The Pros and Cons of Strattera—A Nonstimulant medication for ADHD

A national survey in 2016 estimates that 6.1 million children in the United States have been diagnosed with attention deficit hyperactivity disorder (ADHD), a common neurodevelopmental disorder often diagnosed in childhood but can last well into adulthood, especially without proper treatment. If your child was diagnosed with ADHD, check out our blog on what to do next.

To address ADHD effectively, understanding stimulant and non-stimulant medications is crucial. Today, we'll focus on Strattera (generic atomoxetine), a non-stimulant medication for ADHD.

What are the pros and cons of Strattera?

If you’ve been prescribed Strattera to treat ADHD, you may be looking to compare the pros and cons. Below is a chart detailing the different factors of this medication.

	Pros	Cons
Effectiveness	Effectively controls and treats ADHD symptoms	Takes 3-4 weeks of continued use to be fully effective
Side Effects	Does not cause common stimulant side effects like insomnia or dependence	Can cause side effects similar to some antidepressants, including decreased appetite, nausea, vomiting, upset stomach, etc. High blood pressure and serious heart problems in individuals with heart disease.
Risk Profile	Not a controlled substance, lower potential for abuse and dependency	Can increase the risk of suicidal thoughts, particularly in children and teens; requires close monitoring
Prescription	Less strict regulations; can be prescribed for more than a 30-day supply	Needs consistent use; may not be the best option for occasional ADHD medication needs
Duration	Longer-acting compared to certain stimulants; effects can last 24 hours or more	Less efficacy compared to stimulant medications for some individuals
Special Considerations	Suitable for children with Tourette's syndrome; does not aggravate tics	Possible side effect of urinary retention, which may be an advantage or disadvantage depending on individual circumstances

Stimulant vs non-stimulant ADHD meds for adults

While many may be familiar with central nervous system (CNS) stimulant medications to treat ADHD, such as Adderall, Concerta, Ritalin, Focalin, and Vyvanse, they may not be the best fit for everyone.

Another treatment option for ADHD in adults, children, and adolescents is what’s called “non-stimulant medications.” Strattera (atomoxetine) was the first non-stimulant medication approved by the U.S. Food and Drug Administration (FDA) to treat ADHD in adults and children over the age of six.

Below we outline the differences between stimulant and non-stimulant medications.

Stimulants	Non-stimulants
Several drugs approved by the FDA to treat ADHD	Only Strattera has been approved by the FDA to treat ADHD
The first-line treatment for ADHD as its more effective than non-stimulants	The second or third-line treatment for ADHD as it’s less effective than stimulants
Works by increasing the levels of dopamine and norepinephrine in the brain	Works by increasing the amount of norepinephrine in the central nervous system

Keep in mind that CNS stimulants do not cure ADHD. Instead, they work by reducing ADHD symptoms. Compare ADHD medications: Adderall vs Vyvanse.

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How effective is Strattera?

Strattera is classified as a norepinephrine reuptake inhibitor. It works by increasing the amount of norepinephrine in the central nervous system, a brain chemical that helps to increase attention span and focus while reducing hyperactivity and impulsive behaviors. Learn about the difference between norepinephrine and epinephrine.

Strattera is longer-acting compared to certain stimulants such as Ritalin. Its effects can last for 24 hours or more. Compare the benefits of Ritalin vs. Adderall.

A disadvantage is that Strattera takes 3-4 weeks of continued use to become fully effective. As a result, some patients give up before one month because it doesn't seem to work.

If an individual needs ADHD medication only occasionally, for example, to improve focus and attention for a short period, taking Strattera may not be the best option. In this case, stimulant medications may be the better ADHD treatment.

Are non-stimulant ADHD medications effective?

Non-stimulant medications like Strattera are approved by the FDA to treat ADHD symptoms. However, they are generally considered less effective than the stimulant medications used to treat symptoms of ADHD.

Is Strattera better than Ritalin or Adderall?

Strattera and Adderall are two distinct medications for ADHD treatment. Adderall is a stimulant, that combines dextroamphetamine and amphetamine to increase dopamine and norepinephrine transmitters in the brain. In contrast, Strattera, a non-stimulant, is the brand name for atomoxetine, a norepinephrine reuptake inhibitor that prolongs the availability of norepinephrine to the brain's neurons. Check out ADHD treatment: Strattera vs. Adderall.

