Generally, there are two types of medication used to treat ADHD: stimulants and non-stimulants. While stimulant medications are considered first-line treatment for ADHD, there are many reasons why patients and doctors may elect to treat with non-stimulants instead. It is important that you speak to your provider about which options will work best for you.
Why Use Non Stimulant ADHD Medication?
There are a number of reasons why non-stimulants can be a viable substitute when treating ADHD. A person may have a natural tolerance to typical stimulants and not experience improved symptoms when prescribed with such.1
Additionally, because stimulants can be addictive, patients with a history of substance misuse may elect to use non-stimulants instead. Stimulants are a controlled substance and patients may be uncomfortable with extended use.1
Non stimulant medications for ADHD may be used in cases where:
- Stimulant medications have not been beneficial
- Someone has experienced side effects from stimulant medications
- Someone has a history of heart conditions
- Someone has a history of psychosis, schizophrenia, bipolar disorder
- Someone has a history of substance abuse
- Someone suffers from tic disorders
Stimulant vs Non-Stimulant ADHD Meds
Non-stimulant medication options for the treatment of ADHD include bupropion (Wellbutrin SR, Wellbutrin XR), SNRIs (selective norepinephrine receptor inhibitors) such as atomoxetine (Strattera), and alpha 2 agonists such as guanfacine (Intuniv).1
While these may not be as effective as stimulants for treating ADHD symptoms, they can still be useful for a certain population. In addition, because non-stimulants are easier to prescribe, patients have more readily available access to them. Those who opt to medicate with non-stimulants require fewer follow-ups and decrease their likelihood of developing a physiological dependence.
Side Effects of Non-Stimulant ADHD Medication
Non-stimulant medications come in a variety of forms and thus have different side effects. However, someone can expect to experience a few typical adverse reactions. Medications may leave you feeling run down, uncomfortable, or moody. You should consult your doctor about any symptoms before beginning a regular medication routine.
Side effects of non-stimulant ADHD medications can include:
- Fatigue
- Nausea
- Headaches
- Decreased appetite
- Mood swings
- Sleep difficulties
- Depression
Atomoxetine
Atomoxetine is part of a class of medications known as SNRIs and is primarily used in the treatment of depression and anxiety. It also comes in the brand name of Strattera. Atomoxetine is the generic medication. This medication works by increasing the amount of neurotransmitters in the brain and has been proven clinically effective for combating ADHD symptoms. Research also suggests that it works to improve social and family functioning; and, in some studies, it has been shown to be non-inferior to stimulant medications.1
Side Effects of Atomoxetine
While an FDA approved method of treating ADHD, Atomoxetine does come with a myriad of side effects. Atomoxetine carries a black box warning, the most serious warning from the FDA for suicidal ideation in adolescent patients. Still, Atomoxetine is typically well tolerated, producing mainly mild adverse effects including nausea, vomiting, dry mouth, and constipation.2
Long-Acting Guanfacine
Guanfacine is an alpha-2-agonist used for treating ADHD in children or as an off-label (not FDA approved) medication for adults. It comes as a brand name of Intuniv. Guanfacine is the generic medication. Originally designed as a treatment for high blood pressure, this prescription has been shown to improve a patient’s impulsivity and inattentiveness.9
Side Effects of Long-Acting Guanfacine
Side effects of Guanfacine tend to be relatively mild. However, the drug can cause decreased blood pressure and heart rate. Alternatively, if a patient stops taking their prescription abruptly, they may experience the opposite. Doctors recommend that users slowly decrease dosages if they are seeking to stop taking the medication. Patients should also maintain regular height and weight check routines.3
Wellbutrin
Wellbutrin is the brand name for the medication buproprion. It works by decreasing the reuptake of certain neurotransmitters in the brain and is used as an off-label medication for the treatment of ADHD.4
An off-label medication means that it is not FDA approved, but doctors may prescribe it at their discretion because they have a reason to believe it can provide a benefit for a patient. In a recent 2005 study, participants prescribed Wellbutrin reported an overall improvement in their ADHD symptoms.5
There have been a few other clinical trials testing its effectiveness, but further studies are needed before wellbutrin is approved for FDA use in ADHD.
