Non-Stimulant ADHD Medication

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:

• The side effects of stimulants are too great
• You don't respond to stimulants
• You have a history of bipolar disorder
  
• You have a history of certain heart conditions
• You have a history of drug use
  

Non-stimulant medications include Strattera (atomoxetine), tricyclic antidepressants (TCAs), Effexor (venlafaxine), Wellbutrin (bupropion), and some high-blood pressure medicines. Of these, Strattera has been studied the 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.

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 the risk of suicidal thoughts in children and adolescents.

Tricyclic Antidepressants

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

• Elavil (amitriptyline)
• Norpramin (desipramine)
• Pamelor (nortriptyline)
• Tofranil (imipramine)
  

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.

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.

Anti-Hypertensive Drugs

In addition to the above drugs, Catapres (clonidine) and Tenex (guanfacine) are sometimes used off-label to help manage ADHD characteristics. 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
  

Wellbutrin

Wellbutrin (bupropion) is a different type of antidepressant that has been found to reduce symptoms of ADHD and depression in many patients.

Side effects of Wellbutrin may include:

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

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:

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

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.

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.