Comparing Rates of Anxiety and Related Side Effects Across ADHD Medication Classes

ADHD Medications:

How Often Do They Cause Anxiety or Similar Symptoms?

ADHD medications are effective, but anxiety, nervousness, and restlessness are common side effects.

Here’s a quick overview of how often these symptoms are reported with each major medication class.

Stimulants(Methylphenidate:

Ritalin, Concerta; Amphetamines: Adderall, Vyvanse)

Anxiety or nervousness: 2% to 15% of patients

Restlessness or insomnia: 10% to 25% of patients

Amphetamines (like Adderall) may have slightly higher rates than methylphenidate (like Ritalin).

Atomoxetine (Strattera)

Anxiety: 6% to 10% of patients

Insomnia: 5% to 10% of patients

Sometimes preferred for patients with both ADHD and anxiety.

Alpha-2 Agonists(Guanfacine ER/Intuniv, Clonidine ER/Kapvay)

Anxiety: Rare (less than 2%)

Drowsiness or sedation is much more common than anxiety.

Bupropion (Wellbutrin, off-label for ADHD)

Anxiety or agitation: 2% to 7% of patients

Insomnia: 10% to 15% of patients

Can help with depression, but may cause anxiety in some.

Key Points

Stimulants are most likely to cause anxiety and restlessness, especially at higher doses.Atomoxetine is a non-stimulant option that may be better for patients with anxiety, but can still cause symptoms. Alpha-2 agonists rarely cause anxiety and may help with sleep, but sedation is common. Bupropion can be helpful for ADHD with depression, but may increase anxiety in some.

Summary:
When choosing ADHD medications, consider the patient’s history of anxiety and monitor for these side effects. Adjusting the medication or dose can often help minimize anxiety and improve outcomes.

For more information, contact Dr. Justin L Herbert, PharmD/RPh, Integrative Pharmacy Specialist, Charlotte, NC.