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The Difference Between Stimulant and Non-Stimulant Medication for ADHD

By Peg Rosen

When it comes to ADHD medication, you may already know that there are two main types—stimulants and non-stimulants. But you may not be aware of key differences between them.

Not all kids respond equally well to both, and it’s not uncommon for kids to switch from one to the other. What makes these types of medications so different?

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For one thing, stimulants have been around for much longer. They’ve been used to treat ADHD (also known as ADD) since the 1960s and are the most effective type of medication for most kids. They’re also the most widely prescribed. There are many brands in this category, including Ritalin, Focalin and Adderall.

Non-stimulants are a newer option. One of the most common, atomoxetine, has been used to treat ADHD since 2002. (This drug is widely known by its brand name, Strattera). Less commonly used are drugs called alpha-2 adrenergics, which at much higher doses are used to treat high blood pressure.

This chart allows you to closely compare stimulants and non-stimulants. You can use it to discuss medication options with your child’s doctor.

Stimulants Non-Stimulants: atomoxetine (Strattera) and alpha-2 adrenergics
How they work

Mainly target receptors of the brain chemical dopamine.

Very effective at improving attention and reducing hyperactivity and impulsivity.

Atomoxetine (Strattera): Targets the brain chemical norepinephrine. Can improve attention and reduce impulsivity and hyperactivity.

Alpha-2 adrenergics: How they work in the brain to help with ADHD is not clear. But they reduce hyperactivity and impulsivity. They may also improve attention.

How quickly they start and stop working

Fast acting. A child will feel effects within 30 to 90 minutes of the first dose, depending on the drug and individual sensitivity.

These drugs—and their effects—leave the system within three to 12 hours, depending on whether they’re short-acting or long-acting.

Atomoxetine (Strattera): Takes two to four weeks for the drug to have full effect. Kids can be tapered off quickly, usually within a few days.

Alpha-2 adrenergics: Takes two weeks to know if the drug is effective. Kids on high doses over a long term may need to be tapered off slowly to avoid side effects when the drug is discontinued.

Dosing frequency

Extended-release pills last six to 12 hours—enough to cover the school day.

Atomoxetine (Strattera): Once, sometimes twice, a day

Alpha-2 adrenergics: From one to three times a day

Common side effects

Loss of appetite, trouble sleeping

(Uncommon side effects include increased anxiety, agitation, headaches, tics, psychosis.)

Atomoxetine (Strattera): Moodiness

(Uncommon side effects include nausea, loss of appetite, sluggishness.)

Alpha-2 adrenergics: Sleepiness, fatigue

(Uncommon side effects include loss of appetite, drop in blood pressure, nausea.)

Risks

Could cause weight loss and possibly impact height. (Weight and height should be monitored.)

Use with caution in kids with pre-existing heart conditions because these drugs can, in rare instances, cause complications. A cardiologist should approve the child taking it.

Atomoxetine (Strattera): Very rare incidence of liver complications.

Alpha-2 adrenergics: May cause dizziness and fainting if it greatly impacts blood pressure.

Effectiveness

Improves attention and reduces impulsivity and hyperactivity in 70 to 80 percent of patients.

Atomoxetine (Strattera): Improves attention and reduces impulsivity and hyperactivity in about 50 percent of patients.

Alpha-2 adrenergics: Reduces impulsivity and hyperactivity in 60 percent of patients.

When doctors might prescribe these drugs

Generally, this is the first line of drug treatment for children with ADHD and ADD.

Atomoxetine (Strattera): May be prescribed if a child can’t tolerate the side effects of stimulants. May also be an alternative for teens and young adults who might benefit from 24-hour coverage.

Alpha-2 adrenergics: Most often used in addition to stimulants to help kids with severe symptoms.

To better understand how ADHD medication works, learn more about how ADHD affects the brain. Use our ADHD medication log to help find the dosage that works best for your child. And know the signs that your child’s ADHD medication might need fine-tuning.

Understood is not affiliated with any pharmaceutical company.

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