March 28, 2023

In this video (part 1 of 2), I talk about stimulant medications used to treat ADHD (Attention-Deficit Hyperactive Disorder). The different medications reviewed are: amphetamine/dextroamphetamine (Adderall XR and IR), lisdexamfetamine (Vyvanse), methylphenidate (Concerta and Ritalin IR, SR, and LA), and dexmethylphenidate (Focalin IR and XR). My aim of the video is to help others understand the differences between these drugs and what they do. Hopefully it can help you decide which medication would be right for you, but please be sure to discuss this with your doctor or PCP!

Hello and welcome to the third episode of adhd for grownups today we’re going to be talking about adhd medications specifically stimulants part two will include non-stimulants there are two types of adhd medication stimulants and non-stimulants stimulants are going to stimulate the central nervous system or the cns non-stimulants sure you guessed it do not

Stimulate the central nervous system what is the central nervous system it’s basically just your brain and spinal cord and as you know it controls lots of things but importantly having to do with adhd it controls your memory your movement speech and spatial awareness as i mentioned today we’re just going to talk about stimulants the next video is going to be about

Non-stimulants but here are the stimulants we’re going to talk about today amphetamines and dextroamphetamines an example of that would be adderall lis dexamphetamine vyvanse methylphenidate examples are concerta and ritalin and dex methylphenidate an example of that would be falkelin focalin i don’t take this one so i this is actually the first time i heard of

It so i’m not sure how to pronounce it i’m going to guess focalin sorry i said it weird the first time the first stimulant we’re going to talk about is adderall the generic name or the chemical name is going to be amphetamine dextroamphetamine and up in the right hand corner here is the chemical structure of amphetamine dextromphetamine so there are two types of

Adderall we have extended release xr and immediate release ir immediate release can also just be called adderall but extended release you always have to put that xr in there to really specify which adderall you’re talking about so extended release kicks in within 30 to 90 minutes depending on your stomach contents um so if you just ate a big meal it’s going to

Take a little closer to 90 minutes for that to kick in and it’s not going to be as effective but compared to if you just woke up and you haven’t eaten breakfast yet and you take it it’s going to kick in closer to 30 minutes some people even say that it kicks in 10 to 15 minutes for them it really depends on the person and your metabolism this lasts about 7 to 12

Hours of course again this depends on how much you’ve eaten that day how much you ate right before you took it and your tolerance level that’s why there are different doses sometimes if you become tolerant to adderall you have to increase your dose or even switch medication and like i mentioned there are different doses doctors usually like to start you out on 5 or

10 milligrams and then they up it from there and it goes all the way up to 30 milligrams immediate release these kick in within 5 to 20 minutes this isn’t as dependent on your stomach contents as the xr is but again if you did eat a huge meal that will affect it a little bit um it lasts only about three to four hours depending on your tolerance and the dosages

That the immediate release comes in are 5 10 and 20 milligrams i want to point out a lot of people that are against the use of adderall they like to point out that it sounds a lot like methamphetamine which is the main ingredient for meth you know the drug that people do the illegal drug um but it’s not to be confused with that amphetamine and dextroamphetamine

Are not the same thing as methamphetamine a little more on adderall we’re going to talk about the mechanism of action really quick and the effects it has on the body so what it’s going to do is increase the production of and inhibit the reuptake of these three molecules or neurotransmitters so reuptake normally if your presynaptic neuron if you haven’t watched

The other video i’d highly recommend going back to check it out it’s five minutes it kind of explains this part the presynaptic neuron is going to send out these molecules and if the postsynaptic neuron doesn’t take it within a certain amount of time the brain’s like okay well if you’re not going to use it then i’ll just take that back adderall prevents that from

Happening so it kind of ensures that these molecules are going to get taken up by that postsynaptic neuron at some point and while it’s preventing the reuptake it’s also increasing the production of dopamine serotonin and norepinephrine so you’re going to have more dopamine serotonin norepinephrine and your brain isn’t going to try to take it back so you’re just

Going to be using that more and there’s going to be more available for you to use so effects that adderall can have on the body there are some good and there are some bad and i want to emphasize that not everyone experiences all of the good things and not everyone experiences all of the bad things i have personally tried adderall and vyvance so i can speak from

Personal experience on those when we get to it but i want to emphasize please remember that this does not apply to everybody so positive effects that adderall has it’s going to improve your attention span you’re going to have better focus and concentration i personally have more energy i yawn a lot when i haven’t taken my adderall and then once it kicks in i feel

