Nonstimulant ADHD medications: How they work, who they’re for, and what to expect

What are nonstimulant ADHD medications?

Nonstimulant ADHD meds are prescription drugs that treat symptoms of attention-deficit/hyperactivity disorder (ADHD) without using stimulant ingredients like dextroamphetamine (Adderall) or methylphenidate (Ritalin).

Both stimulant and nonstimulant ADHD medications work on neurotransmitters in the brain that affect focus and self-control (like norepinephrine and dopamine). The key difference is timing. Stimulants increase dopamine and norepinephrine activity quickly, often within one hour. Nonstimulants work more gradually, affecting brain chemistry over a period of weeks. Both types of medications can provide symptom relief throughout the day, but nonstimulants take a few weeks to start working.

You’ve probably heard more about stimulants for ADHD since they’re generally considered the first-line treatment. A 2018 meta-analysis in The Lancet Psychiatry looked at 133 studies comparing the safety and efficacy of different medications and concluded that stimulants were the preferred treatment option for ADHD (specifically methylphenidate for children and amphetamines for adults).

But that doesn’t mean nonstimulants are a “consolation prize.” For the right person, they’re not just the fallback option but rather the better fit. “We discuss all of the treatment options upfront so clients know what their options are,” explains Kate Hanselman, PMHNP, VP of Clinical Psychiatry at Thriveworks. “There are many reasons why I would recommend trialing a nonstimulant first, and they’ll be tailored to that client’s situation and needs.” We’ll get into those reasons in a bit.

Different types of nonstimulant ADHD medications

Among the nonstimulant medications used for ADHD, some are FDA approved for it, while others are widely prescribed off-label. In general, there are three main options for nonstimulant ADHD meds:

1. Selective norepinephrine reuptake inhibitors (SNRIs): These work by increasing the amount of norepinephrine available in the brain, which can help improve focus, attention, and impulse control. Common side effects can include nausea, decreased appetite, fatigue, and sleep changes. Options include:

• Atomoxetine (Strattera): The most well-established nonstimulant medication with a long track record
• Viloxazine (Qelbree): A newer nonstimulant medication that may be a good fit for people who want a nonstimulant but didn’t respond well to other treatments

2. Alpha 2-adrenergic receptor agonists: These work by calming certain brain signals involved in attention and impulsivity. Common side effects can include sleepiness, dizziness, dry mouth, and low blood pressure. Options include:

• Clonidine ER (Kapvay): May be helpful when hyperactivity or impulsivity occurs alongside sleep difficulties, since it can be more sedating than guanfacine
• Guanfacine ER (Intuniv): May be less sedating than clonidine so it’s helpful for daytime ADHD symptoms

3. Wellbutrin (bupropion): An antidepressant sometimes used off-label for ADHD. It is not FDA-approved for ADHD and is usually considered after other nonstimulant medications.

When asked how she chooses between nonstimulants, Hanselman points to three factors: “Tolerability, efficacy, and the person’s history. If they’ve tried a nonstimulant before and it was effective, we’ll likely start there, whereas if they tried a certain nonstimulant and it wasn’t effective or tolerated, we’ll start elsewhere.”

How to know if a nonstimulant ADHD medication is right for you

There are a number of reasons why you or your provider might consider a nonstimulant option, including:

ADHD isn’t your only mental health concern. Stimulants can sometimes intensify symptoms of other mental health conditions, like anxiety or bipolar disorder. Nonstimulants like atomoxetine and guanfacine can improve ADHD symptoms without affecting other mental health conditions.

You have a history of substance abuse or are in recovery. Stimulants are controlled substances with a high potential for abuse. For someone in recovery, a nonstimulant removes that risk factor entirely. This isn’t about distrust. It’s about a treatment plan that supports your recovery rather than complicating it.

You’re having trouble with the side effects. Stimulant side effects can include appetite loss, insomnia, jitteriness, emotional blunting, or rebound crashes. If stimulants helped you focus but created new problems, a nonstimulant may give you a better balance.

The stimulant shortage is affecting your access. The ongoing shortage of stimulant medications has left many people unable to reliably fill their prescriptions. Switching to a nonstimulant can prevent interruptions to your treatment.

Your provider recommends it based on your full clinical picture. Factors like blood pressure, heart conditions, sleep disorders, tic disorders, or your overall medication regimen may be reasons to consider a nonstimulant.

Opting for a nonstimulant option really depends on a variety of factors, says Hanselman, including “each person’s symptoms, needs, tolerance for certain classes of medications, and perhaps medical history or other medications’ risk for interaction.”

There’s also a surprising practical reason behind some people’s preference for nonstimulant medications, Hanselman says: “Nonstimulants can have a 90-day prescription while stimulants require 30-day prescriptions and a higher frequency of visits.”

What to expect when you start a nonstimulant ADHD medication

It can take up to two months to feel a difference

Unlike stimulants, which often produce noticeable effects with the first dose, nonstimulant ADHD meds need to build up in your system gradually. The typical timeline is four to eight weeks at the right dose before you’ll experience the full benefit. What does it feel like in the meantime? Not much. And that’s the hard part.

During the first two to three weeks, you might notice subtle changes. You may be slightly less reactive, or your sleep may improve a bit, but you probably won’t feel a clear “on” switch. This can be discouraging, especially if you’ve taken a stimulant before and remember how immediate the effect was.

Hanselman tries to prepare patients for this upfront: “If their expectation is for the immediate effect that stimulants can provide, I let people know it may take some time to be effective.”

