How does Strattera Work?
ByI have recently started posting to this blog. I have really appreciated the great response to it, and I am watching the comments to find questions which may be worth answering on the blog. As my subscribers know, I have a database of thousands of questions on ADHD, and I will use these as well to draw for content. To become a subscriber, please go to: The ADHD Doctor.
Tim wrote a comment the other day with a question: “I’ve recently started taking Strattera (2 weeks ago). Would you please comment on its effectiveness, how long it may take (should I already be noticing a difference if it is right for me?), why its not prescribed for kids (or is it or when it might be acceptable to use it if it is effective), and what I should be looking for in regards to figuring out whether or not it’s working?”
Let’s answer this one.
Strattera is the first non-stimulant medication which has come out for ADHD. It is FDA (and Health Canada – for us Canadians 
) approved for the treatment of ADHD from the age of 6 years old and up. It is approved for Childhood ADHD, Adolescent ADHD as well as Adult ADHD. As a Psychiatrist who deals predominantly with children and teens, I occassionally like to smile at the idea of there being ‘Geriatric ADHD’. While I cannot comment on that at length, I am aware of adults who have started Strattera in their sixties with good effect.
Stratter’s other name is: Atomoxetine.
How does Strattera work?
Strattera selectively blocks the reuptake of norepinephrine (or noradrenaline) in the brain. This, in and of itself, can increase the ability to pay attention and improve hyperactivity. The interesting thing is that Strattera gradually has a downstream effect on the dopamine in the brain, specifically in the frontal lobe. Now, I am throwing around a lot of medical terms very quickly here. Allow me to explain:
The frontal lobe is the ‘command center’ of the brain. This is the area that new brain imaging studies show is most affected in individuals with ADHD. This command center allows people to use their ‘executive functions’, which are the thinking skills which allow for: sustained concentration, impulse control, delayed gratification, etc.
Norepinephrine and Dopamine are called ‘neurotransmitters’. These are little brain chemicals which jump from one nerve cell to the next in the brain to carry a message through the brain.
In individuals with ADHD, research shows that they have ‘underactivity’ of the dopamine and norepinephrine in the frontal lobes.
ADHD medication generally increases the activity of the brain chemicals dopamine and norepinephrine in the frontal lobe, and in so doing, they increase the attention, and decrease hyperactivity and impulsivity (i.e. they increase these ‘executive functions’.
So, coming back to Strattera.
Strattera brought some very unique features to ADHD treatment which were not there prior to its release.
The benefits of strattera include:
- 24 hour symptom control – although it takes the medication about 3-4 weeks to ‘kick in’, when it does, it works 24 hours per day, contrary to the stimulants which work up to 12 hours per day
- No abuse potential at all: because there is no increase of dopamine in the part of the brain called the nucleus accumbens, Strattera cannot be abused to provide any pleasure
- No increase in tics: because Strattera doesn’t increase dopamine in the part of the brain called the striatum, there is no increase in motor or vocal tics with its use. So, for people with ADHD and Tourette’s, this is likely the best ADHD medication
- Good for ADHD + Depression or ADHD + Anxiety: A recent study showed that Strattera helped depression and anxiety (when they were present in combination with ADHD) and the ADHD. This can often mean that someone could take one medication for their condition – i.e. Strattera, instead of needing to take two medications – i.e. one for ADHD and one for the anxiety or depression
- May help for nocturnal enuresis: Strattera causes some ‘urinary retention’. This means that for some children who wet themselves at night, this medicine may lead to more dry nights. This is not a main treatment use for strattera, but it can be a side benefit
- May not cause ‘personality changes’: Some of my teenage patients complain that their stimulant medicine helps their concentration, but may take away their personality, or spontaneity. Strattera is a good option for this, as it does not clinically appear to cause these results
Strattera works for approximately 75% of people who take it. There are some data which suggest that if one takes it after having had treatment with a stimulant, that this may yield a slightly lower response rate. Why is this? It is my clinical impression that this does not relate to the fact that the stimulant has ‘changed the brain’, but rather the fact that as in many conditions in medicine, if something doesn’t respond completely to the first treatment used, it is much less likely to respond to the second treatment – i.e. it is ‘harder to treat’.
