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Why Some ADHD Medications Increase Anxiety
If you have ADHD and are experiencing anxiety while taking stimulants, know that there are many ADHD meds that don’t cause anxiety. Nothing is worse than taking a medication to fix one symptom, but you have a different symptom that gets worse!
Stimulant medications can exacerbate symptoms of anxiety, especially in people with co-occurring ADHD and anxiety. These medications help improve focus, reduce hyperactivity and restlessness, and lower impulsivity.
However, because they increase dopamine and norepinephrine levels, this can sometimes result in sensations such as restlessness, a rapid heart rate, and overthinking that mimic your body’s natural fight-or-flight response.
If you are experiencing a side effect of increased anxiety, that doesn't mean that your ADHD treatment isn't working; it just means that you and your provider need a different approach to treat your ADHD symptoms. Many people with ADHD also have co-occurring anxiety, and one of the common ADHD medication side effects is anxiety, which can complicate things further.
However, experiencing anxiety from ADHD meds is actually quite common, and there are effective alternatives available. Let's go over ADHD medication options that do not contribute to additional anxiety, so you can find relief from both conditions.
The Connection Between ADHD and Anxiety
ADHD and anxiety are common co-occurring disorders in adults. Studies suggest that at least 25% of adults with ADHD also have an anxiety disorder. Untreated ADHD can worsen anxiety symptoms, such as feeling behind or being unable to stay organized.
ADHD and anxiety have overlapping symptoms, which make it more challenging to find out what's going on. Common overlapping ADHD and anxiety symptoms include:
- Having trouble managing tough emotions
- Restlessness
- Overthinking
- Impulsiveness
- Difficulty focusing
- Trouble finishing tasks
One of the major differences between the two is that ADHD symptoms will be present since early childhood, whereas anxiety tends to develop later or is more situation-based.
Healthcare providers understand this symptom overlap and know how to determine whether you have one, the other, or both. If you do have both, treatment can be more complex, but it is possible. Clinicians can successfully treat both conditions with CBT, medication, and other lifestyle changes.
Non-Stimulant Medications That Won't Trigger Anxiety
Non-stimulant ADHD medications are typically the go-to choice for people who have anxiety or experience too much anxiety from taking stimulants. These medications take longer to "kick in" and start showing symptom improvement, but they do tend to offer full-day coverage after a few weeks without the added anxiety.
They work differently in the brain than stimulants, so they don't produce the "speedy" sensation that stimulants may cause.
Many take between 4 and 6 weeks for maximum symptom control. Non-stimulants are not controlled substances like stimulants, so they are a great option for people with substance use disorder (SUD) or concerns about misuse. Let's go over some of the common ADHD meds that don't cause anxiety.
Strattera (Atomoxetine): The First FDA-Approved Non-Stimulant
Stattera (atomoxetine) was first FDA- approved in 2002 and is the first non-stimulant option for individuals with ADHD. Unlike stimulants, Strattera doesn't cause anxiety; in fact, it can help anxiety symptoms in some people. Strattera may be one of the best ADHD medications for adults with anxiety.
It is a selective norepinephrine reuptake inhibitor that helps prevent the reabsorption of norepinephrine and dopamine in the prefrontal cortex of the brain, allowing the brain greater access to these two neurotransmitters without the stimulating effects of stimulants.
It does not affect the brain's reward center like stimulants do, lowering the chance of misuse. Staterra helps to manage symptoms of restlessness, impulsivity, and inattention.
Strattera is taken once a day and builds up in your system over time. You should see benefits in 4-6 weeks of taking it.
Some common side effects from Strattera include:
- Appetite loss
- Nausea/ upset stomach
- Sleepiness
- Dry mouth
- Headache
Anyone with anxiety, SUD, or people who just do not tolerate stimulant medications could potentially be a good candidate for this non-stimulant ADHD medication.
Qelbree (Viloxazine): A Newer Non-Stimulant Option
Qelbree (Viloxazine) is one of the ADHD meds that don't cause anxiety, but tends to start working faster than Strattera. A study comparing Strattera and viloxazine showed that many people had symptoms improve after just two weeks.
It works in the brain similarly to Strattera but is even more selective and also affects serotonin, which may contribute to a reduction in anxiety and depression symptoms. Because Qelbree was FDA-approved in 2021, no generics are currently available. Qelbree works to manage symptoms of impulsivity, restlessness, and attention issues.
