The Most Effective Adderall Alternatives

What Is Adderall?

Adderall has become a widely known and frequently prescribed medication. It's predominantly used to help manage symptoms of ADHD [1], but in some cases is also used by people needing support in managing their response to stimuli, or needing help in improving their ability to focus. It can be helpful in increasing and sustaining attention, as well as reduce impulsivity. Medications designed to help manage ADHD symptoms typically work by elevating dopamine, serotonin and norepinephrine. Increasing the levels of these neurotransmitters and hormones effectively rebalances the brain, changing its state from being overstimulated to being in a normal state of stimulation [2]. Whilst Adderall, when correctly prescribed, can be very helpful to many people, its not safe to take without a prescription - it's therefore advisable to use proven alternatives to Adderall which can help in similar ways, but without the risk of serious side effects. Adderall's side effects including headaches, anxiety, depression, irregular or increased heart rate, sleeplessness and many others [3]. We'll therefore look at effective alternatives to Adderall, many of which are available over the counter without prescription.

The Range of Alternatives Available

There are a wide range of alternative options. These include alternative prescription medications for ADHD [4], which may be better suited to your individual needs, or which may be prescribed if Adderall is unavailable, as happening during the recent Adderall shortage. There are also non-stimulant medications, such as Atomoxetine and Clonidine, which may be better options for people who don't respond favorably to stimulants. These non-stimulant medications work in different ways, with some working to modulate norepinephrine and others being alpha agonists, meaning they mimic the roles of epinephrine and norepinephrine in the body [5],[6].

Beyond prescription drugs, there's a further group of alternatives which are arguably of greatest interest to most people, over-the-counter (OTC) Adderall alternatives. This comprises a range of predominantly natural alternatives to Adderall, but some synthetic substances also fall into this category [7]. This group includes standalone individual single ingredient supplements, as well as more comprehensively formulated all-in-one supplements such as ThinkEase [8]. 

Prescription Alternatives to Adderall

There are a range of options available on prescription. I'll run through the most commonly prescribed options, but as with any prescribed medication the advice of your own doctor will help clarify which, if any is the best option for you.

1. Atomoxetine (Strattera)

Atomoxetine is a widely prescribed non-stimulant ADHD medication. It works by increasing norepinephrine levels as a means to modulating attention and impulses. As it's a non-stimulant, it doesn't affect dopamine pathways, which can be beneficial to people who are sensitive to stimulants, or don't respond favorably to them.

What makes it different to Adderall?

• As it's a non-stimulant it doesn't directly affect the central nervous system and may be less likely to be misused [9].
• It can take longer to work than Adderall [10].
• Has a different side effect profile to Adderall [11].

2. Guanfacine Extended-Release (Intuniv ER)

Guanfacine was initially developed as a high blood pressure medication, but an extended-release form was later developed as a treatment for ADHD. It works by influencing the processes in the pre-frontal cortex, stimulating alpha-2A adrenergic receptors [12]. 

What makes it different to Adderall?

• It can work in a more targeted way, as it doesn't boost dopamine and noprepinephrine, instead working to stimulate alpha-2A adrenergic receptors [13].
• As it's a non-stimulant it can be beneficial for people susceptible to poor sleep or reduced appetite when using Adderall [14].

3. Methylphenidate (Ritalin)

Methylphenidate is a stimulant that works to boost dopamine and norepinephrine. It can therefore be helpful in alleviating some of the main symptoms of ADHD, including hyperactivity and inattention. It's a prescription medication that's been widely studied over many years and there's a large body of research supporting its safety and efficacy [15].

What makes it different to Adderall?

• It's composed differently to Adderall, which means some people may find it easier to tolerate [16].
• Methylphenidate typically requires higher or more frequent dosages than Adderall [17].

4. Modafinil (Provigil)

Modafinil is often prescribed for conditions such as narcolepsy as it's effective in promoting wakefulness. However, it is also sometimes prescribed to help address ADHD symptoms because of its effectiveness in improving alertness and focus [18]. 

What makes it different to Adderall?

• Modafinil is a considered to be a milder stimulant, meaning it can be effective in treating ADHD symptoms, but with reduced levels of anxiety compared with Adderall [19].
• It's less likely to be misused as it's classified as a Schedule IV controlled substance (Adderall is Schedule II) [20].

5. Dexmethylphenidate (Focalin)

Dexmethylphenidate works by targeting dopamine and norepinephrine regulation, which can help in reducing symptoms of impulsivity and inattention [21].

What makes it different to Adderall?

• It relies on dexmethylphenidate instead of amphetamine salts, which means its effects and side effects are different to Adderall, which may in turn better suit some people [22].
• It can, generally speaking better suit children, whereas Adderall is generally better suited to adults [23].

6. Lisdexamfetamine (Vyvanse)

Lisdexamfetamine is converted into dextroamphetamine after it's metabolized, which in turn works to boost dopamine and norepinephrine. It's effective in improving attention levels as well as reducing hyperactivity and inattention [24].

What makes it different to Adderall?

