ADHD medication is among the most effective treatments in all of psychiatry — with response rates of 70-80% for stimulant medications. Understanding your options helps you have a productive conversation with your prescribing psychiatrist and set realistic expectations.
Stimulant medications work by increasing dopamine and norepinephrine availability in the prefrontal cortex. There are two classes: amphetamines (Adderall, Vyvanse, Dexedrine) and methylphenidates (Ritalin, Concerta, Focalin). Both classes are highly effective; which works better for a specific person is largely individual and requires trying both if the first doesn't work well.
Vyvanse (lisdexamfetamine) is a prodrug converted to active d-amphetamine in the body, producing a smoother, longer-lasting effect with lower abuse potential. It's often preferred for adult ADHD. Adderall XR provides extended release over 8-12 hours. Immediate-release stimulants (Adderall IR, Ritalin IR) work for 4-6 hours and can be useful for targeted dosing.
Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor — not a controlled substance, takes 4-6 weeks to reach full effect. Good option for people who don't tolerate stimulants, have substance use history, or need medication that works around the clock. Wellbutrin (bupropion) is sometimes used off-label for ADHD and has evidence for mild-moderate effect. Intuniv/Kapvay (guanfacine/clonidine) reduce hyperactivity and impulsivity and can be combined with stimulants.
When discussing medication with your psychiatrist: describe your most impairing ADHD symptoms specifically; mention any cardiovascular concerns, history of anxiety, sleep problems, or substance use; ask about the difference between IR and XR formulations; and ask what "working well" should look like so you can accurately report back. Medication adjustment often takes 2-3 tries to find the right medication and dose.