Neurotransmitters and Medications

Updated: Sep 13, 2020



Warning! I'm not a doctor, nurse, health care professional, or even a person talking to a nurse. Please talk with your doctor and verify that anything mentioned in this post is correct/up to date.


With all the talk about coping mechanisms lately, now may be a good time to bring up some of the things that happen biologically in people with ADHD. There are a lot of myths about there being no differences in the ADHD brain, but none of that is true. In the ADHD brain there a few different things that can be going on to change the way that our brains work, and all of it is genetic. With irregular levels of dopamine, serotonin, and norepinephrine, it can cause people to be mentally foggy and seek the chemicals that their brain needs. Though the world has come a long way in the last twenty years of understanding ADHD, it's important to mention that there is still a lot that scientists don't know


Dopamine

Many of you have probably heard of this particular brain chemical. It's where the term "dope" comes from, and for good reason. It helps you feel rewarded and have a good sense of accomplishment. But many people don't realize that it also plays a large role in planning, focus, striving, and being interested in things. When you have ADHD, you don't have enough and it makes your brain seek it out by trying new things, eating food, shopping, new relationships, risky behavior... The things we naturally do to lift our spirits can come in as many forms as there are people in the world, but in a normal brain, there's a good baseline of general happiness that lets them stay focused even when they aren't getting that "high". This is not to say that ADHDers are depressed (although they can be more prone to it) but it does make adapting to this difference difficult.


Why is Dopamine low? How do we fix it?

In ADHD, our bodies have a GENETIC difference that either causes us to make less dopamine, sucks up too much dopamine between our cells, or both. Stimulants fire up the parts of our brain that make dopamine and help us be closer to "normal". Science is also showing that exercise, meditation, and other healthy activities help ADHD more than any other mental disorder, and it's because of this dopamine effect.


Serotonin

This neurotransmitter is responsible for stabilizing moods, sexual drive, focus, and signaling in your body's digestive functions. According to Dr. Amen's seven types of ADHD theory, I'm considered an overfocused ADHD. I jump into something, and get stuck thinking and doing only that thing for a while until it gets too boring and I find something new. I get SO focused on something that I feel like a horse with blinders and earmuffs on. Nothing else exists in the world when I'm deep into a task. This is called hyper-focus and it's caused partly by low serotonin.


How do you fix it?

This is another chemical that can be boosted with exercise and meditation, but if that's not enough an ADHDer might be prescribed an antidepressant. This doesn't mean that they're necessarily depressed, but this is the same brain chemical affected in depression, so it tends to respond well.


Norepinephrine

ADHD was the first mental disorder to be found with a difference in norepinephrine levels. It's the body's stress response neurotransmitter and it's created with dopamine. It affects alertness, arousal, reaction time, and focus. In people with ADHD, this neurotransmitter is also lower than normal.


The same stimulants that increase dopamine increase norepinephrine and the same non-stimulants that treat depression mentioned above prevent it from being taken out of the system.


Medication Can Be Tricky

With so many different chemicals and structures affected in the brain, it's hard for doctors to know EXACTLY what type of ADHD medications will work, and which ones will not. What we do know is there are a lot of different medications used for the treatment of ADHD which weren't available when I was a kid.


Stimulants

Stimulants such as Ritalin, Adderall, and Dexedrine are the most researched and usually the most effective treatments for ADHDers who medicate. They work by firing up the brain to make more dopamine. That way the baseline of dopamine is at the right level.


Strattera

This is the non-stimulant ADHD specific medication currently available in the US. There are some off-label medications that may be prescribed, but they aren't approved by the FDA specifically for ADHD. Strattera works by increasing norepinephrine. It's not as effective in treating hyperactive ADHDers, so they're usually not the first line of trial. It's also known to increase the risk of suicide in children, so if your child has depression this might not be the right choice for them.


Other Medications

In some cases, there may be a need to use a medication that isn't intended for ADHD specifically but is known to have a positive affect. In that case, there are a few other medicines that might be used.


Some blood pressure medications can be used to treat ADHD. They do a good job with hyperactivity, aggression, and impulsivity but don't do as well with focus and attention. Most people that I have encountered who use these types of medicines tend to use it as a booster rather than as their main medication.


For ADHDers with depression, certain antidepressants seem to have a positive effect on their ADHD symptoms. These are typically antidepressants that target both dopamine and norepinephrine together or are tricyclic.

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