Stimulant Vs. Non Stimulant ADHD Meds: Key Differences

Stimulant Vs. Non-Stimulant ADHD Meds

The two main medications used to treat ADHD include stimulants and non-stimulants. While they both work to increase concentration and attentiveness and decrease impulsivity seen in ADHD, one may be a better fit for certain individuals than others. Stimulant medications have been shown to be the most effective medication for symptom management in ADHD and may be a good initial treatment.¹

The major difference between stimulant and non-stimulant medications are their mechanisms of action, their side effect profiles, and their interaction with other medications that patients may be taking.

Stimulant medications work by increasing the amount of neurotransmitters sent to the brain, including dopamine, norepinephrine, and serotonin. They also help stop these chemicals from being degraded. Non-stimulant ADHD medications can work on similar neurotransmitters by decreasing their degradation in the brain. Many of the non-stimulant medications are used as an off-label treatment for ADHD, which means they are not FDA-approved, but have been shown to be effective in some patients with ADHD.

Stimulants for ADHD

Stimulant medications work through two main mechanisms. In both ways they increase the amount of neurotransmitters in the brain. They are used as the first line medical treatment for patients with symptoms of ADHD. However, professionals recommend that children under six years old work with a behavioral therapist before caregivers consider stimulant medication.

Stimulants are a good first line treatment to help alleviate common symptoms of adult ADHD, including restlessness and hyperactivity. However, stimulants are a controlled substance and should be taken with caution, especially for patients with histories of heart conditions, arrhythmias, blood pressure, and tic disorders.

Patients should speak to their doctor about the side effects and possibility of overdosing and have emergency contact information readily available. Stimulants should be kept away from children and stored in a safe area.

Common stimulant medications to treat ADHD include:*

• Adderall (mixed amphetamine salts)
• Ritalin (methylphenidate hydrochloride)
• Concerta (methylphenidate hydrochloride)

*Stimulant medications for ADHD carry a black box warning for drug abuse and dependence, and the risk of sudden death and serious heart events due to misuse. A black box warning is the most serious warning from the FDA.

How Quickly Do Stimulants Work?

Stimulant medications come in two forms, short-acting and long-acting, and vary in how quickly they take effect. Research has shown that stimulants work very quickly, usually within an hour, and their effects last between three and four hours. However, this short window means patients must take stimulant medication multiple times during the day.

Common types of short-acting stimulants include Adderall, Ritalin, and Dextrostat. They act immediately or within one hour of administration. Their effects usually last 3-4 hours. They may be used for patients that need symptom control during the morning and afternoon, but not in the evening such as children who are in school. ²

Common types of long-acting stimulants include Concerta, Adderall XR, and Vyvanse. Similar to short-acting stimulants, they act immediately and effects are felt within one hour. However, these effects last up to 10 hours, allowing patients to take much fewer pills throughout the day. Long-acting stimulants are better for patients who may have trouble remembering to take medications throughout the day.

Side Effects of Stimulants for ADHD

Stimulants have a number of side effects, such as appetite suppression, weight loss and dry mouth. More severe side effects seen with stimulant medication include chest pain/palpitation in patients with pre-existing heart conditions (this requires prompt attention from a physician or emergency services). For children, pediatricians should monitor growth restriction and appetite suppression with height and weight checks. Women may have side effects related to menstruation or complications with pregnancy. Patients should always let their physician know about any side effects they may have from their ADHD medication.

Common stimulant side effects include:

• Appetite suppression
• Nausea/vomiting
• Dry mouth
• Weight loss
• Abuse potential

Benefits of Stimulants

In clinical trials, 70% of patients with ADHD show improvement in distractibility and attentiveness after beginning stimulant medication.¹ Studies have also shown that children diagnosed with ADHD treated with stimulant medication have improved decision making skills and school work productivity.³

Stimulants are the best medical treatment for patients of all groups including children six years or older, teens, and adults. For children under six years of age, it is recommended that behavioral therapy be implemented.³ Doctors begin treatment for ADHD for both adults and children when their symptoms impede their quality of life at work, school, and in relationships.³

Risks of Stimulants

Life threatening risks to be aware of include stimulant overdose, cardiac side effects of stimulants, and serotonin syndrome, especially when taking antidepressant medications. They all present with racing heart rate, sweating, tremors, agitation, and increased blood pressure and require emergency intervention. Patients should call 911 or go to their nearest emergency department.

