Tarnow Articles

Psychopharmacology: Stimulants By Jay D. Tarnow, M.D.

Many people have asked about the "bad" feelings they experience when taking stimulants. Different people describe these bad feelings in various ways. The first problem is that patients with ADHD have a great deal of trouble describing their feelings and also have difficulty with the details. Good physicians listen carefully to what patients say and how they describe their feelings. They ask questions to help make the proper diagnosis. With problems of the brain, the physician is even more dependent on the patients' descriptions. Therefore, patients should come to their doctor armed with a diary of their self-observations, feelings, side effects, and observations of significant people in their lives such as family, friends, and teachers. Patients should try writing their feelings down before their appointment with the doctor so they can get the most from their visit.

These "bad" feelings are often described as depression, sadness, or irritability. Sometimes these feelings that the patient is experiencing are a result of the stimulant making the patient with ADHD more aware of their internal feelings.

Prior to taking the stimulant, the ADHD symptoms of distractibility, hyperactivity, and impulsivity may have kept the patient unaware of internal negative feelings. These ADHD symptoms keep the patient so outside-focused that the internal world does not play a very prominent role in their awareness. In addition, symptoms of ADHD can also create enough chaos in one's life that a person is always dealing with the external crises in their lives and they are distracted from their internal world. Dealing with a crisis is very arousing and thus, the sad feelings are pushed aside. Anger is another defense mechanism used by the person with ADHD to avoid feeling depression. Like a crisis, anger mobilizes the adrenaline system, which excites a person and leads to an increase in dopamine and norepinephrine in the brain. These are the two neurotransmitters that are felt to be lacking in patients with ADHD. Thus, when the adrenaline system is stimulated, patients with ADHD have better concentration and focus.

These neurotransmitters also ward off depression. If we treat the patient with a stimulant like methylphenidate (Ritalin, Concerta, Metadate, Methylin), Dexedrine, or Adderall; then the patient becomes more focused, less distractable, and more inwardly focused on the details. Then, for the first time, they may become aware of the depression they have been carrying around for years.

As we all know, it is not easy to have ADHD. There are many hurts and traumas that take a toll on one's self esteem. Thus, the patient who complains about becoming depressed, sad, or just feeling "bad", needs to be further assessed for an underlying depression. Many patients will also complain that the stimulant takes away their typical exuberant personality. They have learned to use this personality to make up for the difficulties caused by the ADHD. They become fearful that they cannot make it without this exuberance. However, these insecure feelings are common whenever we change. Until we know how to use our new skills and experience success, we must feel the fears and recognize they are part of change. This is where psychotherapy can be so helpful. Also, the work of a child or adolescent is school. Therefore, that exuberant, class clown personality is not the best for learning and can be left for after school or weekends, when the stimulants are not taken.

All the stimulants, like any medicine, can cause side effects in some people. Recognizing side effects and reporting them quickly and accurately to your doctor is very important. However, it is not always the medicine that is causing the negative effect, such as "bad" feelings. Sometimes changing the stimulant will ameliorate these negative feelings. Sometimes adding an anti-depressant will be helpful.

Because the stimulants are short acting, they do not usually cause any personality changes when the medicine wears off or is not taken on a certain day, unless there is an underlying co-morbid condition such as depression.

Remember that the stimulants have been proven to be the most effective and the safest of all medications and herbs for ADHD.