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Common Non-Stimulant Medications for ADHD

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July blog post 9 adhd online

Stimulants medications are typically a mental health provider’s first choice of treatment for ADHD. Examples of stimulants are Adderall, Ritalin, Vyvanse and Concerta. But for some people, stimulants aren’t the best option. In these cases, non-stimulant medications can be a good alternative for treating ADHD.

Types of Non-Stimulants

There are three kinds of non-stimulants that mental health providers may use to help treat ADHD. These include:

  • ADHD-specific non-stimulants
  • Antidepressants
  • Blood pressure medications

Who Uses Non-Stimulants

Some people experience unpleasant or severe side effects when they take stimulants. Others have pre-existing health conditions such as a thyroid or heart issue that means they may not react well to a stimulant, explains Raafia Muhammad, M.D., M.P.H., the clinical division chief and interim chief medical officer at ADHD Online.

Some non-stimulants, such as Qelbree, may be a good option for people who work nights. They can be taken at any time of day, and they don’t have the wakefulness side effect that many stimulants have, Dr. Muhammad says.

If you have a mood disorder along with ADHD, a non-stimulant may be a good choice. “Some of the symptoms of ADHD blend in with so many other conditions like depression or anxiety,” says Dr. Muhammad. “No one can say that what you have is 10 percent ADHD or 40 percent depression. Sometimes, in order to treat both conditions, you get a two-for-one kind of thing by using a non-stimulant to address the mood as well as the ADHD symptoms.”

Another situation where a non-stimulant might be better for you is when you have been on stimulants, but you don’t feel like they help. Or maybe they used to work, but they don’t seem to anymore, even after you’ve tried various kinds. In these cases, Dr. Muhammad says, you can try a non-stimulant medication or possibly even add one to the stimulant you’re taking.

For example, you might be taking a long-acting stimulant such as Vyvanse, but you have trouble shutting your mind down late at night. “With those patients, we may prescribe a non-stimulant such as Kapvay to boost the effects and help the stimulant work better,” Dr. Muhammad says.

Stimulants vs. Non-Stimulants

STIMULANTS NON-STIMULANTS
First line of treatment for ADHD Second or third line of treatment for ADHD
Work for 70–80% of people Not as effective as stimulants, but can be helpful for people who can’t take stimulants
Work quickly Take up to six weeks for full effect
May wear off suddenly Effects last longer
Risk of abuse or addiction Little to no risk of abuse or addiction. (Still, use of most should be tapered slowly and not discontinued abruptly.)
Considered controlled substances, which can make them more difficult to get, especially when traveling Not controlled substances

ADHD-Specific Non-Stimulants

These non-stimulant medications are approved by the U.S. Food and Drug Administration specifically to treat ADHD. (The below isn’t a comprehensive list of all possible side effects. Please check with your provider or the medication manufacturer’s website for more information.)

Strattera (atomoxetine)

Strattera (atomoxetine) is the first non-stimulant that the FDA approved for treating ADHD in 2002.

How it works: Norepinephrine is a chemical messenger in your brain called a neurotransmitter. It affects your memory, sleep cycle, mood, attention, arousal and alertness. Strattera is a norepinephrine reuptake inhibitor, or SNRI. That means it boosts the amount of norepinephrine in your brain. This helps decrease hyperactivity, inattention and impulsive behavior.

Common side effects:

  • Constipation
  • Dry mouth
  • Insomnia
  • Nausea
  • Fatigue
  • Decreased appetite
  • Erectile dysfunction
  • Urinary tract problems
  • Painful menstruation
  • Hot flashes

Qelbree (viloxazine)

The FDA approved this non-stimulant for treating ADHD in children ages 6 years and older in April 2021 and adults in May 2022.

How it works: Like Strattera, Qelbree is an SNRI that increases the amount of norepinephrine in your brain. Along with ADHD, it can also help with anxiety and depression, says Dr. Muhammad.

Common side effects:

  • Insomnia
  • Headache
  • Drowsiness
  • Fatigue
  • Nausea
  • Decreased appetite
  • Dry mouth
  • Constipation

Intuniv ER (guanfacine)

Intuniv ER is an extended-release medication that’s normally used to treat high blood pressure. The FDA has approved it to treat ADHD in kids ages 6 to 17 years, but it’s often prescribed for people of all ages. It can be used alone or along with a stimulant.

How it works: Intuniv ER decreases adrenaline levels and can improve ADHD symptoms such as emotional sensitivity, social aggression and hyperarousal.