Ritalin (methylphenidate) is also a medication used to treat Attention Deficit Hyperactivity Disorder (ADHD), but it has a different mechanism of action and characteristics than Strattera. Here are some key differences between Strattera and Ritalin:

Strattera	Ritalin
A non-stimulant medication that works by increasing the availability of norepinephrine in the brain	A stimulant medication that works by increasing the levels of dopamine and norepinephrine in the brain, enhancing focus and attention
A longer-acting medication that can last for 24 hours or more, making it suitable for a once-daily dosing regimen	Ritalin may require multiple doses throughout the day, depending on the specific formulation
May take several weeks of consistent use to reach full therapeutic effect	Often a quicker onset of action, providing more immediate relief of symptoms
Common side effects may include insomnia, decreased appetite, and increased heart rate.	Common side effects may include insomnia, decreased appetite, and increased heart rate.
Low potential for abuse and dependence	Higher potential for abuse and dependence

What are the side effects of Strattera?

A possible side effect of Strattera is urinary retention, which can actually be an advantage for children who have enuresis (problems with bedwetting).

Strattera can have other side effects similar to some antidepressants, including decreased appetite, nausea, vomiting, upset stomach, stomach pain, constipation, weight loss, dry mouth, headache, dizziness, daytime sleepiness or sluggishness, and mood swings.

This non-stimulant ADHD medication can also cause high blood pressure, increased heart rate, and other serious heart problems in people with a history of heart disease.

One pro of taking Strattera to treat ADHD is it does not cause many of the common side effects seen with psychostimulants, such as insomnia, dependence, or withdrawal.

This non-stimulant medication also has some anti-depressive effects. Therefore, it may be a better choice for people with symptoms of ADHD as well as depression.

Strattera and suicidal thoughts

Strattera can increase the risk of suicidal thoughts. Therefore, children and teens taking this medicine need to be monitored for suicidal thinking and ideations.

Are non-stimulant ADHD medications addictive?

A key advantage of a non-stimulant ADHD drug like Strattera is that it is not a controlled substance. This is because it has a lower potential for abuse and dependence compared to stimulant medications.

Since Strattera is not a Schedule II controlled substance, you can receive a prescription of Strattera for more than a 30-day supply. In contrast, stimulants are subject to strict federal regulations on how these drugs are prescribed and dispensed.

A doctor must issue a prescription every month for the medication to be dispensed by the pharmacy. The prescription for a non-stimulant ADHD medication such as Strattera can be called into the pharmacy for more than a 30-day supply at a time.

Is Strattera the only non-stimulant ADHD medication?

Strattera was the first non-stimulant that was FDA-approved. However, other non-stimulants that can be used to treat ADHD include guanfacine, clonidine, and certain antidepressant drugs.

In adults and children with both ADHD symptoms and depression, antidepressant medications called tricyclic antidepressants have been found to be useful. Another type of antidepressant called monoamine oxidase inhibitors is also occasionally used.

Strattera is also sometimes a better choice for children with Tourette's syndrome because, unlike stimulants, it does not aggravate tics.

However, these drugs can cause unpleasant and sometimes intolerable side effects, such as weight gain, blurred vision, upset stomach, drowsiness, dizziness, and low blood pressure.

Why is atomoxetine not a stimulant?

Atomoxetine is the active ingredient in the non-stimulant ADHD medication sold under the brand name Strattera.

This drug is a selective norepinephrine reuptake inhibitor. As the name suggests, it works on the reuptake of norepinephrine. Therefore, it is not a stimulant.

Also, unlike stimulants that are commonly used to treat ADHD, Strattera (atomoxetine) is not a controlled substance because it has a low risk of abuse, misuse, and addiction.

Does Strattera change your personality?

Strattera works by changing the way the brain absorbs a chemical called norepinephrine. Norepinephrine affects a person's overall mood. Therefore, Strattera can affect a person's mood and personality.

Like other antidepressant drugs, this non-stimulant ADHD medication has been linked to an increased risk of suicidal thinking and behaviors in children and adolescents.

As noted above, parents must be vigilant for any worrying change in mood, behavior, or personality if their child has been prescribed Strattera.

What is the best ADHD medication with the least side effects?

In addition to therapy and counseling, medications are a generally safe and effective treatment for attention deficit hyperactivity disorder (ADHD).

Doctors can choose from a range of drugs, including stimulant and non-stimulant ADHD medicines. However, these medications do not affect everyone in the same way. One medication might work better for one person than another.

The same goes for the side effect profile—an ADHD medication may cause severe side effects in one individual but be well tolerated by another.

For the best results, you should discuss different treatment options with your doctor, including your preferences and expectations. Your doctor should be able to guide you to the ADHD treatment that is right for you, along with the correct dose that controls your ADHD symptoms while causing minimal to no side effects.

Keep in mind that you or your child may need a combination of medication, skills training, and behavioral therapies for the most effective ADHD treatment.