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Stimulant medication helps 60-80% of the teenagers and adults with ADHD in lowering the symptoms and their effects. But, in some cases, non – stimulants are required instead of stimulants and here are reasons:
Some cases require a substitute for stimulants or another agent added to the treatment.
The newest medication approved for ADHD by the FDA, has been tested in controlled studies in both children and adults and has been found to be effective is Atomoxetine (Strattera). Advantages include 24-hour coverage, less weight loss and the ability to call in refills. Further information can be seen in articles regarding Atomoxetine.
Tricyclic antidepressants like desipramine (Norpramine) imipramine (Tofranil) and nortryptiline (Pamelor) are effective in the treatment for ADHD. They are a 24 hours covering medicine and reduce sleep difficulties the stimulants give. Yet, effects that might not be to pleasant can appear: dry mouth, blurred vision, constipation, dizziness and sedation. When using tricyclic treatment, it is important to closely monitor the heart rhythm and do blood tests because they are known to cause cardiac conduction changes.
Bupropion (Wellbutrin), an antidepressant with an indirect effect on the neurotransmitter dopamine, has been useful in clinical trials for treating both children and adults suffering from the ADHD condition. It can cause a sense of jitteriness and sleep difficulties. It is generally not given to individuals with seizures because it can lower the threshold for seizure. It has also been proved to reduce the necessity of smoking.
Clonidine and guanfacine work in some cases. Those are medication that constitute a blood pressure class, a-adrengeric agonists. Clonidine has a sedative effect over night or can be administered 2-3 time for whole day coverage. It must not be stopped suddenly because it may cause blood pressure rebound. If these medications are administered, the patient should monitor blood pressure and heart rhythm. They will help on most of the ADHD effects but also may cause variations like weaker effect on attention. Shire Pharmaceuticals is trying to improve the guanfacine's formula and hope to receive FDA approval.
Manic Depressive Disorder (Bipolar Disorder) is treated usually with mood stabilizers that include lithium and few seizure medications like valproate (Depakote) and carbamazepine (Tegretol). The percentage of children affected by Bipolar Disorder was brought to discussions by specialists and some of them see mood swings as a part of the ADHD while others see it as a sign of a second separate disorder. In either case, the mood stabilizers may be useful to help modulate irritability and rapid mood shifts. These medications require closer medical monitoring, blood tests and sometimes EKG.