Stimulant vs. nonstimulant ADHD medications: Which is better for you?

ADHD, or attention-deficit/hyperactivity disorder, is one of the most common neurodevelopmental disorders. People living with ADHD may have trouble paying attention, controlling impulsive behaviors, and can also be hyper, or overly active. (Keep in mind these aren’t the only symptoms.). If you have an ADHD diagnosis or suspect you might have ADHD, it’s reassuring to know that there are effective treatments out there, including medication. Remember, it's important to have a conversation with a mental health professional to explore the available options and find the approach that works best for you.  

There are two main categories of ADHD medication: stimulants and non-stimulants. They have both been FDA-approved to help manage your symptoms and come with their own risks, benefits, and side effects. In this article, we'll break down how these medications work, provide some common examples, and share important questions to ask your doctor when discussing medication options.  

Stimulant medications for ADHD

Stimulants are the most common type of prescription medication that health care providers use to treat ADHD. They work by increasing the levels of certain chemicals—known as neurotransmitters—in the brain. Neurotransmitters are the body’s chemical messengers, carrying signals from nerve cells to other cells in the body. Stimulants work on two neurotransmitters in particular—dopamine and norepinephrine—which play important roles in your ability to pay attention, think, and stay motivated.  

By elevating your brain’s levels of dopamine and norepinephrine, stimulants help you manage ADHD symptoms like short attention span, impulsive behavior, and hyperactivity. In fact, studies show that these drugs improve ADHD symptoms in about 70% of adults and up to 80% of children.

Stimulants are considered to be controlled substances. That means the federal government regulates their production and use because of their potential for abuse. Some states have laws restricting how much of a controlled substance you can receive at a time (and whether you can be prescribed them via telehealth), which means you may not be able to get more than a 30-day supply before requesting a refill.  

Types of stimulant medications  

There are a few ways to classify stimulant medications. The first is by their chemical formulation. Stimulants can be either methylphenidate-based or amphetamine-based. Both types of medications work by increasing the levels of dopamine and norepinephrine, as mentioned above.  

Another way to categorize stimulant medication is by how they release active ingredients into your body.

Immediate-release stimulants are short-acting, which means they kick in quickly and you’ll take them “as needed” throughout the day. Your doctor might suggest this type of medication if you want quicker relief from symptoms and flexibility over how and when you take your medication.  

Unlike immediate-release stimulants, extended-release medications are typically taken once in the morning each day. They are formulated to release their active ingredients over an extended period, usually over the course of 8-16hours. The doctor might suggest this type of medication if you’re interested in long-lasting symptom control without needing to remember to take multiple doses throughout the day; extended-release stimulants are a convenient option.  

Examples of ADHD stimulant medications:  

• Ritalin (methylphenidate hydrochloride). Ritalin is an immediate-release methylphenidate-based medication that provides rapid symptom relief. Typically, Ritalin is taken multiple times throughout the day, ideal for those who want flexibility in dosage adjustments to meet their varying schedule and needs.   ‍
• Concerta (methylphenidate). Concerta is an extended-release methylphenidate-based medication. This means that it only requires one daily dose that offers a consistent and sustained effect throughout the day.  ‍
• Adderall (amphetamine/dextroamphetamine salts). Adderall is an amphetamine-based medication available in both immediate and extended-release forms. The extended-release form is known as Adderall XR, and works like other extended-release medications.  ‍
• Vyvanse (lisdexamfetamine). Vyvanse is an extended-release amphetamine medication that is taken once daily. It has a lower potential for misuse and abuse.

Related article: Managing Adderall and anxiety

Side effects  

Choosing the right medication always comes down to striking a balance between its benefits and side effects. Like all medications, stimulants that treat ADHD have them, too. Some are mild and improve over time, while others do not. Because of their effectiveness at managing ADHD symptoms, it’s important to talk about the potential side effects as well as the benefits of these medications with your provider.  

Common side effects of stimulant medications include:

• Insomnia and sleep issues: Stimulant medication can disrupt your sleep patterns, making it difficult to fall or stay asleep.  
• Loss of appetite: When taking these medications, some people find a decrease in appetite that can lead to weight loss.  
• Increased heart rate and blood pressure: These medications are known to elevate heart rate and blood pressure. Depending on your medical history, your provider may order an electrocardiogram (EKG) screening to avoid complications involving an undetected heart rhythm issue.  
• Nervousness or anxiety: Especially at higher doses, stimulants can lead to anxious or nervous feelings and irritability.  

Rare but serious side effects of stimulants can include:

• Sudden cardiac death
• Seizures
• Addiction  
• Psychosis

Make sure to chat with your doctor with any concerns you have. They can help you understand more about what to expect when you take ADHD medications.