Some common side effects of Qelbree include:
- Insomnia
- Dry mouth
- Headache
- Sleepiness
- Decreased appetite
Because there is no generic version available yet, Qelbree may be more expensive than other non-stimulant ADHD drugs.
Intuniv (Guanfacine) and Kapvay (Clonidine): Blood Pressure Medications for ADHD
Other ADHD meds that don't cause anxiety include a group of blood pressure drugs now used to treat ADHD, Kapvay (clonidine), and Intuniv (guanfacine). Kapvay and Intuniv were originally just for high blood pressure, but providers found that they could help manage symptoms of ADHD too. Kapyvay and Intuniv are alpha-2 adrenergic agonists that work to treat symptoms of ADHD like impulsiveness and restlessness.
They primarily work in the prefrontal cortex to improve cognitive function. They can help reduce anxiety and insomnia by relaxing the fight-or-flight response, and are sometimes taken alongside stimulants to mitigate their “speedy” effects.
Alpha-2 adrenergic agonists may be helpful for those with insomnia, impulsivity, and hyperactivity.
Common side effects of Kapvay and Intuniv include:
- Drowsiness/sedation
- Dizziness
- Constipation
- Low blood pressure
- Dry mouth
- Headache
These non-stimulant ADHD meds that don't cause anxiety are typically taken at night due to their sedative factor, but tend to provide all-day symptom improvement after 2-5 weeks.
Antidepressants That Can Help With Both ADHD and Anxiety
Another class of ADHD meds that do not cause anxiety and are being used successfully "off-label" are antidepressants, mainly Wellbutrin. Off-label just means that the FDA hasn't officially approved the drug for that specific use yet, but many providers are seeing symptom improvements by using certain antidepressants for ADHD.
These types of drugs are especially beneficial to those with comorbid anxiety or depression. Antidepressants tend to address multiple symptoms at once, making them an alternative choice to stimulants.
Wellbutrin (Bupropion): A Dual-Purpose Option
Wellbutrin is different from your typical SSRI, which is commonly used for depression, as it is a norepinephrine-dopamine reuptake inhibitor (NDRI). It helps to block the reabsorption of these two neurotransmitters in the brain, which is why it works for symptoms of ADHD. It helps increase the amount of norepinephrine and dopamine the brain has access to, without the overstimulation that comes with stimulants.
Compared to other SSRIs and antidepressants, Wellbutrin tends to be better tolerated and doesn't cause the sexual side effects or weight gain issues that are common with other antidepressants.
Individuals with comorbid depression or substance use disorder may benefit from Wellbutrin as a non-stimulant ADHD med that doesn't cause anxiety. It tends to take about 4-6 weeks to show improvement, though some individuals do see symptoms getting better after only a couple of weeks.
Wellbutrin has been shown to decrease symptoms of depression, but could potentially exacerbate current anxiety symptoms as it may increase nervousness in some people.
Some common side effects of Wellbutrin include:
- Dry mouth
- Insomnia
- Headache
- Dizziness
- Weight loss
Other Antidepressants Sometimes Used for ADHD
There are some other antidepressants that providers find may help ADHD symptoms off-label when stimulants or other non-stimulants don't work well.
Some tricyclic antidepressants like nortriptyline (Pamelor) can be used at lower dosages than for depression. Effexor (venlafaxine) is another off-label antidepressant that is an SNRI, boosting both norepinephrine and serotonin, working for some people with ADHD.
These are less commonly used drugs for ADHD, but are viable options when stimulants are not a good fit. It's important to work with a healthcare provider to find a good medication for your symptoms of ADHD. Be honest and let them know you are concerned about anxiety from stimulants, and they will work with you to find the best option.
What to Expect When Switching ADHD Medications
Finding the right ADHD medication without anxiety issues takes some patience, and you may not stick with the very first medication that your doctor tries, but that's all a part of normal ADHD treatment.
If you are currently on a stimulant but are having concerns and want to switch to a non-stimulant, your provider will gradually taper you off the stimulant while adding the new non-stimulant slowly at the same time to manage symptoms during the transition period.
Non-stimulants are not as fast-acting, so be prepared to wait a few weeks before you really start to see any improvements. After the initial waiting period, you should see results.
It's a good idea to keep track of your symptoms during the transition period so you can rate the new medication to see how well it is working for you. If the new non-stimulant doesn't show enough improvements or you have unwanted side effects that linger, you can discuss trying a different medication.
Working With Your Doctor to Find the Right Fit
Your provider can not know about your concerns with anxiety if you do not tell them, so be sure to be as honest and open about any of your worries. A symptom journal is a good way to keep track of both anxiety and ADHD symptoms so you can really gauge how you're doing on your new medication.
