Attention-Deficit/Hyperactivity Disorder (ADHD)

The short version

●ADHD is a neurodevelopmental disorder defined by persistent inattention and/or hyperactivity-impulsivity that begins in childhood and impairs functioning across settings.
●First-line treatment is stimulant medication (methylphenidate, amphetamines), which has among the largest effect sizes in psychiatry; non-stimulants (atomoxetine, guanfacine) and behavioral strategies are alternatives.
●A large network meta-analysis (Cortese 2018) confirmed stimulants as the most effective ADHD medications across age groups.
●There is no robust randomized evidence that ketamine treats ADHD, and ketamine is not an ADHD treatment. Honest framing matters here.
●Ketamine's relevance to people with ADHD is limited to treating a co-occurring treatment-resistant depression or anxiety disorder — not the ADHD itself.
●Anyone searching "ketamine for ADHD" is best served by optimizing established ADHD care first; ketamine enters the picture only for a comorbid mood disorder.

Clinical definition

ADHD is a neurodevelopmental disorder with onset in childhood (several symptoms before age 12) defined by a persistent pattern of inattention (careless mistakes, difficulty sustaining attention, distractibility, disorganization, forgetfulness) and/or hyperactivity-impulsivity (fidgeting, restlessness, difficulty waiting, interrupting). DSM-5 requires symptoms in two or more settings (e.g., home and work or school) with clear evidence of functional impairment, and specifies three presentations: predominantly inattentive, predominantly hyperactive-impulsive, and combined. ADHD persists into adulthood in the majority of cases, where hyperactivity often attenuates into inner restlessness while inattention, disorganization, and emotional dysregulation predominate. It is highly comorbid with depression, anxiety, and substance use disorders.

How it differs from related conditions

vs. Major depressive disorder

Depression can impair concentration and motivation, mimicking inattentive ADHD, but is episodic with low mood and anhedonia; ADHD is lifelong and present before any mood episode. The two frequently co-occur.

vs. Anxiety disorders

Anxiety impairs concentration through worry; ADHD inattention is not driven by worry. Comorbidity is common and can complicate diagnosis.

vs. Bipolar disorder

Distractibility and impulsivity overlap, but bipolar symptoms are episodic and accompanied by mood elevation and sleep changes; ADHD is chronic and stable.

vs. Normal high activity / situational distraction

ADHD requires cross-setting impairment and a developmentally excessive, persistent pattern — not context-specific restlessness.

First-line treatments

Stimulants (methylphenidate, amphetamines)

First-line, with among the largest effect sizes of any psychiatric medication for their indication; about 70% respond. Require cardiac screening and have abuse potential, so are monitored.

Non-stimulants (atomoxetine, viloxazine)

Useful when stimulants are contraindicated, not tolerated, or where substance-use risk is a concern; slower onset and smaller effect.

Alpha-2 agonists (guanfacine, clonidine ER)

Adjunctive or alternative, particularly for hyperactivity/impulsivity and comorbid tics or sleep problems.

Behavioral and skills-based interventions

CBT for adult ADHD, coaching, and environmental/organizational strategies; most effective combined with medication.

When standard treatments fail

Apparent stimulant "failure" usually reflects a dosing, formulation, or diagnostic issue rather than true resistance — switching stimulant class (methylphenidate ↔ amphetamine), adjusting dose or timing, or addressing an undiagnosed comorbidity (depression, anxiety, sleep apnea, substance use) resolves most cases. When ADHD genuinely does not respond, re-evaluate the diagnosis and treat comorbidities. Importantly, ketamine is not part of the ADHD treatment ladder — there is no controlled evidence that it improves core ADHD symptoms.

Where ketamine fits

Honest answer: ketamine is not a treatment for ADHD. There is no robust randomized controlled evidence that ketamine improves the core symptoms of inattention, hyperactivity, or impulsivity, and it is not part of any ADHD treatment guideline. The reason people search "ketamine for ADHD" is usually that they have ADHD alongside depression or anxiety that has not responded to standard care. In that situation, ketamine may be appropriate for the mood or anxiety disorder — not the ADHD. Treating the comorbid depression can secondarily improve concentration and motivation, which patients sometimes experience as "ADHD getting better," but the mechanism is mood improvement, not a direct effect on ADHD. The responsible path for ADHD is to optimize established treatment: a correct diagnosis, an adequate stimulant or non-stimulant trial, and behavioral strategies. Tovani does not offer ketamine as an ADHD treatment.

Where this fits with Tovani

Tovani does not treat ADHD with ketamine, and eligibility screening reflects that. A patient with ADHD and a co-occurring treatment-resistant depression or anxiety disorder may be a candidate for ketamine for the mood disorder, with their ADHD managed by their prescribing clinician through standard means. Stimulants are also held on session days and coordinated with the prescriber. Patients seeking ketamine specifically to treat ADHD are redirected to evidence-based ADHD care.

Check eligibility The science behind ketamine

Frequently asked

Does ketamine help ADHD?

There is no good evidence that ketamine treats the core symptoms of ADHD (inattention, hyperactivity, impulsivity), and it is not an ADHD treatment. If concentration improves after ketamine, it is usually because a co-occurring depression lifted — not a direct ADHD effect.

I have ADHD and depression — can ketamine help?

Possibly, for the depression. When ADHD coexists with treatment-resistant depression or anxiety, ketamine may be appropriate for the mood disorder while your ADHD is managed with standard treatment. Tovani screens for this.

What is the actual first-line treatment for ADHD?

Stimulant medication (methylphenidate or amphetamine) has the largest effect sizes; non-stimulants and behavioral/coaching strategies are alternatives. Most "treatment failures" are dosing or diagnostic issues, not true resistance.

Why does Tovani not offer ketamine for ADHD?

Because the evidence does not support it. Offering ketamine as an ADHD treatment would not be honest or clinically appropriate. We will help with a comorbid mood disorder if one is present, but ADHD itself should be treated with established care.

References

Cortese S et al. 2018, The Lancet Psychiatry — Network meta-analysis of medications for ADHD across children and adults, establishing stimulants as the most effective treatment. (PMID 30097390)
Cipriani A et al. 2018, The Lancet — Network meta-analysis of antidepressants — relevant to the comorbid depression that is the actual indication when ADHD patients seek ketamine. (PMID 29477251)
Murrough JW et al. 2013, American Journal of Psychiatry — Ketamine RCT in treatment-resistant depression, the comorbidity for which ketamine may be appropriate in ADHD patients. (PMID 23982301)

Last reviewed by Dr. Ben Soffer, DO on May 30, 2026. This page is educational and not a substitute for clinical evaluation. A physician determines whether ketamine therapy is appropriate for your specific situation.