Nonstimulant Therapy and Other ADHD Drugs

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.


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.

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.

 

Atomoxetine might cause:

Other less-common risks include:

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:

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:

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.

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.

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.

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.

The most common ones include:

Rarely, the drugs can cause irregular heartbeats.

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

Also, keep these guidelines in mind:

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 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).

.

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.

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.

Don’t take them if you:

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

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.

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

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

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.”

Pagination

Some say it’s the hardest part of life with ADHD.

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