ADHD- Treatment Algorithm

Question 1

When a person has predominant ADHD, what medications can you start them on?

Answer 1

Methylphenidate, dexmethylphenidate
Dextroamphetamine, mixed amphetamine salts

Question 2

If MPH doesn’t work in a patient with predominant ADHD, what can you try next?

Answer 2

AMP (and vice versa!)

Question 3

If a patient with predominant ADHD has tried MPH and AMP and neither have worked, what do you try next?

Answer 3

Atomoxetine, guanfacine ER, clonidine ER, or bupropion

Question 4

If a patient with predominant ADHD has tried atomoxetine, guanfacine ER, clonidine ER, and/or bupropion and THAT doesn’t work, what do you try next?

Answer 4

Combo therapy or a TCA

Question 5

If a patient has active substance abuse/history of it, what do you start?

Answer 5

Atomoxetine, guanfacine ER, clonidine ER, or bupropion

Question 6

If a patient with active SUD/history of it has tried atomoxetine, guanfacine ER, clonidine ER, and/or bupropion and that doesn’t work, what do you try next?

Answer 6

Combo therapy or a TCA

Question 7

If a patient with ADHD has predominant Tourette’s, what can you start?

Answer 7

Dopamine antagonist or an alpha-2-agonist

Question 8

If a patient with ADHD has predominant Tourette’ and they have some response to a dopamine antagonist or alpha-2-agonist, what can you add?

Answer 8

Stimulant, atomoxetine, or alpha-2-agonist

Question 9

If a patient with ADHD has predominant Tourette’s and has an inadequate response, what do you do?

Answer 9

Try an alternate dopamine antagonist or alpha-2-agonist

Question 10

If a patient with ADHD has predominant BPD, what do you start?

Answer 10

Atypical APS, Li, AED

Question 11

If a patient with ADHD has predominant BPD that has some response to an atypical APS, Li, or an AED, what do you add?

Answer 11

A stimulant

Question 12

If a patient with ADHD has predominant BPD, that has an inadequate response, what do you do?

Answer 12

Alternative or additional mood stabilizer

Question 13

If a patient with ADHD has predominant depression or anxiety, what do you start?

Answer 13

An antidepressant (duh)

Question 14

If a patient with ADHD has predominant depression or anxiety and has some response to an AD, what do you add?

Answer 14

A stimulant

Question 15

If a patient with ADHD has predominant depression or anxiety and has an inadequate response, what do you do?

Answer 15

Try an alternate AD