ADHD Medication: We compare stimulants vs non-stimulants

ADHD medication, the reluctant last resort which becomes the saving grace for many ADHD-diagnosed children and their families, is an important part of your child’s treatment plan, targeting core symptoms. Holistic ADHD treatment, of course, comprises of medication and non-pharmacological interventions, i.e. ADHD education, behavioural therapy, and lifestyle and diet changes. 

If your child has recently started medication, this is what you need to know: ADHD medication consists of stimulants1 and non-stimulants. There are three main groups of nonstimulant medications: ADHD-specific non-stimulants, antidepressants and blood pressure medication. 

In South Africa, though, the only ADHD-specific medication licensed for use is methylphenidate (stimulant) and atomoxetine (non-stimulant).

 

Here’s how they compare: 

 STIMULANTSNON-STIMULANTS
When is it used• First-line ADHD medication.
• They work for 70% to 80% of people.
• They’re used to treat moderate and severe ADHD.
• Second- and third-line medications.
• It’s used in cases where stimulants don’t work or cause unpleasant side effects.
How they workStimulants increase dopamine and norepinephrine levels between the brain’s synapses. They work as soon as they cross the blood-brain barrier, which takes 45 to 60 minutes.Atomoxetine is a noradrenaline reuptake inhibitor. It works on the neurotransmitter, norepinephrine.
EffectivenessExpect reduced hyperactivity, distractibility, and impulsivity, and improved concentration and focus.Sustained focus, improved mood, greater attention to detail, better memory, better sleep, and reduced impulsivity are all signs the treatment is working.
How quickly they start and stop working• Methylphenidate only alleviates symptoms while the dose is active. It’s available in immediate and modified release forms.
• The immediate-release form takes effect an hour after administration and its effects last from three to six hours. Most patients require a two to three times daily dosing schedule.
• Modified release preparations provide eight- to twelve-hour symptom control.
• The effectiveness of short-acting medications stops working once your child stops taking them.
• It can take between five to seven days to see the benefits.
• Peak efficacy usually occurs between two to six weeks after starting the medication, but it can take up to eight weeks.
• Kids can be tapered off quickly, usually within a few days.
Dosing frequencyThe short-acting forms are usually taken two or three times a day
• The long-acting ones, just once a day.
Atomoxetine can be dosed once or twice daily with the second dose given in the evening.
Common side-effects• Decreased appetite
• Weight loss
• Insomnia
• Headache
• Irritability and jitteriness
• Tics
• Upset stomach (nausea, vomiting, constipation)
• Decreased appetite
• Dizziness
• Fatigue
• Mood swings
• Dry mouth
• Insomnia
• Menstrual cramps
• Difficulty in passing urine
Benefits• It is fast-acting and you may see symptom improvement within two hours after administration.
• Reduced side effects
• Minimised long-term consequences
• Fewer behavioural and social problems
• They don’t pose the same risk of abuse or addiction.
• They have a longer-lasting effect.
• Decreased ADHD symptoms, especially with impulsivity and aggression

Other medication 

In the case where your child responds poorly to methylphenidate or atomoxetine, if the side effects are severe, or they have significant co-morbid conditions, your doctor may use tricyclic antidepressants (TCAs), and dopamine reuptake inhibitors. 

 

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Questions to ask your doctor when starting medication 

When your child starts medication for the first time, or changes medication, ask your doctor: 

• What is the medication used for? 

• How soon can we expect to see improvement? 

• Is the medication addictive? 

• How should the medication be taken? (With food?) 

• When is the best time to take the medication? 

• What are the side effects? 

• What should we do if we experience side effects? 

• How long will my child need to take the medication? 

• If we choose to stop taking medication, do we wean off or stop completely? 

• What are the long-term effects of taking the medication? 

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References 

1. ADDitude. (2021). Stimulants vs. Nonstimulants: Understanding ADHD Medications. ADDitude [Online]. Accessed on 6 June 2022. Available from https://www.additudemag.com/stimulants-vs-nonstimulant-adhd-medication-video/ [ADD] 

2. Healthline. (2021). ADHD Treatment Options: Therapy, Medication, and More. Healthline [Online]. Accessed on 6 June 2022. Available from https://www.healthline.com/health/adhd/treatment-overview#1 [HL] 

3. Khan, S. (2021). How do stimulants work? RXList [Online]. Accessed on 8 June 2022. Available from https://www.rxlist.com/how_do_stimulants_work/drug-class.htm [RX] 

4. PABC. (n.d.) ADHD Stimulant vs. Non-Stimulant Medications. PAB Counselling [Online]. Accessed on 6 June 2022. Available from https://pabcounseling.com/adhd-stimulant-vs-nonstimulant-medications/ [PABC] 

5. Rosen, P. (n.d.) The difference between stimulant and nonstimulant medication for ADHD. Understood [Online]. Accessed on 6 June 2022. Available from https://www.understood.org/en/articles/the-difference-between-stimulant-and-non-stimulant-medication-for-adhd [U] 

6. Van der Westhuizen, A. (2010). Attention Deficit Hyperactivity Disorder (ADHD). SA Pharmaceutical Journal. 77(8): 10-20 [SA] 

7. WebMD. (2021). ADHD Medications and Side Effects. WebMD [Online]. Accessed on 6 June 2022. Available from https://www.webmd.com/add-adhd/adhd-medication-chart#1 [WMD] 

8. WebMD. (2021). Nonstimulant Therapy and Other ADHD Drugs. WebMD. Accessed on 6 June 2022. Available from https://www.webmd.com/add-adhd/adhd-nonstimulant-drugs-therapy [WMD3] 

9. WebMD. (2021). Stimulant Medications for ADHD. WebMD [Online]. Accessed on 6 June 2022. Available from https://www.webmd.com/add-adhd/adhd-stimulant-therapy [WMD2] 

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