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Many people find that they have more noticeable side effects with amphetamines, while methylphenidate may cause fewer physical side effects, says Ditzell.
Ongoing anxiety, significant increases in blood pressure, severe irritability, and sleep problems that interfere with your daily life warrant a visit with your healthcare provider. You may need a dose adjustment or a different medication altogether, says Larson.
Because stimulants can be habit-forming, any signs of misuse or dependence should be discussed with your doctor right away, says Ditzell. Seek immediate medical attention if you experience serious side effects, such as chest pain or shortness of breath.
Unlike stimulants, nonstimulants take about two to six weeks to start working, but they provide more steady, 24-hour coverage, rather than a sharp on-and-off effect, says Barbara Sparacino, MD, a triple board-certified psychiatrist based in Miami. These medications gradually increase norepinephrine levels and may be an option if stimulants aren’t working well or are causing unwanted side effects, she says.
And because they have a long, steady effect, nonstimulants don’t usually cause the rebound effects, like irritability or exhaustion, that some people feel when stimulants wear off, says Dr. Sparacino. You may still feel tired at the end of the day, but it tends to be a more natural fatigue, rather than a sudden crash, she adds.
Atomoxetine and viloxazine can improve your ability to start tasks, stay focused, and block distractions, says Sparacino. Guanfacine ER and clonidine ER are often used to manage impulsive reactions like blurting or snapping.
Larson notes that guanfacine ER and clonidine ER are officially approved for ADHD in children ages 6 to 17, but in adults they’re sometimes prescribed off‑label when stimulants aren’t a good option.
Talk with your healthcare provider if side effects are persistent and bothersome, or if you notice significant changes in mood, like new or worsening depression or agitation, says Sparacino.
Some people experience increased irritability or depressive symptoms while taking atomoxetine, says Larson. Any persistent worsening of mood or suicidal thoughts means it’s time to talk to your healthcare provider.
Larson also notes that atomoxetine carries a rare risk of liver damage, which may appear as yellowing of the skin or dark urine, and it should be stopped right away if these symptoms occur.
“People with complex medical or mental health histories should work closely with a prescriber who can choose the safest medication and monitor symptoms over time,” says Sparacino.
Some medications, including antidepressants, are prescribed “off-label” when standard treatments don’t work well, aren’t tolerated, or when someone has ADHD along with conditions like depression or anxiety, says Larson.
“‘Off-label’ doesn’t mean ‘experimental with no evidence.’ It simply means the medication isn’t approved [by the U.S. Food and Drug Administration] for ADHD specifically, even if there’s decent data and experience supporting its use in some cases,” explains Sparacino.
The most common off-label option for ADHD is bupropion (Wellbutrin), says Dr. Stone. It’s an antidepressant that can help with focus, motivation, and co-occurring depression, and it’s often used when someone wants a single medication to address both depression and ADHD, explains Sparacino. Bupropion may also be combined with stimulants to extend their effect.
Ditzell notes that nonmedication tools such as cognitive behavioral therapy, coaching, mindfulness, exercise, and good sleep habits can also help manage ADHD symptoms.
When starting a conversation about ADHD medication with a healthcare provider, Sparacino recommends being as specific as possible about what daily life and your workday look like. Instead of saying “I’m distracted,” try describing the patterns you notice, such as missed deadlines, losing track of time, constantly switching tasks, feeling overwhelmed, or hitting a wall every afternoon.
It’s also important to share your health history, including past medications, family history, substance use, and any supplements you’re taking. Sparacino suggests using the questions below as a starting point when talking with your healthcare provider:
Still, finding the right ADHD medication is a collaborative process, says Sparacino.
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