Stimulants (enhance arousal in the prefrontal cortex)
| Drug |
Mechanism of action |
| Methylphenidate (Ritalin, Methylin, Focalin) |
Inhibits presynaptic dopamine transporters and, to a smaller extent, norepinephrine transporters in central adrenergic neurons; increases dopamine and NE concentrations in the synaptic cleft |
| Amphetamine (Adderall, Evekeo, Dexedrine etc.) |
Competitive inhibitor of dopamine and NE reuptake by acting directly at dopamine transporter and norepinephrine transporter binding sites; stimulates peripheral alpha and beta receptors |
Non-stimulants
| Drug |
Mechanism of action |
| Atomoxetine |
Selective norepinephrine reuptake inhibitor; increases norepinephrine and dopamine concentrations in the prefrontal cortex. Lacks abuse potential. Increases suicide risk; may cause decreased appetite, nausea, vomiting, diarrhea, fatigue, mood swings, dizziness, insomnia, liver damage, and QTc prolongation. 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. Use caution when prescribing to patients with cardiovascular disease, hyperthyroidism, or hypertension.
