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.
I have ADHD and used to take strattera a long time ago and it worked but now I am in Collage and the symptoms of ADHD are for some reason more prevalent now. I can’t really live in the moment if you know what I mean. I try but for some reason my mind always stays busy. It’s like there is a constant inter monologue or threw line going on in my head and I can’t just relax. If I take Strattera again would this possibly go away?
It may – the only way to find out is to try it again.
in addtion to my last note my son still is ADHD today and age 28 but deals with it in other ways besides taking meds. Yes it can be done.
I have an 8 year old son with ADHD. We have tried most of the stimulant drugs but it seems each one has a side effect. He has been on the Daytana patch which I love, its been great but I’ve noticed an eye blinking tic recently so his neurologist suggested switching to Strattera. I’m nervous to start it but I have no choice since the stimulants bring out tics for him. Do you find this happens a lot?
my daughter is 10yrs old and was diagnosed with ADD(no hyperactivity) at age 5. We have tried 7 different meds between then and now and found that strattera has been the best fit. She went off the meds over the summer and is now starting them again and I just had a question about it. She complains about being very tired at school and I wanted to know if giving it to her at night would still be helpful at school the next morning? I was afraid that she will lose the benefits of it during the night.
Found this blog after talking to my doctor about trying to medicate what I believe is a life long battle with add/adhd.
Every thing I have read about ADD/ADHD fits me to a T. Even though I was a bright child and got very high marks in tests my inability to focus and do homework made me a failing student. I’m messy and could never keep a clean home or workspace which is a point of shame for me. My lack of a degree has effected my ability to take care of my family because at the job I currently work I do not make enough to support them to the extent I am capable of. I also feel I have various addiction issues. I have been a marijuana abuser since I was 18 years old in reference I am now 35. I realize now that I probably do self medicate my issues with marijuana. I also have unhealthy addictions to video games and sex. Relationships have never been easy for me. I never had a problem finding love but after time I would start to feel restless and would find reasons to alienate that person until the relationship was over. I used to abuse alchohol but I was thankfully able to keep that under control. I am a diabetic and my lack of focus and impulse control issues makes it hard to control my blood sugar in a consistant manner. Plus my smoking pot contributes to the health issues I am already dealing with. I am a father now with two beautiful daughters and a woman who loves me. It’s because of her that I am seeking treatment for this because she works in the mental health field and she’s seen the symptoms and is raising a daughter from her previous marriage who was diagnosed with ADHD and we are very similer in behavior. I talked to my doctor and am currently trying strattera to hopefully get a hold on this. Having read others issues with this condition makes me very sad because I feel with more education and guidance I could have maybe faced this fully at a younger age. As it stands now I feel like I have lived a life wasted dealing with something I couldn’t understand. I do feel better reading others stories and also want to thank you for having this place for discussion of these issues.
I found this blog and I think it may provide the step in the right direction in terms of advice. I am a 23 year old college student who has been diagnosed with bipolar disorder, chemical dependency, and ADHD. I have been clean (no drugs, including alcohol) for almost 2 years. Both of my manic episodes in life have been drug-related or drug-induced, so I lately have been questioning the bipolar diagnosis. Before I got clean and began a strict medication regimen, I was on Lexapro for depression. I began buying Adderall from others students and of course, with no direction from an MD, used it incorrectly. It led to no sleep and a manic episode.
Now, I am on Strattera and Lamotrigine for mood regulation. I found Strattera worked in the very beginning. I was so cloudy from just getting clean and finally being free from all the chaos of mania that I noticed an increase in concentration. That was May of 2009. Now, in November 2011, I feel like Strattera’s efficacy has declined, for me. I’ve been on a string of antidepressants, most recently Wellbutrin, and recently my doctor took me off all antidepressants because Strattera has antidepressant benefits and “sometimes, depression just goes away on its own,” as she put it. I would say my mood has been slightly better.
A few weeks ago my doctor said she was thinking about trying Adderall with me, but worried because of the abuse potential, and because I had abused it in the past. As she said, “It worked for you but you abused it.” As a person with a history of substance abuse issues (otherwise known as addict), I expressed a slight worry about Adderall. A few minutes later I realized she had made a mistake. Yes, I obtained Adderall without a prescription but I never took out-of-this-world doses, never snorted it, never used it for anything but trying to complete my homework. I left that meeting discouraged because I wanted to revisit the idea of trying Adderall but we ran out of time. A meeting a few weeks later, I brought up Adderall. She said she would need to think about it. I should mention that about a month prior to her even suggesting Adderall, she increased my Strattera. I had lost the Rx and so I officially began taking the new dose at this time. I take 60 mg at night because it makes me sleepy, and 18 mg in the morning. I have also begun taking a supplement called L-Tyrosine on my own (my doctor doesn’t comment on amino acids.) I notice no change. If anything, I notice that now, I am more distracted than EVER. I actually cannot do a task for more than 5 min unless it is enjoyable. On my browser, if I come across a word I don’t know, I Google it. Then I open more and more tabs as things pop into my head. These are usually websites that have nothing to do with what I am currently trying to achieve, ie, schoolwork. Currently I have an exam at 9:00 and I have 7 tabs open; only 1 is related to studying for the exam.
