Treatment for ADHD: Stimulants vs. Non-Stimulants

Treatment for ADHD: Stimulants vs. Non-Stimulants

Adjusting to a diagnosis of ADHD (attention-deficit/hyperactivity disorder) can involve learning an extensive amount of new information. This includes researching the various medications available to treat ADHD while trying to decide about treatment for yourself or a loved one. Unfortunately, this can be overwhelming due to the sheer volume of available data.

Sometimes the best approach to learning something new is to get a handle on the basics first. The same is true for learning about ADHD therapy options. ADHD has traditionally been treated with a combination of psychotherapy (“talk therapy”) and medication. Regarding medications, two major classes are used to treat ADHD: Stimulants and Non-Stimulants.

Stimulants for ADHD

The class of medications known as stimulants is by far the most commonly used for treating attention deficit hyperactivity disorder. Of these, the two most common stimulants are methylphenidate and amphetamines. Both stimulant drugs increase the concentration of stimulatory neurotransmitters – norepinephrine and dopamine – in the brain, though by slightly different mechanisms. These are the chemicals responsible for helping you to focus. Increasing these help treat the attention deficit, hyperactivity, and impulsivity of ADHD. 

Methylphenidate

This medication increases the concentration of norepinephrine and dopamine in the brain by preventing neurons from reabsorbing them (i.e., reuptake inhibition). Methylphenidate is similar to amphetamines’ function, efficacy, and common side effect profile. The most significant differences between the two are how quickly the medication works and how long its effects last.

Methylphenidate has a more rapid onset and shorter duration of action compared to amphetamines. This means the effects of methylphenidate are felt sooner after taking the medication but tend to last for a shorter time. As a result, methylphenidate might be more beneficial for someone needing to focus rapidly and for shorter intervals.

Amphetamines

Like Methylphenidate, Amphetamines also increase the concentration of norepinephrine and dopamine in the brain. However, they do this by increasing their release rather than preventing their reuptake. This slight difference in mechanism of action might be the cause behind slight variations in effectiveness in different people.

Amphetamines have a slower onset of action and longer duration of action compared to methylphenidate. This means it takes longer to begin to feel the effects of the medication after taking it, but the effects last longer. As a result, this might be more convenient for someone needing to focus for more extended periods.

Non-Stimulants for ADHD

These types of non stimulant ADHD medication, while used much less often, do have an essential role in the treatment of ADHD. Though stimulants are effective for most people who try them, they don’t work for everyone. In these instances, non-stimulants may prove beneficial. 

Some patients may find that the side effects of stimulants are intolerable or too risky. This is not an unwarranted concern with the long list of potential side effects ranging from minor appetite suppression to significant cardiovascular issues. In some situations, using a stimulant may be contraindicated (e.g., structural heart disease). 

Some parents or patients may request first initiating ADHD treatments with a non-stimulant before resorting to stimulants. They may be worried about the side effects, dealing with a controlled substance, or the risk of developing a substance use disorder. Other patients may have concurrent medical conditions that can benefit from using a specific non stimulant ADHD medications (e.g., Tourette’s Syndrome). This two-for-one approach can also decrease the number of drugs patients must remember to take.

Atomoxetine

This non-stimulant shares a similar mechanism of action as methylphenidate. Atomoxetine is also a reuptake inhibitor that increases norepinephrine levels in the brain. However, it does not increase dopamine levels. 

Atomoxetine is particularly useful when you are trying to avoid the use of a stimulant due to the presence of a concurrent substance use disorder. The most significant difference between this medication and methylphenidate is that it may take several weeks to have a recognizable effect on your ADHD symptoms. 

Clonidine

This antihypertensive medication is also a non-stimulant ADHD medication. Clonidine stimulates alpha-2 adrenoreceptors in the brain. These same receptors exist in blood vessels and can cause an undesired drop in blood pressure when stimulated.  

Clonidine’s exact mechanism of symptom improvement in ADHD is uncertain. It’s theorized that its action on these adrenoreceptors in the brain stimulates the prefrontal cortex and increases concentration. Clonidine is particularly helpful in simultaneously treating tics from Tourette’s syndrome.

Guanfacine

This non-stimulant is a selective alpha 2A adrenergic agonist working by a similar mechanism as clonidine. Guanfacine may have less significant common side effects on blood pressure in ADHD patients. Therefore, guanfacine might be a potential treatment option for those who experienced improvement with clonidine use but had to discontinue its use due to hypotension. 

Your ADHD Treatment Journey

This is not a comprehensive review of every potential medication available for the treatment of ADHD. However, these are some of the most commonly used medications. Knowing the two main categories (stimulants and non-stimulants) and a few drugs in each category is a good start in learning about these mental health treatment options. This information provides a foundation to continue learning and open up a dialogue with your healthcare provider about pursuing the therapy for your ADHD that is best for you. 

A diagnosis of ADHD for you or your loved one can be overwhelming. There’s a lot of new information about the condition and treatment options. Knowing the two main categories of medications and some basic information about some of those medications can go a long way. This knowledge can help you move forward in making the best treatment decision for you. At Southern California Sunrise Recovery Center, we want our clients to be informed but not overwhelmed. If you or a loved one have been diagnosed with ADHD and are considering treatment, we want to talk to you. Call us at (714) 942-4143 to speak to a team member and learn more today.