Is there a reason to start with methylphenidate rather than an amphetamine if I am mostly inattentive?

There is a reason to individualize the first stimulant, but being mostly inattentive is not, by itself, a proven reason to start methylphenidate rather than an amphetamine. Cortese and colleagues' short-term network meta-analysis in adults found both classes better than placebo on clinician ratings, and amphetamines were favoured over methylphenidate in some efficacy ratings, yet that work is not subtype-specific and should not be read as methylphenidate is for inattentive type or the reverse. Amphetamines were less well tolerated versus placebo on dropouts. If the change is persistent, distressing, or affecting daily functioning, bring a brief timeline to the prescribing clinician rather than changing the dose independently. References: https://pmc.ncbi.nlm.nih.gov/articles/PMC6109107/ https://www.nice.org.uk/guidance/ng87/chapter/recommendations https://www.camh.ca/en/professionals/treating-conditions-and-disorders/adult-adhd/adult-adhd---treatment/adult-adhd---pharmacotherapy https://www.caddra.ca/wp-content/uploads/CADDRA_ADHD-Medication-Chart_May2026.pdf