Non-Stimulant Therapy for ADHD

EP: 1.Clinical Subtypes of ADHD

EP: 2.Factors That Predispose for ADHD

EP: 3.ADHD: Patient QOL and Misconceptions

EP: 4.What Prompts Patients to Seek an Evaluation for ADHD

EP: 5.Accurately Diagnosing ADHD

EP: 6.Challenges With Diagnosing ADHD

EP: 7.Non-Pharmacological Strategies for ADHD

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EP: 8.Non-Stimulant Therapy for ADHD

EP: 9.Short- and Intermediate-Acting Stimulants for ADHD

EP: 10.Long-Acting Stimulants for ADHD

EP: 11.Prodrug Therapy for ADHD

EP: 12.Treatments for ADHD: Efficacy and Safety Data

EP: 13.Substance Abuse and ADHD

EP: 14.Adult ADHD Treatment Recommendations

EP: 15.Switching Medication for ADHD

EP: 16.Multimodal Treatment of ADHD

EP: 17.Novel Nonstimulant Therapy for ADHD

EP: 18.Exciting Therapies Under Investigation for ADHD

EP: 19.Treating ADHD: Current Unmet Needs

EP: 20.Managing ADHD During COVID-19

EP: 21.Evolution of Therapy and Destigmatizing ADHD

Transcript: Theresa Cerulli, MD: What are some of our pharmacological treatment options? Andy, I think you’re doing a paper on the nonstimulants for ADHD [attention deficit hyperactivity disorder] if I remember correctly.

Andrew J. Cutler, MD: That’s right. I’m working on a paper summarizing the currently available nonstimulants as well as some in development, and we’ll talk about that later. But as far as currently available nonstimulants, we have only 3 that are FDA approved. Of those, there is only 1 approved for both children and adults, and that’s atomoxetine. Atomoxetine is a norepinephrine reuptake inhibitor. As I’ve already said, it is effective for children and adults.

We also have 2 drugs that are considered alpha-2 agonists. They work by binding to specific norepinephrine and noradrenergic receptors. These are extended-release versions. We have guanfacine [Intuniv], and we have clonidine [Kapvay]. Both of these options are approved only for children and adolescents. But they are approved as monotherapy or to be given in combination with stimulants, which is where I find I get the best results, for a variety of reasons.

Now, there are some treatments that are used off-label. We have antidepressants, such as bupropion. We use SNRIs [selective norepinephrine reuptake inhibitors]. Older tricyclic antidepressants, especially desipramine, also get used. Of course, there are limitations there with efficacy and tolerability.

Even with the 3 FDA-approved treatments, we’ve got issues with inadequate or inconsistent efficacy. Their efficacy is not as strong as the stimulants, and there are some safety and tolerability issues.

A final group of medicines that are used are the wakefulness-promoting agents modafinil or armodafinil. Again, they’re not FDA approved, but there is some evidence that they can be helpful for certain patients. Therefore, they sometimes work their way into our algorithm.

Transcript Edited for Clarity