What I learned Reading Hundreds of Strattera Reviews

What is Strattera, Anyway?

Atomoxetine (brand name Strattera) is a selective norepinephrine reuptake inhibitor (SNRI) used to treat attention deficit hyperactivity disorder (ADHD)3.

Unlike Adderall and Ritalin, atomoxetine is a non-stimulant treatment for ADHD.

Atomoxetine may be less effective than psychostimulants for ADHD23, but is also much less toxic to the central nervous system. Atomoxetine is also less likely to cause insomnia (some patients reportedly sleep better with atomoxetine).

Atomoxetine is often prescribed in combination with other therapies like counseling and cognitive behavioral therapy (CBT).

Atomoxetine has been noted to precipitate hypomania in people with a bipolar disposition.22

Fun facts:

  • Atomoxetine has shown promise as a treatment for problematic gambling in teenagers with ADHD24 and hoarding disorder
  • Atomoxetine may facilitate stroke recovery25

What I learned Reading Hundreds of Strattera Reviews

I perused hundreds of Strattera reviews and also drew upon my own experience with Strattera.

Here are the keys to success with Strattera:

  • Strattera can take up to 6 weeks to work, so don't give up too early.
  • Strattera doesn't work for everyone - some people respond better to traditional psychostimulants.
  • Some people experience better results taking Strattera at night (if it doesn't interfere with your sleep)
  • The most common and irritating side effect of Strattera is dry mouth. Keep a water bottle with you at all times!

Here are some notable Strattera reviews that surface on Reddit:

I've tried so many different meds but am on Strattera right now. I love it, after trying several different stimulants in a row this has been a dream. No side effects, that I know of and I feel so...functional! It's magical ;)

Oh my god this is awesome. Remember that Strattera is not a stimulant like methlyphenidate/amphetamines. So it took one month for me to "feel" it. And the feeling is not BAM in your face like a stimulant, but it is gradual. I didn't even notice it until right now when I realized that in the last two days I did this...

For me, it took over a month for it to have noticeable effects and still had to have the dosage uped to 80 mg. I personally can't notice if it's working, but my family can notice when I'm on it or not.

Strattera might help you a lot. The first two weeks are really awkward though, if you are a guy you will notice a lot of dysfunction with your private parts in terms of urinating and maintaining an erection. Also taking it without a meal can give you mad heartburn so avoid doing that, also it makes you thirsty as fuck throughout the day. Also it can screw up your sleep (i.e. you will go to bed and wake up without feeling rested) so some people take it at night instead of the morning.

Strattera literally saved my winter break. I did not want to continue it permanently because the dry mouth side effect made my post nasal drip allergy impossible to treat. But its also a very good medication so whether or not it works out for the long term is down to your own experience.

I need to report an n=1 of atomoxetine's amazing effects on my memory. I've used ritalin and adderall in the past to help with adhd, but recently was switched to strattera. Dose has been 80mg about 2.5 months now and memory is incredibly improved. Just gonna spit out some of the random things I can remember now.

I've been taking Strattera since late Novemeber. Currently I'm taking 60mgs daily, normally first thing in the morning. Its been a great help.

A few things:

Like you my doc started me on a low dose and over the course of a month I worked up to the target dose. I did initially experience some negative side effect for a couple days whenever the dosage was upped. These side effects always left after 1-3 days of being on the dosage.

If you take it in the morning I recommend taking it on a full stomach.

Strattera is quite a bit different from the stimulants available for adhd as it may not be fully effective for quite a while. I did experience some positive benefits within a couple days of starting the meds however it was probably about a month before I noticed a consistent change. I definitely recommend patience when starting this med.

If you have any more questions about my experience with the med I'd be glad to answer them!

Strattera Popularity and Prescribing Rates

One study26 looked at prescribing trends in Irish children and adolescents with ADHD between 2002 and 2011. Among this population, atomoxetine was the second most prescribed drug after methylphenidate.

