Could Non-Stimulant ADHD Medication Make The Difference For You?

ADHD is a neurodevelopmental disorder that affects millions of people worldwide. The condition is characterized by symptoms such as inattention, hyperactivity, and impulsivity. While there are various treatment options available for ADHD, medication along with coaching remains the most effective form of treatment.  

ADHD drugs are designed to help manage the symptoms associated with the condition. These medications work by increasing levels of certain neurotransmitters, such as dopamine, in the brain. These brain chemicals regulate attention and behaviour, as well as being associated with pleasant reward feelings. There are two main types of ADHD drugs: stimulants and non-stimulants.

Stimulant medications, such as Ritalin and Adderall, are often prescribed as a first-line treatment for ADHD. These drugs have been shown to be effective in reducing symptoms like hyperactivity and impulsivity. However, they can also have side effects like decreased appetite and trouble sleeping.

Non-stimulant drugs work by releasing neurotransmitters, but unlike stimulants, they increase the levels slowly. You may not see any affect at first, but gradually you will start to see an improvement in your ability to sit still, to set your mind to a task, and your overall outlook should improve too.  

Non-stimulants are not considered dangerous or addictive

Because stimulants affect appetite and increase heartrate and blood pressure, they are considered dangerous and therefore are categorised class B drugs. This means their prescription is carefully monitored and it is illegal to possess them if your name isn’t on the prescription. It is also illegal to buy them, sell them, or give them away.  

Non-stimulants aren’t a controlled substance as they don’t carry the same risks to health and can’t be used recreationally. Not being controlled means they are easier for doctors to prescribe, and carry fewer potential side effects. However, one drawback with their cumulative effect is that slower improvements are difficult to appreciate so you might not feel that they are working since you don’t see the benefits of the medication working right away.  

You may be prescribed non-stimulant medication as a second line of treatment if you respond badly or have too many side effects from taking stimulants. This is because, as a first line of treatment, if it is successful, the stimulant option is successful and no further exploration into therapy is necessary.

Side effects of stimulants and non-stimulants

The side effects you experience from stimulants can be both mental and physical and shouldn’t be overlooked or written off as acceptable in return for the benefits that medicating ADHD brings.

As noted previously, side effects of stimulants include reduced appetite, increased pulse rate and blood pressure. They may also include insomnia, palpitations, dehydration, tics and repetitive movement, tooth grinding and lip biting, and even mania and hallucination in extreme circumstances.  

With regard to insomnia - one of the more common side effects - it’s been observed that this is often solved by switching from one brand of stimulant to another. Non-stimulant medication doesn’t have the associated side effect of insomnia, and changing brands doesn’t appear to help if your ADHD keeps you awake with racing thoughts you can’t control. If you don’t react well to stimulant medication and non-stimulants aren’t helping with your insomnia, it may be worth speaking to a sleep coach as they can help you with your sleep hygiene. They can talk to you about your bedtime routine, what you eat or drink in the final hours of the day, the lighting conditions in your bedroom, evening activities and relaxation techniques.  

Because non-stimulant medications take longer to show their effects titration (the process of adjusting the dose and time you take your medication) can take longer too. This can be frustrating if you feel you are need more impactful results, but if you’re experiencing side effects with the stimulant alternatives, then patience is required.  

Different types of non-stimulant medication work in different ways, making it important to get the right assessment for your type of ADHD. The three main types of ADHD are:

• ADHD Combined Type. This is the most common and what is typically understood to be ‘ADHD’.
• ADHD Inattentive and Distractible Type. The second most common form makes people inattentive and easily distracted, but without hyperactive symptoms
• ADHD Impulsive/Hyperactive Type. The rarest type as you’ll have all the impulsivity, energy and activity that we associate with ADHD, but you’re not easily inattentive or easily distracted.

Atomoxetine is a norepinephrine reuptake inhibitor, meaning that there is more norepinephrine in the brain. This helps with ADHD’s primary symptoms of hyperactivity, impulsive behaviour, and lack of focus.  

Guanfacine is a time released medication taken once daily and affects receptors in the brain which improve symptoms such as emotional sensitivity, aggression and over-stimulation. There are few side effects, it’s not a controlled substance, meaning any doctor can prescribe it and there is little chance of abuse or dependency. It is used alone, or alongside stimulant medicinal therapies.

Clonidine is an extended release drug which reduces blood pressure. It can also stimulate the release of norepinephrine, which is known to reduce ADHD symptoms. Again, this drug can be used as a stand-alone monotherapy, or in conjunction with stimulant medicines.

Antidepressants for ADHD

Antidepressants are another alternative to stimulant medication as they have the similar purpose of increasing dopamine and norepinephrine, two of the main neurotransmitters which are found to be at low levels in the ADHD brain. An added bonus is that if you also have depression or anxiety as comorbidity or secondary symptom your course of antidepressants will help with both.  

The most common antidepressant prescribed for ADHD symptoms is bupropion, a norepinephrine and dopamine reuptake inhibitor. The next most commonly prescribed is venlafaxine, a newer serotonin norepinephrine reuptake inhibitor.  

There have been studies looking into whether wakefulness promoting medications (non-stimulant treatment for sleep disorders such as narcolepsy) and even anti-viral medication can be effective as second or third line treatments for ADHD, but research appears to suggest that they are about as effective as the placebos used in clinical testing.  

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