Episode 40 – ADHD Medication: Stimulants vs. Non Stimulants [Solo Episode] with Jane McFadden

Jane McFadden:
Hello and welcome back to ADHD Mums. In this podcast we tackle the tough, often unspoken realities of motherhood, neurodiversity and mental health.

Hello everyone and welcome to another episode of ADHD Mums. Today we’re diving into a topic that’s really relevant for all of us navigating life with ADHD. Stimulants versus non-stimulants. What is the difference and which one should we try? What makes the difference and how do we know what to request when we see the psychiatrist or the pediatrician for our children?

Before we dive into the details of medication, I want to start with something that we all know about but we might not fully connect to us and our ADHD treatment, and that is the fight or flight response.

Think about this: you’re walking through a dark car park and suddenly you hear footsteps behind you. Your body instantly prepares itself to either fight or run away. Your heart races, your breath quickens, and you might even start sweating. That is your body’s fight or flight response kicking in.

This response was originally meant for life-threatening situations but here’s the thing — it’s not just for those moments anymore. Nowadays, everyday stress can trigger that same response. A phone call from your children’s school, a bad day at work, even a loud noise — we can all be set off into fight or flight so much quicker than before.

So you might be thinking, that’s just not relevant, can we just get to the point? Well, this actually goes back to the central nervous system, and this is the core of how ADHD stimulants work. The adrenaline that’s released when we’re in fight or flight mode is really similar to what happens when we take stimulants like Ritalin or Dexamphetamine.

These medicines rev up the system by increasing the adrenaline and dopamine and basically giving your body a triple shot coffee effect but a lot more targeted. Your heart rate goes up, your breath quickens, and you suddenly get that burst of energy and focus.

So let’s break down the difference between stimulants and non-stimulants for ADHD, starting with the most common ADHD medications.

First up, stimulant medications. These are the most related to the central nervous system because they work by stimulating the system to produce more adrenaline and dopamine. This is what helps with focus and energy, which is why they’re the first line of treatment for ADHD.

Adderall is more of an American term but it’s probably the most well-known ADHD medication aside from Ritalin, and it’s made up of amphetamine and dextroamphetamine. These two work together to boost dopamine and adrenaline, helping you to stay alert and focused.

And of course, all of the amphetamine words that I’m using — please don’t be put off by the word amphetamine. Dexamphetamine is nothing like methamphetamine and it’s a shame that people hear amphetamine and think addiction.

I believe ADHD stimulants to actually be the opposite of addiction. If you look at the research around drug and alcohol use in ADHD people, what we see is the main reason they use those things is to alleviate their symptoms — anxiety, depression, stress — all the things that are coming out of their neurodivergent condition that are not being treated or understood.

A lot of the time people self-medicate with alcohol and drugs. So if you medicate ADHD properly, the research shows that those people or those children are less likely to turn to drugs and alcohol later. It’s actually the undiagnosed children that are more likely to go into teenagehood self-medicating those symptoms, and it’s more the undiagnosed adults that are still doing that.

So when we think about using stimulants and we don’t want to medicate our kids, just remember we’re actually doing it for their benefit. And if you go back to one of my other episodes, From Skeptic to Advocate, that shows my journey around how my first instinct was I would never medicate my kids, to now where I advocate it openly and talk about the massive benefits it has.

This isn’t about making your life easier or being a lazy parent. This is actually about helping your child’s brain path. It’s about neuroplasticity and it’s about healing your child’s brain so they can actually come off medication in the future.

So while their brain is developing, it’s a great time to help it fire properly. If we aren’t helping it fire properly, then they will have an ADHD brain forever. Whereas if we medicate early with the right medication, by the time their prefrontal cortex is developed, they will actually have a neurotypical brain — or at least won’t have the same deficits around functioning.

I’m really hoping that my children will be able to come off ADHD medication by the time they’re 21, 25. Twenty-five is more when boys come off medication because their prefrontal cortex and their maturity level is so much more delayed.

And then there’s Ritalin, which works similar to Adderall but is kind of different. Ritalin comes in various forms: immediate, intermediate, and extended release. You can choose the version that works best with your schedule.

A lot of parents prefer the long release because their children can take it in the morning, go to school, and not have to line up at recess to take another tablet. That can be jarring and sometimes stigmatizing. Some prefer Concerta, which is a long-acting form of Ritalin. It provides a more level mood across the day.

Let’s talk about Vyvanse, also known as Lisdexamphetamine. Vyvanse is unique because it’s a pro-drug. It doesn’t start working until it’s metabolized by your liver and turned into the active form. This slower activation, over about an hour, makes Vyvanse harder to abuse and more stable throughout the day.