Non-Stimulants for ADHD

Non-stimulant medications for ADHD include antidepressant medications and previously used antihypertensive medications. They are typically used for ADHD when patients cannot take stimulant medications or have not benefited from stimulant medications. They work to increase the neurotransmitters in the brain by inhibiting their reuptake.

Non-stimulant ADHD medications treat the same symptoms as stimulant medications. However, they differ in how they manage those symptoms. One size does not fit all for these medications. While most patients will respond to stimulant medication, some may respond better to non-stimulants instead. The FDA has approved atomoxetine, guanfacine, and clonidine for the use in teenagers.

Non-stimulant medications, such as atomoxetine, should not be used by patients currently taking other types of antidepressants, anti-anxiety medications, or stimulants as these may increase the risk of serotonin syndrome.

The most common non-stimulant medications to treat ADHD include:**

• Strattera (atomoxetine)
• Intuniv (guanfacine)
• Wellbutrin SR and Wellbutrin XL (bupropion hydrochloride)

**Non-stimulant medications for ADHD carry a black box warning for suicidal thoughts and behaviors  in children, adolescents, and young adults. A black box warning is the most serious warning from the FDA. Intuniv (guanfacine) does not carry this black box warning.

How Quickly Do Non Stimulants Work?

How quickly non-stimulants take effect can vary based on the medication. Atomoxetine can take weeks to reach full effect in the treatment of ADHD, while bupropion can begin working within one month.^4,5

Side Effects of Non-Stimulants for ADHD

Serious side effects of non-stimulant medications include serotonin syndrome, especially when combined with other antidepressant or anti anxiety medication. Patients experiencing tremors, seizures, sweating, increased blood pressure, and palpitation should call 911 or go to their nearest emergency department. Atomoxetine carries a risk of increased suicidal ideation in teens. Patients should be monitored closely in the first month of treatment.

Common non stimulant side effects include:

• Nausea or vomiting
• Headaches and dizziness
• Abdominal pain

Benefits of Non Stimulants

The major benefit of using non-stimulant medication is they are not a controlled substance and therefore do not carry a risk of substance abuse. Additionally, they are a great choice for the 10-30% of patients with ADHD who do not respond to stimulant medications.¹

Risks of Non Stimulants

Patients should be aware of the risk of serotonin syndrome with Wellbutrin and atomoxetine. Additionally, teenagers and children can have increased suicidal ideation in the first month of treatment and should be monitored closely during this time. Patients should call 911 in any emergency situation.

Stimulants Vs. Non-Stimulants for ADHD: Which Works Better?

Deciding between non-stimulant and stimulant medication is a personal choice between doctors and patients. While stimulant medications have been shown to be more efficacious for agitation and concentration, the doctor and patient should come to a consensus on the best treatment based on individual needs.¹

Regardless of which medication (if any) you decide to take, many professionals recommend therapy, such as CBT for ADHD, as part of a treatment plan. Patients may benefit from finding a neurodiversity-affirming therapist who can work with them to learn their individual strengths. For children under six, the best treatment for management of ADHD symptoms is behavioral management therapy.

Below are reasons why you and your physician may choose a non-stimulant over stimulant medication:

• Treatment failure with stimulants
• Minimal risk of substance abuse
• Intolerable side effects of stimulant medications
• The risk of interactions with other medications you are taking

Questions to Ask Your Health Team About Stimulant Vs. Non Stimulant ADHD Meds

Patients should have an active role in their treatment plan for ADHD. It is important that you know what type of medication you’re taking and why, the dosage of that medication, and common side effects. Similarly, you should know what type of therapist to look for and have a clear idea of the goals of that therapy.

Questions to ask your care team about before taking medication for ADHD include:

• How does this medication work?
• What are the common side effects?
• What are more serious side effects?
• What is the dosage of the medication?
• How often should I take these medications?
• How soon should I expect to see resolution in symptoms?

Final Thoughts

ADHD treatment is varied and multimodal. Every patient will respond differently to medications and therapy styles. It’s important to speak with your doctor to determine whether stimulant or non-stimulant medications will best treat your ADHD.