If your medication isn’t working, let your healthcare provider know how it affects you and which symptoms persist. This will help them adjust your treatment.
It's totally normal to try a few different medications before finding the one that fits your unique chemistry just right. It's so important to work with a provider who is knowledgeable about ADHD, as they understand the trial-and-error process and will be ready to answer questions and walk you through the transition period every step of the way.
Combining Medication With Other Strategies for Better Results
Medication works best for ADHD when it is combined with therapy and other lifestyle changes as a comprehensive treatment plan. Managing symptoms of ADHD with anxiety usually requires a strategic and holistic approach. If you do need more than one medication to manage your symptoms, it's ok, that doesn't mean that your medication isn't working, it just means that there is no "magic pill" to fix everything, but many work synergistically together to help.
Therapy Approaches That Help With ADHD and Anxiety
Cognitive behavioral therapy (CBT) can help to address symptoms of ADHD and anxiety together by teaching you how to change negative thought patterns into more positive ones. It's also designed to teach you strategies to manage organization, time management skills, and even mindfulness practices that you can use to help symptoms of both ADHD and anxiety.
Skills training and ADHD coaching are also successful methods for treating ADHD and anxiety together. An ADHD coach can help you develop the necessary skills by giving you actionable goals tailored to your life. They can assist you in establishing routine and structure, offer accountability, and help manage feelings and emotions.
Lifestyle Changes That Support Your Treatment
There are some very important lifestyle changes that you can make to also complement your medication and therapy that help you live with fewer symptoms. Establishing a sleep routine, engaging in regular exercise, and consuming nutrient-dense foods can help manage symptoms of ADHD and anxiety naturally.
Some other behaviors that will help manage symptoms include:
- Reducing caffeine and alcohol intake
- Adding stress management techniques
- Journaling
- Routine building and time management
- Eating more nutritious foods and cutting down on processed foods and sugar intake
None of these will replace treatment, but they can complement your treatment plan.
Getting Started With ADHD Treatment That Works for You
ADHD meds that don't cause anxiety include non-stimulant options such as Strattera, Qelbree, Intuniv, and Kapvay. Antidepressants like Wellbutrin and Effexor are sometimes used off-label. Having co-occurring anxiety doesn't mean that you can't treat your ADHD; it just means that you may need to pivot from stimulants if they are causing excess anxiety issues.
It's so important to work with an ADHD specialist to find the right treatment for ADHD and anxiety. Here at ADHD Advisor, our clinicians are trained to treat individuals with ADHD and co-occurring anxiety disorders.
They will work with you to find a treatment plan that helps both conditions. We provide same-day virtual appointments that work around your schedule, and you can get the treatment you need right from the comfort of your own home. ADHD care has never been more accessible than it is today!
If you are on stimulants and want to change medication or you simply want to get started with ADHD treatment, take our short screening test today to see if you qualify for an ADHD evaluation. You don't have to live with anxiety symptoms to get your ADHD treated. There are ways to manage both conditions safely. Take our screening test now to get started with ADHD treatment for anxiety.
Frequently Asked Questions
What ADHD medications don't cause anxiety?
ADHD medications that don't cause anxiety include the following non-stimulants:
- Strattera
- Qelbree
- Intuniv
- Kapvay
Can you take ADHD medication without worsening anxiety symptoms?
There are a couple of extended-release formulations of Vyvanse or Concerta that may not worsen anxiety symptoms. But, if these stimulants still exacerbate anxiety symptoms, you may need to try non-stimulants instead or try a combination of a stimulant plus Intuniv or Kapvay. Let your provider know about your concerns with worsening anxiety symptoms, and they will help you find the best fit for you.
Are there ADHD medications that actually help with anxiety?
Yes, there are some ADHD meds that help with anxiety. Some people see a reduction in anxiety symptoms with stimulants because they reduce disorganization and other issues that were adding to their stress and anxiety. However, stimulants like Adderall can make anxiety worse.
Instead, go with alternatives to Adderall for anxiety, like non-stimulants. Some non-stimulant medication choices can help with co-occurring anxiety and ADHD, like Qelbree, Strattera, and Kapvay.
Why do some ADHD medications make anxiety worse and what are the alternatives?
Some ADHD medications make anxiety worse because they cause physiological responses that mimic the fight-or-flight system and increase heart rate and nervousness. Alternatives include trying a lower dose or an extended-release stimulant or switching to a non-stimulant option.
