By Mohab Hanna, MD, Child and Adolescent Psychiatrist
Any medication that you take has potential negative side effects. It is essential to realize that these are potential side effects. It does not mean that if you take the medication, you will get those side effects. However, it is always important to know what those side effects are.
ADHD medications are not any different than other medications we prescribe in psychiatry whether for children, adolescents or adults. All psychiatric medications have potential benefits and potential negative side effects. The key of course is that the potential benefit of the ADHD medication needs to outweigh the potential side effects. It is also just as important to consider the potential consequences of not treating with the medications. There also needs to be a clear indication for a medication trial. In other words, is there a clear ADHD diagnosis that warrants the prescribing of the medication?
The presence of the ADHD diagnosis does not mean that someone should take medications. The criteria that I use to determine if there is an indication for an ADHD medication include the frequency, intensity, and duration of the ADHD symptoms. Is there also an interference with function because of ADHD? In other words, how serious of a problem is this? It is also essential to remember that there are other things that can be done to address ADHD besides prescription medications such as ADHD coaching, school and academic interventions, nutritional supplementation, diet modification, and therapy.
Concerta is a long-acting form of Methylphenidate. Concerta (Methylphenidate ER) is available in several dosages (18mg, 27mg, 36mg and 54mg). The same chemical in other brands such as Ritalin. Concerta is designed to last approximately 10 to 12 hours during the day. It needs to be taken in the morning with food- protein preferred. Concerta is in the stimulant class of ADHD medications.
The common potential side effects to be aware of are:
- Stomach aches
- Headaches
- Decreased appetite leading to weight loss with potential impact on growth
- Difficulty falling asleep
- Nervousness
- Moodiness and low frustration tolerance
- Increase in pulse
- Increase in blood pressure
Some of these side effects go away after a few days, but some can persist. You must work closely with your provider to figure out how to manage some of these common side effects. The goal if you take a medication is that there is clear benefit as well as tolerability. I always emphasize that starting an ADHD medication like Concerta is just a trial. We are not committing to any long-term use of the medication. Even if Concerta is helping treat ADHD symptoms, there are times where we need stop the medication due to negative side effects that are significant enough to warrant stopping the medication. Not all side effects are of equal concern. For example, if the Concerta is causing palpitations and a rapid pulse, then this needs to be addressed right away vs if someone is having occasional stomach aches for a few days that will eventually go away. The above list is not a comprehensive list of all possible side effects but these are the most common ones that can be encountered.
Our philosophy at MedPsych is that we are always evaluating the safety, tolerability and effectiveness of the medication as well as the need for the use of the ADHD medication. There is an essential need for close monitoring. For example, if there is weight loss and a negative impact on growth in children as a direct consequence of the Concerta, we need to stop the Concerta and evaluate other options moving forward including whether there is a continued need for ADHD medications. The decision to start an ADHD medication like Concerta needs to occur only after a thorough evaluation with constant need moving forward if an ADHD medication is prescribed.
