🔄 Switching ADHD Medications: From Stimulants to Non-Stimulants

Post 4 in the Series: Safer Psychiatry
By Dr. Srinivas Rajkumar T, Consultant Psychiatrist

🎯 The Question Many Parents Ask

“My child is on methylphenidate. Is there a safer option?”
“I’m worried about appetite loss, sleep issues, and long-term effects.”
“Are there non-stimulant medications for ADHD?”

Yes—there are.

While stimulant medications like Methylphenidate (Addwize, Concerta, Inspiral) are very effective, they:

• Fall under Schedule X in India

• Require strict regulation and monitoring

• May cause side effects like reduced appetite, insomnia, tics, or anxiety

• Raise concerns in cases with family history of addiction, heart issues, or emotional sensitivity

In such cases, switching to non-stimulant ADHD medications can be a safer and more sustainable strategy.

🧠 When to Consider a Switch

You might explore non-stimulant options if:

• Your child/adolescent has trouble eating or sleeping

• There are emotional side effects (irritability, mood swings)

• There’s co-existing anxiety or OCD traits

• You have concerns about dependency or misuse

• You’re looking for longer-term maintenance without legal complexity

✅ Non-Stimulant Medications for ADHD in India

1. Atomoxetine (Brand: Attentrol)

• First-line non-stimulant

• Works on norepinephrine, not dopamine

• Helps with inattention, impulsivity, emotional regulation

• Once-daily dosing (morning or night)

• Common side effects: mild nausea, fatigue (settle over time)

💡 Especially helpful when ADHD overlaps with anxiety or mood symptoms.

2. Clonidine / Guanfacine (Off-label use)

• Helpful in hyperactive/impulsive ADHD, especially in younger children

• Also supports sleep and emotional calming

• Often used at night due to its sedating properties

• Needs regular BP and heart rate monitoring

💡 Excellent option for kids who are “restless by day, sleepless by night.”

3. SSRIs + Skill Training (in selected cases)

• If attention issues are secondary to anxiety or depression

• SSRIs (like escitalopram or fluoxetine) + executive function coaching/therapy may help

• Not a replacement for core ADHD symptoms—but valuable in mixed presentations

🧠 How I Plan the Switch (Sample Timeline)

If a patient is on Addwize 10 mg twice daily and has appetite loss and poor sleep:

1. Introduce Atomoxetine 10 mg at night for a week

2. Titrate slowly to 18–25 mg based on weight/symptom response

3. Gradually taper methylphenidate over 1–2 weeks

4. Review weekly with parent/school feedback

5. Add behavioural strategies + structure coaching

📊 Outcome: More consistent focus, better appetite, no legal/pharmacy hassles

👨‍⚕️ Why Consult a Psychiatrist for This?

Because ADHD is not just a medication condition. It affects learning, emotions, habits, family dynamics—and managing it well needs expertise.

As a Consultant Psychiatrist based in Chennai (Apollo Clinics, Velachery & Tambaram), I provide:

• Customized ADHD treatment plans

• Guidance on when and how to taper stimulants

• Monitoring for side effects, emotional changes

• Support with school strategies and home routines

📞 Call 8595155808 for appointments
🌐 Online consults available across India

📌 Summary

Stimulants are powerful—but not always necessary for everyone with ADHD.
Non-stimulant medications, used with structure, sleep, and emotional support, can offer an equally effective, safer path—especially for long-term management.

🧾 Next in the Series:
“Responsible Psychiatry: Balancing Effectiveness with Safety” — A Message for Clinicians and Caregivers