• As it requires metabolizing before reaching its active form, it can be slower acting that Adderall [24].  
• Again due it's slower release, there's evidence it's less likely to be misused [25]. 

7. Further Prescription Based Alternatives to Adderall

Additional prescription Adderall alternatives include Clonidine Extended-Release (Kapvay), Dexedrine (Dextroamphetamine), Concerta (Extended-Release Methylphenidate), Desoxyn (Methamphetamine Hydrochloride). These range in their modes of action, effectiveness in treating different ADHD symptoms and side effect profiles.

It's can also be helpful to consider the relative merits of Extended-Release Guanfacine (Intuniv) vs. Immediate-Release Guanfacine, Immediate-Release vs. Extended-Release Stimulants and Novel Delivery Formats (such as patches or chewable tablets). Which option best suits your needs depends on a range of factors, discussion with a medical professional will help you identify the best alternative for your individual needs.

Natural and OTC Alternatives to Adderall

There are a number of non-prescription based options available over-the-counter, meaning these can be bought directly or ordered online. They can be a useful alternative for people looking for the benefits Adderall often provides, but without the potential side effects, or requirement to consult with a medical professional in order to obtain a prescription.

8. Nootropic Supplements

Nootropic supplements are typically branded supplements which combine a number of different nootropic substances into a single product. Whilst it may be possible to buy each ingredient separately, it's typically expensive to do so. Accurately dosing each ingredient while ensuring the ingredients taken have synergistic benefits can also be challenging. It can therefore be advantageous to choose a reputable nootropic brand and avoid the difficulty, cost and possible risks associated with trying to develop an individual nootropic stack [26].

Considerations

• Nootropic brands vary in effectiveness, purity and safety, choosing a reputable brand is key.
• Nootropic supplements may not be as effective in treating more severe ADHD symptoms, but their effects can help and they're well suited to people looking for some of the benefits of Adderall, but who may not have ADHD symptoms.

9. L-Theanine & Caffeine

L-Theanine is known for its ability to promote relaxation without any sedative effects. When combined wity caffeine (with coffee for example), L-Theanine can help create a calmer caffeine response by blocking adrenosine [27].

Benefits

• Combining L-theanine and caffeine has been shown to boost focus, memory and reaction speed, whilst also mitigating jitteriness and anxiety experienced by some people when taking caffeine in isolation [28].
• More research is needed into the benefits of L-theanine and caffeine for people with ADHD.

Considerations

• Caffeine tolerance differs significantly between people. For individuals less tolerant, excessive amounts of caffeine can disrupt sleep, or cause anxiety.
• Due to caffeine's stimulant effects it's advisable not to take within 6 hours of your planned bedtime. 

10. Ginkgo Biloba

Ginkgo biloba has been used in traditional medicine, most notably Ayurveda for centuries. It works by enhancing blood flow in the brain, whilst also having antioxidant benefits due to its flavonoids and terpenoids.

Benefits

• Improved cerebral blood flow can help increase memory recall and concentration [29].
• Some, albeit limited, research suggests Ginkgo may help reduce inattention in individuals diagnosed with ADHD, but further research is needed.

Considerations

• Ginkgo can interact with some medications, including blood thinners [30].
• Research into Ginkgo's benefits for people diagnosed with ADHD remains limited.

11. Bacopa Monnieri

Bacopa Monnieri also has a long tradition of being used in Ayurvedic Medicine, due to its wide ranging benefits for the brain. These include improved mental clarity, memory support and reduced stress response [31]. research suggests that the bacosides in Bacopa work to improve communication between synapses in the brain.

Benefits

• Supplementing with Bacopa can lead to cognitive function improvements [32], particularly for memory and learning.
• Further clinical trials are needed, but research suggests Bacopa may alleviate symptoms of restlessness and inattention in children.

Considerations

• Supplementing for several weeks is required for Bacopa Monnieri's benefits to be observed.
• Using supplements with standardized bacoside content is essential, as it ensures both quality, consistency and efficacy.

12. Omega-3 Fatty Acids

Omega-3s, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are vital to the maintenance of brain cell membranes [33]. These essential fats are most commonly found in fish oil, algae, nuts and seeds.

Benefits

• Omega-3 supplementation may help alleviate some symptoms of ADHD, particularly impulsivity and hyperactivity [34].
• Omega-3 works to improve neuronal communication and may also have anti-imflamation benefits.

Considerations

• The ratio of EPA to DHA is important, supplements can vary widely in the content of each form of Omega-3.
• Fish oil based Omega-3 supplements can, in some cases, affect blood clotting if taken in high doses.

13. Herbal Stimulants (Guarana and Panax Ginseng)

Guarana is derived from the seeds of the Paullinia Cupana plant and contains a range of phytochemicals and caffeine [35]. Ginseng, a herb used in traditional Asian medicine, is best known for its ability to enhance mental performance and boost energy levels.

Benefits

• Guarana can help increase attention levels for short periods, whereas Ginseng's benefits are broader based cognitive support.
• A limited study into the effects of Korean Red Ginseng suggested it can help children with symptoms of inattention, hyperactivity and inattention by reducing hyperactivity and improving social functioning [36]. 

