No miracle cure, but a real difference
For ADHD there is effective treatment: a combination of medication, explanation and practical support. Medication works for most people, but not for everyone, and rarely on its own. Here is what there is, how it works, and, honestly, what to watch out for.
Why medication takes effect
In ADHD, two signalling substances in the brain, dopamine and noradrenaline, work less efficiently. They are involved in attention, motivation and reining in impulses. Medication helps restore that balance.
The paradox of stimulants
Stimulants make someone without ADHD more restless, but someone with ADHD often calmer and more focused. The parts of the brain that should rein in the restlessness do their job better.
About 70 to 80%
For around 70 to 80% of people with ADHD, stimulants are effective on the core symptoms: more concentration, less impulsivity, less inner restlessness. The effect varies per person and per drug.
What medication there is
Roughly two groups: stimulants (first choice) and non-stimulants (when stimulants do not work or are not possible). Choose a tab.
Stimulants: first choice
The guideline names methylphenidate and dexamfetamine as first-choice drugs, often in a long-acting form (better spread across the day, fewer peaks and troughs, lower risk of misuse).
Methylphenidate (known as Ritalin, Concerta, Equasym XL, Medikinet CR among others) inhibits the reuptake of dopamine. Dexamfetamine (Amfexa, Tentin among others) and lisdexamfetamine (Elvanse, a prodrug that is released gradually) instead stimulate its release. Because of the difference in action, one drug may suit you while another does not.
Finding the right type and dose can take several weeks, and goes with trial and error.
Non-stimulants: second choice
If stimulants do not work enough, or are not possible because of side effects or other conditions, there are non-stimulating options. Atomoxetine (Strattera) inhibits the reuptake of noradrenaline; the effect is generally smaller and it takes four to six weeks to work fully. Sometimes guanfacine or, off-label, bupropion are used.
These drugs do not fall under the Opium Act and give 24-hour cover, but are not tolerated equally well by everyone.
Second choice does not mean inferior: for some people this is precisely the drug that fits.
Side effects and points of attention
Common side effects of stimulants are reduced appetite, poor sleep, palpitations, dry mouth and sometimes irritability. In people with a history of anxiety, stimulants can heighten anxiety. That is why a medical check should take place beforehand (including heart and blood pressure).
Recent research points to a possibly raised risk of cardiovascular problems with long-term use. That is a reason for periodic monitoring, not for panic: for many people the benefit far outweighs the risk. Discuss this with your doctor.
Stimulants fall under the Opium Act. Use them only on prescription and never share them with others.
What helps alongside medication
Medication works best combined with support. For some people that part is even more important than the medicine.
🧠 Psychoeducation
Understanding how ADHD works for you is a treatment in itself. It explains a lifetime of experiences and takes away blame and shame.
📝 Cognitive behavioural therapy
CBT teaches practical skills: planning, organising, handling emotions and procrastination, and working on a better self-image.
🧑 ADHD coaching
A coach helps bring structure to daily life: routines, systems and a concrete approach to the things that keep going wrong.
🏃 Lifestyle
Regular exercise, enough sleep and a fixed daily rhythm dampen the symptoms. Not a replacement for treatment, but a solid foundation.
"The medication did not switch everything off, but for the first time it turned the volume down. Only then did I notice how loud it had been all those years."
Where this information comes from
First choice, ranking and long-acting preference
Mechanism, brand names and effectiveness (70-80%)
Side effects, Opium Act and cardiovascular risk
Non-medication treatment
🏎 Need help right now?
If there is immediate danger to yourself or someone else: call 112. Feeling low or having thoughts of suicide? In the Netherlands you can call or chat day and night with 113 via 0800-0113. Outside the Netherlands, contact your local emergency line.