Description
Advantages
Treats most of the symptoms of ADHD (hyperactivity, impulsivity) but less effective for treatment of inattention
of distractibility. Does not cause the side effects of the stimulants (insomnia, decreased appetite, irritability).
Usually covered by insurance.
Disadvantages
Not as effective as stimulants for treatment of ADHD. Can take 2-3 weeks or longer before optimal benefits realized.
Excerpt from the book: ADHD Medications: Does It Work and Is It Save? Available on Amazon
About twenty years ago, I was attending a dinner after a major medical conference on ADHD. Strattera had just been approved for the treatment of ADHD in 2002. One of the researchers who performed the safety and efficacy studies for Strattera was present, and he was asked how Strattera was “discovered.” He stated that they had been searching for a non-stimulant treatment for ADHD and asked some of the pharmaceutical companies if they had any potential prospects. One pharmaceutical company had been developing atomoxetine in the 1980s as a potential new treatment for depression. However, about the same time, Prozac was developed, and this pharmaceutical company did not feel that atomoxetine could compare favorably to Prozac. As a result, atomoxetine was shelved and no further development was pursued.
However, because atomoxetine was a norepinephrine reuptake inhibitor, and because this researcher was well aware of the role of nor- epinephrine in the treatment of ADHD, he felt that atomoxetine might be a good alternative to stimulant medications.
In initial studies, the positive effects in treating ADHD were encouraging. They pursued further studies of the safety and effective- ness in children with ADHD and received FDA approval for Strattera (atomoxetine) as a treatment for ADHD in 2002. In 2017, researchers looked back at their experience with Strattera (atomoxetine) and found that in forty-two studies of 8,398 children and adolescents, atomoxetine was consistently effective at treating the primary symptoms of ADHD.17 Effect size was 1.37, which is considered highly effective and comparable to the stimulant medications. However, another review of eleven studies of more than two thousand children with ADHD found that atomox- etine was effective for the treatment of ADHD, but that Concerta18 and Adderall19 were superior to Strattera.
Remember that ADHD is associated with decreased activity of the neurotransmitters norepinephrine and dopamine in three prominent brain areas. It was initially felt that atomoxetine functioned as a norepi- nephrine reuptake inhibitor, increasing the activity of the neurotrans- mitter norepinephrine in the brain. Further research demonstrated positive effects on dopamine as well. As a result, Strattera is an effective non-stimulant option for the treatment of ADHD, because it functions in a similar way to the stimulant medications but without the stimulant side effects.
Although Strattera does not produce the common side effects seen with stimulant medications (insomnia, irritability, mood suppression), it does have its own side-effect profile. The most common side effects to Strattera are a decrease in appetite, abdominal pain, vomiting, upset stomach, and sedation.20 Strattera can also increase heart rate and blood pressure (in contrast to clonidine and guanfacine, which lower blood pressure and heart rate), although no evidence indicates that Strattera causes serious cardiac side effects.
When I first started prescribing Strattera, I did not feel that it was very effective in my patients, and I was considering discontinuing its use. However, a major drawback of Strattera is that it can often take 2–3 weeks to take effect, and the full effects might not be seen until 4–6 weeks. This can be a major disadvantage. You have to wait six weeks to see the optimal effect of Strattera, and if you don’t see much benefit, you might increase the dose, requiring another wait of six weeks. Although I would still start treatment of ADHD with a stimulant, especially meth- ylphenidate, I do consider Strattera to be a good option to stimulants if side effects prevent their effective use, especially mood side effects and irritability.
