ADHD treatment often includes prescription medications, such as Ritalin and Adderall. In this Forbes article, Mindpath Health’s Zishan Khan, MD, discusses their approved uses, side effects and how they compare to one another.
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition affecting around 9.8% of children and around 2.5% to 4% of adults worldwide. The condition, which causes inattention and hyperactivity, among other symptoms, may disrupt an individual’s academic, professional, or personal life, underscoring the need for proper treatment.
Treatment often includes prescription medications, such as Ritalin and Adderall. These stimulants have been approved by the Federal Drug Administration (FDA) for over 20 years and are generally safe and effective. While the two medications have similar profiles, there are some circumstances in which either Ritalin or Adderall may be more beneficial than the other.
What is Ritalin?
Ritalin is a brand name of methylphenidate, a central nervous system (CNS) stimulant commonly prescribed to treat the symptoms of ADHD, such as inattention and impulsivity. Ritalin is available as a tablet, in chewable form, a liquid solution, and a long-acting capsule; the dosage depends upon the individual’s age and weight.
Approved uses of Ritalin
Methylphenidate treats ADHD and narcolepsy, a sleep disorder that causes excessive drowsiness that may impair daily functioning. The medication is approved by the FDA to treat ADHD in individuals ages 6 and older.
“Taking Ritalin [for ADHD] can have the resultant effect of stability, calmness, and improved concentration,” says Zishan Khan, MD, a psychiatrist with Mindpath Health.
Side effects of Ritalin
Side effects are typically mild and may last for a few days to a few weeks, says Brian Clark, a trained nurse anesthetist. Possible side effects include, but are not limited to:
- Decreased libido
- Difficulty sleeping
- Drowsiness
- Dry mouth
- Headache
- Heartburn
- Irritability
- Loss of appetite
- Muscle tension
- Nausea
- Nervousness
- Vomiting
- Weight loss
In rare cases, Ritalin can cause serious side effects that require immediate medical attention. Possible serious side effects include, but are not limited to:
- Blistering
- Chest pain
- Excessive drowsiness
- Fainting
- Fever
- Hallucinations
- Impaired speech
- Irregular heartbeat
- Irregular mood
- Muscle weakness or numbness in arms or legs
- Paranoia
- Seizure
- Shortness of breath
- Vision changes
“Any CNS stimulant can strain one’s heart, with the possibility of arrhythmias, rapid heart rate, chest pain and heightened blood pressure,” says Dr. Khan. “Extra caution should be taken if prescribed to someone with a pre-existing heart condition, a family history of heart concerns, or [to someone who] frequently experiences chest tightness or discomfort.”
Additionally, stimulants such as Ritalin should not be taken within 14 days of monoamine oxidase inhibitors (MAOIs). While not contraindicated, a medication like Ritalin may lower the efficacy of certain drugs used to treat seizures in children and adolescents.
What is Adderall?
Adderall is a prescription medication that contains a combination of dextroamphetamine and amphetamine. Like Ritalin, Adderall is a CNS stimulant that increases the chemicals in the brain that promote alertness and focus.
“The amphetamine class of drugs tends to be somewhat more potent [than methylphenidate], theoretically suggesting that one would require a lower dosage to achieve a similar effect,” explains Dr. Khan, though he notes this does not hold true for every individual.
Approved uses of Adderall
Adderall is approved for treating ADHD in adults and children aged 6 and older. Additionally, this medication is prescribed to treat narcolepsy.
Side effects of Adderall
Adderall has the potential for side effects, which Clark says tend to be mild and short-lived. These side effects include, but are not limited to:
- Agitation
- Changes in libido
- Constipation
- Diarrhea
- Dry mouth
- Headache
- Nausea
- Painful menstrual cramps
- Weight loss
In rare cases, Adderall may cause serious side effects, including sudden death in children and adolescents, and heart attack, stroke or sudden death in adults. The risk is higher for individuals with heart conditions.
Should you experience serious symptoms, seek immediate medical attention. Serious side effects include, but are not limited to:
- Breathing difficulties
- Depression
- Dizziness
- Hallucinating
- Impaired speech
- Itching, blistering or bruised skin
- Mania
- Muscle weakness or numbness in arms or legs
- Paranoia
- Seizures
- Swelling
- Tics
- Vision changes, and more
You should not take Adderall if you are currently taking MAOIs. If taking an MAOI, wait 14 days before beginning an Adderall prescription.
Ritalin vs. Adderall: What’s the difference?
Ritalin and Adderall are similar in terms of efficacy, side effects and cost, says Dr. Khan. “In a very general sense, neither medication’s intrinsic property makes it a better option for the treatment of ADHD,” he says.
Oftentimes, determining which medication is most efficacious requires trial and error. These medications are often used interchangeably—if one does not work, the other is an option. However, certain circumstances may result in one medicine being prescribed.
These medications come in short-acting (three to four hours) or long-acting (four to six hours) formulations.
Does insurance cover Ritalin and Adderall?
Prescription stimulant medications to treat ADHD, such as Ritalin and Adderall, are considered medically necessary in specific cases, including when an individual has been diagnosed with ADHD, narcolepsy, or as an adjunct therapy for an individual already receiving depression medication. Because they are considered medically necessary, these medications are covered by most insurance plans, as well as Medicare.
When to see a doctor
Ritalin and Adderall have a decades-long history of use in the US, demonstrating safety and efficacy for treating ADHD in children, adolescents, and adults. While most side effects, such as suppressed appetite and trouble sleeping, are mild and temporary, seek medical help if the side effects are severe or persistent.
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