A few years ago, at an ADHD conference, a doctor who was presenting on non-stimulant therapy noted the effectiveness statistic of stimulants and non-stimulants. Historically, almost every study has shown that 80 to 85% of people with ADHD respond to one or both families of stimulants. That would be the Adderall/amphetamine family and the Ritalin/methylphenidate family family. Whereas non-stimulants, primarily Strattera/atomoxetine are roughly 20 to 25% effective. Of course, percentages of efficacy can be a guiding principle in terms of treatment. But he was also careful to point out that we are all a sample size of one. Statistics talk about population. But what works for you, is what works for you.
As a sidenote, I do think it’s important to challenge the findings of studies. We have to ask what the metric is for, “effective.” Often studies are judging mild, moderate, and robust response. But nobody wants to take a bunch of pills every day for a mild response. So it is important to note whether studies are talking about robust response or lumping all three categories together. Of course, who has time to read studies? I struggled to find the time, and it’s my job. At a time when our society is more and more looking to dismiss science, it is even more important to invest in it. Because even what we know, should be challenged. Studies can be redesigned. New data can be discovered. Metrics can be changed. And conventional wisdom can shift overtime.
This is one of the reasons that it’s so important to have a competent and experienced prescriber. Because what the book says is an aggregation of what has been shown and what is thought to have been proven in large groups of people. But you are a sample size of one. And for you to get good care, you need a provider who is grounded in the science and seize the big picture but who also has enough clinical experience to see you as the unique individual that you are and tailor your treatment to your needs. Science is certainly a big part of the answer. But it’s not the whole answer.