Alpine Psychiatry: Navigating the Upper Limits of Stimulant Doses for Adult ADHD

At Alpine Psychiatry, we believe in personalized medicine for adult ADHD. While medication plays a role, we understand each patient is unique, requiring a holistic approach that integrates research-based options with individual needs. This allows us to optimize treatment while carefully considering potential side effects, especially at higher doses.

Recently, we were impressed by a study by Grady et al. (2024) that dives into the complexities of high-dose stimulants for adult ADHD. This insightful research helps us navigate the delicate balance between efficacy and safety, empowering us to make informed decisions for our patients.

Understanding the Landscape:

• Approximately 4.4% of adults struggle with ADHD, often relying on methylphenidate or amphetamine-based stimulants as first-line therapy.

• Both classes show similar effectiveness, but amphetamines, being more potent, typically start at lower doses.

• Stimulant types include immediate-release, extended-release, and even long-lasting formulations (up to 16 hours) to cater to individual needs.

• For patients who have undergone bariatric surgery, medication absorption becomes a concern. Thankfully, stimulants generally adapt well, while options like liquid formulations or transdermal patches offer valuable alternatives.

Case Study: Ms. H's Journey:

Ms. H, a 30-year-old woman battling ADHD, depression, and anxiety, faced significant challenges with focus and task completion. Further complicating matters, she had undergone Roux-en-Y gastric bypass surgery.

Initially, Ms. H relied on a high-dose dextroamphetamine/amphetamine combination alongside other medications. However, due to potential rapid metabolism post-surgery, we explored alternative avenues to ensure optimal outcomes with minimal risk.

Considering her unique situation, a transdermal methylphenidate patch emerged as a viable option. This delivery method offered improved efficacy and reduced potential for adverse effects due to its sustained release mechanism.

Thankfully, Ms. H experienced a marked improvement in her ADHD symptoms after transitioning to a 30mg/day patch, and did so without encountering any unwanted side effects. This case exemplifies the value of tailoring treatment strategies to individual circumstances.

Dose Response and Metabolism: A Closer Look:

Finding the right stimulant dose for adults with ADHD is a journey, not a destination. Individual responses vary, influenced by factors like:

• Genetics: Variations in genes affecting dopamine function can influence response to stimulants.

• Age: Younger adults may tolerate higher doses better than older adults.

• Metabolism: Faster metabolism can necessitate higher doses, while slower metabolism requires lower doses to avoid side effects.

• Comorbidities: Other medical conditions can impact medication interactions and dose needs.

Alpine Psychiatry is adept at navigating these complexities. We carefully monitor patient response, adjusting doses as needed based on clinical assessments, individual feedback, and genetic testing (where appropriate).

Your Partner in Personalized Care:

At Alpine Psychiatry, we don't shy away from complex ADHD cases. Our team possesses the expertise and experience to carefully evaluate each patient's medical history, lifestyle, and unique needs. We then leverage research-backed strategies, while prioritizing minimizing risks, especially when considering higher stimulant doses.

Ready to explore personalized ADHD treatment options? Reach out to us today.