The shifts may be subtle at first

How can you tell if your nonstimulant medication is actually working? Instead of waiting for a dramatic change, try tracking specific, concrete behaviors. Are you completing more tasks at work? Following through on conversations? Feeling less overwhelmed by your to-do list? These gradual shifts are signs the medication is doing its job.

Side effects are possible

While you won’t get the jitteriness that tends to accompany stimulant medications, nonstimulant medications can still come with unpleasant side effects. These differ depending on the type of medication but can include nausea, fatigue, dizziness, and changes in sleep or appetite, among others. Hanselman notes that these should go away as you adjust to the medication, but if they’re too unpleasant you can talk to your provider about making a change.

How to switch from a stimulant to nonstimulant medication

If you’re transitioning off a stimulant, your provider will typically start the nonstimulant while gradually reducing your dose of the stimulant. There may be a brief period when you take both medications at the same time.

During this time, it’s normal for your ADHD symptoms to feel worse. This is the gap between stopping a fast-acting medication and waiting for a slower one to reach full effect. Knowing this gap exists ahead of time often makes it easier to get through.

Hanselman approaches this like any other medication change: “We can take it as slowly as the client needs for tolerability. If there’s a gap, they may see a return of previous symptoms, so we discuss how to use their tools to manage this during that time.”

The hardest part for patients is usually distinguishing a rough transition from a medication that simply isn’t going to work. “Because nonstimulant medications take a while to start working, it’s worth reassessing with your provider if you still aren’t feeling better after a month or two,” Hanselman says.

Can you take a nonstimulant with a stimulant?

Yes, and this is more common than most people realize. Combination treatment, using a stimulant and a nonstimulant together, can make sense when a stimulant helps during the day but doesn’t cover everything.

For example, a provider might pair a stimulant with guanfacine to address residual impulsivity or evening hyperactivity that the stimulant doesn’t reach. Or they might add atomoxetine to extend focus into hours when a stimulant has worn off. Research supports the use of certain combinations when managed by a prescriber.

But this shouldn’t be a DIY decision—combination treatment requires careful dose adjustments and monitoring by your provider. Still, it’s worth knowing the option exists if one medication isn’t fully addressing your symptoms.

How to talk to your provider about nonstimulant ADHD medications

If you’re curious about trying a nonstimulant option, here are some questions worth asking your provider:

• Given my medical history [anxiety, heart condition, substance abuse history, sleep issues, etc.], would a nonstimulant be a better starting point than a stimulant?
• What should I track over the next few weeks to know if this is working?
• What’s the plan if this medication doesn’t help after six to eight weeks?
• Would combination treatment make sense for me?

If you’ve already tried a stimulant, describing your experience in detail can help your provider make a better decision. That might look like:

• I’m still experiencing these specific symptoms even on my current dose…
• My focus improved, but I can’t sleep and my anxiety is worse.
• I’ve been unable to fill my stimulant prescription for three months.

A good ADHD medication conversation should feel collaborative, not rushed. Your provider should take the time to explain their reasoning and involve you in the decision. If you’re looking for that kind of care, ADHD treatment at Thriveworks may be a good fit.

Frequently asked questions (FAQs)

What is the most effective nonstimulant ADHD medication?

There isn’t one single nonstimulant that is more effective for ADHD. Atomoxetine (Strattera) has the most research behind it and is often considered the first-choice nonstimulant. Viloxazine (Qelbree) is newer but also FDA-approved for ADHD. Your provider can help you determine the right medication for you.

How long does it take for nonstimulant ADHD meds to work?

Most take four to eight weeks to reach the full effect. You may notice subtle changes in sleep and reactivity in the first two to three weeks, but meaningful symptom improvement typically takes longer. This is one of the biggest adjustments for people switching from stimulants.

Are nonstimulant ADHD meds controlled substances?

No. Unlike stimulants, nonstimulant ADHD medications are not controlled substances. They don’t carry the same prescribing restrictions, which makes them easier to access and a common choice for people in recovery or those affected by the ongoing stimulant shortage.

Can nonstimulant ADHD meds make ADHD worse?

No, but the four- to eight-week onset period might feel that way, especially if you’re transitioning off of a stimulant. What feels like worsening symptoms is often the gap between stopping a fast-acting medication and waiting for a slower one to start working. If symptoms feel significantly worse or new symptoms appear, contact your provider.

Do nonstimulant ADHD meds work for adults?

Yes. Atomoxetine and viloxazine are both FDA-approved for adults. Guanfacine and clonidine are approved for children and adolescents but are sometimes used off-label in adults. Bupropion is another off-label option used fairly commonly in adults, particularly in those also experiencing depression.

What are the side effects of nonstimulant ADHD meds?

Side effects vary by medication, but common ones include nausea, fatigue, decreased appetite, and sleep changes. Atomoxetine and viloxazine both carry FDA boxed warnings for an increased risk of suicidal thoughts and behavior (in children and adolescents for atomoxetine, and in both children and adults for viloxazine). Discuss this with your provider before starting. Unlike stimulants, nonstimulants don’t typically cause jitteriness or rebound crashes.

Can I take a nonstimulant with a stimulant?

Yes, and it’s more common than most people realize. Providers sometimes combine a stimulant and a nonstimulant when a stimulant helps during the day but doesn’t cover everything, like residual impulsivity, evening hyperactivity, or hours when the stimulant has worn off. Combination treatment requires careful dosing and monitoring by your provider.