Nonstimulant Therapy and Other ADHD Drugs

Stimulant medications are usually a doctor's first choice for treating ADHD, but they’re not for everyone. They can cause bad side effects for some people. For others, they just don’t work very well.

If you’re looking for other medications that work for the disorder, you've got several choices.

Sometimes your doctor will add one of these medicines to the stimulant you take, or he might have you take one of the following by itself.

There are three main groups of nonstimulant medications for the condition:

ADHD-specific nonstimulants. These were specifically created to treat the disorder and are FDA-approved for that.

Blood pressure medications. They can also help some people control ADHD. Some of these have the same active ingredient as ADHD-specific nonstimulants.

Antidepressants . These can help against the disorder by working on chemicals in the brain. They're also helpful for people who have ADHD and depression, anxiety, or another mood disorder.

ADHD-Specific Nonstimulants

Atomoxetine (Strattera) is OK for children, teens, and adults. It seems to boost the amount of an important brain chemical called norepinephrine. This appears to increase a person's attention span and lessen their impulsive behavior and hyperactivity.

Clonidine ER (Kapvay) and Guanfacine ER (Intuniv) are approved for children ages 6 to 17. Doctors also prescribe them to adults. These two drugs have an effect on certain areas in the brain. Studies show they lower distractibility and improve attention, working memory, and impulse control.

Advantages of Nonstimulants Over Stimulants

Nonstimulants don’t tend to cause agitation, sleeplessness, or lack of appetite. They also don’t pose the same risk of abuse or addiction.

Plus, they have a longer-lasting and smoother effect than many stimulants, which can take effect and wear off abruptly.

 

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What Are the Side Effects of Nonstimulants?

Atomoxetine might cause:

Other less-common risks include:

  • Jaundice and liver problems. Call your doctor right away if you get yellowing of the skin or whites of the eyes.
  • Suicidal thinking. There’s a possibility that atomoxetine, like many antidepressant drugs, may slightly raise the risk of these thoughts in teenagers.
  • Erections that last more than 4 hours.
  • Serious allergic reactions. Some people get rashes, hives, or swelling, although this is rare.

Clonidine (Kapvay) side effects include:

Since it can cause drowsiness, make sure you know how it affects you before you drive or use heavy machinery.

Rarer and more serious side effects include:

Guanfacine (Intuniv) can cause:

Rarer and more serious side effects include:

  • Low blood pressure
  • Heart rhythm changes

Who Shouldn't Take Nonstimulants?

Talk to your doctor about your medical history and go over all the risks.

You should probably not take atomoxetine (Strattera) if you:

Don't take clonidine (Kapvay) if you're allergic to it.

You should probably not take guanfacine (Intuniv) if you:

  • Have an allergy to any of the ingredients in it
  • Take other products containing guanfacine, like the blood pressure medicine guanfacine hcl (Tenex)

Nonstimulants: Tips and Things to Be Aware Of

Before you take this type of medicine, be sure to tell your doctor if you:

If you and your doctor decide nonstimulants are right for you, take your medicine exactly as prescribed. Your doctor may order some lab tests once in a while to make sure the drug is working well and not causing you any problems.

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Blood Pressure Drugs Used to Treat ADHD

Some drugs normally taken for high blood pressure, like clonidine (Kavpay) and guanfacine hcl (Tenex), may help control symptoms of the disorder.

They also can help lower some of the side effects of stimulant meds, especially sleeplessness and aggressive behavior.

They can be used alone or along with stimulants.

How Do High BP Drugs Treat ADHD?

Experts aren’t sure, but it’s clear that they have a calming effect on certain areas of the brain.

Combining stimulants with one of these drugs is controversial, though. Some children taking both stimulants and clonidine hcl have died. It's unclear whether their deaths were due to the combination of drugs.

If you take them together, your doctor should watch you closely to help lower your risk of problems. They can screen you for heart rhythm irregularities, check your blood pressure often, and do electrocardiograms.

If your doctor thinks that taking these two medications has more possible benefits than risks, it may be a good option for you.

Who Should Not Take High BP Drugs?

They might not be a good fit if you have a history of low blood pressure or if you or a family member has had a heart problem.

What Are the Side Effects?

The most common ones include:

  • Drowsiness
  • Lowered blood pressure
  • Headache
  • Dizziness

Rarely, the drugs can cause irregular heartbeats.

High Blood Pressure Drugs: Tips and Precautions

When taking one of these meds for your ADHD, be sure to tell your doctor if you:

  • Are nursing, pregnant, or plan to become pregnant
  • Are taking or plan to take any dietary supplements, herbal medicines, or nonprescription medications
  • Have any medical problems now or in the past, including low blood pressure, seizures, heart rhythm disturbances, and urinary problems
  • Start having irregular heartbeats (heart palpitations) or fainting spells

Also, keep these guidelines in mind:

  • Always take or give the medication exactly as prescribed. Call your doctor about any problems or questions. It's best not to miss doses or patches, since this may cause the blood pressure to rise quickly, which may cause headaches and other symptoms.
  • Your doctor will probably want to start the medication at a low dose and increase it gradually until your symptoms are under control.
  • For very young children, clonidine tablets can be changed into a liquid by a compounding pharmacy. This will make it easier for them to take. Tablets can be crushed and mixed with food if you have to.
  • Do not stop taking clonidine or guanfacine suddenly. This can cause an increase in blood pressure. These medications must be tapered off gradually.

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Antidepressant Drugs for ADHD

Several types of these can treat the disorder, too. They're sometimes the treatment of choice for children or adults who have ADHD and depression.