Considerations

• The doses and effectiveness of Guarana and Ginseng vary depending on how they're prepared.
• Both Guarana and Ginseng can cause elevated heart rate, anxiety and insomnia in people sensitive to their effects.

14. Vitamins and Minerals

Some vitamins and minerals have been studied for their effects in addressing ADHD symptoms, most notably zinc and magnesium.

Benefits

• Zinc is important for neurotransmitter function. Research suggests zinc deficiency can exacerbate ADHD symptoms [37].
• Magnesium is central in the regulation of muscle and nerve activity, due to its role in numerous enzymatic reactions. Low levels of magnesium has been correlated with hyperactivity [38].

Considerations

• Validating a deficiency in zinc or magnesium can determine whether supplementation is required.
• A range of other vitamins and minerals are essential to the brain's health, including B vitamins (B6, B9, B12), iron and Vitamin D.

15. Caffeine Supplementation

Taking caffeine as a supplement (typically in the form of a tablet or capsule) can be a more reliable and accurate way to experience caffeine's benefits, as coffee and tea can vary widely in their caffeine content.

Benefits

• Caffeine can, albeit temporarily, reduce fatigue and improve focus by blocking adenosine receptors [27].
• Adults with ADHD may find that caffeine can help improve alertness and attention for short periods of time.

Considerations

• Regular consumption of caffeine leads to tolerance and reduced effects.
• Caffeine can cause insomnia, anxiety and elevated heart rate, particularly if consumed in high doses.

16. Behavioral Support

Non-pharmacological support, such as cognitive behavioral therapy (CBT) and psychoeducation can help improve ADHD symptoms over the blonger-term.

Benefits

• CBT may be helpful as it can better equip people to manage their time, complete tasks and regulate their emotions.
• .Behavioral techniques can be long-lasting and effective even if medications are changed over time.
• Approaches should be tailored to each person's needs and therefore provide targeted support where it's most needed.

Considerations

• Behavioral therapy often works most effectively when combined with appropriate medication or supplements.

References and Further Reading

1. https://www.psychiatry.org/patients-families/adhd/what-is-adhd
2. https://www.caron.org/blog/what-does-adderall-do-to-your-brain-it-depends
3. https://www.webmd.com/drugs/2/drug-63163/adderall-oral/details
4. https://my.clevelandclinic.org/health/treatments/11766-adhd-medication
5. https://childmind.org/article/what-are-nonstimulant-medications-for-adhd/
6. https://en.wikipedia.org/wiki/Alpha-adrenergic_agonist
7. https://www.healthline.com/health/are-there-natural-alternatives-to-adderall-and-do-they-work
8. https://onemindpsyberguide.org/thinkease-review/
9. https://pubmed.ncbi.nlm.nih.gov/20861593/
10. https://pubmed.ncbi.nlm.nih.gov/24472252/
11. https://pi.lilly.com/us/strattera-pi.pdf
12. https://www.sciencedirect.com/topics/medicine-and-dentistry/alpha-2a-adrenergic-receptor
13. https://pmc.ncbi.nlm.nih.gov/articles/PMC3143019/
14. https://pubmed.ncbi.nlm.nih.gov/19106767/
15. https://pubmed.ncbi.nlm.nih.gov/17242993/
16. https://pubmed.ncbi.nlm.nih.gov/12142863/
17. https://pmc.ncbi.nlm.nih.gov/articles/PMC6581573/
18. https://pubmed.ncbi.nlm.nih.gov/12417966/
19. https://jcsm.aasm.org/doi/10.5664/jcsm.26970
20. https://www.fadavis.com/product/nursing-pharmacology-davis-drug-guide-deglin-vallerand-sanoski-17
21. https://pubmed.ncbi.nlm.nih.gov/18176337/
22. https://www.novartis.com/us-en/sites/novartis_us/files/focalin.pdf
23. https://pubmed.ncbi.nlm.nih.gov/10405498/
24. https://pubmed.ncbi.nlm.nih.gov/17577466/
25. https://pmc.ncbi.nlm.nih.gov/articles/PMC3666194/
26. https://thinkease.com/collections/best-brain-supplements
27. https://pubmed.ncbi.nlm.nih.gov/1356551/
28. https://pubmed.ncbi.nlm.nih.gov/18006208/
29. https://pubmed.ncbi.nlm.nih.gov/23538078/
30. https://pmc.ncbi.nlm.nih.gov/articles/PMC9855530/
31. https://pubmed.ncbi.nlm.nih.gov/23772955/
32. https://pubmed.ncbi.nlm.nih.gov/29165401/
33. https://pubmed.ncbi.nlm.nih.gov/19523795/
34. https://pubmed.ncbi.nlm.nih.gov/21961774/
35. https://pubmed.ncbi.nlm.nih.gov/18077056/
36. https://pubmed.ncbi.nlm.nih.gov/25369174/
37. https://pubmed.ncbi.nlm.nih.gov/18385818/