Non-stimulant medications can be used as an alternative to stimulant medications for people who cannot tolerate stimulants due to side effects or other medical conditions, or for people with drug-use issues. Some non-stimulant medications may also be used in combination with stimulant medications. Honest communication with a person's prescriber is the best way to make decisions about medication treatment.
Disclaimer: I am not a medical doctor and cannot prescribe any medications nor provide special authority codes for stimulant medication. The below information is for educational purposes only and should not be taken as recommendations or specific prescription advice. My knowledge comes from my training in neurobiology and psychopharmacology as part of my psychology training, psychopharmacology textbooks, drug information sheets, research articles, and listening to webinars from ADHD expert psychiatrists and pediatricians.
Non-stimulant options include FDA-approved ADHD medication, as well as some antidepressants. As with ADHD stimulant drugs, there are more options in the US than there are here in New Zealand, so just the New Zealand options you are most likely to encounter are reviewed below. Each type of medication has multiple entries on the Medsafe factsheet website. As I don't know which formulations are being dispensed, I would encourage people wanting to learn more to search the Medsafe database themselves.
Good evidence for use with ADHD:
Atomoxetine (Strattera): This medication is a norepinephrine (noradrenaline) reuptake inhibitor, which means that it increases available norepinephrine in the spaces between neurons in the brain. It may take several weeks to see the full effects of atomoxetine, which is more like the timeline of an antidepressant compared to a stimulant medication.
Clonidine: This medication is an alpha-agonist medication used primarily to treat high blood pressure. It works by activating alpha-2 adrenergic receptors, which causes blood vessels to relax and reduces blood pressure. It is believed that clonidine's effect on these receptors in the brain can also trigger the release of norepinephrine. Clonidine can be used in addition to stimulant medication. We only have the shorter-acting version of this drug available in New Zealand, and we do not have its longer-acting cousin, guanfacine, which also has good evidence of effectiveness for ADHD.
Atomoxetine may be prescribed in place of stimulant medication in people with a recent history of illicit drug use, or people with a history of selling drugs. This is because it is not a drug that is abused and has no street value. Atomoxetine does not require a special authority code as stimulant medications do, but I suspect that many GPs would want some pretty good evidence that ADHD was present in order to prescribe it.
Antidepressant medication:
Bupropion is a medication that is primarily used for smoking cessation or as an antidepressant, but it has also been found to be effective in treating ADHD symptoms. Bupropion is believed to work by increasing the levels of dopamine and norepinephrine in the brain.
Venlafaxine belongs to a class of medications called serotonin-norepinephrine reuptake inhibitors (SNRIs), which work by increasing the levels of serotonin and norepinephrine in the spaces between neurons in the brain. These neurotransmitters are involved in regulating mood, anxiety, and attention, among other functions. While some studies have suggested that SNRIs like venlafaxine may have some benefits for managing ADHD symptoms, there is less evidence and results are inconsistent.
For an informative article that explains more about the above medications as well as ones not available in New Zealand, click here.
