Frequently Asked Questions
FAQs about Stimulant Medications
What is a stimulant drug?
Stimulants are prescription drugs that tend to promote wakefulness and mental activity. They have been around in various formulations for decades, and are among psychiatry's most well-studied drugs. Some popular stimulants include Adderall, Ritalin, Concerta, and Vyvanse.
Due to stimulants having the power to increase energy and wakefulness, they are becoming increasingly popular recreational drugs, especially on college campuses. Stimulants are just like any other medication; potentially dangerous when administered outside of clinician supervision, but quite safe when taken at the proper dosage to treat a medical condition.
What conditions can stimulants treat?
Stimulants are most commonly used to treat AD/HD, particularly in children. Some clinicians also prescribe stimulants on an off-label basis to treat depression, particularly if the depression appears to be related to ADHD or has led to difficulties with motivation. Some people with sleep disorders, particularly narcolepsy and shift-work sleep disorder, also benefit from stimulants to remain wakeful during the day.
How do stimulants reduce hyperactivity?
The idea that a drug that increases alertness and energy could improve concentration in people with hyperactive tendencies might seem strange. After all, when people without ADHD take stimulant drugs, they often find themselves overwhelmed with energy, anxiety, and distraction. Stimulants can also have a paradoxical effect in people with AD/HD. Rather than globally increasing activity, they help people to sharpen their focus and concentrate on the task at hand.
Doctors have proposed a number of theories to explain this phenomenon. One possibility is that people with AD/HD don't have as much of a chemical reward associated with concentration and work. Stimulants can increase brain chemicals associated with motivation and reward, making it easier—and more rewarding—to concentrate. Another possibility is that the hyperactivity common among people with ADHD is a desperate attempt to remain focused, so stimulants reduce hyperactivity by sharpening focus.
Who should take stimulant drugs?
Stimulant drugs can be highly effective for people who are properly diagnosed and whose dosage is monitored. However, they can also be addictive. Like all medications, they are not without side effects. For this reason, most medical bodies and almost all research argues that people—particularly children—should not take stimulant drugs until they have tried other options, such as psychotherapy, changes in the environment, and family support. People who do take stimulants should continue with psychotherapy. Since psychotherapy can amplify the effects of the drug, reduce the necessary dosage, and perhaps even shorten the length of time that the drug is necessary to take. RCBM has several therapists who are specialized in ADHD coaching to help cope with symptoms to improve your life.
What are the side effects of stimulants?
Like other drugs, stimulants can produce a range of side effects. Not everyone experiences these side effects, and very few people experience the most severe side effects. Many users find that the side effects appear immediately, but that as the body adjusts, the side effects disappear. If you experience side effects that are intolerable, talk to your doctor about a reduced dose or alternative medication. In some cases, lifestyle remedies may also help with side effects. For instance, the shakiness that some people experience when they take stimulants may improve with more frequent meals. The most common side effects of stimulant drugs include:
- Changes in appetite that can lead to weight-loss.
- Weight-loss even without dietary changes.
- Restlessness, anxiety, or aggression.
- Shakiness and light-headedness.
- Increases in blood pressure or heart rate.
- Nausea, vomiting, or diarrhea.
- Changes in vision.
- Very rarely, stunted growth in very young children who take high doses.
- Very rarely, suicidal thoughts and actions.
- Very rarely, extreme aggression, psychosis, or dangerous behavior.
How do I know if a stimulant is working?
Unlike some other psychiatric medications, stimulants begin working immediately after you take them. They do not need time to build up in your system. However, your body may need some time to adjust, and you might also find that you steadily make lifestyle changes that increase the effectiveness of the stimulant. If you do not notice improvements in concentration, mood, or motivation within a week, talk to your clinician at RCBM. You might need a higher dose, a different drug, or a different diagnosis.
Is there anything I can do to increase the efficacy of my stimulant medication?
Never increase your dosage without first consulting your clinician! Doing so can endanger your health and increase your odds of chemical dependency. Some steps that may increase the effectiveness of your drug include:
- Talking with your clinician about the best time of day to take your medication, then continuing with that dosing schedule.
- Eating small, regular meals.
- Pursuing psychotherapy alongside medication.
- Making lifestyle changes such as planning your time, sticking to a routine, and avoiding common distractions such as social media and smartphones.
Do stimulants ever stop working?
As the body becomes more accustomed to stimulants, it may develop a tolerance that reduces or eliminates the effectiveness of the drug. Your clinician can discuss with you the best ways to deal with this. Do not increase your dosage without a medical consultation! Our clinicians do their best to respond to questions via phone or email. Sometimes, an increased dosage is all you need. In other cases, your clinician might recommend pairing your current drug with a different drug, trying a new medication, or taking a “drug holiday” to allow your body time to readjust.
What about the possibility of addiction or abuse?
When your body becomes dependent on a drug to feel normal, addiction becomes extremely likely. If you become addicted to stimulants, it's not your fault. The good news is that when monitored by a clinician and taken at the right dose, the chances of addiction are very slim. If you do become addicted, your clinician can help steadily wean you off of the drug, then work with you to find a more appropriate treatment.