Common side effects:

  • Drowsiness
  • Dry mouth
  • Fatigue
  • Difficulty sleeping
  • Nausea
  • Stomach pain
  • Dizziness
  • Irritability
  • Slow heart rate
  • Low blood pressure

Kapvay ER (clonidine)

Kapvay ER is also an extended-release medication that’s normally used for high blood pressure. The FDA has approved it to treat ADHD in kids ages 6 to 17 years, either by itself or along with a stimulant. Like Intuniv, doctors often prescribe it for adults too.

How it works: Kapvay ER reduces blood pressure and boosts norepinephrine in the brain. It can improve ADHD symptoms such as hyperactivity, impulsivity and inattention.

Common side effects:

  • Fatigue
  • Cough
  • Runny nose
  • Sneezing
  • Irritability
  • Sore throat
  • Nightmares
  • Mood changes
  • Constipation
  • Increased body temperature
  • Ear pain

Antidepressants

Sometimes antidepressants are used to treat ADHD symptoms, especially if you have depression or anxiety along with ADHD. They’re usually not as effective as stimulants or ADHD-specific non-stimulants. But a stimulant can be added to these if needed, says Dr. Muhammad.

Wellbutrin (bupropion)

Wellbutrin (bupropion) is used to treat depression, help people stop smoking, and prevent depression in people with seasonal affective disorder, or SAD. It’s the most prescribed antidepressant for ADHD. “For some patients with a mood disorder, this may be a good option,” says Dr. Muhammad. “They get the mood disorder benefit, and they also get the attention benefit.”

How it works: Wellbutrin is a norepinephrine dopamine reuptake inhibitor, or NDRI. It increases the levels of the neurotransmitters dopamine and norepinephrine in your brain, which can decrease ADHD symptoms.

Common side effects:

  • Anxiety
  • Dry mouth
  • Irregular heartbeat
  • Hyperventilation
  • Irritability
  • Restlessness
  • Shakiness
  • Difficulty sleeping

Effexor and Effexor XR (venlafaxine)

These are newer antidepressants that your doctor might prescribe if you have depression as well as ADHD.

How it works: Effexor is a serotonin-norepinephrine reuptake inhibitor, or SNRI. It boosts the neurotransmitters norepinephrine and serotonin in your brain, which can help your concentration and mood.

Common side effects:

  • Headache
  • Nausea
  • Diarrhea
  • Dry mouth
  • Sweating
  • Nervousness
  • Restlessness
  • Fatigue
  • Insomnia
  • Sexual side effects
  • Increased blood pressure

Tricyclic Antidepressants

Research has found that tricyclic antidepressants such as Pamelor (nortriptyline), Tofranil (imipramine), and Norpramin (desipramine) improve ADHD symptoms in some people. However, the side effects of these medications can be unpleasant. Common side effects include faster heartbeat, blurred vision, constipation, urinary retention, dry mouth, low blood pressure, tremor, weight gain and sexual difficulties. They’re considered a third-line treatment for ADHD.

Monoamine Oxidase Inhibitors, or MAOIs

A category of antidepressants called monoamine oxidase inhibitors, or MAOIs — particularly Nardil (phenelzine) and Parnate (tranylcypromine) — can help improve symptoms of ADHD. They’re not used very often, though, because they can have major side effects and serious interactions with other medications and certain foods.

Blood Pressure Medications

Tenex (guanfacine) and Catapres (clonidine) are sometimes used to treat ADHD. These are the immediate-release forms of the FDA-approved versions — though Tenex and Catapres aren’t technically approved for treating ADHD. “These can help with the mental hyperactivity that people sometimes have, so they’re not necessarily used for the blood pressure control,” says Dr. Muhammad.

Talk to Your Doctor

If your current ADHD medication isn’t helping, be sure to let your doctor know. You might need a complete change, or you may just need to add a non-stimulant to your regimen. Dr. Muhammad says there are various ways to tweak your treatment so it works better for you.

Sources:

Cleveland Clinic: Attention Deficit Hyperactivity Disorder (ADHD): Nonstimulant Therapy (Strattera) & Other ADHD Drugs

Cleveland Clinic: Norepinephrine (Noradrenaline)

Cleveland Clinic: Beyond Depression: Other Uses for Tricyclic Antidepressants

Wolters-Kluwer UpToDate: Pharmacotherapies for attention deficit hyperactivity disorder in adults

Frontiers in Science: Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers

U.S. Food & Drug Administration: Drug Approval Package: Strattera (Atomoxetine Hydrochloride) Capsules

U.S. Food & Drug Administration: Drug Approval Package: QELBREE

Qelbree: What are the possible side effects of Qelbree?

Psychiatric Times: FDA Approves Novel Nonstimulant for Treatment of ADHD in Adults

National Alliance on Mental Health (NAMI): Venlafaxine (Effexor)

Mayo Clinic: Bupropion (Oral Route)

ADDitude: Non-Stimulant ADHD Medication Overview

ADDitude: Clonidine for ADHD

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