I am desperate for help because as soon as I graduate in December, I have to hold down a real job and/or possibly apply and go to graduate school. I know I have great potential but I think I need something that works better for me than Strattera. I want to try an extremely low XR dose of Adderall. I truly feel good to be off antidepressants for now. Lamotrigine is necessary for mood control. But Adderall, I feel, could be an savior because increased concentration = better outcomes, decision making, goals getting accomplished, etc. This leads to feeling better, ie, better mood.
It’s hard explaning this all to my doctor especially because our meetings consist of a 5 minute chat, renewal of prescription, and her cutting me off anytime I say anything personal that does not relate specifically to my mood and attention. Not that that’s bad, but it is not a very conducive environment to feeling heard.
Sorry this is so long but I tried to be as concise as possible. If you could offer anything, even a sentence or resource to look at, I would be immensely grateful. I have 6 weeks left in my final semester at a very tough college and I would like to go out on a note a bit higher than the dismal one I’m currently on. Thank you.
Oops… I just realized my previous comment is so long!
Here is a concise version of my dilemma: I used to buy Adderall from classmates two years ago. Now I am on Strattera prescribed by an MD. I don’t feel like Strattera is working AT ALL for me. I am super distracted and find it hard to get motivated to do even the smallest task. Now I am considering trying Adderall but my doctor is reluctant because of my past history. She keeps increasing Strattera though my symptoms don’t approve. I don’t know what to do, and I don’t want to seem like the stereotypical college student begging for Adderall.
Any advice would be greatly apperciated!
Hi, I am currently on Adderall XR 20mg in the morning for ADD, also pristiq 100mg for depression, and 25mg Lamictal for my so-called bipolar. BTW, antidepressants were the only reason i had one or two manic episodes.
Anyhow, I have been on the Adderall for 2-3 weeks. It definately helps with getting motivated to complete tasks/chores. However, if I’m not moving around and I sit down to read, get on the internet or my cell phone, I get extremely hyperfocused on what I’m reading. It’s very annoying when I should really be exercising, completing chores, paying attention to my son, etc. Hours will pass without accomplishing anything besides reading blogs. Guess I need to let my mind get used to the dose or decrease it. I guess I’m having the same problem as you do with Strattera and hyperfocusing. Sorry, just wanted to let you know that u may want to try Adderall, but it may have the same issue as Strattera. We just need to stay away from our phones and internet!
Dear Dr. Handelman,
My son was Diagnosed with ADHD, just under 1 year ago, he turn 5 just this summer. The doctor that he is seeing is a pediatric neurologist. He has been reluctant to put him on medication due to the fact that he has had a very difficult time gaining wieght but eats a very large amount through out the day. I have recently been working with a children’s mental health centre, he is now in the centers milleu program which is having good benifits as i am not the only one seeing the behavioural difficulties that he has including opposition, impulsivity, and temper control. I just had a meeting with the whole team that over sees the benifits and such for my son both phycologist on the team are recomending that my son go onto strattera and think that if there are no side effects that hinder it’s usage with him it would be a good match. I was wondering if this would be true considering that all the research that i have been doing is suggesting that it is for children 6+?
There is also a history of bi-polar illness and depression in the family as i myself have bi-polar and my mother has clinical depression.
For anyone who has a child that seems to be suffering with ADD or ADHD symptoms or for anyone who has a child that has been diagnosed, I strongly urge you to read Last Child in the Woods by Richard Louv
http://www.youtube.com/watch?v=ejyMJWh2qFw&feature=related
This book is absolutely amazing and definitely an eye opener for parents, teachers, and child care providers of all kinds. I am a parent and a preschool teacher. I am not making money on the book, its just the only book like it of its kind, and I try to tell as many people as I can about it. You can get used sometimes at used book stores, but it is also very inexpensive on amazon or sites alike.
I’ve taken Strattera as well as other ‘selective reuptake inhibitors’, as this class of medications is called. None of them are 100% targeted to only norepinephrine, dopamine or seratonin; i.e. none of them are exactly and ingeniously ‘selective’. What’s more, to detect these three main classes of neurotransmitters*, cells have numerous ‘flavors’ of receptors and these meds still don’t constitute the perfect match as far as usurping the exact combination of subclasses of receptors goes. Scientists still need to learn much more and beyond that, create meds that not only do the job without also targeting other wrong receptors, but molecules that are not overly toxic to totally unrelated parts of our bodies, such as the liver and furthermore easy to metabolize without creating toxic byproducts in the process.
All of them have caused me periodic itchiness, which varied in intensity from time to time. Often this would affect the back of my hands and I’d find myself scratching them until I noticed I was bleeding. Why the variance? It’s doubtful anybody really knows. And remember these meds are all about nerves and the way they behave. It might be connected to many things, perhaps connected to something one has recently eaten, which in turn changes amount of many other chemicals circulating in our bodies at various times, like trace metals, hormones, hundreds of different enzymes, amino acids, levels of vitamins.
