From Vincent Iannelli, M.D.,
Your Guide to Pediatrics.
FREE Newsletter. Sign Up Now!

About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

While a lot of 'new' medications for treating ADHD have been introduced recently, like Adderall XR, Concerta, Focalin, Ritalin LA, etc., they are still all stimulants.

The FDA has now approved Strattera (atomoxetine), a new non-stimulant drug to treat ADHD in adults and children over age 6. This is not the first non-stimulant medication for ADHD though. Antidepressants, including Wellbutrin (bupropion hydrochloride) and tricyclics, like Desipramine and Imipramine, have long been considered second line medications, and are sometimes used when two or more stimulants don't work, are contraindicated, or cause too many side effects. Antidepressants are usually not considered to be as effective as stimulants though. And these medicines aren't FDA approved to treat ADHD, so Strattera's claim of being 'the first non-controlled medication that's FDA-approved to treat ADHD' is technically true.

The introduction of Strattera (pronounced Stra-tair-a) is going to be welcome news for most parents. Although widely known to be safe and effective, stimulants like Adderall and Ritalin, have long had a bad reputation and many parents are anti-Ritalin and hesitant to put their kids on a stimulant. So if it isn't a stimulant, how does Strattera work? It is thought to be 'a potent inhibitor of the presynaptic norepinephrine transporter,'¹ which causes more norepinehrine to be available to increase attention and control hyperactivity and impulsivity. Like the stimulants, it is not yet known exactly how Strattera works though.

Although a new medicine, six research studies have already been done that show that Strattera is safe and effective.

One of these studies, Atomoxetine and methylphenidate treatment in children with ADHD: a prospective, randomized, open-label trial,¹ compared Strattera and Ritalin. These children with ADHD, 228 in all, received either Strattera or Ritalin for 10 weeks, and those who took Strattera were found to have 'symptom reduction' and 'tolerability' that were 'comparable to that observed with' Ritalin.

Strattera Suicide Warning

Although infrequent, the FDA has warned about an increased risk of suicidal thinking in children and adolescents being treated with Strattera. Specifically, like many other psychiatric medications, the FDA states that Strattera 'may increase thoughts of suicide or suicide attempts in children and teens,' and that parents should call their child's doctor if their child has:

• new or increased thoughts of suicide
• changes in mood or behavior including becoming irritable or anxious

This warning doesn't mean that your child can't be prescribed Strattera or that he should stop taking Strattera if it is doing a good job managing his ADHD symptoms and not causing side effects. Instead, the benefit of taking Strattera should be weighed against the possible risks of the drug. And children taking Strattera should be 'observed closely for clinical worsening, suicidal thinking or behaviors, or unusual changes in behavior,' especially in the first few months of starting treatment or when the dosage is changed.

References:

¹Atomoxetine and methylphenidate treatment in children with ADHD: a prospective, randomized, open-label trial. Kratochvil CJ - J Am Acad Child Adolesc Psychiatry - 01-Jul-2002; 41(7): 776-84

²Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study. Michelson D - Am J Psychiatry - 01-Nov-2002; 159(11): 1896-901