Combining a stimulant with a non-stimulant optimizes ADHD symptom management for some people.
A study by Tim Wilens, M.D., and colleagues followed children and teens who were treated for ADHD with the non-stimulant medication atomoxetine, a selective norepinephrine reuptake inhibitor . The children’s symptoms significantly improved; their ADHD rating scale scores dropped from a 34 to a 21. However, 21 is still quite a high level of symptoms. I want all symptoms on the ADHD rating scale to be mild or minimal, on average, which means achieving a score under 18.
How and when to make the switch depends on the patient. It’s important to note you don’t have to go cold turkey on the stimulant. Quite often, there’s an overlap. Sometimes, I layer on the non-stimulant and give it time to start working. That led some colleagues and I to investigate the efficacy of viloxazine, an SNRI which also has some serotonin effects, in patients who had previously used stimulants. For adults with ADHD who had previously used a stimulant, we saw significant improvement in ADHD symptoms on viloxazine, which is sold under the name brand
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