Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Strattera is a prescription medication for Attention Deficit Hyperactivity Disorder, better known as ADHD. Its purpose is to improve attention, concentration and focus, all of which can suffer as a result of ADHD.
In this article we’ll review the medical research on Strattera to determine whether it’s likely to be effective for treating ADHD. We’ll highlight some of the drug’s side effects, and suggest a few natural alternatives that patients may want to discuss with their doctor.
The generic form of Strattera is called atomoxetine, and we’ll use these terms interchangeably throughout this article, as they refer to the same active drug.
Does Strattera Work?
One of the most important considerations when patients are evaluating a new drug is its efficacy; is it proven to work, and to what degree?
ADHD is a condition that affects both children and adults. The efficacy of Strattera in children and adolescents was evaluated in a medical review published in the Pediatric Drugs journal.
The researchers found that Strattera was more effective than all current ADHD medications in both children and adolescents. Patients taking Strattera reported significantly higher scores for health-related quality of life than patients taking a placebo drug.
Strattera has also been found to be effective for adults with ADHD. A clinical trial from 2004 tested the drug on adults with diagnosed ADHD, and found that it reduced average scores on the Clinician Global Impression of Severity Scale, which is used in this instance to measure the severity of ADHD symptoms.
The study authors also noted that patients taking Strattera had lower scores on the Conners’ Adult ADHD Rating Scale (CAARS), a separate tool used by clinicians to measure ADHD symptoms.
An extensive meta-study was published in 2013 to evaluate the results from many individual studies on the efficacy of Strattera for ADHD. Data from over 3,000 patients who participated in clinical trials was included.
This review demonstrated that Strattera was effective on average. ADHD symptoms were reduced as reported by both patients and clinicians. However the researchers did note that the medication “has a poor benefit-risk balance for the treatment of adults with ADHD,” because the benefits were mild and the side effects were worse than with placebo treatment.
How Does Strattera Work?
Strattera is part of a class of drugs called norepinephrine reuptake inhibitors. They prevent a neurotransmitter called norepinephrine from being processed, which leads to artificially elevated circulating levels of it in the brain.
Many of our recent reviews of mental health medications, like our recent buspirone reviews article, referenced the term SSRI, which refers to Selective Serotonin Reuptake Inhibitors. This type of drug is more common, is typically used in antidepressants, and has the same mechanism of action of Strattera but for serotonin instead of norepinephrine.
Norepinephrine is proven in medical studies to optimize central nervous system (CNS) performance, improve brain plasticity and memory consolidation. By artificially increasing its levels, Strattera enhances cognitive functioning in a manner that’s especially beneficial to ADHD patients.
Strattera Side Effects
Strattera has a somewhat concerning side effect profile. It’s required to carry a black box warning label by the Food and Drug Administration (FDA) in the U.S. because it can increase risk of suicidal thoughts and actions in children and adolescents.
A medical paper examined the side effects of Strattera and found that the most common side effects were relatively standard, including headache, abdominal pain and nausea.
The following cardiovascular side effects were also reported as “common side effects” of the drug: increase in heart rate, sinus tachycardia, increase in systolic blood pressure, increase in diastolic blood pressure, heart palpitations.
Around 4% of children and adolescents taking the medication had an increase in heart rate of greater than 25 beats, which is a significant increase.
Clearly Strattera is a drug with serious side effects for patients and their doctors to discuss. Most prescription medications we’ve reviewed haven’t had such a wide breadth of side effects.
Strattera Vs. Adderall
Adderall is probably the most well-known ADHD medication, and is frequently used off-label due to its fame in popular culture. Many patients are curious about which drug is superior for ADHD.
Adderall is an amphetamine, and is part of a class of drugs called stimulants, which increase activity of the CNS and brain.
A clinical trial published in the Annals of Pharmacotherapy journal compared the efficacy of Strattera and Adderall for ADHD. The researchers found that the drugs had similar efficacy, but that the extended release formulation of Adderall led to greater improvements in various ADHD clinical scoring systems, suggesting greater effectiveness overall.
A separate trial found that in children and adolescents who responded poorly to Adderall, switching to Strattera led to improved mental health outcomes and reduction of ADHD symptoms.
Another medical trial compared the use of Adderall XR and Strattera in children, and found that Adderall XR was more effective.
Based on the available research it appears that Adderall XR may be slightly more effective than Strattera for both children and adults, but patients should speak with their doctor about safety, because extended release versions of drugs last longer in the body.
Strattera comes in a wide variety of doses, which is unsurprising given that it’s prescribed to both children and adults. Children need relatively lower doses of medications due to lower body weight.
The medication is sold at the following doses: 10 milligrams (mg), 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg.
The StatPearls medical database, which summarizes clinical research, reports that the typical starting dosage for adults is 40 mg daily.
Children are reported to typically start at a dose of 0.5 mg per kilogram (kg) body weight daily. For a 70 pound child this would equate to a 15.87 mg dose. Because a dose isn’t available at that exact number, the doctor would likely start at the lower dose (10 mg) to be safe and then titrate up.
Should I Take Strattera Generic?
As referenced in the intro section of this article, the generic form of Strattera is called atomoxetine. Both of these drugs have the exact same active ingredient; the branded version just has naming rights.
Because both branded and generic versions have the same active ingredient(s) and therefore same mechanism of action, we typically recommend that patients speak to their doctor about the generic version of drugs because it’s just as effective and often much cheaper.
A medical review compared the efficacy of branded versus generic drugs and found no difference, which is to be expected because they’re the same compounds. The review actually noted that 10% of branded drug users experienced side effects, compared to 9% of generic drug users, but this is likely random variation and doesn’t suggest generic drugs are superior.
For patients who pay out-of-pocket for medications, taking a generic version can sometimes save you thousands of dollars annually.
There are some natural compounds available as supplements which are proven in medical research to have nootropic (cognitive-enhancing) function, and may be worth discussing with your doctor if you’re a patient concerned about the side effects of Strattera.
Ginkgo biloba is probably the most well-studied herbal nootropic compound. A clinical trial on ginkgo found that it improved cognitive function in patients with mild cognitive impairment.
Another medical review published in the Journal of Alzheimer’s Disease found that the results of ginkgo biloba extract supplementation were especially impressive when administered to patients with neuropsychiatric symptoms, which is a promising result for patients with ADHD.
We recommend speaking to your doctor about a ginkgo biloba supplement in extract form (which is more potent than raw powder) which is standardized to 24% flavone glycosides and 8% terpene lactones, which is the medical standard of most ginkgo used in research studies.
Another promising study on natural alternatives to ADHD medications found that caffeine consumption reduced ADHD symptoms and improved cognitive performance in patients with ADHD.
Caffeine is a milder stimulant than amphetamine, which is what’s in Adderall.
For patients interested in caffeine for ADHD, we would recommend speaking to your doctor about black coffee consumption rather than caffeine pills, as black coffee contains other healthy compounds and natural stimulants such as theobromine which are absent from processed caffeine powder.