*there’s another major neurotransmitter only recently discovered, nitric oxide, (Molecule of the Year for 1992), which earned three researchers a Nobel Prize in 1998. Their discovery led directly to the invention of Viagra and its subsequent cousins, all of which, too, are not yet perfectly targeted to just the right subset of receptors nor totally without breakdown byproducts which play some havoc. Hence headaches, backaches, bluish vision, etc. as side-effects. Nitroglycerin had been in use as a source of this neurotransmitter for well over a hundred years, but nobody knew that one of its breakdown products, nitric oxide, was a true neurotransmitter. We’re learning it has many functions, but is most famous as a vasodialator, meaning it relaxes blood vessels allowing increased blood flow.
I’ve had ADHD since I was a tyke back in the ’50′s well before it had a name. I was simply an odd, boisterous, stubborn child, an enigma to my folks.
I’ve learned over many years that I’ve always been quite bright. At age 4 I could never accept the inevitable answer to my obsessive questioning “Why?” about everything I was told to do.
My exasperated and often face-slapping mother insisted that I make do with: “Because I SAID SO!” I already understood at that age that this was tyrannical and totally unacceptable. I took every kind of punishment, but I never shut down and quit asking ‘why.’
I suggest to any of you parents who respond in this way:
Consider that just maybe your AHAD child might be exceptionally bright, perhaps brighter than yourself, and like any adult is insulted by intimidation when he/she intuits the parent actually has no answer, is too proud to admit it or believes the child isn’t ready for the honest truth. Increasingly, scientists suspect that ADHD is a portion of a ‘cluster’ or ‘spectrum’ of related abnormalities. Severe autism at one end, going towards Aspberger’s then less ‘abnormal’ to AHAD. With increasing knowledge comes the discovery that often such children posess a spike or more of genius in some areas beyond their parents’ and that far more of the problem is a communication wall than previously thought. iPads are working miracles opening up surprisingly bright brains to a populous which had naively perceived only subnormal IQ. Google the ground-breaking Aspergers woman, Temple Grandin, who sees both sides and has done so much to help enlighten the formerly ignorant about the degree of intelligence and emotional capabilities of many who lack the capacity to be heard and understood.
One astounding example: It was long thought autistic children didn’t want to be held or touched because they didn’t have the emotional wherewithal to crave it. Turns out that probably ALL autistic children love touch and holding, but at the first encounter with it at birth became phobic because touch was always so spontaneous, often leading to head petting, getting dragged somewhere, picked up, kissed.. just roulette. This suggests that the moment autism is detected, touch needs to be so predicable that the child doesn’t immediately associate it with “all hell will break loose” and henceforth fear it for life.
Is there anyone still reading? I told you I was a problem child. My folks tried to beat me down, but I still suck up knowledge at 63 like a sponge am obsessive about my interests and am proud of it;-)
My daughter is 9 years old. She had ADHD and MERLD (miced expressive receptive language disorder) She is constantly asking questions about the human body. She will obsess on the brain for days at a time. What does it do? When color is it. What does it feel like etc etc etc. Then she will move on to another part of the body. I check her interrnet websites and she look at dozens of sites for answers. I try to give her answers but I’ve finally resorted to “Google it?” She is a bright child. Has an unbelievable memory and as a child always assigned people she meets a color. I’ve always been “Black” and Mom has always been “Red.”
Her fine motor skills like drawing, writing clearly and coloring are still very unrefined and she has a hard time making “small talk” with other kids her age. I guess I am wondering if you ever had a connection between lack fine motor skills and obsessive questioning? Any insights would be appreciated. Thanks!
My son is 6 and has text book features of ADHD/ODD. He was always a very bright, active boy who never sat still, but it wasn’t until he was 4 in pre-K that he started having significant problems both at home and at school. We tried a year of behavior therapy and I cut back on my work to give him more attention/structure (my husband and I are both physicians). Despite our efforts, he continued to get worse. I was very hesitant to start him on medications, but after a year of trying other techniques, we opted for the medication route. It was trial and error, but we finally found the perfect combination of Intuniv 2mg and Concerta 18 mg. It was a dramatic change and he got great reports every day in kindergarten and I was finally seeing the light at the end of the tunnel. The real treat for me is that his ODD symptoms seemed to go away almost completely. Then, the tics started (strange eye movements with head turns). We had him evaluated by a neurologist and neuro-ophthalmologist who both agree they are tics most likely brought on by the Concerta. So we stopped this 3 weeks ago and his behavior in school has deteriorated to the point that we may have to change schools (and his teacher at the current one is excellent with years of experience so this did not come up lightly). Unfortunately, the tics haven’t gone away completely (which is a bit unexpected after stopping the Concerta), but I still think the association between the Concerta and the tics is there as they did get dramatically better after stopping it and the tics developed less than 2 months after starting the medicine. Now, I’m not quite sure what to do as I’m worried about starting him on another stimulant. I’m particularly worried about him developing Tourette’s syndrome. I’ve come across Strattera, but his psychiatrist isn’t a big fan (she participated in the study that showed it wasn’t so helpful in 5 & 6 year olds). Any thoughts?