|
There are four non-stimulant medications that would be considered in the treatment of ADHD. (Not all of these have been approved by the FDA or HPB for ADHD, so consider these off-label suggestions)
Wellbutrin XL is an extended release noradrenaline and dopamine re-uptake inhibitor (NDRI). As such in increases the synaptic concentrations of both noradrenaline and dopamine. It is officially marketed as an antidepressant, but it would be more accurate to call it a hybrid between an antidepressant and a stimulant.
It increases motivation and energy, through noradrenaline. And, it improves increases focus, impulse control and reward through dopamine. That's why it works well as an anti-smoking drug.
It does not particularly improve sadness or anxiety like the selective serotonin re-uptake inhibitors (SSRIs) do and that's why it's not really first line when someone has severe depression.
It's not a first line ADHD drug, because the magnitude of dopamine stimulation is smaller than that of the stimulants. But it works like a charm for someone who has both mild ADHD and mild depression. It's best feature is that it improves mood generally, without the sexual dysfunction and cognitive dulling that is commonly associated with the SSRIs.
Strattera® is a
noradrenaline re-uptake inhibitor (NRI). It turns on noradrenaline and some dopamine circuits
in the part of the brain that regulates focus and attention. It can be as
effective as a stimulant, but it does not work as quickly or consistently.
It is most
helpful in situations where stimulants cannot be used; such as in a patient who
has tics or seizures or has recently been abusing stimulants. Common Strattera
side effects include fatigue and upset stomach. These can be minimized by
starting the medication at low doses, taking it in the evening rather than the
morning, and taking it with food.
Modafinil
Guanfacine
|