Guide to ADHD Treatment

We consider the approach described below to be sound in principle. However, these are merely considerations from a scientific perspective and cannot serve as therapeutic recommendations for individual cases.
In any case, a personalized treatment plan must be developed by a doctor or psychotherapist.
This information is not intended to encourage self-medication, but rather to help people with ADHD and their families better understand medical recommendations and to enable them to discuss the options described with their treating physician and therapist.
Each specific treatment must follow the instructions of the attending physician for that particular case.

Official national treatment guidelines are available in, among other places,

• United States: AAP, 2019: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents¹
• Europe, 2019: Updated European Consensus Statement on the Diagnosis and Treatment of Adult ADHD²
• Canada: CADDRA, 2018³
• Japan⁴
• Germany⁵
• Spain, 2017: Clinical Practice Guidelines on Therapeutic Interventions for Attention-Deficit/Hyperactivity Disorder (ADHD)
• Netherlands, 2019: ADHD Care Standard
• Australia, AADPA 2022: Australian Evidence-Based Clinical Practice Guideline for Attention Deficit Hyperactivity Disorder
• United Kingdom: NICE, 2018 (last updated in 2025): Attention-Deficit/Hyperactivity Disorder: Diagnosis and Management
• Argentina (consensus-based treatment guidelines)⁶

Treatment approaches, treatment manuals, guidelines:⁷

• Group Therapy Manual: “Psychotherapy for ADHD in Adults” (Hesslinger et al., 2004)
  Adaptation of the Dialectical Behavior Therapy Approach for Borderline Personality Disorder to ADHD
• “Treatment Manual for ADHD in Adults” (Lauth, Minsel, 2009)
  For individuals and groups
• “Psychoeducation and Coaching Manual for ADHD in Adults” (D’Amelio et al., 2009),
  A Practical Guide to Treating ADHD and Support Groups for Family Members
• “Training for ADS in Adulthood (TADSE)” (Baer & Kirsch, 2010)
• “Cognitive Behavioral Therapy Treatment Program for ADHD in Adults” (Safren et al., 2009)
  Cognitive Techniques for Individual Therapy
• Interdisciplinary, evidence- and consensus-based (S3) guideline “ADHD in Children, Adolescents, and Adults”⁸

0. Prerequisite: A definitive diagnosis¶

• Questionnaires AND tests, self-perception AND others’ perceptions, elementary school report cards or early secondary school report cards, other reports from childhood and early school years, reports from parents, reports from relatives
  • Caution: A high level of self-interest in attention tests can have consequences similar to those of non-affected individuals (attention is guided by intrinsic factors)
  • Note: The DSM and ICD require that the first symptoms (at least 2 of 18) appear before the age of 12, which is outside the elementary school age range. Barkley, however, considers an onset up to age 18 to be acceptable.
  • Caution: Parents have a poor memory of their children’s symptoms during childhood. 78% did not recall the ADHD symptoms in their children that they themselves had reported 30 years earlier, and 3% attributed ADHD to their children even though it did not exist at the time. ⁹
  • Caution: There is evidence suggesting that most adults with ADHD did not exhibit ADHD symptoms during childhood and that childhood ADHD and adult ADHD may represent distinct ADHD phenotypes⁹
    It would be a mistake to rule out a diagnosis based solely on unremarkable (elementary school) report cards or accounts from relatives. High intelligence or a strong compensatory drive can make people with ADHD appear unremarkable in elementary school. Girls, in addition, are more likely to conform and often go unnoticed even when they are affected.
• Family Medical History
  • Genetic causes
  • Pregnancy and Childbirth Complications
  • Attachment Disorders
  • Physical or sexual abuse
  • Psychological abuse or low-level psychological stress
• Comprehensive differential diagnosis
  • Rule out deficiency symptoms and thyroid problems
    • Complete Blood Count
      • Thyroxine (Thyroid Gland)
      • Zinc
      • Iron (as measured by ferritin levels)
      • Magnesium
      • B1
      • B12
      • B6
      • D3
      • Folic acid
    • According to another opinion, a complete blood count is not necessary¹⁰ While this may be statistically justified, from the perspective of a person with ADHD, we do not believe it is. We know of enough people with ADHD who have experienced a dramatic improvement in their symptoms by correcting a severe vitamin or mineral deficiency, even if this may account for less than 1% of the people with ADHD. If even one in every hundred people with ADHD can be cured by correcting a vitamin or mineral deficiency, this must not be ignored (especially since, in this case, the term “cure” is justified).
  • Rule out sleep-related breathing disorders (which may account for up to 20% of ADHD cases)
  • Rule out an acute stress situation
  • IQ Test
  • Rule out major disorders with similar symptoms
    More on this topic: ⇒ Differential Diagnosis
  • QTc interval analysis prior to ADHD medication is unnecessary in healthy patients with no family history of cardiac problems¹¹¹²
• Identify comorbidities
  • For information on treatment prioritization, see section 5 below.
  • For more information, visit ⇒ Comorbidities in ADHD

