Psychostimulant drugs such as Ritalin and Adderall are the most commonly prescribed medications for attention deficit hyperactivity disorder (ADHD) in children and adults. Drugs in this class affect the brain’s levels of dopamine and norepinephrine, two neurotransmitters that are associated with concentration and focus. These drugs are generally safe and effective, and there is evidence that they reduce hyperactivity and improve concentration in about 60-80% of the people who use them to treat ADHD. However, stimulant drugs may not be the best choice for everyone.
Problems with Stimulants
Some people need to avoid stimulant medications due to pre-existing health conditions. Stimulants are not safe for people with heart problems, as these medications can increase the risk of heart attack, stroke, and sudden death in this population. There is also some evidence that stimulants can exacerbate behavioral problems and thought disturbances in people with psychotic disorders.
Stimulant drugs can also delay growth and weight gain in children, or even increase aggressive behavior in this population. A new study has also found that stimulant medications can make it more difficult for children to fall asleep and stay asleep throughout the night and failing to get enough sleep typically exacerbates ADHD symptoms.
Alternatives to Stimulants
While stimulants are often considered the first line of medication-based treatment for ADHD, there are alternatives. These non-stimulant prescription drugs may be better choices for those who can’t take stimulants due to a pre-existing condition or who have experienced unpleasant side effects with their current medications. Non-stimulant ADHD drugs include:
Strattera was the first non-stimulant medication approved for use in children and can also be prescribed to adults with ADHD. It works by increasing the levels of norepinephrine and dopamine in the brain, which may reduce fidgeting and help with concentration. The most common side effects associated with this medication include upset stomach, constipation, dizziness, drowsiness, and nausea.
Clonidine (Catapres, Kapvay) and Guanfacine (Intuniv, Tenex)
Clonidine and guanfacine are both alpha-2 agonists, which are primarily prescribed to treat high blood pressure but can also be used for ADHD. They work by stimulating norepinephrine and producing a calming effect. Research has shown that these drugs improve attention and impulse control while reducing distractedness, but they also have a sedative effect that may cause tiredness and headaches. People who suddenly stop taking their alpha-2 agonist medication or miss doses may also experience adverse effects.
Bupropion and certain other types of antidepressants are sometimes prescribed off-label to treat ADHD. They work by affecting the levels of serotonin, norepinephrine, and dopamine in the brain, which can reduce aggressiveness and improve attention. However, antidepressants are typically less effective than stimulants at treating ADHD, and many doctors recommend trying behavioral therapy before trying drugs like bupropion.
All prescription drugs come with a risk of side effects and should not be used with certain conditions or some other drugs, so it’s important to discuss your medical history (or your child’s medical history) with your doctor before starting a stimulant or non-stimulant ADHD medication. Your doctor should be able to go over the benefits and risks of all possible treatment options so that you can make a safe choice for yourself or your child.