Child Development

What Are Non-Stimulant ADHD Medications?

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Most kids who take medication to treat attention-deficit hyperactivity disorder (ADHD) take stimulants like Adderall. In general, stimulants are considered the most effective type of medication for ADHD.

But stimulants aren’t your child’s only option for medication. Many parents feel wary about putting their kids on stimulants, and that’s okay. Your child may have also already tried stimulants and found them to be unhelpful.

Whatever your reason is for not wanting your child to take stimulants, it’s important to be aware of all of the options. Here are the most common non-stimulant medications used for ADHD in children, along with their side effects and risks.

Stimulant vs non-stimulant medication

ADHD medication is generally divided into two types: stimulants and non-stimulants.

The first-line treatment for ADHD (for kids over the age of 6), as recommended by the American Academy of Pediatrics, is stimulant medication. For children under the age of 6, behavioral treatment is recommended first before trying stimulant medication. Stimulants work by increasing the levels of dopamine and norepinephrine that are available in the brain. These brain chemicals play a critical role in ADHD symptoms like inattention and hyperactivity. 

Stimulants are the most well-known type of ADHD medication. You’ve probably heard of a few brand names, like Adderall or Ritalin.

Stimulant medication is recommended as the first-line treatment because it’s effective. Studies show that up to 80% of kids with ADHD see improvement with stimulant medications.

Why do people take non-stimulant ADHD medication?

But there are some people who can’t or don’t want to, take stimulants. For those people, non-stimulant ADHD medications can be a useful option. Although non-stimulants aren’t as effective as stimulants, they still help many people.

Non-stimulant ADHD medication is a large category that includes any type of medication intended to treat ADHD symptoms that isn’t a central nervous system stimulant. Different types of non-stimulant medications used for ADHD include antidepressants, blood pressure medication, and atomoxetine.

Some reasons why people choose to take non-stimulants over stimulants include:

  • They don’t find any symptom relief from stimulant medications
  • They don’t tolerate the side effects of stimulant medication
  • They have a pre-existing heart condition (stimulants can cause high blood pressure)
  • They are a child under the age of 6 (most stimulants are not approved for kids under 6 years old)
  • They are a child whose parent is nervous about putting them on stimulants
  • They have a pre-existing substance use disorder
  • They have severe anxiety
  • They have or are at risk for tic disorder or Tourette's syndrome

Many reasons to forgo the first-line treatment for ADHD (stimulant medication) are medically informed, but others may be based on stigma and misunderstanding. For example, parents may worry that taking stimulant medications will lead to addiction when there is no scientific evidence to suggest this.

Make sure you talk to your child’s pediatrician about all of their treatment options so your child can have the best chance at being able to manage their ADHD symptoms.  

Differences between stimulant and non-stimulant ADHD medication

There are many differences between stimulant and non-stimulant medications.

Efficacy

The main difference, as we’ve already discussed, is that stimulants are more effective. Around 80% of people taking stimulants see improvement in their symptoms. The response rate for Strattera (atomoxetine), the most common non-stimulant ADHD medication, is around 50%.

Time to work

Non-stimulants also take longer to work. Some stimulants can start working within half an hour of taking them. Non-stimulants can take between several days to weeks to have any benefit.

Side effects

There are also differences in side effects between stimulant and non-stimulant medications. All FDA-approved ADHD medications are generally considered safe. But some kids may not tolerate the side effects of stimulant medications, which include:

  • Insomnia
  • Decreased appetite
  • Temporarily delayed growth
  • Rebound effect (irritability when effects of stimulants wear off)

Some kids may have an easier time tolerating the side effects of non-stimulants like Strattera.

But not all non-stimulants are created equal. For example, tricyclic antidepressants come with many very unpleasant side effects. Both stimulants and non-stimulants can also have dangerous drug interactions with other common medications. 

Risk of addiction

There is no evidence suggesting that stimulant medications, when taken during childhood and adolescence, lead to a higher risk of addiction in adulthood. In fact, kids with ADHD who receive treatment and take stimulants have a lower chance of developing substance use disorder than kids whose ADHD is untreated.

But stimulants are a Schedule I substance, and all stimulants can be abused. If your child or teen already has a problem with drug or alcohol addiction, then their pediatrician might recommend that they take non-stimulant medication. This is especially true if they abuse other stimulant drugs like cocaine or methamphetamine. 

There is no similar risk for abuse or addiction with non-stimulants, which are not controlled substances.

Be honest with your pediatrician about your concerns and your child’s history. They can make an informed decision about whether or not stimulant medication may carry a risk of addiction for your child.

