Patients often want some treatment that will help their ADHD without using a stimulant such as Adderall, Ritalin, Vyvanse or Concerta. They may have different reasons. Some people have intolerable side effects from the stimulants or they may have insufficient help from them. Some people don’t want to be on stimulants for fear they may become physically or psychologically dependent on them. Others may be in recovery from substance abuse problems and don’t want to relapse from taking an abusable medicine. And some people just don’t want to take any medicine.
There are several non-stimulants, non-abusable, non-DEA controlled medications. Strattera is effective in 70% of ADHD patients. Wellbutrin is effective in 57%. The stimulants are effective in 80 to 90% of ADHD patients. Provigil is effective in a considerably lower percentage of patients. Clonidine and guanfacine tend to be less robust in reducing ADHD symptoms of inattention. Omega-3 fatty acids are helpful in a small group of patients. Effexor and Desipramine help some patients.
The major drawback to Strattera is that it takes 1-3 months to get a significant to maximal benefit, and the fact that it may cause a very rare liver toxic reaction has intimidated some patients from taking it. The advantages of Strattera over the psychostimulants includes its effective benefit 24 hours a day once it is working and it’s continuing to work for days to weeks if it is missed or forgotten.
Wellbutrin, like Strattera, has a lagging onset of benefit. So it can take 6 to 12 weeks to see the full benefit. Wellbutrin is an antidepressant as well as an ADHD medication. If the patient has depression as well as ADHD, Wellbutrin may be a parsimonious solution.
Provigil is usually well received by patients for whom it works. However, it is quite expensive and is seldom covered by insurance companies because it is not FDA approved for ADHD.
Clonidine and guanfacine are often used to augment stimulants. They also are beneficial to use in evenings or at bedtime because they tend to assist sleeping rather than disrupting sleep like the stimulants.
Omega-3 fatty acids have been more effective than placebo in studies where it was used along with a stimulant.
Effexor and Desipramine are older antidepressants that are frequently limited in their use for ADHD because of side effects.
Neurobiofeedback has now been classified as an effective treatment for ADHD by the American Psychological Association. It requires 30 to 60 sessions of computer guided and psychologist supervised sessions over 6 to 12 months which usually cost in the range of $4000-$7000. By the end of the therapy there is a group of patients who have a reduction in ADHD symptoms as much as a patient who is taking a stimulant. Long-term studies of several years have found some patients maintain this level of benefit.
Contact Atlanta psychiatrist Dr. Hege’s office for an appointment for an evaluation for the most helpful treatment for you.