Non-Stimulant ADHD Medication

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

Non-stimulants may be used if:

Non-stimulant medications include Strattera, tricyclic antidepressants (TCAs), Effexor, Wellbutrin, and some high blood pressure medicines. Of these, Strattera has been studied most extensively for use in the treatment of ADHD in adults and children. It appears to have fewer side effects than TCAs and to be more effective than Wellbutrin.

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

Below are non-stimulant medications used to treat ADHD.

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.

Atomoxetine is in the class of medications known as selective norepinephrine reuptake inhibitors (SNRIs). 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.

It can take at least six weeks for Strattera to reach a maximal therapeutic effect. Once maximal effects are reached, however, they last 24 hours and may also have carry-over effects to the next day.

Side effects of atomoxetine may include:

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

Strattera also has a warning for risk of suicidal thoughts in children and adolescents.

If your child is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Tricyclic Antidepressants

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

These antidepressants are typically tried when a person hasn't responded well to stimulants. They may also be prescribed if you have symptoms of depression or anxiety in addition to ADHD.

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, but once this level is reached, benefits last throughout the day.

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:

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

More serious side effects of tricyclic antidepressants may include problems with heartbeat or heart rhythm.

If you or your child have heart problems or a family history of them, TCAs should be used with caution and close medical monitoring.

Tricyclic antidepressants may also increase the risk of seizures in patients with a history of seizure disorder. As with all medications, the use of tricyclic antidepressants requires close monitoring and consultation with the prescribing doctor.

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 don't appear to be as effective in improving symptoms of inattention. They are usually only used to treat ADHD when a person can't tolerate or doesn't respond to Strattera or stimulants.

Side effects of clonidine and/or guanfacine may include:

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

Qelbree

The FDA has approved another non-stimulant medication for adults, children and adolescents (ages 6 to 17) with ADHD called Qelbree (viloxazine). Like Straterra, Qelbree is also a selective norepinephrine reuptake inhibitor.

As with some other ADHD medications, Qelbree can be sprinkled on applesauce and eaten, which helps children who have difficulty swallowing pills take their ADHD medication.

Common side effects of Qelbree include:

  • Decreased appetite
  • Fatigue
  • Insomnia
  • Irritability
  • Nausea
  • Somnolence (tiredness)
  • Vomiting
  • Constipation
  • Dry mouth
  • Headache

Qelbree also contains a warning for the risk of suicidal thoughts and behaviors. It's essential to monitor any child taking the drug for changes in mood and behaviors, especially when they are first starting the medication.

Qelbree can also cause an increase in heart rate and blood pressure. Additionally, the medication can also activate mania, so candidates will be evaluated for bipolar disorder before starting the drug.

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.

Side effects of Wellbutrin may include:

  • Irritability
  • Weight loss due to decreased appetite
  • Insomnia
  • Worsening of existing tics

Wellbutrin may also make some people more prone to seizures.

Effexor

Effexor (venlafaxine) is an antidepressant sometimes used off-label to treat ADHD. It helps with concentration and mood.

Side effects of Effexor can include:

Black Box Warnings

All antidepressants (including Strattera, Qelbree, TCAs, Wellbutrin, and Effexor discussed in this article) carry a black box warning of suicidal thoughts or ideation and/or behavior, so it’s essential to monitor anyone taking these medications for changes in mood and check in with the prescribing doctor.

Non-Stimulant vs. Stimulant ADHD Medication

There are pros and cons to both non-stimulants and stimulants for treating ADHD. First, the doctor will evaluate your medical history thoroughly to recommend an ADHD medication for you.

As with many other medications for mental health disorders, your ADHD medication will likely be titrated by your doctor. This means that the doctor will prescribe you a medication and monitor its effectiveness as well as your side effects. They will adjust your dose—or change the medication entirely—as needed.

Risk of Addiction

Stimulants are linked with a higher risk of misuse or addiction, whereas non-stimulants present a lower risk. As a result, doctors may prescribe people with ADHD and a history of substance misuse non-stimulants.

Side Effects

Both non-stimulant and stimulant medication may cause:

  • Aggression or irritability
  • Changes in behavior, mood, and/or suicidal ideation
  • Decreased appetite
  • Increased heart rate or blood pressure
  • Loss of appetite
  • Nausea
  • Severe depression
  • Sleep difficulties (insomnia)
  • Stomachache
  • Weight loss due to decreased appetite

If you experience severe depression or any side effects from medication, contact a mental health professional right away. Some side effects may be reduced or eliminated by adjusting your dose, which should always be done under the guidance of a doctor.

Further potential side effects of stimulants that aren't typically associated with non-stimulants are transient headaches and behavioral rebound—an increase in ADHD symptoms. In rare cases, exacerbation of tics has occurred. People taking stimulants may experience additional mental health side effects including dysphoria, euphoria, mania, or psychosis.

Time It Takes to Feel the Effects

Stimulants are generally taken more frequently and wear off faster than non-stimulants, which are usually taken only once per day and have longer-lasting effects.

However, it usually takes longer for the effects of non-stimulants to kick in as opposed to stimulants, which are faster-acting.

Contraindications

It is recommended you don't take stimulant or non-stimulant medication if you have taken a monoamine oxidase inhibitor (MAOI) in the past 14 days or if you have a history of glaucoma. Additionally, if you have a history of seizures, it is advised you use caution if you're taking either a stimulant or non-stimulant.

  • Non-stimulants: It is recommended that you don't take non-stimulants such as Strattera (atomoxetine) if you have a history of pheochromocytoma, severe cardiac disorders, or severe vascular disorders.
  • Stimulants: Your doctor might avoid prescribing you stimulants if you have hyperthyroidism, moderate to severe hypertension, or symptomatic cardiovascular disease. If you are taking an anticoagulant medication, an anticonvulsant, or a tricyclic antidepressant, it is recommended you use caution if taking a stimulant.

A Word From Verywell

Check in with your prescribing doctor before and while taking a non-stimulant ADHD medication. It's important to let them know about other medications you are taking and any associated medical conditions that could present risks. Ask them about side effects that could come up and be sure to understand what's unique to each medication before starting it.

As you seek the right medication to treat your ADHD, remember to take care of your mental health. Speaking with a qualified therapist, especially one who specializes in ADHD, can help you cope with the behavioral and emotional symptoms you're experiencing.

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10 Sources
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