Because stimulant medications help the greatest percentage of people, they’re usually the first medication trialled. But in cases where stimulants don’t work, or cause unpleasant side effects, non-stimulants can be helpful.
They may also be used first if there are concerns about diversion (or abuse) of medications, if somebody has an increased risk of developing a psychiatric illness such as psychosis, or if more consistent effects on ADHD symptoms is needed at both the start and the end of the day (times of day it’s more challenging to address with stimulants).
Atomoxetine
The most common non-stimulant medication used in New Zealand is atomoxetine. About 60% of people who trial atomoxetine for ADHD achieve a positive therapeutic benefit.
For more information read:
Clinical responses to atomoxetine in attention-deficit/hyperactivity disorder: the Integrated Data Exploratory Analysis (IDEA) study. - Abstract - Europe PMC
This works by increasing levels of the neurotransmitters noradrenaline and dopamine in the prefrontal cortex (the front part of the brain that helps with planning and organising activities).
These medications may take several weeks to start working. For example, atomoxetine is often taken for a month before therapeutic benefits are found. Side effects can include a reduction in appetite (although to a lesser extent than that seen with stimulant medications), gastrointestinal effects such as stomach cramps, nausea and appetite loss, an increase in blood pressure (which is small and not clinically significant for most people).
Although there is a caution between the use of this medication and suicidal ideation, this is very uncommon, and there is no link between this medication and completed suicide. Any change in suicidal thoughts should prompt a discussion with the treatment provider.
Clonidine
This has it’s main effect on the alpha receptors in the prefrontal cortex. It can be helpful for symptoms of ADHD and can be used on it’s own, although it’s often used added on to other medications such as stimulants.
It is sedating and can help with problems with initiating and maintaining sleep. However, for some this sedating effect can limit the extent to which it can be used in the day.
It can also be linked to reductions in both blood pressure and pulse rate, as well as dizziness. These should be monitored by the prescribing clinician, balancing benefits of this medication against these potential problems.
Bupropion
This is a stimulating antidepressant that predominantly uses the dopamine neurotransmitter system. Although the evidence for this medication is not strong, this is sometimes used in adults who, as well as ADHD, have generally low levels of energy and mood.
The table below lists non-stimulant medication options to treat ADHD available in New Zealand. There are other options available. Generally, these are prescribed to treat ADHD and a co-existing condition(s).
Non-stimulant medication options in New Zealand
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