Antidepressants seem to improve attention span, impulse control, hyperactivity, and aggressiveness. Children and teens who take them are often more willing to take direction and are less disruptive.

But these drugs generally don’t work as well as stimulants or nonstimulants to improve attention span and concentration.

Antidepressants have the advantage of a low potential for abuse, and there is no evidence that they suppress growth or contribute to significant weight loss.

Most of them work by boosting the levels of brain messenger-chemicals (neurotransmitters), such as norepinephrine, serotonin, and dopamine.

How Do High Blood Pressure Drugs Treat ADHD?

How high blood pressure drugs work in treating ADHD is not yet known, but it is clear that they have a calming effect on certain areas of the brain.

Clonidine can be applied in a weekly patch form for gradual medication release. This delivery method helps decrease some side effects, such as dry mouth and fatigue. After a few weeks, side effects usually diminish considerably.

Clonidine and guanfacine can help reduce some of the side effects of stimulant therapy, especially sleeplessness and aggressive behavior. However, combining stimulants with one of these drugs is controversial, because there have been some deaths in children taking both stimulants and Catapres (a patch form of clonidine).

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It is not known whether these deaths were due to the combination of drugs, but caution should be exercised whenever such combinations are used. Careful screening for heart rhythm irregularities and regular monitoring of blood pressure and electrocardiograms help reduce these risks. If your doctor thinks that combining these two treatments offers more benefits than risks, it may be a good option.

The main kinds of these drugs used to treat ADHD are:

Tricyclic antidepressants. They've been shown to be helpful and are relatively inexpensive. But they can cause some unpleasant side effects, like dry mouth, constipation, or urinary problems. Options include:

Bupropion (Wellbutrin) is a different type of antidepressant that is very effective in treating ADHD in adults and children. It's generally well-tolerated, but it also has some side effects that may be a problem for some people who have anxiety or seizures.

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Monoamine oxidase (MAO) inhibitors are a group of antidepressants that can treat ADHD with some benefit. But they're rarely used because they sometimes have dangerous side effects and can cause serious problems when you take them with foods and other medications. They may help people if no other medications have worked. Examples include phenelzine (Nardil) or tranylcypromine (Parnate).

Venlafaxine (Effexor and Effexor XR) is a newer antidepressant that boosts the levels of norepinephrine and serotonin in the brain. It helps improve mood and concentration. It's not often used to treat ADHD, though.

In October 2004, the FDA determined that antidepressant medications raise the risk of suicidal thinking and behavior in children and teens with depression and other psychiatric disorders. Discuss any questions or concerns with your doctor.

Who Should Not Take Antidepressants?

Don't take them if you:

  • Have a history or a tendency toward manic behavior or manic depression (bipolar disorder).
  • Have taken a MAO inhibitor antidepressant, such as phenelzine (Nardil) or tranylcypromine (Parnate), within the last 14 days.
  • Bupropion (Wellbutrin) can't be taken if you have any history of seizures or epilepsy.

Talk about the pros and cons of antidepressants with your doctor to figure out if they might be right for you.

Side Effects of Antidepressants

The most common side effects of tricyclics include:

An overdose can be deadly.

Tricyclics have the potential to cause certain heart defects, too. You may need ECG tests at a doctor’s office to look for these problems.

Bupropion (Wellbutrin) sometimes causes stomach upset, anxiety, headaches, and rashes.

Venlafaxine (Effexor) can cause nausea, anxiety, sleep problems, tremor, dry mouth, and sexual problems in adults.

MAO inhibitors can cause a wide variety of side effects, including dangerously increased blood pressure when combined with certain foods or medications.

Antidepressants Treatments: Tips and Precautions

When taking one of these meds, be sure to tell your doctor if you:

  • Are nursing, pregnant, or plan to become pregnant
  • Take or plan to take any dietary supplements, herbal medicines, or nonprescription medications
  • Have any medical problems now or have had any in the past including high blood pressure, seizures, heart disease and urinary problems
  • Have a history of drug or alcohol abuse or dependency, or if you have had mental health problems, including depression, manic depression, or psychosis
  • Get any depressive symptoms or feelings that you might harm yourself
  • Start to have irregular heartbeats (heart palpitations) or fainting spells

Keep these tips in mind if you take antidepressants or give them to your child:

  • Always give the medication exactly as prescribed. Call your doctor with any problems or questions.
  • Antidepressants usually take at least 2 to 4 weeks before you start to notice if they're working. Be patient, and don't give up before giving them a chance to work.
  • Your doctor will probably want to start your medication at a low dose and raise it slowly over time until your symptoms are under control.
  • It's best not to miss doses. You take most once or twice a day. If you miss a day or two of venlafaxine (Effexor), it can cause an unpleasant withdrawal symptoms.
  • Tell your doctor if you notice any new or unusual side effects.
WebMD Medical Reference Reviewed by Smitha Bhandari, MD on June 11, 2017

Sources

SOURCES:

Strattera web site.

Kapvay web site: "Monthly Prescribing Reference."

Food and Drug Administration.

American Academy of Childhood and Adolescent Psychiatry.

Medscape web site: “Once-Daily Guanfacine Approved to Treat ADHD.”

Intuniv web site.

Attention Deficit Disorder Resources web site: “Medication Management for Adults with ADHD.”

WebMD Medical Reference: “Should My Child Take Stimulant Medications for ADHD?"

National Institute of Mental Health web site: “Questions Raised about Stimulants and Sudden Death.”

HelpGuide.org web site: “ADD & ADHD Medications.”

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