1. Step: Self-Education and Psychoeducation¶

1.1. Self-Education¶

Self-education through books, videos, support groups, and forums fosters personal knowledge and empowerment in managing ADHD.
The goal is to strengthen personal responsibility and promote self-determined living through personal sources of information and the sharing of experiences within the community.

• Psychoeducation provided by psychiatrists, psychologists, etc.

• Read books about ADHD (several)

• Use ADxS.org as a source of information

• YouTube videos by experts (lectures)

• Attend presentations (e.g., by CHADD)

• Attend self-help groups, preferably those led by a trained professional (which can be found, for example, at CHADD, Attention Deficit Disorder Association or The Learning Disabilities Association of America)

• Forums offer a way to connect with other people with ADHD and get help with questions, e.g., reddit/ADHD

• The very diagnosis of ADHD brings with it the realization that one is different from others, both in a negative and a positive sense. This realization is often accompanied by high hopes for an improvement in one’s life situation.¹³

• The realization that other people have gone through or are going through the same thing often brings a surprising sense of relief to people with ADHD

  • A sense of coming home among like-minded people
  • Willingness to address the issue
  • Exchange of Experiences
  • Building Self-Esteem

1.2. Psychoeducation¶

Targeted education about ADHD led by professionals, designed to positively influence the interactions, attitudes, and behaviors of patients and their caregivers.
The goal is to promote a comprehensive understanding of ADHD through professional guidance in order to make it easier to cope with the Disorder.

2. Step Two: Medication¶

2.1. Decisions in Borderline Cases: Medication or Not?¶

Medication is mandatory only when people with ADHD experience significant impacts on their quality of life.
If the ADHD symptoms are pronounced enough to warrant a diagnosis but not severe enough to make medication absolutely necessary, the decision to prescribe medication is left to the discretion of the doctor and the patient.
A long-term analysis of 8,051 such cases showed that medication almost completely eliminated the occurrence of reactive disorders in women during the first two years of follow-up and significantly reduced the incidence of tic disorders in men during the first three years.¹⁴ No other benefits or drawbacks were observed.¹⁵ 68.2% of children diagnosed with ADHD at age 4 or 5 received ADHD medication before the age of 7, and 42.2% received it within 30 days of diagnosis.¹⁶

In our experience, in such borderline cases, it is advisable to try medication first, even if finding the right dosage requires a fair amount of persistence. The goal here is not to establish long-term medication, but to enable people with ADHD to make an informed decision based on their own experience.
The decision should take into account that untreated severe ADHD is associated with a reduction in life expectancy of 8 to 11 years. In cases of borderline or subclinical ADHD, this figure may be lower, but it is barely possible that it will drop to zero. Furthermore, the decision should take into account the exceptionally high effect size of ADHD medications—which, at 0.9 to 1.5, is significantly higher than what would otherwise be expected in medicine or psychiatry—as well as their rapid onset of action within days and their comparatively low incidence of side effects.

