For decades, the conversation around ADHD treatment has been dominated by one word: Stimulants. Adderall, Ritalin, Vyvanse. While these medications are effective for many — often described as "putting on glasses for the brain" — they are not the only path.

At my practice, I prescribe both stimulant and non-stimulant medications.

Whether due to side effects like insomnia, appetite suppression, and anxiety, a history of substance use, or simply a personal preference for a gentler approach, many families and adults seek alternatives. As a holistic psychiatrist, my goal is to widen the lens. We need to look at the unique neurochemistry of the individual. We must adopt a "top-down view" of your physiology to find the molecule that unlocks your capacity without compromising your well-being.

ADHD is complex. It is not just a dopamine deficit; it involves norepinephrine and the prefrontal cortex's ability to regulate impulses. Non-stimulant medications target these pathways differently, offering a distinct "superpower" of their own: stability without the crash.

Why Choose Non-Stimulants? The "24-Hour" Advantage

Stimulants work fast—often within 30 minutes—but they wear off. This "on/off" cycle can be jarring. You might be focused at work but irritable and scattered by dinner time. Non-stimulants function differently. They take weeks to build up in the system, but once they do, they provide 24/7 coverage.

24-Hour Control: You don’t wake up "unmedicated." The benefits persist into the evening, helping with homework, bedtime routines, and social interactions, which are often neglected by short-acting stimulants.
Anxiety Reduction: Stimulants can sometimes exacerbate anxiety. Non-stimulants, particularly Atomoxetine, often treat comorbid anxiety alongside ADHD.13
Tic Disorders: For children with tics, stimulants can sometimes make them worse. Non-stimulants are the preferred alternative as they do not typically exacerbate tics.

**Ready for concierge ADHD treatment?**

If you have felt cornered by the choice between "stimulants or nothing," know that there are other paths. Let us explore a medication strategy that honors your unique brain chemistry.
Contact Dr. Caroline Fu to schedule a consultation and discover the options available to you.

The Big Three: Evidence and Efficacy

1. Atomoxetine (Strattera)

This is the most well-studied non-stimulant and the first to be FDA-approved for ADHD in adults. It functions as a selective norepinephrine reuptake inhibitor (NRI).

The Mechanism: By increasing norepinephrine availability in the prefrontal cortex, it strengthens the brain's "brakes," improving impulse control and working memory. It essentially improves the signal-to-noise ratio in the brain.
The Evidence: Research confirms significant effectiveness in adults and children. While the effect size (a statistical measure of strength) is generally smaller than stimulants, it is a robust option for those with comorbid anxiety or oppositional behaviors.
My Clinical Take: This is a marathon medication, not a sprint. We must be patient for 4-6 weeks to see the full benefit. It is an investment in long-term stability.

2. Alpha-2 Agonists: Guanfacine (Intuniv) and Clonidine (Kapvay)

Originally developed as blood pressure medications, these drugs work by strengthening the connections in the prefrontal cortex via the alpha-2A adrenergic receptors.

The Mechanism: They essentially "close the noise gates" in the brain, reducing distractibility and emotional reactivity. They improve the functional connectivity of the prefrontal cortex networks.
The "Superpower": These are exceptional for the emotional dysregulation aspect of ADHD—the rejection sensitivity, the quick temper, and the hyperactivity.13 They are less effective for pure "inattention," but excellent for the "driven by a motor" feeling.
Combination Therapy: I often use Guanfacine as an adjunct to stimulants. It smooths out the "edges" of the stimulant, helps with the rebound effect in the afternoon, and can assist with sleep.

3. Viloxazine (Qelbree)

The newest player on the field. Like Atomoxetine, it is a norepinephrine reuptake inhibitor, but it has a potentially faster onset of action and a different side effect profile.

The Evidence: Recent studies show it is effective for both children and adults. It also has some activity on serotonin receptors, which may offer mood benefits, though this is still being explored.
Clinical Nuance: It offers a sprinkle-able capsule option, which is a game-changer for children who cannot swallow pills.

A Systemic Approach to Prescribing

In my concierge practice, I have the time to monitor these medications closely. Non-stimulants require titration and patience. We don't just write a script and say "see you in three months." We partner. We track blood pressure (for Guanfacine) and mood (for Atomoxetine). We navigate the "bottlenecks" of side effects together.

We also discuss the investment — not just financial, but the investment of time in finding the right molecule. I often tell my patients, "We will find a new path." It may take trial and error, but with a top-down view of your physiology, we will find the path forward.

Key Takeaways

24/7 Coverage: Non-stimulants work around the clock, aiding evening and morning function.
Comorbidity Friendly: Excellent for patients with anxiety, tics, or substance use history.
Patience is Key: These medications take time to build up in the system; do not give up too early.

Request an Appointment with Dr. Caroline Fu

Sources

NEW STUDY: Non-stimulant Medications for Adults with ADHD: An Overview, accessed February 3, 2026, https://www.adhdevidence.org/blog/news-tues-6-25-24

Nonstimulant Medications for Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents | Pediatric Annals - Slack Journals, accessed February 3, 2026, https://journals.healio.com/doi/10.3928/19382359-20241007-07

Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis - PMC - PubMed Central, accessed February 3, 2026, https://pmc.ncbi.nlm.nih.gov/articles/PMC6109107/

Evidence Based Treatment of ADHD | UC Davis MIND Institute, accessed February 3, 2026, https://health.ucdavis.edu/mind-institute/resources/understanding-adhd/adhd-treatment

A Potential Natural Treatment for Attention-Deficit/Hyperactivity Disorder: Evidence From a National Study - PMC - NIH, accessed February 3, 2026, https://pmc.ncbi.nlm.nih.gov/articles/PMC1448497/

The Ultimate Guide to Non-Stimulant ADHD Medications