While stimulant medications like methylphenidate (Ritalin) and amphetamine/ dextroamphetamine (Adderall) are the most commonly prescribed drugs for ADHD, non-stimulant drugs are also an option. Non-stimulants are preferred in some cases because they offer some advantages. Non-stimulant drugs don’t tend to cause sleeping problems, agitation, lack of appetite, abuse, and addiction, which are common side effects of stimulants. In addition, non-stimulants effects last longer and are smoother compared with stimulant medication. What are the main non-stimulant drugs, and their pros and cons? Read on to get the details.
Non-stimulant medication for ADHD
Proven alternate choices to stimulant drugs include atomoxetine (Strattera), long-acting guanfacine (Intuniv), long-acting clonidine (Kapvay), and bupropion (Wellbutrin)
Atomoxetine (Strattera) is a non-stimulant drug approved by the FDA, and is now considered an option as first line therapy for ADHD. It can be recommended for children, teenagers and adults. Atomoxetine works by increasing a brain chemical called norepinephrine, leading to improved attention span, lessen impulsivity and hyperactivity. The effects of atomoxetine last longer, but it seems to be less effective compared with stimulant drugs. Possible side effects include digestive problems like upset stomach,nausea and lack of appetite as well as dizziness, fatigue, and mood changes. This drug comes with a warning for potential risk of suicidal thoughts. Other potential serious side effects include jaundice and other liver dysfunctions and serious allergic reactions.
A 2017 review study/meta-analysis looked at the cardiovascular side effects like increased blood pressure and heart rate of the ADHD medication methylphenidate, amphetamines, and atomoxetine. This study found that there was a statistically significant increase in systolic, diastolic blood pressure, and heart rate in children and adolescents taking amphetamines and atomoxetine, while methylphenidate increased systolic blood pressure only. Researchers suggest that those taking any of these drugs should regularly have their heart rate and blood pressure monitored to avoid heart complications.
Long-acting alpha agonists and short-acting alpha agonists
Long-acting guanfacine (Intuniv) belongs to alpha agonists, a class of drugs recommended for high blood pressure, but had been approved by the FDA to treat ADHD as well. Guanfacine can also help manage other conditions associated with ADHD like tics, sleeping issues and aggression. It can also be a good choice for children who lost weight while being on stimulant drugs, because it does not suppress the appetite.
Long-acting clonidine (Kapvay) is also a non-stimulant, alpha agonist, FDA approved drug for ADHD. Like long-acting guanfacine, long-acting clonidine can be used alone or added to a stimulant drug.
There are another two alpha agonist drugs that are not approved by the FDA for ADHD, but could be used, as needed, if other drugs fail to manage the symptoms. They are short acting drugs clonidine (Catapres) and short-acting guanfacine (Tenex).
Possible side effects of all these drugs include sleepiness, and daytime fatigue, dizziness, drowsiness, dry mouth, irritability, low blood pressure, stomach pain, and nausea. Rare, but more serious side effects include low blood pressure and changes in the heart rhythm.
Bupropion is an antidepressant recommended for adults over age 18 for depression but is not FDA approved for ADHD. However, it may be recommended off-label for ADHD in some cases. There are three versions of this drug: long-acting, intermediate, and short-acting bupropion. This drug works by increasing the dopamine levels in the brain. Although the research is ongoing, it appears that it is less effective compared with stimulants or other non-stimulant drugs, but may be used has been less frequently studied as a treatment for ADHD. More common side effects include anxiety, dry mouth, irregular heartbeats, sleeping problems, restlessness, and irritability. Rare, but serious side effects include seizures, confusion, fainting, allergic reactions, hallucinations, and experiencing extreme distrust of others.
Talk to the doctor about the possible side effects of this medication and do let him know if they occur. You may need the dose adjusted or switch to another prescription mediation. If the approved drugs for ADHD do not work, your doctor may also evaluate whether it is another condition and not ADHD causing the symptoms.
Psychotherapy is a great addition to prescription medication. Brain experts believe that children with ADHD could greatly benefit from short-term counseling right at the time they receive the diagnosis. This therapy can help children understand this condition and how to cope with their difficulties. For adults with ADHD, psychotherapy offers emotional support and helps improve time management, staying organized, solving problems, as well as strategies to manage anger and irritability.
A healthy lifestyle is also important to manage symptoms of ADHD. The first step should be to avoid processed food and switch to a healthy diet, Mediterranean style. For more details check this article. Some vitamins and over-the-counter supplements had also been found to improve the symptoms. An exercise routine, and stress management techniques can further help. Limit exposure to news from TV and time spent on electronic devices.