ADHD is a common neurological condition affecting between 2.5% and 4.4% of the adult population, with even higher rates seen in children.[1][2] People with ADHD can struggle to pay attention, behave impulsively, and face obstacles in education and the workplace as well as at home.[3]
There are three types of ADHD, based on the different symptoms displayed: inattentive type, hyperactive type, or combined.[4] ADHD is commonly treated with stimulant medications, and approximately 75-92% of patients see improvements.[3]
Two of the main medications used to treat ADHD are Concerta and Adderall. These medications are both stimulants, but they have slightly different effects. Here’s everything you need to know about both drugs and when you might want to choose one rather than the other.
- ADHD is a neurodevelopmental disorder that can interfere with executive function but can be effectively treated with medication
- Concerta and Adderall are two common drugs used to treat ADHD in both adults and children. There are few differences between them in terms of effectiveness and side effects
- The best outcomes for ADHD are found when medications are combined with behavioral therapy to help patients learn new coping strategies
Understanding Concerta and Adderall
Both Concerta and Adderall are CNS stimulants, meaning that they increase the levels of norepinephrine and dopamine in the brain.
Concerta’s active ingredient is methylphenidate, which blocks norepinephrine and dopamine from being reabsorbed into cells and broken down.[5] It is a slow-release medication.[3]
Adderall uses a combination of amphetamines, known as mixed amphetamine salts (MAS).[6] This includes 25% levoamphetamine and 75% dextroamphetamine.[7] Adderall actively increases the amount of norepinephrine and dopamine released into the brain.[8]
Concerta vs. Adderall: Key differences
The differences between Concerta and extended-release Adderall are minor. They are both slow-release medications, typically lasting approximately 8-12 hours.[9] Adderall reaches maximum concentration within approximately 7 hours.[10] For Concerta, this is around 4.7 hours.[5]
Adderall is also available in an immediate-release format, which reaches peak concentration in 3-4 hours and typically lasts 4-6 hours.[11][12] Similarly, methylphenidate, the active ingredient in Concerta, is available in an immediate-release form that reaches peak concentration in 1-2 hours and lasts around 3-4 hours.
Effectiveness comparison: Concerta vs. Adderall
Research into the effectiveness of Concerta vs. Adderall has had mixed results. Some studies have shown a small but consistent benefit for Adderall over Concerta.[7] Others suggest that Concerta is better for improving visual memory and distractibility.[3] Overall, there is little to choose between the two drugs in terms of effectiveness.[9]
For most patients, choosing the right medication involves trial and adjustment in collaboration with a physician to find the best fit for their needs.
Side effects: Comparing risks and tolerability
The side effects of Concerta and Adderall are also relatively similar, including:
- Decreased appetite
- Dizziness
- Insomnia
- Nausea
- Tachycardia and palpitations
For children, stimulants can reduce their growth by approximately 2cm if taken long-term.[2]
Children taking Concerta appear to develop fewer side effects, which is why some (though not all) guidelines recommend offering this as the first-choice medication.[1][13][14]
Potential for misuse
Both Adderall and Concerta are listed as Schedule II drugs, as a result of their potential for misuse and abuse. In extended-release forms, however, they are less likely to be misused than immediate-release versions. The immediate-release version of Adderall has greater potential for misuse.[15]
Factors to consider when choosing between Concerta and Adderall
There is little evidence to help patients or doctors choose between Concerta and extended-release Adderall.[16] Children should generally be offered Concerta before Adderall.[9]
Some patients may prefer short-release Adderall, especially if they work shifts and need to be able to sleep at unexpected times of the day. Immediate-release medications can also be cheaper than extended-release versions.
Patients may respond better to one drug over the other and it is simple to switch between them.[2]
Alternative treatments for ADHD
Although stimulants are the most common treatment for ADHD, alternative options are available.
Non-stimulant medication
Some non-stimulant medications have been shown to be effective in the treatment of ADHD and are licensed by the FDA for this use.[9] These include tricyclic antidepressants, noradrenaline reuptake inhibitors such as atomoxetine, vasodilators including clonidine and guanfacine, and other antidepressants such as bupropion.[1][17]
Behavioral interventions
Not all treatments for ADHD include taking medication. Behavioral interventions can teach a patient how to adapt to their condition and develop strategies to support them in everyday life. These interventions can be especially powerful for children, particularly when they include the parent, child, and school in the process.[2]
Combination therapy
The best results for people with ADHD can often be found by combining medication with behavioral interventions.[18]
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