I've read that stimulants are dangerous for kids, or are over-prescribed. Does my child really need to take a stimulant?
It's true that some children who don't actually need them take stimulant drugs. Most research suggests that this tends to happen when desperate parents seek help from family physicians—not psychiatrists, psychiatric nurse practitioner or physician assistant. In their zeal to help, family physicians and pediatricians may prescribe stimulants to children who do not really need them, or neglect to tell parents about the benefits of psychotherapy.
If you see a psychiatrist, psychiatric nurse practitioner or physician assistant, the likelihood that this will happen is much lower. Monitor your child closely. If he or she is thriving while using stimulants, it's likely you've found the right drug. If nothing changes, or your child gets worse, consult your doctor. Your child might have been misdiagnosed, or he or she might be taking the wrong medication.
Will my child or I have to take stimulants forever?
There's no easy answer to this question. Much depends on how severe your symptoms are, whether you continue with psychotherapy, and what lifestyle changes you are willing to make. Some children grow out of AD/HD, but for most, it continues to be a struggle. Many find that stimulants offer relief, allowing them to find other ways to manage their symptoms. If those management tools are sufficiently effective, you or your child might not need to permanently take stimulants.
In some cases, clinicians recommend cycling stimulants by taking them for a brief period of time to regain focus, taking a break, and then trying again later. If you or your child need stimulants for a long period of time, this is one way to minimize side effects, chemical dependency, and the risk of addiction.
What are the symptoms of AD/HD?
AD/HD are more than just difficulty concentrating, and symptoms manifest differently in different people. Some common symptoms include:
- A constant need for stimulation; chronic boredom.
- Frequently forgetting or losing things.
- Unable to concentrate, despite making a great effort to do so.
- Hyperactive, aggressive, or distracted behavior, particularly in children.
- Depression; this is a common and often-overlooked symptom in adults, particularly those who struggle at work or in relationships because of AD/HD.
- Difficulty following a conversation.
- Frequently interrupting other people.
- Inability to sit still; may be fidgety, bite nails, or shred scraps of paper.
- Inability to maintain a tidy work space.
- Difficulty with time management; may greatly overestimate or underestimate how long tasks will take.
- Working very slowly due to the delays associated with frequent interruptions. Adults, for example, may compulsively check social media, causing a 30-minute task to take four hours.
- Chronic procrastination.
For further questions or concerns, please call or email your clinician at RCBM. We will do our best to assist you and answer any questions you might have in a timely manner. Our team at RCBM is dedicated to giving those patients who are struggling from AD/HD the tools to manage their symptoms and live a normal life.
Can you tell me more about psychological testing?
For further information about testing, please click here.
Will information that I disclose during my visits be kept confidential?
Absolutely. The Rochester Center for Behavioral Medicine feels that confidentiality is among our most important responsibilities.
How long is a therapy session?
Therapy sessions last between forty-five and fifty minutes.
Do you do physicals at RCBM?
No, we do not do physicals at RCBM. We refer to primary care doctors, and we have a list of doctors that we commonly consult with.
How long will I need to be in therapy?
This depends on the case. At RCBM, we believe in focused psychotherapy and do not believe in keeping people in therapy beyond the time that they need to be there.
How frequently will I be meeting with the doctor?
This depends. Some individuals need to see the doctors on a frequent basis, sometimes on a monthly basis, and sometimes in stable cases, meetings with doctors may not be more frequent than every three months.
Do you give injections at RCBM?
Yes, we offer one specific injection, which is a medication called Vivitrol. This is a medication for individuals with an alcohol use disorder. One of our trained nurses is responsible for administering these injections to our patients.
What will happen during an initial office visit?
During the initial office interview, a full history will be obtained.
What do I need to bring with me to my first appointment?
Please bring your list of concerns, what issues you want resolved and how you want things to be better. We also suggest bringing a list of your current medications and dosages.
What kind of research studies do you do?
The Rochester Center for Behavioral Medicine is involved in many research studies. Click here for more details.
Can I be in therapy while participating in a research study?
Yes, although this varies from one research study to another.
What is a nurse practitioner?
A nurse practitioner is a master’s level nurse. Nurse practitioners can prescribe medication under the auspices of a physician.
What is the difference between a psychiatrist, a psychologist, a counselor and a social worker?
A psychiatrist is a physician who is initially trained as a general doctor. After general training, psychiatrists specialize in psychological and neurological disorders.
What is a medication review?
A medication review is performed by a psychiatrist or a psychiatric nurse practitioner. Typically, med reviews last between ten and twenty minutes.
Does anyone have weekend/evening hours?
Yes. Some of our clinicians do work weekend and evening hours.
Do you have emergency appointments?
There are many clinicians at the Rochester Center for Behavioral Medicine. Each tends to be busy and maintain an active schedule but should an emergency arise, whether with a new or existing patient, please feel free to contact us and we will do our best to accommodate you.
Do you do brain scans at RCBM?
We do not do brain scans at RCBM. We do, however, work with various sites throughout the country that perform brain scans.
Does anyone in the office see children?
Yes. The Rochester Center is fully equipped with an experienced staff of clinicians who specialize in disorders of children.