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CASE STUDY: Patient 2: Jessica is a 32-year-old female that was recently diagnos
CASE STUDY: Patient 2: Jessica is a 32-year-old female that was recently diagnosed with ADHD. She was referred to your office by the psychologist that completed the ADHD assessment. Jessica has always struggled in school and jobs. She is often “written up” at her job for not completing tasks that are assigned to her. She becomes easily distracted by her other co-workers. She finds herself spending a lot of time conversing with colleagues. Her colleagues are frequently annoyed with her for constantly talking to them and interrupting their work and tasks. Jessica is here to discuss medication options to treat ADHD. Disscussion Post: ADHD is defined in the DSM-5 as persistent, age-inappropriate, and impairing symptoms of inattention and/or hyperactivity/impulsiveness (Isfandnia et al., 2024). In Jessica’s case, discussing non-stimulant medication for ADHD involves understanding their mechanism of action and weighing their benefits and disadvantages. Mechanism of Action of Non-stimulant Medications Non-stimulant medications like atomoxetine or guanfacine primarily influence the brain’s norepinephrine levels, which helps regulate attention and impulse control. Unlike stimulant medications, they do not directly impact dopamine levels, which can reduce the risk of abuse but may result in less immediate effect. Why Is Non-Stimulant Medication Appropriate for Jessica? Considering Jessica’s struggle with focus and distraction, non-stimulant might be appropriate if there are concerns about addiction abuse potential, or if Jessica has a personal or family history of substance use disorder. Non-stimulants may also be considered if stimulant medications cause intolerable side effects, or if Jessica has anxiety, which stimulants can sometimes exacerbate. Advantages of non-stimulants. Lower Abuse potential: These medications have less risk for addiction, which is important for patients with a history of substance abuse. Longer Lasting Effects: Non-stimulants typically have longer-acting benefits, meaning fewer fluctuations in focus or attention throughout the day. Lower risk of exacerbating anxiety: Non-stimulants are less likely to cause anxiety or jitteriness as they do not primarily affect dopamine. Disadvantages of non-stimulants Slower onset of action: Unlike stimulants, non-stimulants may take several weeks to show improvement, which may not suit patients who need rapid symptom relief. Less Potent: Stimulants generally show stronger effects in managing ADHD symptoms, and some patients may not respond as well to non-stimulants. Comparison To Stimulants Advantages of Stimulants According to Bruno et al. (2022) “Stimulants are considered the most effective treatment for ADHD and are generally recommended as first-line pharmacological treatment; however, a significant minority of individuals may have an inadequate response, do not tolerate or have a contraindication to these medicines Some of the advantages of stimulant medications include; rapid onset of action and high efficacy for symptom control Disadvantages of Stimulant: This may include; a higher potential for abuse and dependency and a higher probability to exacerbate comorbid conditions like anxiety or tics. Park et al. (2024) explained that psychostimulants cannot be used in adequate doses owing to adverse effects, such as the exacerbation of tic symptoms and sleep disorders, despite psychostimulants showing partial efficacy. Legal Considerations: Stimulant medications are classified as controlled substances, Monitoring for misuse or diversion is a legal concern. Jessica’s medical record should include documentation of risk assessments for substance use. Ethical Consideration: There is an ethical concern when considering Jessica’s well-being and potential side effects. Stimulants. While effective, could exacerbate anxiety, impacting her overall mental health. So, non-stimulants may provide a safer option despite delayed efficacy. Social Implications: Jessica’s social interactions at work might improve with better symptom control. However, nonstimulants might delay symptom relief, prolonging the period in which she remains disruptive at work, and affecting her relationship with colleagues and job performance. The con stance emphasizes that while non-stimulant medications reduce some risks, like addiction, their slower efficacy, less robust symptom control, and potential side effects need to be carefully weighed against the advantages of stimulant medications. According to Bruno et al. (2022), “s. References Bruno, C., Havard, A., Gillies, M. B., Coghill, D., Brett, J., Guastella, A. J., Pearson, S., & Zoega, H. (2022). Patterns of attention deficit hyperactivity disorder medicine use in the era of new non-stimulant medicines: A population-based study among Australian children and adults (2013–2020). Australian & New Zealand Journal of Psychiatry, 57(5), 675–685. https://doi.org/10.1177/00048674221114782Links to an external site. Isfandnia, F., Masri, S. E., Radua, J., & Rubia, K. (2024). The Effects of Chronic administration of stimulant and non-stimulant medications on executive Functions in ADHD: A Systematic Review and Meta-Analysis. Neuroscience & Biobehavioral Reviews, 105703. https://doi.org/10.1016/j.neubiorev.2024.105703Links to an external site. Park, H. N., Kong, N. Y., Kim, H., Kim, Y. T., Jung, S., & Lee, H. (2024). Effectiveness and tolerability of combination pharmacotherapy with Stimulant and Non-Stimulant in children with attention deficit hyperactivity Disorder. Journal of Korean Academy of Child and Adolescent Psychiatry, 35(1), 82–89. https://doi.org/10.5765/jkacap.230048
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