Non-stimulant ADHD medication

Here are the different types of non-stimulant ADHD medication that may be options for your child.

Again, non-stimulant refers to any type of medication used for ADHD that isn’t classified as a central nervous system stimulant. Each of the following medications works differently, so we’ll go through detailed information about all of them.

Strattera

Atomoxetine, sold under the brand name Strattera, was the first non-stimulant ADHD medication to be approved by the Food and Drug Administration (FDA). It’s around 50% effective and is considered a third-line treatment by the American Academy of Child and Adolescent Psychiatry (AACAP). 

Although Strattera isn’t a stimulant, it also increases the amount of norepinephrine in the brain (just like stimulants do). In this way, it can help kids manage ADHD symptoms like inattention and restlessness.

Side effects with Strattera are usually mild, but they do happen. Some of the most common side effects of Strattera for kids and teens include:

  • Upset stomach, including nausea and vomiting
  • Drowsiness
  • Dizziness
  • Headache
  • Decreased appetite
  • Mood swings

Tricyclic antidepressants

Tricyclic antidepressants, or TCAs, are sometimes used to treat ADHD. These medications are sold under the brand name Pamelor, among others. They were one of the earliest types of antidepressants. They’re thought to work for ADHD by altering levels of dopamine.

One review found that although Pamelor was more effective than a placebo for treating ADHD in the short term, the overall quality of evidence was low.

TCAs are not approved by the FDA to treat ADHD in children.

Tricyclic antidepressants aren’t usually the first-choice treatment, even for people with depression, because they tend to cause unpleasant side effects. Some of these side effects include:

  • Low blood pressure
  • Weight gain
  • Upset stomach
  • Tremor or involuntary muscle movements
  • Sweating
  • Blurred vision
  • Difficulty urinating

These side effects aren’t usually dangerous but can be so uncomfortable that it’s difficult for kids to tolerate the medication.

Wellbutrin

The antidepressant medication bupropion, sold under the brand name Wellbutrin, is another non-stimulant treatment option for ADHD. Like other antidepressants, it works by increasing levels of certain brain chemicals like serotonin and norepinephrine.

Wellbutrin is not approved by the FDA to treat ADHD. However, some providers may use it “off-label” if other medications haven’t worked. Wellbutrin is used for depression in adults, but it hasn’t been proven to be safe or effective for children.

In general, children under the age of 18 shouldn’t be taking Wellbutrin. If your pediatrician has determined that this is the best course for treatment, talk to them about possible risks and side effects.

Anti-hypertensive drugs

Blood pressure medications, or anti-hypertensive drugs, are sometimes used to treat ADHD. Two specific medications in this category that are FDA-approved to treat ADHD in children are Kapvay (extended-release clonidine) and Intuniv (extended-release guanfacine). 

These medications can be used as a standalone treatment for ADHD or in addition to stimulant therapy. One literature review reported that 9 out of the 10 studies they looked at found clonidine to be effective for ADHD. These medications are up to 65% effective.

We don’t yet know how, exactly, these blood pressure medications help kids with ADHD. We do know that these medications send messages to your blood vessels to relax, which helps lower blood pressure. This mechanism could also affect parts of the brain that are affected by ADHD.

These medications do come with some side effects, including:

  • Drowsiness
  • Dizziness
  • Weakness
  • Upset stomach
  • Headaches
  • Dry mouth

On rare occasions, these medications can cause irregular or slow heartbeat. Your child’s pediatrician may monitor their heart rate and blood pressure while taking these medications.

Qelbree

Lastly, Qelbree is the newest non-stimulant medication for ADHD. It was approved by the FDA to treat ADHD in children over the age of 6 in April of 2021.

Qelbree contains an ingredient that is a norepinephrine reuptake inhibitor, similar to Strattera. Both of these medications work by raising norepinephrine levels in the brain, but we don’t know yet how exactly this happens.

Some of the most common side effects of Qelbree for children include:

  • Drowsiness and fatigue
  • Nausea and vomiting
  • Decreased appetite
  • Trouble sleeping
  • Irritability

Like many other medications on this list, Qelbree can also increase suicidal thoughts in children. They can also induce manic episodes in people who have or at risk for bipolar disorder. 

Talking to your doctor about non-stimulant ADHD medication

Whatever your reason is for wanting your child to try non-stimulant ADHD medication, talk to your pediatrician about it. They can talk to you about your concerns, provide accurate information about risks and side effects, and make the medication choice that’s right for your child.

This article is for informational purposes and is not a substitute for individual medical or mental health advice. Please consult with your or your child's prescribing doctor before changing, starting, or stopping a medication routine.