Potential risks of stimulants  

The potential risks associated with stimulant medications are primarily related to the dangers of addiction –including tolerance, dependence, and withdrawal—when it comes to controlled substances due to their stimulating effects. Immediate-release stimulant medication also has a higher risk for abuse because you will feel the effects of the medication almost immediately, even if you don’t have ADHD. Your healthcare provider can help you find the safest most effective treatment for you, and help keep an eye on your usage and how you’re doing.  

Non-stimulant medications for ADHD

Non-stimulant medications are prescription medications, but they are not controlled substances like stimulants. That means you are less likely to misuse them or become dependent on them. Most non-stimulants work by increasing levels of norepinephrine, though some medications, like Wellbutrin (bupropion) affect your dopamine levels and can also be beneficial in treating ADHD.

The main reason your doctor may prescribe non-stimulants instead is because of concerns about using a stimulant and its side effects, or because stimulants are not readily available. However your doctor may also suggests pairing both to increase effectiveness.

Examples of non-stimulant ADHD medications:  

• Strattera (atomoxetine): Strattera comes in capsules taken once daily. It’s suitable for children ages 6 and up, and also used off-label to treat comorbid depression and ADHD.
• Qelbree (viloxazine): Qelbree is typically taken once daily and comes in the form of an extended-release tablet. It’s suitable for children ages 6 and up.
• Intuniv (guanfacine): Intuniv is an extended release tablet taken once a day.
• Kapvay (clonidine): Kapvay is an extended release tablet taken once or twice a day.

Side effects  

Non-stimulant ADHD medications have a reduced risk of dependence and abuse, but they still have some side effects to consider as well. These can vary based on the specific medication, but may include:  

• Drowsiness: It’s common to feel tired on these medications, especially when you first start taking it. You may take them at bedtime to minimize this effect, but talk to your doctor about possible options as well.  
• Dizziness: You may experience dizziness on these medications, especially if you happen to stand up too quickly. To minimize this risk, you will want to rise slowly from a seated or lying position.  
• Dry mouth: Some people report feeling like their mouth is dry when taking non-stimulant medications. You can help manage this side effect by staying well-hydrated and using sugar-free lozenges or chewing gum.

Benefits of stimulant and non-stimulant ADHD medications

Stimulant medications can help manage symptoms of ADHD in both children and adults. When used as directed, many people with ADHD experience significant improvements in attention, focus, and impulse control when taking these medications properly.  

Non-stimulant medications can help do the same and are just as effective treatment. They may be a better treatment choice for some people, especially as there is a lower potential for someone to abuse this type of medication. Non-stimulants don't work as rapidly as stimulants, and It can take several weeks of consistent use to feel the full effects of these medications and your healthcare provider will help guide you through the process and make any adjustments to help you find the right dose.  

Comparing ADHD medications  

It’s important to understand the differences between stimulants and non-stimulants when, with the help of a professional, you start to consider which might be right for you.  

Can you change from one type of medication to the other?

Landing on the right medication can take time. If you find that a medication prescribed by your doctor isn't working or comes with intolerable side effects, discuss it with your doctor. Switching between stimulant and non-stimulant medications is possible and permitted, and it’s best done under the care and guidance of a mental health professional. Other reasons your doctor might change your ADHD medication aside from you not responding to it effectively might be because potential interactions with other medications you’re taking, or there could be issues with the availability of the drug. For example, there is currently a national shortage of stimulants, whcih make non-stimulants a popular (and effective) option today.

To learn about stimulant and non-stimulant medications for ADHD, check out: Wellbutrin vs Adderall

Which ADHD medication is more effective?  

When it comes to choosing between taking a stimulant or non-stimulant medication to manage your ADHD symptoms, your psychiatrist will consider your unique situation and medical history. Remember that not everyone responds to medication the same way. There’s no one-size-fits-all medication, which is why it’s so important to work with a qualified mental health professional when starting (or changing) a medication.  

When you speak a psychiatrist, here are some questions you should ask to better understand both types of ADHD medications:

• How does this medication work?
• What are the common side effects?
• What are more serious side effects?
• What is the dosage of the medication?
• How often should I take these medications?
• How soon should I expect to see a lessening of my symptoms?  

If you’re looking for someone to talk to about your ADHD consider Talkiatry. We’re a national psychiatry practice that specializes in mental health conditions like ADHD. To get a personalized treatment plan and learn more about whether stimulants or non-stimulant medication could work for you, fill out a quick online assessment. You can get matched with a psychiatrist and schedule your first appointment within days.  

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.