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Non Stimulant ADHD Medication

ADHD Medication

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Updated May 12, 2009

While stimulants are typically the first choice of medication used to treat ADHD, several non stimulants that may be prescribed. These include atomoxetine, tricyclic antidepressants, and bupropion. Of these, atomoxetine has been studied most extensively for use in the treatment of ADHD in adults and children, appears to have fewer side effects than the tricyclic antidepressants, and seems to be more effective than bupropion.

Non stimulants may be prescribed if the patient does not respond to stimulants, if side effects of stimulants are too great, if the patient has a history of certain heart conditions, if the patient has a history of drug abuse or bipolar disorder.

Atomoxetine (Brand name: Strattera)

Atomoxetine is the first non stimulant medication that has been FDA approved for the treatment of ADHD in adults and children (over age 6 years). Atomoxetine is in the class of medications known as selective norepinephrine reuptake inhibitors. Studies have found that this drug improves symptoms of ADHD and in addition reduces oppositional and defiant behavior and anxiety.

Atomoxetine differs from the stimulant medications in several ways. Atomoxetine does not seem to have a potential for abuse and thus is not classified as a controlled substance. Atomoxetine also appears to have a longer onset of action as compared to the stimulants (which work on the day they are taken), thus the therapeutic effect of stimulants may be more quickly noticeable as compared to atomoxetine. It could take at least 6 weeks for atomoxetine to reach maximal therapeutic effect. Once maximal effects are reached, however, they last 24 hours a day and may also have carry over effects to the next day. Atomoxetine must be taken on a daily basis, whereas doses of stimulants may be skipped – over the weekend, for example.

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 and irritability.

Tricyclic Antidepressants

The tricyclic antidepressants most frequently used in the treatment of ADHD include, desipramine (Brand name: Norpramine), imipramine (Tofranil), and amitriptyline (Elavil), and nortriptyline (Pamelor). These antidepressants are typically tried when the patient has not shown good response to stimulants. They may also be prescribed if the patient has symptoms of depression or anxiety in addition to the ADHD. Tricyclic antidepressants are thought to increase the amount of norepinephrine (similar to stimulants) in the brain. Unlike stimulants it may take several days or even several weeks to see the therapeutic benefits of the tricyclic antidepressants, 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, thus if a patient is going to go off the medication, he or she should be tapered off gradually over a period of time.

Common side effects of the tricyclic antidepressants may include, drowsiness, dry mouth, constipation, blurred vision, stomachaches, headaches, vivid dreams and insomnia. More serious side effects may include problems in heartbeat or heart rhythm, as tricyclic antidepressants can slow down the transmission of the electrical signal to the heart. If there is a family history of heart problems or any heart problems in the patient, these medications 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.

Bupropion

Bupropion (Brand name: Wellbutrin) is a different type of antidepressant that has been found to reduce symptoms of ADHD and depression in many patients. Side effects may include irritability, weight loss due to decreased appetite, insomnia, and a worsening of existing tics, and may make some individuals more prone to seizures.

Anti-Hypertensive Drugs

In addition to the above drugs, clonidine (Brand name: Catapres) and guanfacine (Brand name: Tenex), are sometimes used to help manage ADHD symptoms. 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. They do not appear to be as effective in improving symptoms of inattention.

Additional Reading:
Stimulant Medications Used to Treat ADHD
Stimulants - Side Effects and Safety
ADHD - Treatment Approaches

Source:

Mohab Hanna, MD. Making the Connection: A Parent’s Guide to Medication in ADHD. Ladner-Drysdale. 2006.

Russell Barkley, PhD. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (Third Edition). Guilford Press. 2006.

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