Can you tell me more about stimulant medications?

The most widely used stimulant medication in Singapore is Methylphenidate, which is available in 3 versions and brands: Ritalin, Medikinet and Concerta. They differ in their duration of action, ranging from 4 to 12 hours. The benefits and side effects of Methylphenidate have been very robustly studied over the decades. It is the ADHD medication which local psychiatrists and pediatricians have the most experience with.
Another stimulant medication called Lisdexamfetamine (Vyvanse) has been available in Singapore from 2023. Studies have found that if a child does not respond well to one type of stimulant medication (e.g. Ritalin), he or she may respond better to another (e.g. Vyvanse) because they work differently in the brain.

How do stimulant medications work?

Stimulants work by boosting levels of certain neurotransmitters such as dopamine and norepinephrine in the brain. This enhances communication between the brain cells. Neurotransmitters, also called brain messengers, are important in helping us maintain focus, control impulses and perform complex tasks.

How long do the effects of the stimulants last?

Ritalin’s effects last around 4 hours and it can be taken up to 2 to 3 times a day. Medikinet’s effects last about 8 hours while Concerta and Vyvanse have effects lasting 12 hours. These longer-acting medications are taken once a day, typically in the mornings, with or after breakfast.
The longer-acting medications may be more convenient and simpler to administer for children who have long days in school and tuition after. They take about 30 to 60 minutes after ingestion to have an effect.

Do they come in different doses or strengths?

Yes, all the medications come in different dosages and strengths. The psychiatrist will start your child on a low dose and increase it gradually until a noticeable improvement is observed. The eventual dose will depend on many factors, such as the child’s age, body weight, response and side effects. There will be a learning curve to master the use of the medications. The psychiatrist will guide you and your child along and answer any questions which you may have.

Can my child take other medications (e.g. flu medications) while on stimulants?

Yes, it is safe for your child to take other medications as they will not interfere with each other. However, if your child is having an acute infection and fever, we should stop the stimulant medications until your child has completely recovered from the infection.

What are the side effects of stimulants?

The child may have difficulty falling asleep while the medication is taking effect. Hence the medications should be taken in the earlier part of the day so that the effects would have worn off by bedtime.
The child’s appetite may be suppressed, and this can affect his or her growth. The psychiatrist will monitor the child’s appetite and weight. If necessary, the type, frequency and dosage of the medication will be adjusted to minimize side effects. We can also take a pause from medications during the weekends or school holidays (also known as “medication holiday”) to promote “catch-up growth”. Most children using stimulant medications continue to eat and grow well, but this side effect may be a concern for children who are already very underweight.
A minority of children may feel grumpy or moody while on medications. In such instances, the medications may need to be changed. Headache and stomachache are uncommon side effects and can be addressed by taking the medications with food and ensuring your child drinks enough water.

What medical conditions make stimulants unsuitable?

In the presence of heart conditions (e.g. hole in the heart) or epilepsy (recurrent seizures or epileptic fits), stimulant medications may not be suitable. If a child has tics (sudden and repetitive movements or vocalizations), stimulant medications may still be used with close monitoring.

Will my child become an addict after taking stimulants?

It is a myth that children become addicts after taking stimulant medications. In fact, studies have found that children with ADHD who receive medical treatment have a reduced risk of cigarette smoking, alcohol abuse and other forms of addictions later in life.
It is important to teach the child about the medications, store them safely, follow the prescribed instructions, supervise the use of medications, and attend regular reviews with the psychiatrist. They should be told not to share the medications with their classmates.

Aren’t medications bad for kids?

It is understandable that some parents do not want their kids to be medicated. However, many studies have confirmed that early treatment of ADHD leads to superior outcomes later in life. Children with untreated ADHD are more likely to suffer from low self-esteem, under-achieve academically, have difficulties managing their emotions and socializing with their peers. They are also more likely to have poor impulse control and conduct problems.
The safety profile of ADHD treatment is backed by many decades of scientific studies. With close supervision and careful monitoring by a psychiatrist, most children with ADHD will benefit from treatment with minimal side effects. In our experience, parents and teachers often observe prompt and noticeable improvements with treatment.
Equally important in a holistic treatment plan are cognitive strategies, regular exercise, a balanced diet, good sleep, behavioural therapy and parental coaching. If parents do opt against medications, the child will still benefit from dietary supplements (such as V-Rin Omega-3 available in our clinic) and individual therapy, art therapy, or family therapy with our psychologist or therapist.

Are branded medications better? Can my child use generic medications?

Brand name medications are manufactured and tested by large pharmaceutical companies. They tend to be more consistent in standards and quality. Therefore, many patients prefer brand name medications and believe they have less side effects.
After the patent of the branded medication has expired, other companies are permitted to manufacture the generic version. They contain the same active ingredient and are less expensive. However, it is possible that there is subtle variation in the effectiveness and side effect profile of generic and brand name medications, due to differences in the manufacturing process and other constituents, which can affect the way the medication is released and absorbed.

Seek Help Today

Thank you for taking the time to read about ADHD. If you or someone you know is struggling with symptoms like those mentioned, don't hesitate to reach out to our expert clinicians. Understanding, support, and proper treatment can make a significant difference in managing ADHD and improving quality of life.

Your well-being matters, and we're here to help every step of the way.

Dr Victor Kwok
Senior Consultant Psychiatrist
Private Space Medical
Dr Tay Kai Hong
Senior Consultant Psychiatrist
Private Space Medical