Side Effects of Wellbutrin
Wellbutrin carries a black box warning, the most serious warning from the FDA for suicidal ideation in adolescent patients.4
Additionally, doctors do not recommend use in patients with severely low BMI and have a history of a seizure disorder.
Other common side effects of wellbutrin can include:4
- Increased heart rate
- Insomnia
- Headache
- Tremors
Effexor
Effexor is the brand name for the medication venlafaxine. It is another SNRI that functions by blocking the reuptake of neurotransmitters within the brain.6
Typically used in the treatment of depression and anxiety, it can also be utilized as an off-label medication for those with ADHD. While some studies have shown Effexor as an effective non-stimulant for ADHD, the data isn’t very concise.
Side Effects of Effexor
Effexor carries a black box warning, the most serious warning from the FDA for suicidal ideation in adolescent patients.
Common side effects of Effexor can include:
- Headache
- Nausea
- Insomnia
- Decreased libido or the inability to orgasm
Serious adverse reactions can include:
- Increased suicidal ideation
- Steven Johnson syndrome
- Serotonin syndrome
*It is important to note that Effexor should not be combined with stimulants or antidepressants, as it may increase the likelihood of a patient developing serotonin syndrome.6
Best Non Stimulant ADHD Medications for Kids
While stimulant medications are considered first-line treatment for children with ADHD, some parents may elect to pursue alternative methods. In these cases, non-stimulants can be a good option. The FDA has approved three non-stimulants for the use in children: atomoxetine (Strattera), a combination of guanfacine (Intuniv) clonidine (Catapres), and viloxazine (Qelbree). These medications have been proven effective in managing inattentiveness and agitation associated with ADHD.7
Despite being less potent than traditional stimulants, non-stimulants greatly reduce any risk of abuse and addiction in children. 7
The following are reliable non-stimulant ADHD medications for children:
Atomoxetine
Strattera is the brand name for atomoxetine and it was the first non-stimulant medication to be approved by the FDA for the treatment of ADHD in children and adolescents.7
Doctors recommended that children start dosages at a rate of 0.5 mg/kg (milligrams per kilogram) with a maximum of 1.4 mg/kg or 100 mg as a total dosage.7
A child prescribed Starttera can expect a decrease in negative ADHD symptoms including restlessness, impulsivity, and inattentiveness. Patients should be carefully monitiored while taking Strattera as it carries a black box warning, the most serious warning from the FDA, for increased risk of suicidal ideation in children and adolescents.7
Common side effects of Strattera may include:
- Headache
- Dry eyes
- Nausea/vomiting
- Loss of appetite
- Abdominal Pain
Qelbree
Qelbree is the brand name for viloxazine and works similarly to Effexor by increasing the number of neurotransmitters in a patient’s brain.8
Clinical trials have shown the drug to be effective in children for combating ADHD symptoms when prescribed in daily doses of between 100 mg and 400mg.8
For adolescent patients, weekly doses start at 200mg with a maximum recommendation of 400mg.8
Side effects of Qelbree are commonly mild. However, like Strattera, patients should be carefully monitored while taking Qelbree as it carries a black box warning, the most serious warning from the FDA, for increased risk of suicidal ideation in children and adolescents.8
Common side effects of Qelbree may include:
- Nausea
- Vomiting
- Headache
- Increased blood pressure
- Heart rate increase
Questions to Ask Your Health Team About Non Stimulant ADHD Medication
It is important that you and your healthcare team formulate a treatment plan that is both effective and healthy for you or your child. Knowing what medication you are taking, understanding how it works, and what symptom(s) resolution you are looking for is critical when seeking treatment. Similarly, you should be aware of the size of your dosage and how your prescription affects you.
Questions to ask your care team about which non stimulant ADHD medications are right for you include:
- Do you think a stimulant or non-stimulant medication would be a better fit for me?
- What is the dosage and how often should I take the medication?
- How will I know that the medication is working?
- What are common side effects that I can expect?
- What should I do if I experience serious side effects?
Final Thoughts
The treatment of ADHD is multi faceted. Non-stimulants can be helpful for many who have not had success with previous methods of treatment. Along with medications, patients can work to improve ADHD symptoms through therapy and self-help methods. If you’re struggling with symptoms, there is help available.
