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.

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

 

#ADHD, #adultADHD, @dougmkpdp,  @addstrategies, @adhdstrategies

 

 

 

About doug with ADHD

I am a psychiatric physician. I learned I have ADHD at age 64, and then wrote two ADHD books for adults, focusing on strategies for making your life better. I just published my first novel, Alma Means Soul. Your Life Can Be Better; strategies for adults with ADD/ADHD available at amazon.com, or smashwords.com (for e books) Living Daily With Adult ADD or ADHD: 365 Tips O the Day ( e-book). This is one tip at a time, one page at a time, at your own pace. It's meant to last a year. As a child, I was a bully. Then there was a transformation. Now I am committed to helping people instead abusing them. The Bully was published in January, 2016. It's in print or e book, on Amazon.
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4 Responses to Non Stimulant ADHD Meds — ADHD Tip O the Day 980

  1. holdthatthought says:

    great post as always

    question: you mentioned that Tricyclic Antidepressants can be prescribed for ADHD and to also treat depression and anxiety. what would happen if somebody were to be prescribed stimulants (front line treatment) meds and developed greater symptoms of anxiety? or exacerbated pre-existing anxiety symptoms?

    Like

    • dino – good question. my ritalin made me a little jittery and when I switched to Daytrana (ritalin in a skin patch, expensive). no problems. the anxiety is one of the more frequent possible side effects from stimulants.
      1. talk to your doctor
      2. I would tend to stay away from the TCAs usually.
      3. there are serotonin antidepressants that help with anxiety. so do the antihypertensives. so they could be added. also the stimulant dose could be lowered, or if you haven’t, you could try the other stimulant – ritalin may have less anxiety tendency than Adderall.
      4. SSRI – serotonin- Citalopram (Celexa)
      Escitalopram (Lexapro)probably the best

      not so good:
      Fluoxetine (Prozac)
      Paroxetine (Paxil, Pexeva)
      Sertraline (Zoloft)

      as always, thank you for contributing your comment.
      best wishes
      doug

      Like

  2. Martha Puryear says:

    Very good one! ❤️

    Sent from my iPad

    Liked by 1 person

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