Four Non-Stimulant Medications for Treating ADHD

Non-stimulant medications are a safe and effective option in the treatment of ADHD. We tell you when they can be used and what their effects are.

Written and verified by the psychologist Elena Sanz.

Last update: 12 June, 2023

Attention deficit hyperactivity disorder (ADHD) makes everyday life difficult. Indeed, children and adults with this condition have trouble concentrating, feel restless and agitated, and demonstrate poor self-control. Furthermore, they may need help calming down, organizing, and managing their attention. One alternative is non-stimulant medication.

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

Pharmacological treatment of ADHD

ADHD is a condition that presents with attention difficulties, impulsivity, and hyperactivity. This seems 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 alertness in the medium term. Therefore, any alteration in their levels can produce distractibility, anxiety, or motor restlessness.

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

These drugs have decades of study and research behind them that support their effectiveness in terms of symptom improvement. But, there are also some non-stimulant drugs that are advantageous or can be used as a complementary treatment in certain cases.

Non-stimulant medications for ADHD

Non-stimulant medications are a newer alternative that may alleviate or improve ADHD symptoms. They’re safe and effective drugs that, since they don’t contain stimulants, don’t generate addiction. Consequently, they’re non-controlled substances. Let’s see the four main types.

1. Atomoxetine

This drug is a selective inhibitor of norepinephrine reuptake. It works by blocking the reabsorption of said substance and increasing its levels in the synaptic space. Therefore, it contributes to improving attention and reducing impulsivity and hyperactivity.

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

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

2. Viloxazine

This non-stimulant drug was recently approved for the treatment of ADHD and shows promise. Viloxazine, like atomoxetine, works by modulating norepinephrine levels in the brain. Further research is required, but it appears to be effective in reducing the severity of symptoms. It’s also well tolerated (Johnson et al., 2020).

3. Guanfacine

There’s 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 (Álamo et al., 2016). This benefits cognitive performance and impulse control.

Research supports the use of this drug to treat ADHD. An article published in CNS Drug Reviews also suggests that it might 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’s both an extended-release and a more rapid-acting type of clonidine used as monotherapy or adjunctive therapy. As reported in a review in Adolescent Health, Medicine and Therapeutics, 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, a greater scientific endorsement. However, as suggested by the Child Mind Institute, non-stimulant medications for ADHD may be used when stimulating drugs don’t seem to work, aren’t well tolerated, or there’s a history of substance addiction in the sufferer.

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

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

• They last for 24 hours as opposed to stimulants which last between six and twelve hours.
• Their action isn’t immediate. In fact, two to four weeks may be required for the full effects to be experienced.
• Although they’re usually well tolerated, they can have side effects. For instance, nausea, loss of appetite, mood swings, and drowsiness. In addition, blood pressure levels should be controlled, since these drugs can either raise or lower it.
• It’s crucial for the patient to have a medical follow-up throughout the process. Only a professional can prescribe the medication and make the pertinent changes, in case of any adverse effects or ineffectiveness. Moreover, the medication must be withdrawn 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’re not the only treatment option. In fact, they can be combined with stimulant drugs and also successfully combined with psychotherapy.

Although these medicines help to stabilize or improve symptoms, they don’t exempt the patient from learning a series 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’ve been diagnosed with ADHD, it’s essential that you see a professional. They can evaluate your case and suggest and guide you in the most appropriate approach.