Non-stimulant ADHD Medications

July 9, 2010 11:13 PM

My husband seems to have adult ADHD, and it seems to be getting worse as he gets older. He's been to a psychiatrist who has diagnosed him with ADHD and put him on both Adderall and Concerta. Adderall works very well for him, but it gives him serious heart problems (cold extremities, irregular heart rate, a sense of panic). Concerta, on the other hand, gives him a bad stomach and doesn't do anything for his concentration. What are people's experiences with non-stimulant ADHD medications, like Strattera?
posted by BombasticBibliophile to health & fitness (19 answers total)

Strattera gave me heart palpitations, raised my blood pressure, and caused some weight loss. It also did absolutely nothing for my concentration.

I currently take the non-extended release Adderall and it works great.
posted by elsietheeel at 12:14 AM on July 10, 2010

I had moderate success with Ritalin, but my doctor changed me to Strattera, and it was pretty horrible. The main side effects were impotence and inability to pee (they should just put "frustration involving the penis" in the list of side effects). I stopped using it after about a month, went back on the Ritalin for a while, but eventually quit and changed some habits (and my job), and managed to concentrate better on my own.
posted by Joakim Ziegler at 12:36 AM on July 10, 2010

Try Vyvanse. I hate Adderall passionately, but Vyvanse, even though it's just a different formulation of Adderall, has been a lifesaver. I haven't experienced any side effects with it. My psychiatrist shared with me that he won't prescribe Strattera to any of his patients (I asked for it when I told him that I wouldn't take any more Adderall) because none of them ever had a good experience on it.
posted by halogen at 1:11 AM on July 10, 2010 [1 favorite]

This doesn't address the "non-stimulant" part of your question, but has he tried just plain dexamphetamine? I've heard plenty of stories of people who have terrible side effects with Adderall but none on the plain stuff, even though Adderall contains DA and they are otherwise pretty chemically similar. Everyone seems to respond differently.

Also, how long has he been taken the Adderall? I had annoying side effects when I first started taking DA, but they stopped after a couple of weeks.
posted by A Thousand Baited Hooks at 1:16 AM on July 10, 2010

If Adderall is giving him palpitations and panicky sensations I doubt dexedrine is going to do him any favors. It generally hits even harder.

OP: The only non-stimulants I know of which are approved for ADHD are Strattera and Intuniv. Strattera may not technically be a stimulant but it blocks the reuptake of adrenaline so from the point of view of the person taking it I'm not sure that's a great distinction.

I don't know a whole lot about Intuniv but it may well be the only viable option if your husband can't take serious stimulants as it's mostly a medication to lower blood pressure. Unlike Strattera which will definitely still amp you up. So that's the one I would ask your doctor about.
posted by Justinian at 1:40 AM on July 10, 2010

Seconding the Vyvanse recommendation. It's amphetamine, just like adderall, but attached to an amino acid that has to be cleaved off before it's functional. So it releases more smoothly and slowly. That should help with his panic and heart fluttering. Myself, I take 10 milligrams of regular, generic Adderall, and it works just great. But there are a lot of different reactions that people can have to any medication.

This sounds ridiculous, but I've had the same problems your husband has with a specific generic formulation of regular release adderall. The CorePharma manufactured generic gave me a racing heart and panicky feelings. I will only use Sandoz or Barr now. I know that generics are supposed to be exactly the same, but for some reason -- maybe it was even just that "batch" -- those pills were just awful.

Intuniv sounds interesting, and I'd never heard of it before this thread.
posted by Made of Star Stuff at 2:28 AM on July 10, 2010

have you tried having him just do things like not drink anything with caffeine in it?

Also some studies have shown that gluten free diet could also help.
posted by majortom1981 at 4:55 AM on July 10, 2010

My child takes Intuniv after having bad reactions to stimulants. For him, it mitigates impulsive and aggressive behavior, but does not produce the ability to focus that a stimulant does.
posted by Daily Alice at 5:09 AM on July 10, 2010

I had a terrible panic-attack style reaction to Strattera. Racing heartbeat, acute hypertenstion, disorientation, anxiety, fluctuating body temp, etc. Really bad.

