Before Non-Stimulant Medications
Not long ago, restlessness in schoolchildren and even adults was typically diagnosed as “attention-deficit/hyperactivity disorder” and treated with immediate prescription of stimulant-based ADHD medication. At that time, non-stimulant medications were not used.
Unfortunately, many of those diagnosed did not in fact have ADHD, but some other illness such as obsessive-compulsive disorder, or simply a highly energetic temperament. Inappropriate prescriptions due to misdiagnosis are potentially serious errors: OCD, for example, is similar to ADHD in being associated with restlessness, distractibility and excessive double-checking that slows performance—but has entirely different effects on the brain. Since ADHD medications are formulated to improve concentration, and people with OCD are troubled by involuntary “concentration” on obsessive thoughts, ADHD meds can make OCD worse.
Even when the diagnosis is correct, stimulant-based ADHD medications can have undesirable side effects, including:
- Chronic agitation
- Mood swings (often induced by the drugs’ tendency to take effect quickly and wear off rapidly)
- Loss of appetite
- Addiction or dependence (misuse is always risky and increasingly common)
The Rise of Non-Stimulant Alternatives
Nonetheless, in many cases of ADHD, medication is helpful for reducing distractibility and improving self-control. For those who want to avoid or minimize stimulant risks, the FDA has recently approved several non-stimulant alternatives. However, these drugs have a few potential disadvantages:
- They only lead to significant improvement in ADHD symptoms for 50–60 percent of those who take them (compared to 70–80 percent of patients taking stimulant drugs).
- Like nearly all prescription medications, they can trigger side effects.
- They may pose extra risk to people with medical conditions such as glaucoma or liver disease.
Therefore, non-stimulant options are mostly considered second- or third-line treatments, to be used as replacements for, or supplements to, stimulant medications that have already proved ineffective or problematic.
ADHD medications come in short-acting (effective for about 4 hours), intermediate-acting (effective for up to 8 hours) and long-acting (effective for up to 24 hours) forms. Common long-acting non-stimulant meds include Strattera (generic name atomoxetine), Intuniv (generic name guanfacine) and Kapvay (generic name clonidine).
Strattera, the oldest of the major non-stimulant ADHD drugs, is a selective norepinephrine reuptake inhibitor (a type of mood regulator) with antidepressant effects. It is frequently prescribed in conjunction with therapy treatment.
Intuniv is an alpha-2 adrenergic agonist (chemical-binder drug) commonly used in treatment of high blood pressure as well as ADHD.
Kapvay is a central-acting alpha agonist that was also created as a blood-pressure drug. It slows down a fast heart rate, thus reducing blood flow and overall stress.
If You Need ADHD Treatment
If you or someone in your family has ADHD that is hurting your everyday functioning, discuss your options with a doctor, and:
- Do consider drug-free approaches such as mindfulness exercises, dietary adjustments and talk therapy. Even if you take medication, combining it with non-drug treatments usually means smaller doses are necessary.
- Make sure of your diagnosis before accepting any prescription—get a second opinion, if necessary, on whether you have ADHD, OCD or something else entirely.
- Never take larger or more frequent doses than prescribed, and definitely never take medication in a different way than prescribed.
- Carefully follow any instructions about not taking a medication with other drugs, including alcohol. Especially with a blood-pressure-lowering medication such as Intuniv or Kapvay, mixing it with alcohol can have a dangerous “double depressant” effect.
- Tell your doctor promptly if you notice any major side effects, or any sign of addiction developing (especially if you are taking a stimulant medication, with or without a non-stimulant).
- Don’t expect medication to solve every ADHD problem on its own. Especially with mental disorders, much of treatment’s effectiveness depends on the patient’s attitude and willingness to work at recovering.
Treatment for Stimulant Use Disorder
Whatever the specific conditions or medications involved, it’s all too common for legitimate medical prescriptions to morph into dangerous drug addictions. If you or a loved one struggle with dependence on a prescription (or any other) drug, Cumberland Heights can help. We provide medical detox and rehab for women, adult men, younger men and families.
The sooner substance use disorder is treated, the better the prospects for recovering without long-term health damage. Contact us today to learn more.