2.2. Treatment Prioritization for ADHD with Comorbidities¶

See section 5 for more information.

2.3. Treatment of ADHD Symptoms with Medication¶

2.3.1. Choosing the Right Medication¶

See also Choice of Medication for ADHD or ADHD with Comorbidities

2.3.2. Dosage, Medication Adjustment¶

In our experience, a particularly large number of mistakes are made when dosing the product. These mistakes not only prevent the product from working optimally, but often prevent it from working at all. Therefore, it is especially important to follow the dosing instructions carefully,
For more details, see ⇒ Dosage of Medications for ADHD

2.3.3. Effect size of Various Medications¶

• Effect size at optimal settings:
  • Amphetamine-based medications: 1.1–1.5
  • Methylphenidate: 1.0–1.3
  • Guanfacine: 0.8
  • Atomoxetine: 0.65

For more details, see ⇒ Effect size of Various Treatment Approaches for ADHD

2.3.4. Goals of Optimal Medication Adjustment¶

• To provide an experience of what life without ADHD can be like and how it can feel (enables people with ADHD to set their own intrinsic goals for non-medication-based therapy)
• Establishing the capacity for therapy (bringing attention and concentration to the level necessary for learning more functional behaviors)
  • Improved responsiveness to treatment with dopaminergic ADHD medications, as dopamine increases or restores neuroplasticity¹⁷
  • In ADHD, levels of growth hormones—which are necessary for neuroplasticity (learning)—are reduced. Stimulants increase growth hormone levels.
• The goal is not to completely eliminate all ADHD symptoms **
  • People with ADHD differ from people without the condition only in the number of symptoms they frequently experience. People without ADHD also frequently experience some of these symptoms.
  • Individual prominent symptoms should be treated on a case-by-case basis whenever possible (e.g., impulsivity with the lowest possible doses of SSRIs, aggression with low doses of antipsychotics) rather than attempting to address them alongside ADHD medications, as this would result in an overly broad and intense intervention.
• Don’t Underestimate Emotional Dysregulation
  • Stimulants enable adequate functioning during the day and help prevent breakdowns and comorbidities in the medium term. See Consequences of ADHD.
  • In cases of emotional dysregulation that are not adequately improved by stimulants, the non-stimulant medications atomoxetine or guanfacine—which are effective throughout the day—can be helpful (usually as adjunctive therapy with stimulants). It is essential that people with ADHD be given the opportunity to maintain an appropriate social life in the evenings, outside of work or school demands—both for the sake of their quality of life and for the protective effects this provides. In addition, it is important to protect any children they may have from their parents’ emotional instability.

2.4. Many more small steps in the treatment process¶

The points mentioned here should always be taken into account in the treatment of ADHD, as they can usually provide additional benefits without causing any significant side effects. These points are not alternatives; rather, they should all be considered.
However, their effect size (even when all options are combined) is considerably lower than that of the relevant medications mentioned above. If this were not the case, reports of successful treatment without these medications would be nothing more than a myth. Those new to this topic can find information in support forums, such as ⇒ ADHD Forum by ADxS.org
For detailed information on the effect size of non-pharmacological treatments for ADHD, visit ⇒ Effect size of various ADHD treatment methods

Here is just a small selection:

