ADHD Medications Available in New Zealand Part 2: Non-Stimulants
Non-stimulant medications can be used as an alternative to stimulant medications for people who cannot tolerate stimulants due to side effects or other medical conditions, or for people with drug-use issues. Non-stimulant medications may also be used in combination with stimulant medications to enhance the effects of treatment. All the medications below are less effective than stimulants for most people, but this is a bit of an unfair comparison because stimulants are the most effective of all psychotropic medications.
Non-stimulant options include FDA-approved ADHD medication, as well as some antidepressants. As with ADHD stimulant drugs, there are more options in the US than there are here in New Zealand, so just the New Zealand options you are most likely to encounter are reviewed below
Good evidence for use with ADHD (second-line medication):
Atomoxetine (Strattera): This medication is a norepinephrine (noradrenaline) reuptake inhibitor, which means that it increases available norepinephrine in the brain. Norepinephrine can be converted in the brain to dopamine and vice versa. It may take several weeks to see the full effects of atomoxetine, like an antidepressant medication. It is effective for around 50% of people and is less well tolerated than stimulants (it has more side effects). In New Zealand, drug prescribing regulations require atomoxetine not to be taken concurrently with stimulant meds long-term. I think this is a shame as some studies have found that co-therapy can allow for a lower amount of stimulant to be taken, thus reducing stimulant side effects.
Clonidine: This medication is an alpha-agonist medication used primarily to treat high blood pressure. It works by activating alpha-2 adrenergic receptors, which causes blood vessels to relax and reduces blood pressure. It is believed that clonidine's effect on these receptors in the brain can also trigger the release of norepinephrine. Clonidine will often be used in addition to stimulant medication. We only have the shorter-acting version of this drug available in New Zealand, and we do not have its cousin, guanfacine, which is also effective for ADHD. Clonidine is effective for around 55%-60% of people.
Atomoxetine may be prescribed in place of stimulant medication in people with a recent history of illicit drug use, or people with a history of selling drugs. This is because it is not a drug that is abused and has no street value. Atomoxetine does not require a special authority code as stimulant medications do, but I suspect you would be unlikely to find a GP who would prescribe it for ADHD without an assessment performed first.
Antidepressant medication (third-line medications):
Bupropion is a medication that is primarily used as an antidepressant, but it has also been found to be effective in treating ADHD. Bupropion is believed to work by increasing the levels of dopamine and norepinephrine in the brain.
Venlafaxine belongs to a class of medications called serotonin-norepinephrine reuptake inhibitors (SNRIs), which work by increasing the levels of serotonin and norepinephrine in the brain. These neurotransmitters are involved in regulating mood, anxiety, and attention, among other functions. While some studies have suggested that SNRIs like venlafaxine may have some benefits for managing ADHD symptoms, the evidence is limited and inconsistent.
It is worth talking to your GP if you have an ADHD diagnosis and need an antidepressant, as one of the above antidepressants may help both ADHD symptoms and depression and anxiety. I have seen these medications work really well in a few clients with ADHD for whom previous medications (usually SSRIs) have produced less than favourable results, and some unpleasant side effects. Your GP may need or want to request some guidance from the adult mental health service around antidepressant recommendations for a person with ADHD.
For an informative article that contains the above medications as well as ones not available in New Zealand, click here.