You bring up two important issues regarding the treatment of ADHD with medications. First, the difficulty finding the right combination of medications when co-existing conditions are present and, second, the use of ADHD medications during pregnancy.

When choosing a medication to address ADHD symptoms, it is extremely important to keep co-existing conditions in mind and not make them worse with treatment. Some co-existing conditions such as mild depression/demoralization or anxiety may be the result of untreated ADHD and will improve once the ADHD is treated. However, some stimulants may make anxiety (or depression) worse, particularly those in the amphetamine class, so its best to avoid those if you can if you have anxiety. In addition, other therapies such as cognitive behavioral therapy (CBT) have been shown to improve symptoms of anxiety in persons with ADHD. This treatment can be a particularly useful adjunct for those with anxiety/self-esteem issues or who can not take medications for whatever reason.

That brings us to the second issue, pregnancy and medications used to treat ADHD. Basically, the stimulants are not recommended for use during pregnancy in order to avoid any possibility of damage to the developing fetus. There have been no studies done in humans, but cardiac defects have been seen in animals given very high doses of stimulants during pregnancy. If you are contemplating getting pregnant, it is best to discuss this with your prescribing physician and ob/gyn and wean off any stimulant treatment.

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