How can you tell if strattera is working?
Generally, one should notice an improvement in concentration, and a decrease in hyperactivity and impulsivity. The benefits should generally last for 24 hours -and be more ‘steady’ than they are with the stimulant medicines. As mentioned above, it takes about 3-4 weeks for Strattera to start working, so one needs a little patience.
The long acting nature of strattera means that the benefits of the medication last into the evening – meaning that if a teen has homework or a project to be done, they can still have the benefits of the medication to help them late at night.
Also, there are a lot of data that people with ADHD have many more troubles driving – increased tickets, motor vehicle accidents, etc. So, if a teen (or adult) is going to drive home late at night after a party -it is better if their ADHD medication is still working in their system.
The last part of your question, Tim, was why this medicine isn’t prescribed for kids. The answer is (as I am sure that you have gathered by now) that it is used for kids too.
There are some safety issues with Strattera, and these will be addressed in an upcoming blog post.
Thanks for the great question Tim, and I encourage other readers of the blog to comment on this or any other post. Please remember, that I cannot comment on every question, or every post, but I will try.
Hi Kris,
Strattera works for both ADD and ADHD.
ADHD is the official term right now, so it encompasses ADD and ADHD.
Best,
Dr. Kenny
Kathy – you have to give it at least 4-6 weeks to see the effects. And yes – anxiety can lift earlier than the ADD symptoms.
See my previous post
Reading this blog has made me consider switching to Strattera and getting off celexa and concerta.
What is the best way to make this switch?
Chris,
Obviously, talk to your doctor…
When it comes to switching from a stimulant to strattera – many people will leave the stimulant in place and then add the strattera and gradually increase the dose and give it time to work. Then the concerta would be tapered and you’d see if it works. That’s what some doctors will do. Ask yours.
My 9 year old has recently begun seeing a counselor/psychologist for his ADD issues. He has been diagnosed as having ADD/WO (no hyperactivity), plus anxiety, impulsiveness and some depression. After reading your blog, I am confused as to whether or not Strattera would work for him – his psychologist has told me to look into this med and see if this is something we’d consider trying. What do you think?
I am 40 and have been disgnosed with about everything under the sun from PTSD to Borderline Personality. I have also been on numerous meds. I finally balanced out 100MG on Topamax daily and 5mg Ativan as needed. Recently I have noticed my train of thought has no caboose, I am very tense and I am developing social phobia to the point where I am stuttering really bad in person and on the phone. Doctor gave me Strattera today. Doctor feels stuttering and Social Phobia feeling is due to underlying anxiety. He has always thought I have been ADD/ADHD throughout my treatment but I have been able to control it and it has not affected my life and/or job. But that time has ended. I do not like taking medicine because in the past I have been on such a rollercoaster ride with meds that I am just a little gun-shy –
Has anyone had any talking issues while on Strattera?
I was first diagnosed with ADD, 2 years ago at age 31. I worked with my doctor in finding the best medicine(s) to address it, and after trying numerous medicines and strength we found the 5 mg of Adderall at breakfast followed by 54 mg of Concerta at lunch, was the best fit. Recently, I had to change doctors, and the new doctor prescribed me Strattera. When the doctor informed me of this change, I was confused as my Concerta/Adderall combination was working well. They also informed me that it may take up to 30 days for the full affects of Strattera to be felt. This in itself would not be of great concern, but only that I am to beginning a new job in about a week (after 6 months of unemployment) and cannot afford to not be at my best. I voiced this concern to my new doctor, but they said this Strattera would provide me the best long term results. I have now take Strattera 2 days and have experience numerous side affects including loss of appetite and hot flashes, but the most concerning is my overall and severe of being lethargic. In general does the lethargicness last for? Also, my doctor said I can continue to take my Concerta until it runs out; is this advised?
