Amphetamines vs. Methylphenidate: What's the Difference?

How to explain the two major stimulant classes to patients—and what therapists should know

When a patient begins ADHD medication, one of the first things they may ask is: What's the difference between Adderall and Ritalin? Or, after an unsuccessful medication trial: Does this mean stimulants don't work for me?

Usually, the answer is more nuanced.

Both amphetamines and methylphenidates are effective ADHD treatments, but they work somewhat differently, and an individual patient may respond much better to one class than the other.

For therapists, understanding this distinction can make medication conversations with patients much easier.

The two stimulant families

Amphetamines

Common amphetamine medications include:

• Adderall (mixed amphetamine salts)

• Vyvanse (lisdexamfetamine)

• Dexedrine (dextroamphetamine)

• Mydayis (mixed amphetamine salts)

Amphetamines increase the availability of dopamine and norepinephrine in the brain through a combination of effects, including BOTH increasing release and reducing reuptake.

Patients sometimes describe amphetamines as having a noticeable effect on motivation, task initiation, mental energy, and the ability to sustain attention.

That can be beneficial, but some patients also experience more noticeable activation—such as anxiety, appetite suppression, insomnia, irritability, or feeling "too stimulated."

Methylphenidates

Common methylphenidate medications include:

• Ritalin

• Concerta

• Focalin (dexmethylphenidate)

• Jornay PM

• Daytrana

Methylphenidate primarily works by blocking the reuptake of dopamine and norepinephrine.

Some patients describe methylphenidates as producing a more focused or controlled effect, although individual experiences vary considerably.

The important clinical point is that there isn't a universally better stimulant class.

A patient who has an unpleasant experience with Adderall has not necessarily "failed stimulants." They may respond very differently to methylphenidate.

What about non-stimulants?

Stimulants aren't the only ADHD medications. Non-stimulants—including atomoxetine, viloxazine, and certain alpha-2 agonists—work differently and are discussed in other articles from our series.

They can be particularly useful when stimulants aren't tolerated, aren't appropriate, or aren't providing an acceptable balance between benefits and side effects.

Research and clinical practice over the years, has pointed amphetamines towards being the first goto medication for adult ADHD, and methylphenidate for chlid ADHD (Samuele Cortese, Lancet Psychiatry, 2018 Sep;5(9):727-738).

However, everyone is different, and there are many factors to consider. We'll discuss some of these, in upcoming posts.

Don't forget formulation

The medication's duration can matter just as much as its class. Many stimulants are available in immediate-release and extended-release formulations. A patient may respond well to a medication but dislike how quickly it wears off. Or the wearing off process may feel nauseating or negative. Different formulations may possibly lead to smoother process.

There are also formulations that run too long, and negatively impact one's sleep. Or some that are desgined to be taken before you fall asleep, and only become more impactful the next day once you're awake.

In short, there is more at work than just the pure chemical, but also how it's delivered, and finding the right formulation can significantly improve the medical experience of treating one's ADHD.

The takeaway for therapists

You don't need to know every ADHD medication to have useful conversations with patients.

The most important things to remember are:

1. Amphetamines and methylphenidates are different stimulant classes.

2. Doing poorly on one does not mean a patient will do poorly on the other.

3. The formulation and duration matter.