Non-stimulant ADHD medications are an alternative for people who cannot take stimulants, do not tolerate them, have a history of substance misuse, or need coverage at times of day when a stimulant has worn off. Four are FDA-approved for ADHD. Atomoxetine (Strattera) and viloxazine (Qelbree) are selective norepinephrine reuptake inhibitors that increase norepinephrine and, in the prefrontal cortex, dopamine. Guanfacine extended-release (Intuniv) and clonidine extended-release (Kapvay) are alpha-2 agonists originally developed for blood pressure that improve attention and reduce impulsivity and hyperactivity, and they are especially helpful for children with tics, sleep problems or emotional outbursts.
The main trade-off is speed and strength of effect. Non-stimulants take two to six weeks to work fully, compared with hours for a stimulant, and their average benefit is somewhat smaller. In exchange, they are not controlled substances, carry no misuse potential, can be refilled normally, and provide steady coverage around the clock. Side effects include sleepiness and low blood pressure with the alpha agonists and stomach upset, reduced appetite or fatigue with atomoxetine and viloxazine. Bupropion, an antidepressant, is sometimes used off-label when ADHD coexists with depression. Non-stimulants can also be combined with a stimulant to smooth out the day. A Stedfast Psychiatry provider will discuss which approach fits your symptoms, medical history and daily schedule after a full ADHD evaluation.