Thanks for your insight.
Hi again, prior to my earlier posts on my sons and there meds my eldest son who is 13 next month is becoming quite troublesome now i think it’s hormones etc but he is quite verbally conflicting and am wondering if the combination of straterra and concerta are still helping him or does he need to also take something to elp him deal ith his hormones going overtime?
I now puberty and hormones happen with teenagers but he really is becoming very difficult and hostile towards us as a family and around school.
Any thoughts?
He is on concerta xl 54mg and strattera 40mg.
are there going to always make nonstimulants for adhd and be still be making nonstimulants for adhd
I take strattera and prolixin with closapene. it makes me more defensive but strangely enough I can’t get angry on it. I have lost most of my fears due to the strattera and it helps me control my behavior!!
can anyone give me any advice with regards to my last post 158?
Kathryn,
Regarding ‘hormones’, you would need to talk to the doctor about assessing for that.
If the ADHD and ODD/behavior problems are no longer responding to the medicine, he may need a higher dose, you may need more family support/therapy, or you could consider adding risperidone.
Hi Dr. Kenny
I’ve found your blog very informative. My son is 6 and diagnosed w/ ADHD Combined (hyperactive, inattentive, and impulsive) in Sept. 2009. He is currently on his 3rd med, all of which have been stimulants.
Adderall XR worked great at first, and then he became angry and not himself. Switched to Daytrana patch because at that time he could not swallow a pill. And it gave him bad rash, so we switched back to Adderall, and the anger issues came back. In February 2010, we switched him to Concerta 36 mg, and he did pretty great on that, and now for summer he is on the lowest dose of Concerta at 18 mg.
With all of these meds, he’s been angry, argumentative, depressed (or sad) tons of trouble sleeping, sometimes not going to sleep until 1 AM, or if he goes to bed on time it takes him a long time to fall asleep, or he falls asleep and then wakes up early and has trouble falling back to sleep. He is skinny, only 40 lbs and has not grown much in height since last year.
I’ve been wondering if Strattera (or another non-stimulant) might help him w/out all these nasty side effects, perhaps bring his appetite back, grow some inches, and sleep better.
Thanks for your input.
Oh, and I forgot to mention, he has a few slight tics w/ the stimulants, and anxiety, he chews his fingernails down to the nubs, and he doesn’t even know he’s doing it.
Mindy,
Yes, Strattera may be an option in this case. It doesn’t cause tics, it often helps anxiety, and has less appetite suppression. If it works well for your son – it may just be the right choice.
Hi,
After having done some research on this medication I am still not sure this is the best medicine for me with ADD. It seems that a common side effect is drowsiness and I’m wondering if a stimulant wouldn’t be better for me. I really have no sign of hyperactivity but think that having more energy would really cut down on my procrastination. At this point I can just lay in bet or watch T.V. and avoid doing anything that would cause me to have to concentrate. Is this better for someone with ADHD?
hi,
My son is 6.10 yo.and was diagnosed that he has adhd associated w apraxia.Our doc,started to prescribed as stratera started 1wk for 10mg,18mg,40mg as his maintenance.As of now we are on our 2nd week and 4 days.I have seen a lot of differences from him now.At first week of taking it,i am so hesitant snd thinking to stop medication because of some noticeable behavior on him,like he would cry out of nowhere,and easily fall asleep.But on his 2nd week and 3 days,i am now seeing a good result.I’ve been monitoring his sped teachers,and his sp,ot and aba therapist and asking them how is he on his medication.All of them give me a positive results that he focused and always good in his work.My felt relieved now and all my worries disappear.Thanks to strattera,i hope my prayers are answered.
HI MINDY,
My son sounds similar to your son he is on 5mg of Methylphenidate hydrochloride and has settled down quite alot although at times he does try it n but hes really coming on and scool are happy with him aswell.
My son is 6 years and 10 months to he being 7 October coming.