Stimulants (enhance arousal in the prefrontal cortex)
| Drug |
Mechanism of action |
| Methylphenidate (Ritalin, Methylin, Focalin) |
Inhibits presynaptic dopamine, and norepinephrine (to a smaller extent), transporters of central adrenergic neurons; increases the concentration of dopamine and NE in the synaptic cleft |
| Amphetamine (Adderall, Evekeo, Dexedrine etc.) |
Competitive inhibitor of dopamine and NE, acting directly on dopamine transporter and norepinephrine transporter binding sites; stimulation of peripheral alpha and beta receptors |
Non-stimulants
| Drug |
Mechanism of action |
| Atomoxetine |
Selective norepinephrine reuptake inhibitor, which causes increased concentrations of norepinephrine and dopamine in the prefrontal cortex. Lacks abuse potential. Increases suicide risk, may cause decreased appetite, nausea, vomiting, diarrhea, fatigue, mood swings, dizziness, insomnia, liver damage, prolongation of QTc. Contraindications similar to stimulants |
| Other medications |
Clonidine and guanfacine are alpha 2 agonists |
Adverse effects of stimulants include decreased appetite, nausea, weight loss, sleep disturbances, headache, tics, increased heart rate and blood pressure, irritability, seizures, psychosis, euphoria, mania and depression. Stimulants may be abused. Stimulants are contraindicated with MAOIs and in glaucoma. Caution should be used while prescribing in patients with cardiovascular disease, hyperthyroidism and hypertension.
