Four non-stimulant medications for the treatment of ADHD

Four non-stimulant medications for the treatment of ADHD

Non-stimulant medications are a safe and effective option for treating ADHD. We tell you when they can be used and what their effects are.

Four non-stimulant medications for the treatment of ADHD
Elena Sanz

Written and verified by the psychologist Elena Sanz.

Last update: June 12, 2023

Attention Deficit Hyperactivity Disorder (ADHD) makes everyday life difficult. Indeed, children and adults with the condition have trouble concentrating, feel restless and agitated, and demonstrate poor self-control. Additionally, they may need help calming down, organizing, and managing their attention. An alternative is non-stimulant medication.

It is important to remember that pharmacological intervention is not required in all cases of ADHD. And most of the first-line medications for treating this disorder are stimulants. However, sometimes, instead, a non-stimulant drug or as a complementary treatment is needed.

Pharmacological treatment of ADHD

ADHD is a condition that presents with attention deficit, impulsivity, and hyperactivity. This appears to be due to a disturbance in the functioning of neurotransmitters such as dopamine and norepinephrine (Clark et al., 1987).

Both of these substances are related to an individual’s ability to regulate behavior, focus on goals, anticipate events, and maintain medium-term alertness. Therefore, any alteration of their levels can produce distractibility, anxiety or motor restlessness.

To correct this phenomenon, drugs known as stimulants, such as methylphenidate or amphetamines, They are used. Trade names like Concerta, Ritalin and Adderall may sound familiar. They generate activation in the catecholaminergic system of dopamine and norepinephrine (Aboitiz et al., 2012).

These drugs have decades of studies and research behind them that support their effectiveness in terms of improving symptoms. But, there are also some non-stimulant medications that are beneficial or can be used as a complementary treatment in some cases.

Non-stimulant medications for ADHD

Non-stimulant medications are a newer alternative that can relieve or improve ADHD symptoms. They are safe and effective drugs which, because they do not contain stimulants, are not addictive. Consequently, they are uncontrolled substances. Let’s look at the four main types.

1. Atomoxetine

This drug is a selective norepinephrine reuptake inhibitor. It works by blocking the reabsorption of this substance and increasing its levels in the synaptic cleft. Therefore, it helps to improve attention and reduce impulsivity and hyperactivity.

Currently, atomoxetine is considered a first-line option in the treatment of ADHD (Montoya et al., 2009). It was also the first drug in its class to be included.

Despite the fact that there is less scientific evidence available on this drug than stimulant drugs, shows efficacy in minimizing symptoms. It also has a positive role in the treatment of other comorbid disorders. For example, depression and oppositional defiant disorder (Cheng et al., 2007).

2. Viloxazine

This non-stimulant drug was recently approved for the treatment of ADHD and is showing promise. Viloxazine, such as atomoxetine, it works by modulating norepinephrine levels in the brain. More research is needed, but it appears to be effective at reducing the severity of symptoms. It is also well tolerated (Johnson et al., 2020).

3. Guanfacine

There is another group of non-stimulant drugs known as alpha-adrenergic agonists. Guanfacine is one such drug. It binds to the postsynaptic alpha-2A adrenergic receptor, generating results similar to those of norepinephrine (lamo et al., 2016). This benefits cognitive performance and impulse control.

Research supports the use of this drug for the treatment of ADHD. An article published in CNS drug reviews also suggests it may be effective in improving hyperactivity in children with pervasive developmental disorders.

4. Clonidine

This drug has the same mechanism of action as guanfacine and is an alpha agonist. There is both an extended-release and a faster-acting type of clonidine used as monotherapy or adjunctive therapy. As reported in a review in Health, medicine and therapeutics of adolescents, both variants show improvement in ADHD symptoms in children and adolescents.

Why Use Non-Stimulant Medications for ADHD?

Stimulant drugs have a long history and, therefore, greater scientific acceptance. However, as suggested by the Child Mind Institute, non-stimulant medications for ADHD can be used when stimulant medications don’t seem to work, are not well tolerated or there is a history of substance dependence in the sufferer.

They are also preferable if the patient has symptoms (such as anxiety) that are worsened or exacerbated by stimulants. Both types of medications can be combined to achieve the desired results. It all depends on the specific case.

The following aspects of these drugs should always be taken into consideration:

  • They last 24 hours as opposed to stimulants which last between six and twelve hours.
  • Their action is not immediate. In fact, it may take two to four weeks to experience the full effects.
  • While they are generally well tolerated, they can have side effects. For example, nausea, loss of appetite, mood swings and drowsiness. Also, blood pressure levels should be monitored, as these medications can either raise or lower it.
  • It is essential that the patient has a medical follow-up throughout the process. Only a professional can prescribe the drug and make the relevant changes, in case of adverse effects or ineffectiveness. Furthermore, the drug should be discontinued gradually and only under medical supervision.

Non-stimulant medications for ADHD are helpful

Non-stimulant medications for ADHD can be prescribed by a professional or requested by the patient or family. However, they are not the only treatment option. In fact, they can be combined with stimulant drugs and also successfully combinedwith psychotherapy.

While these medications help stabilize or improve symptoms, they do not relieve the patient of learning a set of self-regulation skills so they can function better on a daily basis. Indeed, a combination of both alternatives will contribute to the well-being and quality of life of the patient.

A study published in Cognitive therapy and research found that, in the eyes of parents, atomoxetine, along with psychotherapy, appears to be superior in improving ADHD symptoms in children.

Finally, if you have been diagnosed with ADHD, it is essential that you see a professional. They can evaluate your case and suggest and guide you in the most appropriate approach.

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