More recently I've tried Focalin, which is just another amphetamine--but seems to be a little friendlier than the Dexedrine that has traditionally worked for me (but which I've found harder to tolerate as I age.) It's expensive though.

I was also given guanfacine (aka Tenex, Intuniv), which is a norepinephrine agonist, in part to ease the side effects.

This last combination felt better than previous prescriptions but was pricey, and in the end I found it impossible to stay on stimulants indefinitely, as I had before.
posted by snuffleupagus at 5:40 AM on July 10, 2010

Seconding Star Stuff: my kid had a bad reaction to generic Adderall; he's completely great on the real stuff.

Nice thing about ADHD med trials is it doesn't take long to gauge one's reaction, so while there may be a few bumpy days, it doesn't take too long to find something that works (but it can definitely be frustrating).

When something works, it just works, which is great.
posted by dzaz at 5:41 AM on July 10, 2010

Wellbutrin (Buproprion) and Provigil (Modafinil) are frequently prescribed off-label for ADHD. In my experience, however, I did not like Wellbutrin-- it gave me really disturbing dreams-- and Modafinil didn't have any effect on me whatever.
posted by holterbarbour at 7:54 AM on July 10, 2010

Strattera did nothing for me except give me horrible side effects. Was on it for three months before I took myself off of it.
posted by damionbroadaway at 8:38 AM on July 10, 2010

My ex had a horrible experience on wellbutrin. It's sometimes prescribed for ADHD.

I, personally, am scared of all of the reuptake inhibitors because they take so long to get out of your system (not a technical phrase) and one of the things I like about stimulants is their speedy exit from my bloodstream should something go wrong.

My husband had some shaky experiences on Adderall, as did I. The palpitations didn't bother me, especially after my cardiologist confirmed that I was not going to die. I just got used to them and cut down on the caffeine. They can be disturbing, though--the worst part is that they often kick in while the medicine is wearing off--so your first thought is OMG GET ME OFF OF THIS NOW but what helped me was taking an extra, smaller dose later in the day to ease myself off of it. Taking more gave me fewer palpitations! Crazy!

They really bothered my husband and gave him that panicky feeling, especially as he was nervous about taking stimulants already. We both ended up on Vyvanse and he likes it a LOT more. It's very smooth and he has had no problems with it.

Best of luck.
posted by internet fraud detective squad, station number 9 at 9:00 AM on July 10, 2010

Straterra was wonderful for a month, did jack for 5 months and messed me up thereafter (anxiety attacks, etc.). Then again, I was taking it with Ritalin, which you're not supposed to do. (I changed psychiatrists after that.)

If the Adderall gave him those effects, did you try a much lower dose? Or was that on the starting dose? I know that before I was on concerta and was still on ritalin, taking too much caused all sorts of problems (always try to remember if you've taken your ADD meds kids!).
posted by Hactar at 9:05 AM on July 10, 2010

I can also recommend Vyvanse, as I take it. I started with 20 mg for a couple of weeks, then eased up to 50 mg. The side effects were a bit startling at first (cold-flashes, BP elevation), but I found that the side effects lasted only a few days during the initial startup. The positive effects were like night and day. I got shit DONE! I never felt speeded up or shaky, and I was able to remain focused on my list of tasks.

Finally determined that 40 mg was the perfect dosage for me (female, approximately 160 lbs) and have been on it ever since. I can also go off the med for a day or two with no side effects on re-start.

Only downside is that like most of the similar meds, it's a bitch to refill due to regulations and tendency for abuse. My stint in rehab gave me an education on these meds - they are the recreational drug of choice for many teens and young people.
posted by mnb64 at 11:49 AM on July 10, 2010

I had an allergic reaction to Adderall XR (the generic version), so I went on Strattera. It didn't do anything to me but give me freaked out dreams and make me feel uneven. I have heard some great stories about it, though, so I can't say it won't work for anyone.
posted by SNWidget at 2:15 PM on July 10, 2010

Strattera wreaked havoc on my BP (went from low to high, with the added excitement of orthostatic hypotension), and I lost a nearly unbelievable amount of weight. I mean, I went from normal/slightly heavy (the 'heavy' was due to SSRIs), then on atomoxetine I hit the 'cultural ideal for women' and kept going.