• Vitamins and Minerals
  Determine blood levels and adjust the dosage to the upper limits or higher. For more information, visit* ⇒ Vitamins, Minerals, and Dietary Supplements for ADHD*
  • Vitamin D3
    • Essential in Germany from October through May
    • Very important for ADHD, essential for depression. Prescribing serotonergic or noradrenergic antidepressants (which, in our opinion, have significantly stronger side effects than ADHD medications) without first checking vitamin D3 levels constitutes, in our view, medical malpractice (except in cases of severe depression).
  • Zinc
  • Magnesium
  • Iron
  • B12
  • B 6
• Omega-3 fatty acids: 0.27
• Sleep Problems
  • Treat aggressively
  • Melatonin spray (immediate release melatonin, particularly helpful for falling asleep in people with ADHD)
  • Avoid benzodiazepines and SSRIs.
  • If necessary, trimipramine, amitriptyline, or trazodone (each at a low dose)
  • Light Therapy
  • For more information, visit ⇒ Sleep Problems in ADHD
• If possible, do not begin medication treatment for mild residual comorbidities until after assessing the effects of the ADHD medications (usually after about 6 months)
• Testing for and Ruling Out Food Intolerances
  • Effect size in cases of existing intolerance and consistent avoidance: 0.25; in some cases, significantly higher
  • Once you’ve adjusted your intake, you can basically treat it as a hobby—avoiding a specific high-risk food for a month at a time to see what changes result:
    • Gluten
    • Lactose
      *…
  • For more information, visit * ⇒ Nutrition and Diet for ADHD*
• Testing for and Ruling Out Allergies
• Testing for and treating chronic low-grade inflammation (very difficult)
  • Inflammatory issues associated with ADHD may indicate problems with adenosine homeostasis, which strongly influences dopamine
  • For more information, visit * ⇒ Endurance sports, fitness training in the article “Non-Pharmacological Treatment Methods”*
• Plenty of sports and exercise¹⁸: 0.8
  • Endurance sports have a significant effect size in reducing the symptoms of ADHD (and other mental health issues, such as depression)
    • In contrast, strength training has a smaller effect size
  • A sport has to be fun if people are going to stick with it
  • Endurance Sports
    • Increases stress resistance, shuts down stress responses (for 24–48 hours)
    • Effect size in the optimal case (e.g., 5 × 1 hour per week) up to 0.7
  • For more information, visit ⇒ Sleep Problems in ADHD;
• Healthy Eating
  • Avoid sugar¹⁸
  • Avoid unhealthy fats (saturated fats, trans fats; e.g., frying oil)¹⁹
  • Foods rich in antioxidants (vegetables, fruits)¹⁹
    • Helps reduce oxidative stress

2.5. Follow-up Care¶

Source: S-3 Guideline 2018

• Whenever the dose is changed
  • Frequent monitoring (e.g., weekly)
  • Documentation of Adverse Effects Through Patient Surveys
• Regular checkups (at least every 6 months)
  • Effectiveness
  • Adverse effects
  • Children and Adolescents:
    • Check height every 6 months
      • If there are any issues, consider interrupting treatment (e.g., during school breaks)
  • All patients:
    • Body weight
      • 3 months after the start of therapy
      • Further examination after 6 months
    • Heart Rate and Blood Pressure
      • Every 6 months
      • With guanfacine, monitor closely for bradycardia and hypotension
      • In cases of resting tachycardia, arrhythmia, or elevated systolic blood pressure (> 95th percentile), refer the patient to a (pediatric) cardiologist and consider reducing the dose

3. Step 3: Psychotherapy¶

3.1. Psychotherapy to Reduce Symptoms¶

Choosing the right therapist is far more important than choosing the type of therapy. For more on this, see Choosing a Suitable Psychotherapist for ADHD

Behavioral therapy and mindfulness-based therapies are particularly well-suited as psychotherapy approaches for ADHD without comorbidities. Depth psychology therapies are only somewhat helpful when dealing with traumatic or distressing experiences, and psychoanalysis is not very suitable for ADHD—partly because, unfortunately, many psychoanalysts “reject” ADHD.
It is crucial that the patient feels very comfortable with the therapist and feels that he or she is in good hands and accepted. This by no means implies “cuddle therapy,” in which the therapist would simply tell the patient what they want to hear, but rather the positive acceptance and foundation of trust that are the indispensable cornerstones of successful therapy. Without these basic requirements, even the best form of therapy and the therapist’s greatest experience will be of little benefit. Therefore, it’s well worth being persistent in your efforts to carefully select the right therapist.
It is also important to note that this is not about a single therapeutic intervention, but rather that therapeutic interventions should be continued for as long as necessary and in as many forms as needed until a satisfactory condition is achieved.

