September 8, 2025

Should I Medicate My ADHD Child? Part 3

By: Dr. J. Renae Norton

Non-Stimulant ADHD medications

Let’s take a look now at the non-stimulant ADHD medications. About 15%-30% of kids don’t respond to stimulants and this is probably the case for adults, too. If stimulants don’t work for you or you can’t tolerate the side effects of stimulants, non-stimulants may be an option for you. Your doctor may also prescribe these to take WITH stimulants because they can boost the effects. Non-stimulants are not controlled substances, so there’s less chance of abuse. These may also be a good option if you have had problems with drug abuse before. 

Non-stimulant medications usually take a while to start working. Also, they may not work as well as stimulants do in the short term. 

The U.S. FDA has approved four non-stimulants for the treatment of ADHD:

  • Atomoxetine (Strattera)
  • Clonidine (Kapvay)
  • Guanfacine (intuniv)
  • Violexazine (Qelbree)

Atomoxetine (Strattera) and viloxazine (Qelbree) belong to a class of antidepressants called selective norepinephrine reuptake inhibitors (SNRIs). These medications increase your brain’s level of a neurotransmitter called norepinephrine. They may help improve your ability to concentrate and control your impulses, but they may not work as well for symptoms of hyperactivity. You may not feel the effects until you’ve been taking them regularly for about 3-4 weeks, but they generally work for 12-24 hours.

Because they are antidepressants, they may be a good option if you also have anxiety or depression. Atomoxetine is approved for kids aged 6-17, and is also prescribed for adults. One benefit of these is that they don’t cause or worsen tics or other symptoms of Tourette’s syndrome. 

Guanfacine (Intuniv) and clonidine (Kapvay) belong to a class of high blood pressure drugs called alpha-2 adrenergic agonists. These were initially used “off label” for ADHD for many years. Off-label is the term used when a doctor prescribes a medication for a condition for which it has not been FDA approved. Drug makers eventually made extended-release versions, and the FDA approved them as a treatment for ADHD. 

Because these drugs are meant to lower high blood pressure, they have a calming effect, which may help with symptoms such as hyperactivity, the ability to control impulses, and feelings of aggression. Unfortunately they may not help as much in improving attention and focus. 

The side effects of Atomoxetine and viloxazine include: 

  • Stomach pain or upset stomach
  • Nausea or vomiting 
  • Mood swings
  • Headaches
  • Dizziness
  • Sleepiness

These side effects may cause insomnia and appetite suppression, but it’s less common than with stimulants. Adults may also have dry mouth, trouble peeing, and sexual side effects, such as erectile dysfunction. Atomoxetine may also cause high blood pressure, increased heart rate, and liver problems in some people. Such a deal. 

Rarely, SNRIs may increase the risk of suicidal thoughts and actions in some people, especially kids and young adults who have bipolar disorder or depression. Again in my experience, no one is checking to see if the individual has bipolar disorder or even depression before prescribing these medications. When I ask my psychiatrist colleagues why they don’t track the diagnoses, they say all the kids with ADHD that they treat are “Down in the dumps” due to chronic academic failure which they assume will go away once the medication kicks in. 

Guanfacine and clonidine side effects include: 

  • Nausea, stomach pain, or vomiting
  • Loss of appetite
  • Headaches
  • Dizziness
  • Sleepiness, fatigue
  • Dry mouth 

One last issue is that you cannot stop taking these medications suddenly as this can cause your blood pressure and heart rate to rise quickly. 

Off-Label Antidepressant ADHD Medications

Other than the two SNRIs already mentioned, the FDA has not approved any other types of antidepressants for ADHD treatment. However, there are some other medications that are used off label for this purpose, especially for people who have ADHD as well as depression or anxiety. This may also be an option if stimulants don’t work, or for those who can’t tolerate stimulants. Finally, this may be an appropriate choice for those with a history of drug abuse. 

The most common antidepressant prescribed off-label for ADHD is bupropion (Wellbutrin). Bupropion belongs to a class of antidepressants known as norepinephrine and dopamine reuptake inhibitors (NDRIs). It works by increasing the neurotransmitters norepinephrine and dopamine in your brain, which can improve your ability to concentrate. This is the medication I recommend as it helps with anxiety and depression, improving both concentration, motivation and, it has the lowest side effects! 

Bupropine side effects include:

  • Nausea, stomach pain, or constipation
  • Weight loss
  • Dry mouth or a sore throat
  • Headaches
  • Dizziness
  • Insomnia
  • Increased heart rate

Some people may have more challenging side effects, such as anxiety, ringing in the ears, and changes in vision or heart and lung function. Adults may also have sexual side effects. Bupropine may also increase the risk of suicidal thoughts in people aged 18-24 years old. 

Imipramine and Nortriptyline 

If other ADHD drugs haven’t worked out for you, your doctor may suggest a tricyclic antidepressant, such as imipramine (Tofranil) or nortriptyline (Pamelor/Aventyl). Tricyclics are an older class of antidepressants. They can have challenging side effects, so your doctor will usually only try these if you have no other options left to try. 

Imipramine and nortriptyline side effects include:

  • Constipation
  • Increased appetite and weight gain
  • Dry mouth
  • Dizziness
  • Blurred Vision
  • Confusion
  • Seizures
  • Increased heart rate
  • Not being able to empty your bladder fully when you pee, peeing a little bit many times over a day, or feeling like you have to pee but not being able to do so
  • Increased sweating 
  • Sexual dysfunction, including libido changes and impotence

Like all tricyclic antidepressants, both imipramine and nortriptyline can change your heart rhythm. Both may also increase the rise of suicidal thoughts in people aged 18-24 years old. Again, don’t stop taking nortriptyline suddenly because you can have withdrawal symptoms, such as nausea, vomiting, anxiety, headaches, dizziness, and restlessness. If you want to stop taking it, your doctor will decrease your dose over time to wean you off safely. 

New ADHD Medications

New medicines are always in development, and governing agencies continue to approve new brand-name ADHD medications. Most of these drugs that have been used in other conditions and have been tested and approved for use in ADHD. For instance, viloxazine in Europe had been used since 1971 as an antidepressant. Also, generic versions of brand-name drugs become available over time. For instance, in 2023, the FDA approved generic versions of lisdexamfetamine dimesylate (Vyvanse), which is a brand-name stimulant medicine approved in 2007. 

How SAFE ARE ADHD Medicines?

Many ADHD medications are controlled substances. The most common ADHD medicines are stimulants, so they have a high potential for misuse, abuse, and addiction. People who don’t have ADHD may misuse the medicines to feel more alert, curb their appetite to lose weight, or to feel “high”. 

Some people may intensify the effects of the drug by taking higher doses or even crushing and injecting, smoking, or snorting them. This can cause serious side effects, including:

  • Dangerously high body temperature
  • Fast heartbeat
  • High blood pressure
  • Panic attacks
  • Paranoia
  • Psychosis
  • Violent behavior 
  • Seizures

Because of the rise of misuse and abuse, the U.S. Drug Enforcement Administration (DEA) classifies stimulants as Schedule II Controlled Substances. This means that while there’s a medical use for them, there’s also a high potential for them to be abused. To help cut down on the misuse of these drugs, Schedule II Controlled medicines are harder to get because they can’t be refilled. Your doctor must write a new prescription for the medicine each time. 

In the article to follow, I will describe other methods of treatment that I have found to be highly effective and without the risks inherent in the most popular ADHD medications.