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Atomoxetine (Strattera), and how can it be used as a medicine for ADHD

Abstract: What is atomoxetine (Strattera)

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Atomoxetine (Strattera), and how can it be used as a medicine for ADHD

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Question(s): 
Written by: Martin Winkler
First version: 22 Jul 2008.
Latest revision: 25 Jul 2008.

What is Atomoxetine (Strattera)?
Can I treat my ADHD child without psychostimulant medication?

Answer:

During the last couple of months a lot of attention has been given to an "old" antidepressant drug now used for the specific pharmacological treatment of ADHD (Attention Deficit Hyperactivity Disorder).

The basic principles of the use of antidepressant medication for ADHD are well known for years. Side effects of the older tricyclic antidepressant medication were to severe to use this drug treatment as a real alternative to psychostimulants. The atomoxetine offers a similar pattern of positive effects on adhd but less side-effects.

Due to a lot of research and promotion by the pharmacompany in the last years this treatment has become rather popular (esp. in the US). The advertisements stress the "alternative to psychostimulants" and the fact that atomoxetine is not a controlled substance, so doctors would be able to give refill prescriptions with less trouble.

Most ADHD experts have had favourable experiences with this treatment choice, but still think that you have to consider pros and cons of the treatment. Not all patients respond to this treatment, so most ADHD experts would still recommend psychostimulant medication as first choice.

We know rather little about the long-term effects of this treatment and we have to consider the specific side effects of the antidepressant treatment with atomoxetine as well. One of the major problems of the medication is the high cost to the patient (or the health system).

Atomoxetine is an antidepressant with a rather good therapeutical effect on children, adolescents and adults with ADHD. Many controlled studies on children, adolescents and adults have shown the effectiveness and safe use of the medication. It is not a psychostimulant but a "Norepinephrine reuptake inhibitor". Norepinephrine is a neurotransmitter involved in the symptoms of ADHD. While most of the past research focused on dopamine and the dopamine trasporter system these systems are not the main target of the atomoexetine treatment. This system is also involved in the treatment with atomoxetine. The basic principle of the Norepinephrine reuptake inhibition is the same as for SSRI (selective serotonin reuptake inhibition): There is a special transport system for the neurotransmitter Norepinephrine. This can be blocked with atomoxetine. So less neurotransmitter is reabsorbed into the presynaptic cell -> more neurotransmitter is available for action.

This change of neurotransmitter concentration has a positive impact on adhd symptoms.

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