In all therapeutic interventions, it must be ensured that the therapist is familiar with all ADHD symptoms relevant to treatment. Even today, doctors and therapists often fall prey to the fatal misconception that ADHD is limited to the symptoms listed in the DSM or ICD for diagnostic purposes. Therapists who refuse to recognize the original symptoms of ADHD that go beyond the DSM and ICD criteria should be avoided. Otherwise, there is a real risk that the person with ADHD will be held responsible for behaviors that actually stem from ADHD itself. Rather than leading to improvement, this can cause the person’s condition to worsen further.

Appropriate types of therapy may include, among others:

• Mindfulness-Based (Behavioral) Therapy (MBCT) to improve self-awareness and enhance self-control over symptoms, and to learn and practice mindfulness-based stress reduction (MBSR) as well as stress-reduction techniques (e.g., 8-week intensive courses in MBCT + MBSR)
  Particularly in cases of ADHD-HI, it is important to break the vicious cycle of an inability to recover, which perpetuates the constant activity of the HPA axis.
• Neurofeedback for long-term improvement in self-regulation (6 months to 2 years)
  • SMR Training to Improve Impulse Control and Address Sleep Problems
  • Theta-Beta Training to Improve Activation Regulation
  • SCT training to reduce overactivation or increase underactivation
  • A combination of Theta-Beta training or Z-Score training and SCP training (either simultaneously or sequentially) seems to be particularly recommended.
• If necessary, cognitive behavioral therapy for self-esteem issues and social behavior problems. See ⇒ Rejection Sensitivity: Fear of rejection and criticism as a specific ADHD symptom Cortisolergic stress arises particularly in situations that are subjectively perceived as threatening to one’s self-esteem.
• If necessary, depth psychology therapy to treat traumatic experiences
• Trauma therapy (EMDR), if necessary, for traumatic experiences
• For children up to 6 or 10 years of age: parent-centered therapy; child-centered therapy is ineffective.

3.2. Environmental Interventions¶

• Eliminate Stressors
• Optimal design of the work and learning environment, e.g.,
  • Eliminate unnecessary stimuli
  • Enable sufficient arousal
• Discussions with significant others to foster mutual understanding
  • If necessary, systemic therapy (family therapy, parent therapy) to change entrenched patterns of behavior
• Focusing one’s life and career on things that truly interest you
  • For more information, visit ⇒ Motivational Issues in ADHD.

4. Step 4: Review of Comorbidities and Medications¶

4.1. Comorbidities¶

• After 9 to 12 months of ADHD treatment, assess the persistence of comorbidities
• If necessary, specific drug therapy (be aware of drug interactions; for example, use caution with SSRIs)
• If necessary, select specific ADHD medications that also have a positive effect on comorbid disorders
  • Atomoxetine primarily exerts dopaminergic effects on the prefrontal cortex (PFC) and noradrenergic effects on the striatum, while stimulants primarily exert noradrenergic and dopaminergic effects on the striatum.
    ⇒ Atomoxetine for ADHD Atomoxetine is believed to be beneficial for severe ADHD-I or SCT.
  • Be aware of the issues associated with serotonin reuptake inhibitors in ADHD-I.
    ⇒ Notes on Selective Serotonin Reuptake Inhibitors (SSRIs) for ADHD
  • In cases of ADHD with bipolar disorder:
    Whether ADHD medications (especially in cases of bipolar I disorder) can have a destabilizing effect on mood is a matter of debate. Against this view: Barkley²⁰
    It is recommended to treat bipolar disorder first and then address ADHD (see above).

