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The patient is a 9-year-old male who has been diagnosed with ADHD with symptoms of hyperactivity and inattention. I will be discussing the cons of using non-stimulant medications in the treatment of this patient. Currently, only two non-stimulant medications have been approved by the FDA for the treatment of ADHD including Strattera (atomotexine) and Qelbree (Viloxazine) (Cojucaru et al., 2021). Other classes of medications have also been used in the treatment of ADHD including tricyclic antidepressants, non-tricyclic antidepressants, specific norepinephrine reuptake inhibitors, and alpha-2 noradrenergic agonists among others (Idrees et al., 2022). Mechanism of Action of Non-stimulants Non-stimulants work by increasing the levels of norepinephrine and dopamine in the CNS. Strattera for example, inhibits the reuptake of norepinephrine in the presynaptic norepinephrine transporter and also inhibits the reuptake of dopamine in different regions of the brain for example, the prefrontal cortex (Idrees et al., 2022). This leads to an increase in norepinephrine and dopamine levels in the brain. Advantages or Disadvantages of Non-stimulants Non-stimulants are selected as a treatment for ADHD for patients who may have other conditions such as tic disorders, are taking other medications, have experienced side effects from stimulants that they could not tolerate, or whose symptoms have not improved with stimulants (Cojocaru et al., 2021). Their advantages is that they can be effective in controlling the symptoms of ADHD, they have lower risk of dependency and abuse, they are longer acting, they have less stringent regulations, and they ca be prescribed for children with different conditions (Cojocaru et al., 2021; Idrees et al., 2022). On the other hand, their disadvantage is that they take longer, up to 3-4 weeks of continuing use to feel the effects, their side effects may be intolerable such as upset stomach, reduced appetite, nausea, vomiting, and cardiovascular problems (Cojocaru et al., 2021; Idrees et al., 2022). In children, these medications also increase the risk of suicidal ideation necessitating constant monitoring once prescribed (Siffel et al., 2020). They also need to be used consistently for effects to be felt, they may also not be as effective as stimulants in addressing stimulants. Advantages and Disadvantages to Other Classes The greatest advantage of non-stimulants to other classes is that they do not have a high potential for abuse and dependency, and they do not aggravate tics which are a side effect of stimulant medications (Cojocaru et al., 2021). Because of this they have less strict regulations and patients can be prescribed a supply of longer than 30 days. In comparison, stimulants such as Adderall have a high abuse potential and therefore are regulated (Nanda et al., 2023). On the other hand, when compared to stimulants, these medications require to be used consistently for approximately 3 to 4 weeks for results to be seen which can be particularly difficult for patients with severe symptoms (Cojocaru et al., 2021). In comparison, some stimulants have an immediate effect and have been approved as the first line of treatment for ADHD (Nanda et al., 2023). Possible Side Effects When prescribed Strattera or Qelbree for the patient, there are specific side-effects that must be monitored including: reduced appetite, nausea and vomiting, indigestion, fatigue, mood swings, dizziness, and irritability (Chang et al., 2020). Other non-stimulants can present with the following side-effects including trouble sleeping, slow heart rate, low blood pressure, cough, runny nose, sore throat, sneezing, changes in mood, high body temperature, nightmares, ear pain, and constipation (Chang et al., 2020). It is also important to note that non-stimulants such as Qelbree have been associated with an increase in suicidal thoughts and behaviors and therefore, the patient must be closely monitored (Chang et al., 2020). Legal, Ethical, and Social Implications Legal: A legal issue is the question of informed consent to the use of non-stimulant medication as the patient is a minor and will therefore require that a guardian is present to make decisions for him. Another is the provision of adequate information about the medication, particularly, the side effects of the medications and the alternative medications such as stimulants that can be used in the treatment of ADHD. Ethical: Ethical issues that arise first is that non-stimulants do not produce effects immediately and their side-effects may be intolerable for the patient. The nurse must consider whether it is ethical to allow the patient to experience these side effects. Another issue is that there is a risk for suicidal ideation in children and therefore, the nurse must consider whether the risk of suicidal behavior is worth the benefits of using non-stimulants for this patient (Chang et al., 2020; Siffel et al., 2020). Social implication: A social issue that arises is the stigma associated with ADHD behaviors that can result in isolation and rejection from peers. Particularly, taking medications can result in this rejection from peers and demotivate the patient from adhering to his prescription (Schoeman & Voges, 2022). References Chang, Z., Quinn, P. D., O’Reilly, L., Sjölander, A., Hur, K., Gibbons, R., Larsson, H., & D’Onofrio, B. M. (2020). Medication for Attention-Deficit/Hyperactivity Disorder and Risk for Suicide Attempts. Biological psychiatry, 88(6), 452–458. https://doi.org/10.1016/j.biopsych.2019.12.003Links to an external site. Cojocaru, A., Hogea, L. M., Poroch, V., Simu, M. A., Enatescu, V. R., Jeleriu, R., Andreescu, N. I., Puiu, M., Hogea, B. G., & Grigoras, M. (2021). Effectiveness of Psychostimulant and Non-Psychostimulant Drug Therapy in the Attention Deficit Hyperactivity Disorder. Applied Sciences, 11(2):502. https://doi.org/10.3390/app11020502 Idrees, I., Bellato, A., Cortese, S., & Groom, M. (2022). The effects of stimulant and non-stimulant medications on the autonomic nervous system ANS functioning in people with ADHD: a systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 144(1). https://doi.org/10.1016/j.neubiorev.2022.104968Links to an external site. Nanda, A., Janga, L. S. N., Sambe, H. G., Yasir, M., Man, R. K., Gogikar, A., & Mohammed, L. (2023). Adverse Effects of Stimulant Interventions for Attention Deficit Hyperactivity Disorder (ADHD): A Comprehensive Systematic Review. Cureus, 15(9), e45995. https://doi.org/10.7759/cureus.45995 Schoeman, R., & Voges, T. (2022). Attention-deficit hyperactivity disorder stigma: The silent barrier to care. The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa, 28, 1865. https://doi.org/10.4102/sajpsychiatry.v28i0.1865 Siffel, C., DerSarkissian, M., Shovein, K., Spalding, W., Gu, Q., Cheng, M., & Duh, M. (2020). Suicidal ideation and attempts in the united states of America among stimulant-treated, non-stimulant-treated, and untreated patients with a diagnosis of attention deficit/hyperactivity disorder. Journal of Affective Disorders 266(1). https://doi.org/10.1016/j.jad.2020.01.075
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