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Why do we need non-stimulant options?
There are many reasons why we need non-stimulant options for treating ADHD in adults.
1. Stimulants don’t work in all patients
2. Some patients may need another treatment to be added to a stimulant because of incomplete response
3. In some patients, comorbid illnesses like bipolar disorder, may suggest that we should first use an alternative treatment.
4. Comorbidity may be present that may make us prefer alternative medications in order to treat both disorders with the same medication (e.g., depressive disorders, anxiety disorders)
5. Some patients may not be able to tolerate stimulants
6. Some patients may be an increased risk of abuse or diversion of stimulants
What are our pharmacological options?
Atomoxetine is the only FDA-approved non-stimulant for ADHD as of July 2017.
Supported by at least two randomized, controlled clinical trials by at least two different research groups
Supported by at least one randomized, controlled clinical trial
Other antidepressants (venlafaxine, paroxetine, nomifensine, reboxetine, duloxetine)
Buoli M, Serati M, Cahn W. Alternative pharmacological strategies for adult ADHD treatment: a systematic review. Expert Rev Neurother. 2016;16(2):131-44. Review. PubMed PMID: 26693882.
Spencer T, Biederman J, Wilens T. Nonstimulant treatment of adult attention-deficit/hyperactivity disorder. Psychiatr Clin North Am. 2004 Jun;27(2):373-83. Review. PubMed PMID: 15064003.
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