ADHD Medications: A Quick Guide

Key information on stimulant and non-stimulant treatments.

A. STIMULANT MEDICATIONS

Overview: Most common for ADHD; work by increasing dopamine and/or norepinephrine.

General Considerations:

Mood monitoring is always important; therapeutic use generally lowers risk of subsequent substance use disorders; not typically associated with classical physical dependence in therapeutic use.

1. Methylphenidate-Based

(e.g., Ritalin, Concerta, Focalin)

How they work (simplified):

Impact norepinephrine & dopamine; primarily help hyperactivity, impulsivity, and support attention/focus.

Reported Profile & Key Differences:

Effective for many individuals.
Often a milder cardiovascular side effect profile for some (vs. amphetamines).
Extensive history of use (long-term safety/efficacy data).
Mania/Psychosis Risk: Generally NOT associated with increased risk.
- Bipolar Disorder: Not linked to increased mania risk on initiation; may even reduce risk with mood stabilizers. *Careful monitoring essential.*
Growth Effects: Potential modest effects on child growth; regular monitoring needed.

Common Side Effects:

Decreased appetite, difficulty sleeping, headache, stomachache, irritability.

2. Amphetamine-Based

(e.g., Adderall, Vyvanse, Dexedrine)

How they work (simplified):

Significantly impact dopamine & norepinephrine; strong effect on motivation, focus (especially for non-preferred tasks).

Reported Profile & Key Differences:

Often highly effective across a broad range of ADHD symptoms.
Mania/Psychosis Risk: SIGNIFICANT RISK of inducing/exacerbating mania in Bipolar Disorder. *CRITICAL to rule out Bipolar Disorder before prescribing.*
Can also cause new/worsened psychotic symptoms (rare).
May trigger agitation or mania-like symptoms. *Careful monitoring essential.*
Growth Effects: Potential modest effects on child growth; regular monitoring needed.

Common Side Effects:

Decreased appetite, difficulty sleeping, anxiety, irritability; effects can be more intense for some.

B. NON-STIMULANT MEDICATIONS

Overview: Alternatives if stimulants are not suitable or not preferred; work differently.

General Considerations:

Some types may require gradual dose changes if being discontinued to avoid discontinuation effects or rebound symptoms.

1. Atomoxetine (Strattera)

FDA-Approved Age: Children (6+), adolescents, and adults.

How it works:

Selective Norepinephrine Reuptake Inhibitor (SNRI); primarily targets the norepinephrine system.

Reported Profile:

Effective for many; requires daily use.
FDA Boxed Warning - Suicidal Ideation: Increased risk in children, adolescents, and young adults (up to age 24), particularly during initial treatment or dosage changes. *Close monitoring essential.*
Abrupt cessation can lead to discontinuation symptoms.

Common Side Effects:

Upset stomach, fatigue, decreased appetite, mood swings, dizziness.

2. Alpha-2 Adrenergic Agonists

(e.g., Guanfacine ER/Intuniv, Clonidine ER/Kapvay)

FDA-Approved Ages: ER forms typically for children/adolescents (6-17); sometimes used off-label in adults.

How they work:

Directly stimulate specific norepinephrine receptors (alpha-2 adrenergic), particularly in the prefrontal cortex; thought to strengthen PFC regulation.

Reported Profile:

Particularly helpful for impulsivity, hyperactivity, and emotional regulation.
Can be used alone or in combination with stimulants.
May need to be tapered to avoid rebound effects (e.g., on blood pressure).

Common Side Effects:

Drowsiness or sedation (especially initially), dizziness, low blood pressure, constipation, dry mouth.