Are you aware of an alternative medication (SNRI) for children with ADHD?

When your doctor tells you that your child has ADHD ( Attention Deficit Hyperactivity Disorder), you, as a parent, are probably overwhelmed with questions and concerns. You may have different thoughts about the medications your child will be given and their side effects. Usually, stimulant medications are the first choice for ADHD. But these medications don't work for every child. Some parents are also afraid to give their child these medications. So, if you're thinking about a non-stimulant option, your doctor may suggest a type of medication called an SNRI. Today, let's talk about what these SNRIs are and how they work.

What are SNRIs?

Simply put, SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) are a type of medication used to treat depression. They work by increasing the levels of two chemical messengers in our brains. We call these messengers neurotransmitters. These two chemicals are serotonin and norepinephrine.

This medication is not officially approved by the FDA (Food and Drug Administration) to treat ADHD. However, if doctors feel that it is most appropriate and helpful for a patient, they can prescribe this medication 'off-label', meaning for a condition other than the approved condition. This is a common practice among doctors in Sri Lanka and around the world.

This new SNRI type of medication is considered safer and has fewer side effects than the previously used tricyclic antidepressants (TCAs).

There are two main types of SNRIs that have been tested for children with ADHD:

1. Duloxetine: This is approved to treat depression and anxiety in adults. In addition, this medication is also used to treat anxiety in children over 7 years of age and the painful condition fibromyalgia.

2. Venlafaxine: This is a medication approved to treat depression and anxiety in adults. Although it is not officially approved for children under 18 or for ADHD, doctors sometimes prescribe it 'off-label'.

How do SNRIs help with ADHD?

Imagine that the nerve cells in our brain are talking to each other. The ones that help with this conversation, that is, the exchange of messages, are the neurotransmitters we mentioned earlier. Doctors believe that children with ADHD have some problems with the processing of the messengers dopamine and norepinephrine. Some research has found that serotonin is also involved.

Stimulant drugs increase dopamine levels in the brain. SNRI drugs increase serotonin and norepinephrine levels. When these chemicals are increased, communication, or message exchange, between nerve cells in the brain occurs more effectively.

Things to know when using this medicine

If your child's doctor prescribes an SNRI, they will often start with a very low dose . Then, over a few weeks, they will gradually increase the dose until the child finds the dose that works best for them. It can take 2 to 4 weeks to see the full effect of this medication. So, don't panic and say, "I haven't started taking this yet." It's important to be patient.

These medications come in pill or capsule form. If your child has difficulty swallowing pills, some medications can be crushed and mixed into something like applesauce. Talk to your doctor about this.

It is very important to be aware of the possible side effects of taking this medication and the symptoms that may occur if you stop taking it suddenly.

How effective are SNRIs for ADHD?

This is something we need to talk about honestly. There have been decades of research on stimulant medications for ADHD, and between 70% and 90% of people who use them show significant improvement in their symptoms.

However, there is very little research on the effectiveness of SNRIs for ADHD. In a few small studies of the drug venlafaxine, between one-third and two-thirds of the children who took part showed some improvement in symptoms (especially hyperactivity and inattention). However, many dropped out of the studies due to side effects. One study of duloxetine also showed some improvement. So, we can't say yet that these are as effective as stimulants.

What is the most serious risk of SNRIs?

This is the thing you should pay the most attention to as a parent.

These medications have a special, very serious risk warning called a 'black box' warning. This means that, like all antidepressants, these medications can increase the risk of suicidal thoughts or actions in children and young people, especially when they first start taking the medication .

Your child:

• If you are showing symptoms of depression,
• If you're talking about harming yourself,
• If we talk about death,
• If you are showing unusual, sudden changes in behavior,

Call your doctor immediately, without delay. Or take him to the nearest hospital's Emergency Department (ETU). Do not underestimate this risk.

ADHD, SNRI, pediatrics, mental health, stimulant, venlafaxine, duloxetine, medication, side effects, children's mental health