Vyvanse was pretty good. I only switched back to Adderall XR because I work longer hours than Vyvanse stays active in my system (I have the Family Liver, which laughs in the face of all pharmaceuticals metabolized by CYP450 and then destroys them, so I require very high doses of hepatically cleared drugs in order to notice an effect, and even then I don't get much staying power), and people rarely prescribe it bid.

I take Wellbutrin for depression. It does nothing for my ADHD. It does noticeably affect my BP. Concerta, Ritalin and generic methylphenidate, ditto.

Tenex (Intuniv without the rebranding)...I've only seen it help with impulsive aggression and outbursts, not focusing. I have never used it myself. (I used to work with/teach children who often had ADD/ADHD.)

Gluten-free diets will only help if your husband has a genuine gluten intolerance/celiac disease with neurologic symptoms. I do mean genuine, as in diagnosed by a real gastroenterologist or allergist/immunologist. Otherwise, general consensus is that it's an expensive, highly inconvenient placebo. Maybe that will change, but I am doubtful. This doesn't mean that I don't believe diet can help with neurologic disorders--my epilepsy improved when I was on the Modified Atkins Diet.* That, in turn, helped me focus, probably primarily because I wasn't seizing or recovering from seizures. Right now, because MAD is so promising, they're testing Modified Atkins on EVERYTHING from adult epilepsy to hormonal disorders to depression to bipolar to--back on topic--ADHD. I am not sure they're going to find much efficacy outside of epilepsy, possibly hormonal disorders, and epilepsy with comorbid neuropsychiatric problems. But we will see.

*However, Modified Atkins also made me smell awful, and I missed my favorite foods, and I had been a vegetarian for years. The cost/benefit did not outweigh increasing Keppra again, and that is why I quit.
posted by Uniformitarianism Now! at 4:37 PM on July 10, 2010

When I was first prescribed Adderall, the initial recommended dose was WAY TOO HIGH and I got all jittery. I ended up taking 1/4th the dose, with food, more frequently and that works great. So before giving up on stimulants entirely, he might try taking a much lower dose with food every 3-4 hours.
posted by Jacqueline at 6:14 AM on July 11, 2010

I've had a pretty good experience with Strattera. I've been on it since 2007, except for a period of months in 2009 where I went off it because of problems sleeping. I ended up going back on it and changing my dosage schedule, and that worked.

The side effects I have are:

-- occasional *mild* trouble peeing, mostly that my bladder won't empty fully, so I need to go again shortly. It's very occasional, and has not affected my life enough to bother changing meds.

-- occasional, as in about twice a year, waking up from a dead sleep and bolting to the bathroom to puke. This has not happened since I changed my dosing schedule.

-- sleep troubles when I took it before bed. I'd have no problem getting to sleep, but I'd wake up at 3 or 4 AM and not be able to fall asleep again for 2 or 3 hours. Changed when dosing schedule changed.

-- when taking it first thing in the morning on an empty stomach, it would upset my stomach enough that if anything at all, like thinking of something disgusting or smelling a bad smell, occurred, I'd throw up. Again, this went away when my dosage schedule changed.

-- if I don't have enough to eat right before taking it *and* don't drink a full glass of water, it gives me heartburn. I don't need to drink the full glass of water if I'd have a reasonable-size breakfast (which for me is a bowl of cereal or two waffles).

I need to take the Strattera after I eat something, but I had problems remembering to take it when I couldn't hook it to a routine, like going to bed or waking up. I take my breakfast to work and eat it there, because I can't eat anything for about an hour after I get up without feeling queasy, and what's worked for me is creating a Google Calendar alert that emails me at 9:30 every morning asking "Have you taken your Strattera yet?" (It also sends an alert to my iPhone at the same time.) I don't delete the message until I've taken it.

The Strattera has been most helpful with my impulse control: impulse spending, impulse eating, the impulse to not exercise, things like that. My concentration and focus is less helped, but I also have thirty years of avoident behaviors to overcome when it comes to that. :) But it's allowing me to learn better control over focus and to create new coping strategies. For example, right now I installed LeechBlock on Firefox and have ten more minutes on AskMeFi before it blocks my access to the site until 3:30 PM. And I can resist the impulse to take LeechBlock off, which is the important part.
posted by telophase at 10:50 AM on July 12, 2010