During the study period methylphenidate was the most frequently prescribed psychostimulant. The prevalence increased from 3.68/1000 GMS population (95 % CI: 3.44–3.92) in 2002 to 7.51/1000 GMS population (95 % CI: 7.24–7.78) in 2011. Rates of dexamfetamine remained relatively stable over the 10 years, fluctuating between 0.08/1000 GMS population (95 % CI: 0.05–0.11) and 0.15/1000 GMS population (95 % CI: 0.10–0.20). Atomoxetine became available for prescribing in Ireland in January 2007 and immediately became the second most commonly prescribed drug (1.00/1000 population, 95 % CI: 0.88–1.12). Since 2007 rates of atomoxetine have steadily increased to 1.57/1000 population (95 % CI: 1.45–1.70) in 2011. Figure 1 illustrates the prescribing rates of these drugs per 1000 GMS population over the study period. Modafinil was rarely prescribed between 2002 and 2011 with prevalences of less than 0.02/1000 GMS population.

When Do Psychiatrists Prescribe Atomoxetine?

Atomoxetine is not a typical first-line agent for ADHD. The typical first-line treatments are amphetamine (Adderall, Vyvanse) or methylphenidate (Ritalin, Concerta, etc).

Psychiatrists opt to prescribe Strattera when a patients responds poorly to a psychostimulant or has a history of substance abuse. Atomoxetine has less recreational potential compared to other psychostimulants. Atomoxetine may also prefer atomoxetine for ADHD patients with a co-morbid tic disorder.

How Strattera Works: Norepinephrine

Given that Strattera (atomoxetine) is an SNRI, it's no surprise that it works by inhibiting norepinephrine transporters. Norepinephrine (also called noradrenaline) mobilizes the brain and body for action. Norepinephrine:

  • increases concentration and arousal
  • enhances memory formation and retrieval
  • triggers glucose release from stores

Some cells in the brain release norepinephrine to send signals to other cells. Norepinephrine transporters then take the norepinephrine back up to be used to send another signal. Atomoxetine prevents norepinephrine from being taken up. Atomoxetine's norepinephrine re-uptake inhibition boosts norepinephrine levels, resulting in a stronger signal6.

What ADHD Symptoms Are Treated With Atomoxetine?

  • Emotional dysregulation

  • Inattention

  • Hyperactivity
  • Temper
  • Emotional over-reactivity
  • Disorganization
  • Emotional instability

  • Executive functioning (reasoning, learning, planning)

  • Quality of life

Efficacy of Atomoxetine

There is evidence that the reduction in ADHD symptoms can be maintained in children long term on a low dose (1.2-1.8mg per kg per day)6.

Does Atomoxetine Treat Other Disorders That Commonly Occur with ADHD?

Another benefit of atomoxetine is that it can also improve symptoms of other disorders that commonly occur in people with ADHD. These conditions include:

  • Oppositional defiant disorder in children17
  • Hyperactivity in children with autism1

While atomoxetine can treat ADHD in heavy drinkers, it does not improve alcohol abuse 6.

How is Atomoxetine Taken?

Adults

Atomoxetine is provided as a white tablet to be taken orally. It comes in doses ranging from 10 to 100mg. It is often taken once or twice a day. This is usually taken at a low dose for the first 3 days, followed by a higher dose for the next few weeks. It may be increased again after 2 to 4 weeks, if needed6.

Children

The highest dose children weighing less than 70kg can take a day is 100mg7.

How long does it take for it to be effective?

Some patients notice an improvement after a week. However, it is can take as long as a month for the full effects of the treatment to be felt7.

Atomoxetine Side Effects

Common side effects include4:

  • Stomach upset
  • Nausea
  • Vomiting
  • Constipation
  • Tiredness
  • Loss of appetite
  • Weight loss
  • Dry mouth
  • Dizziness
  • Increased blood pressure
  • Drowsiness
  • Trouble sleeping
  • Decreased sex drive
  • Female specific effects

  • Menstrual cramps

  • Irregular periods

Rare but serious side effects needing immediate medical attention include:

  • Liver disease

  • Dark urine

  • Nausea
  • Vomiting
  • Loss of appetite
  • Stomach pain
  • Yellow eyes

  • Heart attack or stroke

  • Chest/jaw/left arm pain

  • Shortness of breath
  • Unusual sweating
  • Weakness on one side of the body
  • Confusion
  • Slurred speech
  • Changes in vision

  • Male specific effects

  • Erection lasting for 4 or more hours

  • Allergic reactions

  • Rash

  • Itching
  • Severe dizziness
  • Trouble breathing

Are there any side effects that specifically effect children?

