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:
STIMULANTS | NON-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 work | Stimulants 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. |
Effectiveness | Expect 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 frequency | The 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.
______________________________________________________________________________________________________________________
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?
______________________________________________________________________________________________________________________
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]