ADHD Treatment: Strattera vs Adderall

Attention deficit hyperactivity disorder (ADHD) affects millions of children, adolescents, and adults in the United States. If you or someone in your family has received this diagnosis, your healthcare provider may recommend taking medication, such as Adderall or Strattera, in addition to talk therapy or CBT (cognitive behavioral therapy), to manage ADHD symptoms. Please continue reading to learn more about these two drugs and how they compare.

Which drugs are used as ADHD treatments?

Several medications are available to manage ADHD symptoms such as hyperactivity and impulsivity and to increase focus and attention span. These drugs work by increasing the levels of certain natural chemicals called neurotransmitters in the brain. ADHD medications are divided into two main categories — stimulant medications and non-stimulant medications.

Stimulants

Stimulants include immediate-release or short-acting drugs that are taken once or twice daily, with the effects lasting for 4-6 hours. Adderall IR is an example of a commonly prescribed immediate-release stimulant.

Stimulants also come in extended-release or long-acting forms (for example, Adderall XR capsules) that are taken once a day in the morning, with the effects lasting throughout the day.

Other examples of stimulants include dextroamphetamine (Dexedrine), methylphenidate (Ritalin, Concerta), and a combination of amphetamine and dextroamphetamine (Adderall).

Stimulants such as methylphenidate and amphetamines are considered first-choice for the treatment of ADHD due to their effectiveness. However, before starting a stimulant for you or your child, it is recommended to discuss the risks and the benefit of this therapy as these medications are controlled substances, and they carry a risk of misuse, and dependence.

Non-Stimulants

Non-stimulants for ADHD such as Strattera take longer to start working. It can take 3-4 weeks before you get the full benefit of these medications. Their effects last for up to 24 hours. Non-stimulants are considered second-line treatments for ADHD. They are used when stimulants are ineffective or cause intolerable side effects. Very rarely, stimulants and non-stimulants are used together; this is done when the effect of a stimulant like Adderall wears off too early, so using a non-stimulant medication can help with ADHD symptoms for the remainder of the day. Keep in mind that this is not a common practice and should not be attempted without a healthcare professional’s guidance.

An example of a non-stimulant ADHD medication is atomoxetine (Strattera), a selective norepinephrine reuptake inhibitor by drug class. Others include guanfacine (Tenex, Intuniv), an alpha-2 adrenergic agonist, and clonidine (Kapvay), a centrally acting alpha agonist. These medications are not controlled substances, so they do not cause dependence as a side effect.

What are the key differences between Strattera and Adderall?

Both Strattera and Adderall are used to treat ADHD. However, there are some key differences between them:

Active ingredient

Strattera is a brand name product that contains the active ingredient atomoxetine. Adderall is a brand name product that contains two amphetamine salts - amphetamine and dextroamphetamine.

Type of ADHD medication

Strattera is a non-stimulant medication and is not a controlled substance. Adderall is a stimulant medication and is a schedule II (two) controlled substance. Stimulant medications are more likely to be misused and cause dependence, tolerance, and withdrawal symptoms upon abrupt discontinuation.

Mechanism of action

Strattera prevents the reuptake of norepinephrine in the brain, increasing the levels of norepinephrine in the central nervous system. Adderall blocks the reuptake of norepinephrine and dopamine by nerve cells in the brain, increasing the amount of these brain chemicals in the central nervous system.

Dosage forms

Strattera is a long-acting medication and can be taken once a day with or without food. The dose can be split into two to be taken once in the morning and then once in the late afternoon or early evening.

Strattera capsules come in dosages of 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, and 100 mg. The capsules should be swallowed whole without crushing, chewing, or opening them. The usual maintenance dose of Strattera is 80 mg per day, and the maximum dose is usually no more than 100 mg per day. Atomoxetine, generic Strattera, is less expensive than the brand name drug.

The immediate-release forms of Adderall are effective for 4-6 hours, and the extended-release forms (Adderall XR) have effects that can last throughout the day. Adderall IR (immediate release Adderall tablets) comes in doses of 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, and 30 mg. Adderall XR comes in doses of 5 mg,10 mg, 15 mg, 20 mg, 25 mg, and 30 mg.

