With the exception of Strattera, most other nonstimulant medications are generally considered second-line medications for ADHD, and tend to be used in children who either had a poor or bad response to stimulants, couldn't tolerate the side effects, or who have coexisting psychiatric conditions that rule out taking stimulant drugs.
A Warning about Antidepressants
Though the picture is not clear, keep in mind when considering the use of antidepressant medications that suicidal thinking has been found be a relatively rare side effect in children and adolescents in at least some studies. This does not mean that these medications should not be used at all, though in reality they are rarely used for treating ADHD in children and adolescents. A risk-versus-benefit approach based on your child's specific needs and treatment history is highly recommended. Work with your physician to monitor any negative side effects, including any aberrations in thinking and behavior.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Prescribed for depression, anxiety, and obsessive-compulsive disorder as well as for controlling anger and aggression, SSRIs are most useful in alleviating coexisting symptoms of conditions accompanying ADHD. They work primarily by eliminating serotonin from the brain's synapses, though they may affect other neurotransmitters to a lesser degree as well.
Popular SSRIs include Prozac, the oldest SSRI, with a long half-life but many known drug interactions; Luvox, which is similar to Prozac but has a shorter half-life and fewer drug reactions; Paxil, a short-acting SSRI which may pose problems with dosing and discontinuation syndrome; and Zoloft, another short-acting SSRI which may also offer some of the benefits of stimulant drugs.
SSRIs have a variety of side effects, many of which are mild or which affect a small percentage of people. The most troublesome side effects may include weight gain, drowsiness, irritability, and thinning hair or hair loss.
Other SSRIs sometimes prescribed to children with ADHD include Celexa and Lexapro. Both have longer half-lives than other SSRIs except Prozac, and fewer drug reactions than most SSRIs as well. Lexapro, which is similar to Celexa, is often preferred by patients and physicians because it is more potent and has fewer side effects.
Serotonin/Norepinephrine Reuptake Inhibitors
These antidepressants have an impact on the levels of both serotonin and norepinephrine, and are useful in treating depressing, anxiety, and ADHD. However, they generally don't offer the symptom relief of stimulant drugs, and are often prescribed when stimulant drugs don't work, or in addition to stimulant drugs.
One widely prescribed drug in this category is Effexor, which seems to stimulate energy as well as lead to a calming feeling.
Although there are no controlled studies on the use of Effexor in children with ADHD, several noncontrolled studies indicate that it may be especially helpful in treating ADHD with co-existing depression and/ or anxiety. However, side effects of higher doses may increase blood pressure, and sudden discontinuation of Effexor could lead to nausea and vomiting.
Another popular drug in this category is Remeron, which works on serotonin, norepinephrine, and histamine to promote sleep, increase energy, and increase appetite. However, one major side effect is a dramatic increase in appetite, and a constant craving for carbohydrates. Everything else being equal, Remeron can be a great medication for your child if he is small or has a poor appetite. But if your child is already overweight, Remeron could make it even harder for him to shed unwanted pounds, and, in fact, could lead to him gaining even more.
Tricyclic Antidepressants (TCAs)
Tricyclic antidepressants (TCAs) the first medications devel-oped to treat depression, work by inhibiting serotonin and norepinephrine reuptake significantly.
TCAs have negligible risk of abuse, and are especially benefi-cial when treating children with ADHD who also have co-existing anxiety and depression. On the down side, it may take several weeks for these drugs to have a full clinical effect, and TCAs gener-ally don't offer the relief of stimulants.
TCAs prescribed for ADHD include Elavil, Sinequan, and Nor-triptyline, all of which have sedating qualities (Elavil has the strongest sedation qualities, while Nortriptyline has the least).
Another TCA, Norpramine, has proven beneficial in children with ADHD when given in small doses. Anafranil, another TCA, has an impact on serotonin levels and is often prescribed for children with ADHD who also suffer from compulsive disorders.
Side effects of TCAs range from sleepiness and constipation to light-headedness and dry mouth, although more serious conditions include cardiac problems, and possible death by overdose.