Newly-Available Drug Shows Promise for ADHD Symptoms

Atomoxetine is the first new drug type in nearly thirty years to be specifically approved to treat attention deficit hyperactivity disorder (ADHD). It came on the market early this year under the brand name Strattera after the US Food and Drug Administration determined that it could be prescribed for children.

Strattera has been generally well received as an addition to the mix of ADHD medications, said Mariellen Fischer, PhD, Medical College of Wisconsin Professor of Neurology. However, she cautioned hopeful parents of children with ADHD that it is not a “wonder drug.” It works quite well for some children, she says, while having little or no impact on the symptoms of others.

ADHD symptoms include a lack of ability to focus and concentrate on tasks at hand, impulsive behavior, and hyperactive physical behaviors. The National Institutes of Health estimate that up to 7% of schoolchildren in the US have ADHD, and many of them continue to exhibit symptoms as adults.

The exact causes of ADHD are not clearly understood, although research to date points to poor function of the brain’s chemical message-sending system as a significant factor.

“Strattera works by increasing the amount of norepinephrine available,” said Dr. Fischer. “Norepinephrine is a neurotransmitter, one of the many brain chemicals that help to transmit information in the brain. Strattera is a fairly ‘pure’ medication. It acts almost exclusively on norepinephrine as opposed to many other medications that impact more than one neurotransmitter.”

A Non-Stimulant, But Not Without Side Effects
Stimulants have historically been the most commonly prescribed drugs used to treat ADHD. These stimulants include the brand names Dexedrine and Ritalin. Clonidine, which is used primarily to treat adults with high blood pressure, has also helped some children with ADHD. And in other cases anti-depressant or other drugs are prescribed “off label” for ADHD children although they are not explicitly approved by the FDA for that purpose.

Strattera, though, is not a stimulant and has no proven impact on depression or blood pressure. Early clinical trials have indicated that troublesome side effects associated with other ADHD medications may be minimized with Strattera, but Strattera can result in side effects of its own.

“I think that in practice the side effect profile of Strattera has been pretty variable,” said Dr. Fischer. “Some people will definitely have side effects issues with this drug. Any idea that it is side-effect free really isn’t accurate. Some kids have had trouble with loss of appetite or stomach pain. Insomnia has been a concern, as well. A lot depends on the individual.”

“One benefit of Strattera is that it is naturally longer-acting, so that you don’t have the ‘onset-offset’ issues that you do with the stimulants,” said Dr. Fischer. “A lot of the stimulants have become available in longer-acting forms, but Strattera still appears to be more even in its mode of action.

“Another thing that adds to its popularity is that Strattera is not listed as a narcotic. It’s not a controlled drug as the stimulants are, so it’s easier in the sense that physicians can call prescriptions in to a pharmacy and it can be prescribed for more than 30 days at a time. ”Every refill of a controlled stimulant requires a written prescription.

One Size Doesn’t Fit All
Many patients only need to take Strattera once a day, said Dr. Fischer, adding to the perception that it is a ‘consumer friendly’ medication that offers a regimen that is easier for young patients to adhere to. However, Dr. Fischer noted that other patients are seeing better results with a “twice-a-day” routine, another indicator that Strattera may not have more one-size-fits-all capability than many other medications.

Strattera has not been in use long enough to provide any advance indicators of which patients should be started on it as a first medication option, Dr. Fischer said. “I think that’s still in the realm of clinical lore rather than driven by empirical research,” she said. “There are kids who haven’t responded well to a stimulant, or kids who may have anxiety or depression problems in addition to ADHD, but again, I don’t think there’s a lot of hard and fast research yet to support which individuals might be better candidates for Strattera.”

Is Strattera as effective in treating ADHD as other medications currently in use? “When you look at the research data that’s been published, that’s what it looks like,” said Dr. Fischer. “What we’re seeing in practice is that there are some kids who have tried it and haven’t done as well as they were doing on their stimulants, so they went back to their stimulants. But I’ve also seen a few kids who didn’t respond well to stimulants but did remarkably well on Strattera. I think it’s another tool, another option. But is it the new cure-all for individuals with ADHD? I don’t think so, at least not based on what we’re seeing thus far.”

No matter which ADHD drug is being considered for a child, Dr. Fischer said, the decision to give such medication to a young son or daughter is still a weighty one. “Parents should have a good diagnostic evaluation done, find a provider that they have confidence in, and then work closely with that person.”

As researchers continue their efforts to find answers about the causes of ADHD, it’s encouraging for health care providers and families to learn that one more tool for treatment is now available.

Dan Ullrich
HealthLink Contributing Writer

For more information on this topic, see the HealthLink article One in Every Classroom: Kids with ADHD Struggle to Make the Grade.

Visit the website of the Medical College of Wisconsin Department of Neurology.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.