Studies specifically investigating the effects of atomoxetine on children and adolescents found that treatment can cause the following side effects:

  • Weight gain9
  • Increase height9
  • Suicidal thoughts2

Are there any drugs or conditions that Atomoxetine may interact with?

Potential Drug Interactions

The primary drug interaction is with monoamine oxidase inhibitors (MAOIs). These can have serious and even fatal effects (Heal, Cheetham, & Smith, 2009; Goldman & Holden, 2014).

  • MAOIs

  • Isocarboxazid

  • Linezolid
  • methylene blue
  • moclobemide
  • phenelzine
  • procarbazine
  • rasagiline
  • selegiline
  • tranylcypromine

  • beta2-agonists and sympathomimetics

Potential Medical Condition Interactions

  • Narrow-angle glaucoma
  • History of pheochromocytoma
  • severe cardiac or vascular disorders sensitive to increases in blood pressure or heart rate

Are There Any Withdrawal Symptoms?

No adverse effects have been associated with stopping the medication. Thus, individuals discontinuing this medication do not need to taper it off (Chalon, et al., 2003).

Is there a risk of becoming addicted to Atomoxetine?

The potential for abuse is low. A study of primates that were able to self-administer atomoxetine found that the monkeys failed to continually administer the therapy19. Another study in humans also found that stimulant abusers did not prefer atomoxetine over a placebo12.

What other diseases might Atomoxetine treat?

Although it is only indicated for treatment of ADHD, there is evidence that atomoxetine may be beneficial in treating other neuropsychiatric and neurodegenerative diseases such as13.

  • Parkinson’s disease
  • Anxiety in Children with ADHD
  • Bipolar disorder in Children with ADHD

Parkinson’s disease

Atomoxetine has been shown to treat several symptoms of Parkinson’s disease including:

  • Learning and memory impairments10
  • Impulsivity related to Parkinson’s disease therapies (Ye, et al., 2015; Rae, et al., 2016)
  • Sleepiness20
  • Restores connections in the brain that were lost to the disease (Rae, et al., 2016)
  • Improves executive functioning (reasoning, learning, planning and executing) (Marsh, Biglan, Gerstenhaber, & Williams, 2009)

Anxiety in Children with ADHD

Treatment with Atomoxetine in comparison to other ADHD therapies, such as methylphenidate, significantly reduced anxiety in children with ADHD18.

Bipolar Disorder in People with ADHD

Bipolar disorder commonly occurs in people with ADHD. So therapies that can treat both are highly sought after. Atomoxetine is successful in reducing mania symptoms in children with ADHD13.

What About Depression?

Despite multiple studies on the effect of Atomoxetine on depression, most studies found that it did not have a major effect on reducing depressive symptoms20.

References

  1. Arnold, L., Aman, M., Cook, A., Witwer, A., Hall, K., Thompson, S., et al. (2006). Atomoxetine for hyperactivity in autism spectrum disorders: placebo-controlled crossover pilot trial. J Am Acad Child Adolesc Psychiatry, 1196-205.

  2. Bangs, M., Wietecha, L., Wang, S., Buchanan, A., & Kelsey, D. (2014). Meta-analysis of suicide-related behavior or ideation in child, adolescent, and adult patients treated with atomoxetine. J Child Adolesc Psychopharmacol, 426–434.

  3. Barton, J. (2005). Atomoxetine: a new pharmacotherapeutic approach in the management of attention deficit/hyperactivity disorder. Arch Dis Child, i26-9.

  4. Camporeale, A., Porsdal, V., De Bruyckere, K., Tanaka, Y., Upadhyaya, H., Deix, C., et al. (2015). Safety and tolerability of atomoxetine in treatment of attention deficit hyperactivity disorder in adult patients: an integrated analysis of 15 clinical trials. J Psychopharmacol, 3-14.

  5. Chalon, S., Desager, J., Desante, K., Frye, R., Witcher, J., Long, A., et al. (2003). Effect of hepatic impairment on the pharmacokinetics of atomoxetine and its metabolites. Clin Pharmacol Ther, 178-91.

  6. Childress, A. (2015). A critical appraisal of atomoxetine in the management of ADHD. Ther Clin Risk Manag, 27-39.

  7. Company, E. L. (2015). Strattera (atomoxetine hydrochloride). Infianapolis, IN: US prescribing information.

  8. Corman, S., Fedutes, B., & Culley, C. (2004). Atomoxetine: the first nonstimulant for the management of attention-deficit/hyperactivity disorder. Am J Health Syst Pharm, 2391-9.