4.2. Medication Review¶

• After completing non-pharmacological treatment measures (on a regular basis, e.g., annually), assess whether medication is still necessary
  • Adjustment, if necessary
  • Reduction, if necessary
  • Termination, if applicable
• Regular physical checkups when taking medication
• Dosage: Attempting to eliminate all ADHD symptoms with medication would be medical malpractice. People without ADHD have 9 out of 32 symptoms (from the complete list of symptoms ⇒ Complete list of symptoms by manifestation) frequently, while people with ADHD frequently experience 26 out of 32 symptoms. Attempting to completely eliminate even the “healthy” 9 symptoms would inevitably lead to an overdose.

Through medication and therapy, we have witnessed remarkable changes in people with ADHD, with some experiencing a tremendous improvement in their quality of life within just one year.
The changes were particularly impressive among the people with ADHD who, with persistence and patience, took advantage of every opportunity that presented itself to improve their condition. For barely any of the people with ADHD did all the forms of therapy they tried prove to be helpful. In our observation, the people with ADHD who were particularly successful were those who did not expect specific results from individual measures, but who consistently tried one measure after another until a satisfactory state was achieved. Once one therapeutic measure was completed, the next one followed—but always only as much at a time as could be comfortably managed.

4.3. Medication Breaks¶

Many doctors recommend that their patients take a break from their medication for at least one week at least once a year to determine whether continued medication is still necessary. However, it is barely possible to imagine that a state of “no longer needing” the medication has set in without the (previously unchanged) medication having already been perceived as no longer appropriate. Normally, a decreasing “need” while the dosage remains the same would cause symptoms of an overdose. We therefore suspect that cases in which people with ADHD do not notice any difference between their current state during the medication break and their previous medicated state are more likely related to reduced environmental demands (vacation/holidays) or the development of tolerance.

Such a break in medication should always be weighed against the increased risk of accidents during this time.

Children with eating or growth problems may benefit from taking a break from medication for several weeks during the holidays in order to build up weight reserves for the upcoming school year or to catch up on height growth (which, if impaired at all, is generally only delayed by MPH).²¹

26.3% of people with ADHD stopped taking their medication at some point, with half of them later resuming treatment.²² Others report continuous use over 5 years (without an interruption of 12 months or longer) in 29% of women and 23.5% of men. Adults aged 31 to 50 are less likely to discontinue medication than those aged 18 to 30 (OR 0.57). Changing ADHD medication twice (OR 0.53) or three or more times (OR 0.26) significantly reduced the risk of discontinuation. Eating disorders (OR 0.71), intellectual disabilities (OR 0.65), and sleep disorders (OR 0.42) were associated with less frequent discontinuation of ADHD medication.²³

5. Prioritizing Treatment for Comorbidities¶

5.1. Prioritization Based on the Severity of the Symptoms¶

As a general rule, the condition that is clinically more severe or that is of greater concern to the person with ADHD should be treated first, in accordance with the guidelines.²⁴

5.1.1. Comorbidities More Serious Than ADHD¶

• Primary treatment of the comorbidity
• E.g., major depression, bipolar I disorder,²⁵²⁶ addiction, psychosis, severe anxiety
• In cases of depression, anxiety, and addiction, while simultaneously treating ADHD, which is usually the underlying cause.²⁷
• When anxiety co-occurs with ADHD, specialized treatment may be necessary.²⁷

5.1.2. ADHD Is More Severe Than Comorbidity¶

• Primary treatment of ADHD as the primary disorder.²⁵
• Mild emotional dysregulation, mood swings, mild impulsivity or aggression, mild anxiety disorders, or dysphoria (particularly dysphoria associated with inactivity) are improved by ADHD treatment.²⁸²⁶²⁹

5.1.3. ADHD and Comorbidity Are Equally Serious¶

If in doubt, we would opt for ADHD treatment.
Treatment for ADHD can significantly reduce the symptoms of comorbid conditions—and even eliminate them entirely.³⁰
In our view, taking the side effects of medications into account—so that the treatment with the fewest side effects is chosen—is also likely to lead to prioritizing ADHD treatment in most cases.

