Non Stimulant ADHD Meds — ADHD Tip O the Day 980

While stimulants are  the first choice of medication used to treat attention-deficit/hyperactivity disorder (ADHD), there are many non-stimulant medications that may be used.

Statistically, stimulants are more effective, 85 % of ADHD ers. Straterra (atomoxetine), has the best response rate of the non-stimulants, 50%.  In my opinion, the non-stimulants have a higher rate of side effects than the stimulants (this is controversial).

Non-stimulants may be used if:

• You do not respond to stimulants
• Side effects of stimulants are too great.
• You have a history of drug abuse. (Some lists include heart conditions and Bipolar, but this is not supported by the evidence. The anti depressant non-stimulants are contraindicated in Bipolar.)

Non-stimulant medications include antidepressants -Strattera, tricyclic antidepressants (TCAs), Effexor, Wellbutrin – and some high blood pressure medicines. Of these, Strattera has been studied most extensively. The antidepressants can improve overall concentration and impulse control, but must be taken daily and may take 3-6 weeks to notice effectiveness. Some also have a problem with withdrawal, sometimes even if a dose is missed.

In 2021, the FDA approved another non-stimulant for the treatment of ADHD in children and adolescents called Qelbree (viloxazine). 

Qelbree and Strattera are both antidepressants, selective norepinephrine reuptake inhibitors.

In my opinion, the anti-hypertensives work mostly by reducing anxiety, which can make ADHD symptoms worse.

Notes: 

1. Every person is unique, and may respond differently to any medication or other treatment.
2. The non medication treatments, including supplements, have very low response rates for ADHD, are not regulated in their manufacture and therefore can be dangerous, and help some people somewhat. They can supplement the more effective medications.
3. A  list of “side effects” for any medication is actually a list of possible side effects.  You probably won’t get them with most medications, and if you do, they can be managed or you can simply stop the medication.

 

Many Links:

October is ADHD Awareness Month – special events

• You do not respond to stimulants (link)

ADHD TREATMENT

 

• ADHD Medication & Treatment
•  
• ADHD Medications

NONSTIMULANTS

Stimulant vs. Non-Stimulant ADHD Medication 

 

Below is detailed information on the various non-stimulants. But first, the cartoons.

 

-and before my ADHD medication.

 

 

“No, I don’t like to put medicines into my body.”

 

I do better on my meds. Somewhat.

Strattera

Strattera (atomoxetine) is the first non-stimulant medication to be approved by the FDA for the treatment of ADHD in adults and children over the age of 6. Studies have found that this drug improves symptoms of ADHD and reduces oppositional and defiant behavior and anxiety. Strattera differs from stimulant medications in several ways:

 

• It’s not classified as a controlled substance. It does not seem to have a potential for abuse and thus is not classified as a controlled substance.
• It takes longer to start working. It also appears to have a longer onset of action as compared to stimulants, which work on the day they are taken. Therefore, the therapeutic effect of stimulants may be noticed more quickly than Strattera.
• It must be taken daily. Strattera must be taken every day, whereas doses of stimulants may be skipped—over the weekend, for example.
• and it’s very expensive.

Side effects of atomoxetine may include:

• Stomachaches
• Weight loss due to decreased appetite
• Nausea
• Vomiting
• Dizziness
• Fatigue
• Dry mouth
• Increased heart rate and blood pressure
• Agitation
• Irritability

Tricyclic Antidepressants

Tricyclic antidepressants may be used off-label in the treatment of ADHD. The most frequently used for this are:

 

• Norpramin (desipramine)
• Tofranil (imipramine)
• Pamelor (nortriptyline)
• Amitriptyline

These antidepressants  may also be prescribed if you have symptoms of depression or anxiety in addition to ADHD.  They have a higher incidence of side effects.

TCAs, like stimulants, are thought to increase the amount of norepinephrine in the brain. Unlike stimulants, it may take several days or even weeks to see the therapeutic benefits of TCAs.

Tricyclic antidepressants need to be taken daily. Missing a dose or stopping the medicine abruptly may cause aches and flu-like symptoms, so if you’re going to go off the medication, you should be tapered off gradually over a period of time.

Common side effects of TCAs may include:

• Drowsiness
• Dry mouth
• Constipation
• Blurred vision
• Stomachaches
• Headaches
• Vivid dreams
• Insomnia

 

More serious side effects of tricyclic antidepressants may include problems with heartbeat or heart rhythm and  may also increase the risk of seizures in patients with a history of seizure disorder.

Anti-Hypertensive Drugs

In addition to the above drugs, Catapres (clonidine) and Tenex (guanfacine) are sometimes used to help manage ADHD symptoms. While these short-acting forms of each drug are not FDA-approved to treat ADHD, the long-acting versions, Kapvay (clonidine) and Intuniv (guanfacine) are. Both these medicines were originally used to treat high blood pressure, but they have also been found to be helpful in reducing hyperactivity and impulsive symptoms. These medicines do not appear to be as effective in improving symptoms of inattention. 

Side effects of clonidine and/or guanfacine may include:

 

• Drowsiness
• Fatigue
• Dizziness
• Nausea
• Decreased blood pressure
• Stomach pain
• Insomnia
• Dry mouth 

Qelbree

Common side effects of Qelbree include:

 

• Somnolence, or tiredness
• Decreased appetite
• Fatigue
• Nausea
• Vomiting
• Insomnia
• Irritability

 

Wellbutrin

Wellbutrin (bupropion) is a different type of antidepressant that has been found to reduce symptoms of ADHD and depression in many patients. Wellbutrin is not approved by the FDA to treat ADHD but may be prescribed off-label. It’s considered a third-line option. Unlike the other antidepressants, it also affects dopamine.

Side effects of Wellbutrin may include:

 

• Irritability
• Weight loss due to decreased appetite
• Insomnia
• Worsening of existing tics
• May make some individuals more prone to seizures

 

 

Effexor

Effexor (venlafaxine) is an antidepressant sometimes used off-label to treat ADHD.10 It helps with concentration and mood.  It has a high incidence of side effects and a more serious withdrawal problem.

Side effects of Effexor can include:

• Tremor
• Sleep issues
• Dry mouth
• Sexual problems 
• Nausea
• Anxiety

 

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