Nonstimulant medications may be suitable for people with attention deficit hyperactivity disorder (ADHD) who cannot take stimulants.
Medication can help to improve ADHD symptoms. The main types of medications for ADHD are stimulant and nonstimulant drugs.
Stimulant drugs are usually the first-line treatment for ADHD, but they are not suitable for everyone. Nonstimulant drugs are an alternative option.
This article discusses nonstimulant medications for adults with ADHD, potential side effects, and safety warnings.
Methylphenidate (MPH) and amphetamines (AMP) are the most common stimulants for ADHD.
Both stimulants block the reabsorption of neurotransmitters dopamine and norepinephrine and increase levels in the area where brain cells connect.
There is the potential for drug misuse with both MPH and AMP. Therefore, the Drug Enforcement Administration (DEA) has regulated them as controlled drugs.
Nonstimulant drugs do not contain either MPH or AMP.
Although nonstimulants are not as effective as stimulants in managing ADHD symptoms, they are the second-line option for people who cannot take stimulants.
Nonstimulant drugs do not have the same potential for drug misuse. Nonstimulants may be suitable for people with ADHD who:
- experience negative side effects from stimulants
- have no improvement in symptoms from stimulants
- have another health condition that stimulants affect negatively
- have a history of substance misuse
- could benefit from a combination of stimulant and nonstimulant medications
Nonstimulant ADHD medications include:
- ADHD-specific nonstimulants: Increase norepinephrine levels in the brain.
- Antidepressants: Help treat ADHD by altering levels of neurotransmitters in the brain.
- Blood pressure medications: Affect levels of norepinephrine and dopamine in the brain.
ADHD-specific nonstimulant medications include the following:
| Generic/brand name | Description |
|---|---|
| atomoxetine (Strattera) | Atomoxetine is a norepinephrine modulator. It works to increase the amount of norepinephrine in the brain to improve signaling. It is the most common nonstimulant for treating ADHD. |
| viloxazine (Qelbree) | Viloxazine is also a norepinephrine modulator. The effects of viloxazine may start sooner than atomoxetine. |
As an alternative to ADHD-specific nonstimulants, doctors may prescribe
Side effects of ADHD-specific nonstimulants
Side effects of atomoxetine are usually short term and include:
- insomnia
- nausea
- loss of appetite
- headaches
- stomach ache
- fatigue
Safety warnings for ADHD-specific nonstimulants
Atomoxetine may take up to 6 weeks to be fully effective. However, its effects are continual, unlike stimulants which work for around 12 hours per day.
In rare cases, atomoxetine may increase the risk of suicidal thoughts in the first few weeks of taking the drug.
Viloxazine is
Both medications can increase blood pressure and lead to mania or hypomania.
Antidepressants that increase norepinephrine levels may have a positive effect on ADHD. Antidepressants that also affect serotonin levels may help people with coexisting conditions such as depression or anxiety.
| Generic/brand name | Description |
|---|---|
| venlafaxine (Effexor) | An antidepressant that |
| Tricyclic antidepressants (TCAs): • nortriptyline (Pamelor) • imipramine (Tofranil) • desipramine (Norpramin) | TCAs |
| bupropion (Wellbutrin) | Bupropion works in the brain to alter neurotransmitter activity. |
Side effects of antidepressants
Side effects of venlafaxine include:
- headaches
- nausea
- diarrhea
- dry mouth
- feeling nervous
- insomnia
- increased sweating
- restlessness
- fatigue
- increased blood pressure
- sexual difficulties, such as delayed ejaculation
Side effects of TCAs
- constipation
- dizziness
- dry mouth
- blurred vision
- confusion
- urinary retention
- fast heart rate
Side effects of bupropion include:
- headaches
- weight loss
- nausea
- dizziness
- dry mouth
- increased heartbeat
- sleeping difficulties
- constipation
- sore throat
These side effects usually improve within 1–2 weeks of taking bupropion.
Safety warnings for antidepressants
The FDA has not approved antidepressants for the use of ADHD. This means that treating ADHD is an off-label use of these drugs.
A doctor can explain the reasons for prescribing an off-label drug to treat ADHD and other options.
Antidepressants contain a black box warning about the risk of suicidal thoughts while taking the drugs.
Anyone taking antidepressants must contact a healthcare professional if they have any suicidal thoughts or behaviors, particularly in the first few months of taking the medication.
TCAs may
Certain types of blood pressure medication called alpha-2 and alpha-2a noradrenergic agents affect norepinephrine and dopamine levels.
| Generic/brand name | Description |
|---|---|
| clonidine (Catapres or Kapvay) | Clonidine is an alpha agonist, which stimulates certain receptors in the brain to release more norepinephrine. |
| guanfacine (Tenex or Intuniv) | Guanfacine is also an alpha agonist. |
Side effects of blood pressure medications
Side effects of clonidine and guanfacine include:
- fatigue and sleepiness
- headaches
- dizziness
- dry mouth
- loss of appetite
- stomach pain
- nausea
- vomiting
Safety warnings for blood pressure medications
Clonidine and guanfacine may slow heart rate, which may cause complications in people with heart issues.
It is not safe to stop taking either drug abruptly due to withdrawal symptoms, which can suddenly raise blood pressure and heart rate.
People will need to contact a doctor if they have concerns about negative side effects they experience from ADHD medications.
If people have suicidal thoughts or behaviors while taking medication for ADHD, they must contact a healthcare professional immediately.
A doctor may be able to adjust the dosage, recommend an alternative medication, or treat unwanted symptoms to reduce negative side effects.
Nonstimulant medications for ADHD may be an effective treatment option for people with ADHD who cannot take stimulants or as an additional treatment.
Medications for ADHD can cause side effects, some of which may ease as people continue taking the medication. In some cases, a doctor may need to monitor blood pressure or other health factors while people are taking certain medications.
If medications are causing persistent or severe side effects, people will need to talk with a doctor before stopping any medication. Suddenly stopping a medication may cause withdrawal symptoms.
If a medication worsens mental health or causes suicidal thoughts or behaviors, people need to contact a healthcare professional immediately.