Medications for ADHD.
Atomoxetine (Strattera).
Key Benefits: No addictive potential. Fewer side effects compared with stimulants. FDA approved for ADHD >6 years old, but also may help with symptoms of depression and anxiety.
Before Starting: Not appropriate if you have poorly controlled high blood pressure or a heart rhythm abnormality. Avoid or take a reduced dose if you have extensive liver disease. Must be stopped if pregnant or breastfeeding.
Side Effects: Sedation (usually improves after 1-2 weeks), mild increase in blood pressure and heart rate, mild decrease in appetite, dry mouth, and irritability.
Monitoring: No monitoring requirements. You should see quick improvement in attention and hyperactivity. You should see some improvement in depression/anxiety in 1-2 weeks.
Bupropion (Wellbutrin).
Key Benefits: No addictive potential. Fewer side effects compared with stimulants. FDA approved for depression, but also used as an adjunctive treatment for ADHD symptoms with the benefit of fewer side effects. No sexual side effects. No significant influence on appetite or weight.
Before Starting: This medication is not appropriate if you have a history of seizure disorder or eating disorder. Eating disorders are often associated with electrolyte deficiencies and paired with the lowered seizure threshold from bupropion, your risk of seizures increases.
Side Effects: Transient (2-week) headache and dizziness are most common. Other side effects include appetite suppression and weight loss, dry mouth, hyperactivity, and irritability.
Monitoring: There are no particular monitoring requirements for this medication. You should start to see improvement in 1-2 weeks after starting the medication.
Guanfacine (Intuniv ER).
Key Benefits: No addictive potential. Fewer side effects compared with stimulants. FDA approved for ADHD in individuals aged 6-17 years old. May also be used for irritability and aggression in childhood/adolescence.
Before Starting: This medication is not appropriate if you have a significant history of low blood pressure or slow heart rate (bradyarrhythmia or heart block).
Side Effects: Transient sedation (1-2 weeks), low blood pressure (only at high doses), constipation, dry mouth.
Monitoring: There are no monitoring requirements with this medication unless you are taking high doses, then intermittent blood pressure and heart rate monitoring is advised.
Clonidine (Kapvay).
Key Benefits: No addictive potential. Fewer side effects compared with stimulants. FDA approved for ADHD and may also benefit anxiety symptoms (especially PTSD and social anxiety), substance withdrawal (especially alcohol and opioids), and Tic or Tourette’s disorder.
Before Starting: This medication is not appropriate if you have a significant history of low blood pressure or slow heart rate (bradyarrhythmia or heart block).
Side Effects: Transient sedation (1-2 weeks), low blood pressure (especially at high doses), constipation, dry mouth.
Monitoring: Intermittent blood pressure and heart rate monitoring is advised. Taper over 2-4 days if medication is discontinued to avoid rebound nervousness, agitation, headache, tremor, and high blood pressure.
Amphetamine (Adderall, Evekeo, Dexedrine).
Key Benefits: Arguably the most effective medication on the market for ADHD symptoms, but does come with addictive potential and is a scheduled II controlled substance.
Before Starting: This medication is not appropriate in the setting of certain underlying heart conditions, heart rhythm abnormality, poorly controlled high blood pressure, certain eating disorders, psychosis, or active manic episodes.
Side Effects: Decreased appetite, weight loss, nausea, insomnia, increased blood pressure and heart rate, psychosis, and emotional dysregulation (especially anxiety and agitation).
Monitoring: Intermittent blood pressure, heart rate, and weight checks. You should notice a rapid improvement in symptoms upon starting this medication.
Lisdexamfetamine (Vyvanse).
Key Benefits: Highly effective for ADHD symptoms, but does come with addictive potential and is a scheduled II controlled substance. Once-daily dosing. Some experience fewer side effects with lisdexamfetamine as compared with amphetamine-derived stimulants.
Before Starting: This medication is not appropriate in the setting of certain underlying heart conditions, heart rhythm abnormality, poorly controlled high blood pressure, certain eating disorders, psychosis, or active manic episodes.
Side Effects: Decreased appetite, weight loss, nausea, insomnia, increased blood pressure and heart rate, psychosis, and emotional dysregulation (especially anxiety and agitation).
Monitoring: Intermittent blood pressure, heart rate, and weight checks. You should notice a rapid improvement in symptoms upon starting this medication.
Methylphenidate (Ritalin, Concerta, Quillivant).
Key Benefits: Highly effective for ADHD symptoms, but does come with addictive potential and is a scheduled II controlled substance. Most report less nausea and other gastrointestinal side effects with methylphenidate compared with amphetamine derivatives.
Before Starting: This medication is not appropriate in the setting of certain underlying heart conditions, heart rhythm abnormality, poorly controlled high blood pressure, certain eating disorders, psychosis, or active manic episodes.
Side Effects: Decreased appetite, weight loss, nausea, insomnia, increased blood pressure and heart rate, psychosis, and emotional dysregulation (especially anxiety and agitation).
Monitoring: Intermittent blood pressure, heart rate, and weight checks. You should notice a rapid improvement in symptoms upon starting this medication.
Viloxazine (Quelbree).
Key Benefits: Newest non-stimulant ADHD medication, FDA approved for ADHD in those >6 years old in April 2021. No addictive potential. Fewer side effects compared with stimulants. May help with symptoms of depression and anxiety and in fact has been used since the 1970s for depression in European countries.
Before Starting: Not appropriate if you have poorly controlled high blood pressure or a heart rhythm abnormality. Must be stopped if pregnant or breastfeeding.
Side Effects: Sedation (usually improves after 1-2 weeks), mild increase in blood pressure and heart rate, mild decrease in appetite, dry mouth, and irritability.
Monitoring: No monitoring requirements. You should see quick improvement in attention and hyperactivity. You should see some improvement in depression/anxiety in 1-2 weeks.
Tricyclic Antidepressants (TCAs, Imipramine & Nortriptyline).
Key Benefits: The oldest medications used to treat the symptoms of ADHD. Cost-effective. No addiction potential.
Before Starting: This medication should be avoided in those with a history of poorly controlled high blood pressure, a heart rhythm disorder, or seizure disorder.
Side Effects: Dry mouth, constipation, urinary retention, decreased libido, erectile dysfunction, and drowsiness.
Monitoring: Intermittent blood pressure and heart rate monitoring is advised if there is a history of hypertension or heart rhythm abnormality. You should see improvement in 2-4 weeks after starting this medication.
