Pharmacologic alternatives to psychostimulants for the treatment of attention-deficit/hyperactivity disorder

Alternatives to psychostimulants are now a routine part of the pharmacologic treatment of ADHD. Bupropion and most tricyclic antidepressants are sound options for managing core behavioral symptoms and, to some extent, cognitive symptoms. Alpha 2 adrenergic agonists can moderately reduce hyperactivity and impulsivity. Certain effective agents, such as desipramine, carbamazepine, neuroleptics, monoamine oxidase inhibitors, are clinically inadvisable in most cases. Lithium, benzodiazepines, antihistaminic sedatives, and buspirone are potentially detrimental. Venlafaxine and beta-adrenergic blockers seem potentially promising. Significant new options include norepinephrine reuptake inhibitors, such as reboxetine and tomoxetine, and possibly selective dopamine agonists. Central anticholinesterases, such as donepezil, may improve core ADHD symptoms and perhaps some associated features that psychostimulants do not--particularly organizational capacity and possibly other executive functions. The potential for bupropion to treat amotivational features should be investigated.