The usual initial dose of Adderall immediate-release for adults and children 6 years and older is 5 mg once to twice daily. Even though there is not a recommended maximum daily dose for Adderall IR, taking more than 40 mg of Adderall IR daily is not recommended.

The typical starting dose to treat narcolepsy (a sleep disorder) is 10 mg once daily.

For Adderall XR, the typical starting dose for adults is 20 mg once daily. The maximum daily dose is 30 mg daily.

Adderall XR capsules should not be crushed or chewed; however, they can be opened and the contents sprinkled on soft food like applesauce for immediate use. Adderall is available in a lower-cost generic version.

Side effects

Common side effects of Strattera include nausea, fatigue, decreased appetite, increased heart rate and blood pressure, drowsiness, and sleep problems. Additional side effects in adults include constipation, dry mouth, erectile dysfunction, cough, headache, and abdominal pain.

Side effects of Adderall include loss of appetite, insomnia, abdominal pain, mood swing, agitation, nervousness, nausea, vomiting, and fever in children. Additionally, adolescents and adults have reported side effects of Adderall, such as decreased appetite, weight loss, headache, dry mouth, anxiety, agitation, dizziness, fast heartbeat, and urinary tract infections.

Risks

Taking Strattera comes with a boxed warning for the increased risk of suicidal thoughts and behaviors in children and adolescents. Other risks include severe liver injury, behavior changes including aggression, heat problems, and worsening of narrow-angle glaucoma.

Risks of taking Adderall include drug dependence (psychological and physical dependence on the medicine). In fact, Adderall has a boxed warning for the risk of misuse. Additional risks include serious cardiovascular events, including heart attack, stroke, sudden death, increased blood pressure, the triggering of manic symptoms in patients with bipolar disorder, worsening of glaucoma, tics, seizures, and long-term suppression of growth in children.

Both Strattera and Adderall can cause allergic reactions. Additionally, both medications can have drug interactions with other medications, such as MAO inhibitors. This can increase the risk of serious adverse effects. That’s why it’s important to give your healthcare provider or your child’s doctor a complete list of your medications before starting Adderall or Strattera treatment.

Is Strattera better than Adderall for ADHD?

Both Adderall and Strattera are FDA-approved drugs for the treatment of ADHD. The two drugs belong to different drug classes, and each is an effective medication for ADHD treatment. Clinical trials comparing the two have not shown one as being superior to the other.

Generally speaking, Adderall and other stimulants are the first line of treatment for ADHD. They are older medications, and their effects have been studied in more detail. However, Adderall carries a risk of misuse and dependence. Also, some people find Strattera to be better tolerated than Adderall.

Just with any medication, people may respond differently to ADHD medications. Your doctor will help you decide between Strattera and Adderall based on your symptoms, medical history, response to medications in the past, and side effects such as high blood pressure.

It is worth noting that behavioral therapy plays an important role in managing symptoms of ADHD along with taking Strattera or Adderall, or both as part of a total treatment program.

Frequently Asked Questions

Does Strattera actually help with ADHD?

Strattera is a non-stimulant medication and is usually a second line of treatment for ADHD. Non-stimulants often do not work as well or as fast as stimulant medications. Your doctor may prescribe Strattera if stimulant medications do not help your ADHD symptoms or you have intolerable side effects.

Does Strattera work the same as Adderall?

Both Strattera and Adderall are used to treat ADHD, but they work differently. Strattera is not a stimulant and is generally less effective than Adderall, which is a stimulant. However, some people may get better results with Strattera if they can tolerate Strattera better.

Will Strattera give me energy?

Strattera is not a stimulant like Adderall and will not give you energy like stimulant drugs. It works differently to treat ADHD symptoms and can make you feel different than a stimulant. For some people, this may be a good thing since the increase in energy and alertness associated with stimulants can cause jitteriness and anxiety for some people. However, many people find their ADHD symptoms are better controlled on stimulant medications like Adderall.

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