medications as a guide for patients and physicians. The risks for future problems with alcohol and other drugs appear to be reduced. Until recently, the phenomenon of reducing hyperactivity with methylphenidate and related stimulant drugs, rather than increasing it. 
It is now known that orally administered methylphenidate and related stimulant drugs produce a relatively slow but steady increase in dopamine activity in the brain. This change in brain chemistry is hypothesized to have two effects that are beneficial to an individual with ADHD. First, increased dopamine may amplify the effects of environmental stimulation, while reducing the background firing rates of neurons. Thus, there would be a greater "signal-to-noise" ratio in the brain, analogous to having now a stronger radio signal received by a radio that no longer emits a large amount of background static. The behavioral effect would be an improvement in attention and decreased distractibility. Symptoms of ADHD may be a result of not having a sufficient "signal-to-noise" ratio in the processing of information for tasks that require concentration and focus. Second, increased dopamine may heighten one's motivation with regard to a particular task, enhancing the salience and interest in that task and improving performance. 
In 2003, a new medication, atomoxetine (brand name: Strattera), was approved by the FDA for the treatment of ADHD in both children and adults. Since Strattera produces an increase in norepinephrine activity in the brain, it is possible that lowered norepinephrine levels may play a role in ADHD as well. Strattera has been marketed as a once-a-day non-stimulant medication that reduces ADHD symptoms by increasing norepinephrine levels-not dopamine levels-in the brain. The full story may be either that both norepinephrine and dopamine are jointly involved in ADHD or that ADHD itself may be two separable disorders, one related to dopamine activity and the other related to norepinephrine activity. According to this hypothesis, the symptoms may overlap to such a degree that it is difficult to distinguish the two disorders on a strictly behavioral basis.