Psychopharmacology and Psychiatry Updates Adult ADHD: Optimizing Stimulant Therapy
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Mar 2, 2026 Oscar G. Bukstein, child and adult psychiatrist and Harvard academic, discusses stimulant treatment for adult ADHD. He covers why amphetamines now outpace methylphenidate. He explains choosing short versus long-acting formulations. He reviews cardiovascular screening, monitoring vital signs and common side effects. He outlines when to switch stimulant classes for inadequate response.
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Shift Toward Amphetamines And Adult Prescriptions
- Stimulant prescribing patterns for ADHD have shifted dramatically over 30 years toward adults and amphetamines.
- Adults now receive more stimulants than children and amphetamines overtook methylphenidate as the most prescribed class in recent decades.
Match Formulation Duration To Daily Needs
- Match stimulant formulation duration to the patient's daily needs rather than only choosing drug class.
- Use short (3–5h), intermediate (4–8h), or long-acting (>8h) preparations based on coverage required and dosing convenience.
Limited Certainty For Methylphenidate Benefits In Adults
- Evidence for methylphenidate efficacy in adults is low to very low with small-to-moderate effects and increased adverse events.
- Trials limited by bias, short duration, and poor generalizability, so benefit-harm balance remains uncertain.