More awake and alert it also is going to control impulse control you’re not going to be as fidgety it gives me a sense of clarity like the cloud and the fog has been lifted and it’s amazing i feel more motivated when i take it and i’m a little more motivated to organize things i’m more organized i can prioritize things i can clean up easily and see things that

Need to be cleaned up stuff like that uh negative effects that it can can have on the body um insomnia i’ve experienced this if i don’t eat enough the same day that i take adderall there’s also the risk of having a reduced appetite this definitely happens to me anxiety that doesn’t happen to me increased heart rate sometimes happens to me dry mouth definitely

I’ve had to pause this video a few times because i took one this morning and my mouth is really dry right now and i keep having to drink water and then of course there’s withdrawal some people experience withdrawal symptoms when they haven’t taken their adderall that was supposed to be the anxiety little thingy vyvanse is another stimulant its generic or chemical

Name is lisdexamphetamine and here is the chemical structure of vyvans it’s a little longer than the uh than the amphetamine structure fibanz can be taken in a few ways you can mix it in a drink or like yogurt there are chewable tablets or there are swallowable pills vyvanse is also long acting like adderall and it comes in these doses and it’s also used to treat

Eating disorders so now we’re going to talk about the mechanism of action for vyvanse and the effects that it could have on the body so first i want to clarify that um liz dex amphetamine is actually a pro drug of dextroamphetamine now if you remember dextroamphetamine is what adderall is made from and pro just means that this molecule lisdexamphetamine vivance

Is inactive until it’s metabolized by the liver so the liver is going to take in that lesdex amphetamine and then it’s going to spit out dextroamphetamine which can then be used by the brain so i made up a little schematic here so here is a vyvanse pill which contains this lisdexamphetamine that is going to you swallow it and it’s going to take about an hour or

Maybe two hours to get to your liver once it gets in your liver liver is going to metabolize it chew on it for a bit and then it’s going to spit out dextroamphetamine this is the chemical that was on the same page as the adderall page and then that dextromphetamine is going to make its way to your brain and increase the production of dopamine and norepinephrine

And inhibit their reuptake it doesn’t have the increased production or reuptake inhibition for serotonin like adderall does but it does have it for the other two effects on the body they’re going to be about the same as adderall personally for me vivants did not work i took 40 milligrams of vyvanse and it it wasn’t working out for me but i have heard really great

Things about it from other people that it does work for it really just depends on the person so trying out different drugs if one doesn’t work don’t give up some something will work for you eventually hopefully um a pro to taking vivants instead of adderall is that it’s smoother than adderall because you have to go through all of this it’s not going to kick in

All at once super strong it’s going to be kind of more of a gradual kick in however the con to it is that there’s no generic version every other medication that i’m going to discuss has a generic version so it’s not going to be called adderall it’s going to be called dextromphetamine amphetamine salts and usually the generics are cheaper however vyvanse does

Not have a generic version and it can be very very expensive if you have to go online and get a coupon and even if you do have the coupon sometimes your insurance won’t cover it and the first time i try to get vivants with different insurance they told me it was going to be like 340 dollars for 30 pills so it can be very expensive if you don’t have the right

Insurance in the coupon another stimulant is going to be methylphenidate there are two methylphenidates ritalin and concerto we’re going to talk about ritalin first here is the chemical structure of methylphenidate there are three types of ritalin there’s the immediate release and that’s just called ritalin the sustained release which is called ritalin sr and

Extended release which is called ritalin la i’m assuming that stands for long acting i was just a guess though so the immediate release ritalin um will obviously act immediately just kind of like with adderall depends on what you’ve eaten but it should kick in within like 15 minutes and then it lasts for about three to four hours there are three doses of immediate

Release ritalin and they are 5 10 and 20 milligrams there’s also a sustained release ritalin this kicks in within about an hour and it lasts four to eight hours and there is only one dose for the sustained release and that would be 20 milligrams and then finally the extended release also kicks in within within about an hour and it could last up to 10 hours they

Have more doses though from ranging from 10 to 60 milligrams i was confused when i looked this up i’m like okay so what’s really is the difference between ritalin sr in ritalin la it literally it’s just sr is intermediate acting and la is long acting that’s the only difference they kick in about the same amount of time and but the ritalin sr lasts less time than

The extended release i believe though that sr since it’s sustained it says sustained it is more of a plateau type of effectiveness whereas extended release has more of a peak and then it goes downhill so let’s see the mechanism of action for ritalin it’s going to inhibit the reuptake of norepinephrine and dopamine by blocking their transporters so normally during

