Comparison of the Various Stimulants
The two classes of medications that are most effective for ADHD. are:
the amphetamines including mixed amphetamine salts, dextroamphetaine
brand names: Adderall, Dexedrine, Dextrostat, Vyvanse (and very rarely Desoxyn since it is so habit forming)
the methylphenidates
brand names: Ritalin, Focalin, Concerta (and the rarely used skin patch, Daytrana)
This page is written in response to the many questions AdultADD.Info has received asking about the difference between Ritalin vs Adderall and Vyvanse (corresponding generics: methlyphenidate vs amphetamines and lisdexamfetamine)
On average, they all have pretty much the same beneficial and side effects, but some effects occur slightly more often with one than with the other. Most people are not average, though, and some find one or the other more effective or to have a different side effect profile.
For most people, I believe the amphetamines reduce ADD symptoms somewhat more and are more alerting than the methylphenidates, but I sometimes encourage my patients to try one of them, find the best dose, then try the other to see which works better. The effective dose required for methylphenidates and for Vyvanse is generally about 25% to 50% higher than for the amphetamines. However, here too, people differ in their responses..
Vyvanse is my preferred amphetamine: it works very smoothly over a 10 hour or longer period of time and wears off very smoothly. However, many people find that it interferes with their sleep though for some this effects wears off after three days or so. Also it is expensive for those without prescription insurance. The least expensive stimulants are the short-acting (four hour) generics (between 30 cents and and a dollar a pill depending on where you buy them and in what quantity. Costco is often the least expensive. It can also be less expensive if your doctor feels it is right for you to get three month supplies at a time and your insurance will pay for it. Nowadays, most mail-in pharmacies insist on three month prescriptions because that is what the insurance companies demand while many local pharmacies will only fill one month prescriptions because the insurance companies won’t allow three month prescriptions. Strange world.
Comparison of Side Effects
Initial mild side effects from the stimulants mostly wear off in less than a week, even insomnia. To minimize insomnia, be sure not to take an amphetamine less than four or five hours before bedtime. However, a few mild effects, when they do occur, are less likely to go away. These include dry mouth and jitteriness.
Methylphenidate wears off more quickly than the amphetamines and, when it does wear off, it not infrequently causes a little rebound depression/irritation/tiredness. However, it interferes with sleep less. Some people take amphetamines during the day and a methylphenidate after dinner, which works through the evening and then. when it wears off four hours later, makes it easier to get to sleep (with a clunk). This does not work for everyone, however.
Studies show that most people with ADD sleep better while taking stimulants. The medication works through the night to keep their constant thinking about thing quiet. However it may reduc the number of hours of sleep a person gets. Overall the result is positive as long it does not cut significantly into sleep time.
eHealth.com has polled thousands of stimulant users online and allows visitors to compare their side effects. It’s a little complicated to do but interesting.
On the basis of over 20,000 people’s feedback, they report the following side effects occur more often with the amphetamine than the methylphenidates
Fatigue 11% vs 5%
Insomnia 7% vs 5%
Dizziness 6% vs 4%
Increased heart rate (higher but percentages not given)
They report the following occur most often with the methylphenidates:
Depression 7% vs 5%
Aggressive behavior (higher but percentages not given)
Loss of appetite (higher but percentages not given)
Anger (higher but percentages not given)
The difference between the percent of of people who report
Comparison of Beneficial Effects
Isiah Berlin, a philosopher, once said there are two kinds of people, hedgehogs and foxes. Hedgehogs know one thing very well while foxes know many things. I have found a parallel effect with the stimulants. Methylphenidates helps people do one thing better (study for an exam, spend an hour fixing something, complete tax returns) while amphetamines help them do many things at the same time (focus when talking to people, do tasks on a list, juggle a schedule, put out fires).
Patient Reports
Ritalin has a more subdued effect. I find that I’m persistent in focusing on one thing at a time and then I move on to the next thing. Its better for studying for or taking an exam. It gives me less physical excitement than the Dexedrine, which is good and bad Also I can wind down more easily at the end of the day..
Dexedrine increases my focus and my excitement about accomplishing what’s next on my plate. I do things with enthusiasm late into the night. It’s better for doing a list of things.
What I like most about the medication in general is that I no longer have to think about keeping things straight. It saves an incredible amount of time being more efficient and not having to constantly worry about my inefficiencies .
