Best Medicine for ADHD
As a physician experienced in the treatment of ADHD, I often receive questions about non-stimulant medications for ADHD. In this blog post, I will go over each of the non-controlled types of medications that treats ADHD. I will go over the advantages and disadvantages of each type and class and their respective side effects. I will also highlight any black box warnings.
Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that works by blocking the reuptake of norepinephrine. It markets under the brand name Strattera.
Advantages: Atomoxetine may be a good option for people who do not experience symptom relief with stimulants or have intolerable side effects. It is not a controlled substance and does not carry the risk for abuse or dependence.
Disadvantages: It may take weeks to achieve a therapeutic effect. Most people do not see an improvement in symptoms until four weeks of consistent dosing. Side effects include loss of appetite, nausea, and constipation. It may also increase suicidal thoughts and actions in children and adolescents, which is a black box warning.
Tricyclic Antidepressants
Tricyclic antidepressants treats ADHD since the 1950s. These drugs work by increasing the activity of norepinephrine and dopamine in the brain.
Advantages: They can be a good option for people who have co-existing depression or anxiety, as they improve both conditions. Some tricyclic antidepressants, such as desipramine, can be as effective as stimulants in treating ADHD.
Disadvantages: They can have serious side effects, including dizziness, dry mouth, blurred vision, and weight gain. They can also cause cardiac arrhythmias or other cardiac problems, and overdose can be fatal.
Anti-hypertensive Drugs
Anti-hypertensive drugs, such as clonidine and guanfacine, are central alpha-2 agonists. They reduce the levels of norepinephrine in the prefrontal cortex, which can improve attention and impulse control.
Advantages: They are effective in reducing symptoms of ADHD, especially hyperactivity and aggression.
Disadvantages: They can cause dizziness, dry mouth, fatigue, and sedation. They may also cause low blood pressure and fainting.
Bupropion
Bupropion is a dopamine and norepinephrine reuptake inhibitor (DNRI) that works by increasing the activity of both neurotransmitters in the brain. It markets under the brand name Wellbutrin.
Advantages: Bupropion can be used to treat both ADHD and depression. It can also help people quit smoking.
Disadvantages: It can cause restlessness, insomnia, and anxiety. It can also increase the risk of seizures, especially in people with a history of epilepsy.
Venlafaxine
Venlafaxine is an SNRI like atomoxetine, but it is also used to treat depression and anxiety.
Advantages: Venlafaxine can improve both ADHD symptoms and mood disorders.
Disadvantages: It can cause nausea, vomiting, dry mouth, and constipation. It can also increase suicidal thoughts and actions in children and adolescents, which is a black box warning.
Viloxazine
Viloxazine is a selective norepinephrine reuptake inhibitor (SNRI) that is currently only FDA-approved in Europe.
Advantages: Viloxazine has a faster onset of action than atomoxetine, with some patients experiencing a therapeutic effect within a week.
Disadvantages: Its side effect profile is similar to other SNRIs, including dry mouth, nausea, and constipation.
In comparison to stimulant medications, these non-controlled types of medications have less potential for abuse or dependence. However, they may have more side effects and may take longer to achieve a therapeutic effect. It is important to work closely with a healthcare provider to find the right medication for you or your child.
It is also important to remember that medication is not the only treatment option for ADHD. Lifestyle modifications such as exercise, healthy eating, and good sleep hygiene can improve symptoms. Behavioral interventions such as cognitive-behavioral therapy (CBT) and parent training can also be effective. Combining medication with non-medication therapies can result in better outcomes.
In conclusion, ADHD can be treated and controlled with medications such as atomoxetine, tricyclic antidepressants, anti-hypertensive drugs, bupropion, venlafaxine, and viloxazine. However, each medication has its advantages and disadvantages, and it is important to weigh them against each other. Patients should work closely with their healthcare providers to find the best medication and dose for them. Lastly, incorporating lifestyle and behavioral modifications can greatly improve ADHD symptoms and should be used in conjunction with medication treatment.