  9. Donnelly, C., Bangs, M., Trzepacz, P., Jin, L., Zhang, S., Witte, M., et al. (2009). Safety and tolerability of atomoxetine over 3 to 4 years in children and adolescents with ADHD. J Am Acad Child Adolesc Psychiatry, 176-85.

  10. Goldman, J., & Holden, S. (2014). Treatment of Psychosis and Dementia in Parkinson’s Disease. Curr Treat Options Neurol, 281.

  11. Heal, D., Cheetham, S., & Smith, S. (2009). The neuropharmacology of ADHD drugs in vivo: insights on efficacy and safety. Neuropharmacology, 608-18.

  12. Jasinski, D., Faries, D., Moore, R., Schuh, L., & Allen, A. (2008). Abuse liability assessment of atomoxetine in a drug-abusing population. Drug Alcohol Depend, 140–146.

  13. Kumar, V., & Varambally, S. (2017). Atomoxetine Induced Hypomania in a Patient with Bipolar Disorder and Adult Attention Deficit Hyperactivity Disorder. Indian J Psychol Med, 89-91.

  14. Marsh, L., Biglan, K., Gerstenhaber, M., & Williams, J. (2009). Atomoxetine for the treatment of executive dysfunction in Parkinson's disease: a pilot open-label study. Mov Disord, 277-82.

  15. Rae, C., Nombela, C., Rodríguez, P., Ye, Z., Hughes, L., Jones, P., et al. (2016). Atomoxetine restores the response inhibition network in Parkinson's disease. Brain, 235-48.

  16. Schelleman, H., Bilker, W., Kimmel, S., Daniel, G., Newcomb, C., Guevara, J., et al. (2013). Amphetamines, atomoxetine and the risk of serious cardiovascular events in adults. PLoS One.

  17. Schwartz, S., & Correll, C. (2014). Efficacy and safety of atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder: results from a comprehensive meta-analysis and metaregression. J Am Acad Child Adolesc Psychiatry, 174-187.

  18. Snircova, E., Marcincakova-Husarova, V., Hrtanek, I., Kulhan, T., Ondrejka, I., & Nosalova, G. (2016). Anxiety reduction on atomoxetine and methylphenidate medication in children with ADHD. Pediatr Int, 476-81.

  19. Wee, S., & Woolverton, W. (2004). Evaluation of the reinforcing effects of atomoxetine in monkeys: comparison to methylphenidate and desipramine. Drug Alcohol Depend, 271-6.

  20. Weintraub, D., Mavandadi, S., Mamikonyan, E., Siderowf, A., Duda, J., Hurtig, H., et al. (2010). Atomoxetine for depression and other neuropsychiatric symptoms in Parkinson disease. Neurology, 448-55.

  21. Ye, Z., Altena, E., Nombela, C., Housden, C., Maxwell, H., Rittman, T., et al. (2015). Improving response inhibition in Parkinson's disease with atomoxetine. Biol Psychiatry, 740-8.

  22. Kumar V, Varambally S. Atomoxetine Induced Hypomania in a Patient with Bipolar Disorder and Adult Attention Deficit Hyperactivity Disorder. Indian J Psychol Med. 2017 Jan-Feb;39(1):89-91

  23. Hennissen L, Bakker MJ et al.. Cardiovascular Effects of Stimulant and Non-Stimulant Medication for Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Trials of Methylphenidate, Amphetamines and Atomoxetine. CNS Drugs. 2017 Mar;31(3):199-215

  24. Park JH, Lee YS et al.. Effectiveness of atomoxetine and methylphenidate for problematic online gaming in adolescents with attention deficit hyperactivity disorder. Hum Psychopharmacol. 2016 Nov;31(6):427-432

  25. Ward A, Carrico C et al.. Safety and improvement of movement function after stroke with atomoxetine: A pilot randomized trial. Restor Neurol Neurosci. 2017;35(1):1-10

  26. Boland F, Galvin R, Reulbach U, et al. Psychostimulant prescribing trends in a paediatric population in Ireland: a national cohort study. BMC Pediatr. 2015;15:118.

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Xavier Kent

I'm interested in nutrition, nootropics, and javascript. I'm a firm believer in getting really good at one thing.

Maryland

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