Reuptake there are these transporters that are going to come in and take the neurotransmitters back if they’re not being taken up by the postsynaptic neuron but ritalin is going to block those transporters so i another little schematic here we have norepinephrine as the n obviously and then the dopamine is going to be the d and this is the cleft club referring

To the synaptic cleft so norepinephrine and dopamine are going to the cleft club norepinephrine is psyched because it’s going to be lit dopamine is also hyped and here comes the transporter hey i’m here to pick these guys up and guess what not a chance ombre back of the line so ritalin is going to prevent those transporters from picking them up and taking them

Away from the postsynaptic neuron giving them a better chance to be taken up by that postsynaptic neuron and used by the brain effects on the body uh you’re going to have improved attention span and concentration this also um specifically is controlling for fidgeting um do not quote me on this i’m not 100 sure i should have looked this up before but i’m pretty

Sure ritalin is taken uh more frequently by people that have a hyperactive type or are more hyperactive than others there are a lot of bad side effects while while adderall and vyvans also had bad side effects i found a lot more for ritalin so i included a lot of them so things like upset stomach rapid breathing your body temperature and your blood pressure

And your heart rate are all going to go up you have circulation issues stuff like that so make sure you’re aware of those things if you’re going to talk to your doctor about taking ritalin the other methylphenidate drug is going to be concerta they’re just like ritalin it’s methylphenidate same exact chemical structure however conserta only has extended release

It’s going to kick in within an hour just like the others um it can last up to 12 hours everything i found online though though all the forums people said it usually lasts about six and then a max of 10 it does remain in your system for about 12 hours though um and the doses are kind of weird for concerto whereas like the other medications like adderall viva and

Sritalin they were more even round numbers like not even but like 5 10 15 20 stuff like that these are kind of weird 18 27 54. so doctors were finding that these concerto they used to be on the more round number doses but they were finding that the doses were not really uh comparable to that of other adhd medications so they just adjusted them to have them be

More comparable to like adderall vivants those kinds of doses and then also it has the same mechanism of action as ritalin and has the same effects on the body same risks so if you’re interested in taking concerta and you miss the ritalin part rewind it a little bit it’s right before concerta and then you can see the mechanism mechanism of action and all that good

Stuff so i was confused when i was researching this like what’s the difference then between ritalin and concerta and the answer is nothing now it is uh concerta and ritalin used to be different because ritalin used to only have immediate acting immediate release type of medicine but now like you know before ritalin also has intermediate and extended release so

Now really the only difference is that concerta doesn’t have intermediate or immediate like ritalin does the all the other difference that may be between there may be between concerta and ritalin are insurance companies might cover each drug differently maybe they cover conservative but not ritalin or maybe there’s like a higher co-pay on them i don’t know i do

Not understand the rhyme or reason for insurance companies doing what they do that’s just how uh just how they work because uh america so yeah the last stimulant we’re going to talk about today is focalin or the uh generic name or the chemical chemical structure name is going to be dex methylphenidate and here is the structure here folklin comes in two varieties

We have the immediate release and that’s just referred to as planofociline kind of like with ritalin the immediate release is just called ritalin and extended release which is focalin xr the immediate release is going to kick in within 20 minutes and it lasts about four hours and there are only three doses for the immediate release and then extended release is

Going to kick in within an hour and it can last up to 12 hours but just like the previous ones just because it says it lasts up to 12 hours doesn’t mean it usually does like for me for example with adderall it says up to 12 hours but it usually only lasts about five or six the extended so this also comes in lots of doses ranging from five to forty going in five

Milligram increments and it’s going to block the reuptake of dopamine and norepinephrine that is the mechanism of action so what’s the difference between methylphenidate and dexmethylphenidate or in other words what’s the difference between ritalin concerta and focaline so even though focalin has a similar chemical structure to ritalin and concerta it actually

Acts more similarly to amphetamine or adderall however even though it has like the same type of um mechanism as adderall and it acts about the same as adderall it is much milder than adderall so if if you’re sensitive to adderall then focalin might be a good route to go if if you like the way adderall works but it makes you maybe a little too anxious or um

You’re experiencing a lot of the negative side effects maybe trifocalin because it has uh milder effects on your brain so that is all we have today about stimulants um check back for the video about non-stimulants i hope to maybe record it in the next few days just a sneak preview here the non-stimulants we’re going to be talking about that people commonly take

For adhd uh stratera cafe intuniv and wellbutrin and i have a message from my four-year-old son i would really appreciate a like a subscription and if you have any questions please leave them in the comments below and uh have a great day see you guys later

Transcribed from video
ADHD Medication – Part 1: Stimulants By What in the ADHD?