Stimulant medications are commonly prescribed to treat the symptoms of hyperactivity, inattention and impulsiveness that are associated with attention deficit hyperactivity disorder (ADHD). However, these medications can cause personality changes and brain and heart problems, and they can be habit-forming. Many non-stimulant medications are available as alternative treatment options for children and adults who want to avoid stimulant effects.
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Atomoxetine is the only non-stimulant medication approved by the Food and Drug Administration (FDA) for the treatment of ADHD. Atomoxetine is an antidepressant that is in the class of drugs known as selective norephinephrine reuptake inhibitors (SNRIs). As opposed to stimulant ADHD medications that target the chemical dopamine in the brain, atomoxetine works on norepinephrine. Because it is an antidepressant, it may be particularly appropriate for those with both ADHD and major depression or some anxiety disorders. Its effects last for 24 hours, and it does not appear to cause bothersome side effects such as loss of appetite and insomnia to the degree that stimulant medications have shown. Atomoxetine is not, however, as effective as stimulant medications at improving symptoms of hyperactivity.
Bupropion (an atypical antidepressant) is the most widely used antidepressant used for off-label treatment of ADHD (i.e., not FDA-approved). Research suggests that bupropion has a moderate effect on ADHD symptoms in adults, but it is not as effective as most stimulant medications. Venlafaxine is an antidepressant that blocks the re-uptake of both serotonin and norepinephrine in the brain. Uncontrolled studies have indicated that venlafaxine can help to improve ADHD symptoms and may be well-suited for use in those with co-occurring depressive and anxiety disorders.
Tricyclic antidepressants (TCAs) such as norpramine and nortriptyline work by boosting the amount of norepinephrine in the brain; however, they may take several weeks to demonstrate improvement in ADHD symptoms and also present potentially serious side effects such as cardiac problems.
Selegiline is a monoamine oxidase type B (MAO-B) inhibitor commonly prescribed to treat Parkinson’s disease that has also shown some promise in treating children with severe ADHD. Some kids have shown improvements in learning and behavior in the classroom while taking 5 milligrams of selegiline twice a day. More research is needed to determine selegiline’s effectiveness in adults with ADHD.
Clonidine and guanfacine are antihypertensive medications commonly prescribed to lower high blood pressure that also work on treating the symptoms of ADHD. These drugs may indirectly affect dopamine through their effects on norepinephrine. They are primarily used to treat children with symptoms of hyperactivity and aggression and have rarely been studied in adults.
Mood Stabilizers and Anticonvulsants
Because bipolar disorder and ADHD share some of the same symptoms, it may be difficult to differentiate a diagnosis or determine whether an individual suffers from both. Mood stabilizers like lithium and anticonvulsant medications such as valproate and carbamazepine are typically prescribed to patients with bipolar disorder, and they may sometimes help to prevent the irritability and mood swings associated with ADHD. More research is needed to determine for whom these drugs are most effective.