How Clinicians Can Navigate Stimulant vs Nonstimulant Treatments for ADHD

Following her 2025 Psych Congress NP Institute session, “The Essential Guide to Prescription Stimulants and Non-Stimulant Therapies for ADHD,” in Orlando, Florida, Co-Chair Julie Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, shares how clinicians can best navigate between stimulant and nonstimulant treatment options for patients with attention-deficit/hyperactivity disorder (ADHD). 

From the importance of assessing specific patient needs and patient education to the practical differences between stimulant and nonstimulant options, Dr Carbray offers a comprehensive overview for clinicians working with patients of any age in this insightful interview.

For more conference insights, visit the NP Institute Annual Meeting newsroom. 

Editors' note: This interview has been lightly edited for clarity.

Psych Congress Network: What are the top 3 things that clinicians should know about the differences between stimulant versus non-stimulant treatment for ADHD? 

Julie Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN: Clinicians should be aware of the following 3 key distinctions between stimulant and non-stimulant treatments for ADHD:

1. Stimulant effects and adverse effects are seen the day they are taken, whereas most non-stimulants take longer to show improved symptoms;
2. Nonstimulant treatments typically do not have reduced appetite or sleep disruption as adverse effects and are generally tolerated well; and
3. Nonstimulant treatments are not controlled substances so they have less potential for misuse, are easier to get filled (due to less prescribing restrictions), and can offer benefits to symptoms not well-managed with stimulant medications alone or in combination with stimulants.

PCN: In your clinical experience, how do you determine which patients will benefit most from stimulants and who will benefit most from nonstimulants? 

Carbray: A thorough discussion of symptoms, sleep, appetite, and information about the demands across the patient's day is a start. Comorbidity of other psychiatric disorders like anxiety or mood disorders may also contribute along with previous attempts that succeeded or did not succeed in managing symptoms.  A discussion of the options with the patient and having them think through advantages and disadvantages of these options will also usually lead to their opinion of which option is a good start for their specific needs. 

PCN: In general, patients and caregivers are more aware of the stimulant options for ADHD treatment than the nonstimulant options. What are some ways clinicians can implement patient education around this medication class in their everyday practice?

Carbray: I usually discuss the options fully each time I approach a medication start or switch, including non-stimulants and what they offer instead or in addition to stimulant medications.  In my experience, the adverse effects of stimulants and worries about their effect is what guides some to start with a nonstimulant versus stimulant and the discussion of effects and potential adverse effects at the start and along treatment makes decision-making always inclusive of both options.

PCN: Parents and other caregivers tend to be very concerned about how stimulant medications will affect the mental and physical development of pediatric patients. Are these concerns valid? How do you navigate those types of conversations in your practice?

Carbray: Outcome data consistently show that stimulants are highly effective in managing symptoms of ADHD, and I discuss this candidly with families, along with data that show development is fostered best when symptoms are well-controlled.  Concerns over future substance use concerns are also quelled by data that consistently show children who are treated adequately for their ADHD symptoms have less rather than more incidence of substance use disorders as they move into adolescence and young adulthood.
 
PCN: How do you monitor outcomes and potential adverse effects in your patients with ADHD being treated with psychopharmacological agents?

Carbray: We track mood, outcome data using screeners, and reports from family members and schools, if we’re working with children, to establish efficacy. Sleep and appetite are also monitored with each visit. We also get weight, height, and blood pressure reports each visit, track any adverse effects, and work closely with pediatricians or primary care physicians if there are any concerns. In adults, we monitor overall functioning and set goals each visit so that we can track whether those goals are moving forward. Rating scales can help but, in my experience, it is quality of life from the patient's perspective that matters most.

Julie Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, holds her PhD (93) and Master of Science (88) degrees from Rush University, Chicago and her Bachelor of Science (87) degree from Purdue University in West Lafayette, Indiana. A clinical professor of psychiatry and nursing at the University of Illinois Chicago and the director of the Pediatric Mood Disorder Clinic, she has been practicing as a Psychiatric Nurse Practitioner for over 35 years.