One of the things I like about Vyvanse is you can have it with food without worrying about absorption. Other stimulants like Adderall or Ritalin work best when timed around meals, but Vyvanse can be taken anytime.

Speaking of timing, this is key. If you take Ritalin with a big meal, it may not work as effectively because it gets absorbed more slowly. And with vitamin C — most of us have heard about this — high doses can interfere with absorption.

For Vyvanse and all stimulants, vitamin C is not good to have with the medication. What happens is the stimulant is excreted too quickly through your kidneys before it does its job. Nothing bad happens to you necessarily, but you don’t get the benefit of the medication.

So it’s best to wait at least an hour before or after taking your meds to eat or drink anything with vitamin C. Same goes for giving kids supplements in the morning — check they don’t have high amounts of vitamin C.

Now, switching gears — non-stimulant medication. These are a great option if you’re sensitive to stimulants or struggle a lot with anxiety. A lot of autistic people struggle with stimulants too. Some people stay up all night, feel shaky or anxious.

Non-stimulants don’t rev up your system the same way. You won’t get that jittery feeling. They also work 24 hours, unlike stimulants which are up and down.

Welbutrin is one of the most popular non-stimulants. It’s also an antidepressant because it blocks the reuptake of dopamine and norepinephrine, regulating mood and focus.

There’s also Strattera, also known as Atomoxetine, an SNRI. It adds focus without overstimulating your system. Non-stimulants take two to six weeks to fully kick in. They require consistent use, unlike stimulants which you can take as needed.

I also like Guanfacine, also known as Intuniv, for hyperactivity. I moved my kids from Vyvanse to Intuniv because they’re all hyperactive.

I argued with the pediatrician about cognitive hyperactivity — racing thoughts even if you can sit still. She didn’t think it was a thing. I disagreed. I believe Intuniv helps with that a lot.

Guanfacine is actually a blood pressure medication that happens to help with ADHD. The exact way it works is unknown, but it’s thought to affect receptors in the brain that strengthen working memory, reduce distraction, improve attention and impulse control.

If you think of it simply — stimulants improve the quality of thoughts, non-stimulants reduce the amount of thoughts.

SSRIs are another interesting one. Some people have great success, others don’t. Personally they haven’t worked for me. It’s unclear whether neurodivergent brains respond differently, whether they just medicate the symptom rather than the cause.

You might wonder why one medication works for one person but not another. It comes down to metabolism. For example, I don’t do well on Ritalin but I do really well on Vyvanse and Intuniv. Others say the opposite.

It really sucks that it’s trial and error. With children it’s even harder — you’re watching them go through side effects and wondering whether to push through. You feel responsible. No one wants to medicate a child, and it frustrates me when people say we medicate kids to make them easier to parent. That’s not true. We do it because we love them.

It’s expensive, time-consuming, and emotionally exhausting. And then it’s not a quick fix. Finding the right one is hard.

One interesting thing coming out is DNA testing to see how your body processes different medications. It could be a game changer. I haven’t tried it, don’t endorse it, but it’s an option.

Let’s talk about side effects. Whether stimulants or non-stimulants, they’re there. You have to weigh the cost-benefit.

Common ones: decreased appetite, dry mouth, headaches, insomnia. More serious ones: extreme weight loss, heart palpitations, severe nausea.

Remember: when your body is in fight-or-flight, digestion slows. That might explain loss of appetite. I force myself to snack, eat lunch, drink water — otherwise I get a raging headache. Sometimes it’s not the stimulant causing the problem, it’s not eating all day.

Sleep can be an issue too. Timing is key.

For children, I like non-stimulants because they give steady coverage. With stimulants, mornings can be rough waiting for them to kick in, and afternoons can crash hard. Do you top up? Do you ride it out? It’s tricky.

Stimulants give that laser focus. Non-stimulants don’t quite reach that level. So you have to weigh what’s best for you.

There is nothing more powerful than education and self-advocacy. I don’t leave it to the medical system to tell me what to do. I go in researched. That’s why I have this podcast — to break down the information.

I also have a medication guide online. You can purchase it through the shop. It covers common questions, simple problem-solving, timing, fatigue, all of it.

If you can, get educated, be confident, and take an active role in appointments. Go prepared. Have your research.

Personally, I like both stimulants and non-stimulants. I’ve tried both, I’ve been on both, and I think both are worth it.

Look at your personal preferences. I hope this was helpful.

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