5.2. Treatment Guidelines for Specific Comorbidities¶

5.2.1. ADHD and Depression:¶

• Note the difference between dysphoria and severe depression in ADHD
  ⇒ Depression and Dysphoria in ADHD
• Always check D3 blood levels and thyroid hormones before prescribing antidepressants for mild or moderate depression
• Summary of the Texas Pediatric Medication Algorithm for ADHD-HI and MDD, based on Burleson Daviss (2018) “Moodiness in ADHD – A Clinicians’ Guide,”, p. 99 (modified)^{3233 34}
  • Impairment caused by ADHD-HI is worse than that caused by MDD:
    • Start of stimulant monotherapy according to the ADHD-HI algorithm.
      • If, as a result:
      • ADHD-HI, but not depression:
        Add an SSRI for the treatment of depression
      • ADHD-HI and depression remain the same:
        Switch to a new class of stimulants
        • From MPH to AMP or from AMP to MPH
          • Unlike MPH, amphetamine-based medications also have a mild antidepressant effect and are therefore preferable to MPH in cases of comorbid depression. ⇒ Amphetamine-based medications for ADHD
        • If MPH and AMP are unsuccessful:
          • Switch to Guanfacine
        • If guanfacine is also ineffective:
          • Switch to Atomoxetine
      • ADHD-HI and/or depression can worsen:
        Switch to SSRI³⁵³⁶
  • Impairment caused by MDD is worse than that caused by ADHD-HI³⁵ or suicidal thoughts/suicidal behavior³³:
    • Starting SSRI Monotherapy³⁵
      • If, as a result,
        • Depression that does not respond to ADHD-HI:
          Add stimulants for the treatment of ADHD-HI
        • If the depression remains the same or worsens:
          Switching to a Different SSRI
      • If, as a result,
        • Depression that does not respond to ADHD-HI:
          Add a stimulant to treat ADHD-HI.
        • If the depression remains the same or worsens:
          Switch to a non-SSRI antidepressant, e.g.,
          • Bupropion²⁵
          • If bupropion is ineffective:
            Nortriptyline, desipramine, or venlafaxine²⁵

5.2.2. ADHD and Addiction¶

• Addiction or alcohol abuse should be stabilized first, but can be treated concurrently with ADHD.²⁸ In particular, there is no longer any reason to withhold stimulants from people with addiction as ADHD medications and to treat them solely with atomoxetine, which is significantly less effective and has considerably more side effects.³⁷

5.2.3. ADHD and Anxiety¶

In our experience, people with ADHD or high anxiety levels often experience more severe side effects when titrating medication doses. This is not a result of any specific effect or increased risk of side effects from ADHD medications in cases of comorbid anxiety³⁸, but rather a consequence of the anxiety itself. Anxiety causes a person to focus their attention on potential side effects, whereas an optimistic mindset directs attention toward the medication’s potential positive effects. This phenomenon is also well-documented in the treatment of chronic pain.
Therefore, clinicians should consider administering anxiety-reducing medication, at least temporarily, to people with ADHD before or during administration.
In the forum, we have repeatedly found that dose titration is particularly difficult for people with ADHD and often fails, in part because they find it much harder to stick with the many gradual dose increases required to determine the appropriate dose. For someone with an anxiety disorder, every dose increase is a new and unique challenge.
People with ADHD and comorbid anxiety also titrated the placebo to lower target doses than people with ADHD without anxiety.³⁹

ADHD medications can help relieve anxiety once they are properly dosed.⁴⁰⁴¹

It has been reported that nervousness or anxiety occur significantly more frequently with AMP medications than with MPH medications.⁴²

Solution:

• Reduce the dose
• Switch to a long-acting medication
• During dosing
  • Stick with this dose for a week. Side effects often subside after a few days.
  • Consider increasing the dose as an option. Side effects often disappear at a higher dose.
• Switching to non-stimulant medications