Adult ADHD Strattera (Atomoxetine)
In the United States, it is reported that 20% of high school students are currently taking or have taken ADHD (Attention Deficit Hyperactivity Disorder) medication.
Generally, stimulant medications such as Adderall (Amphetamine/Dextroamphetamine) and Concerta (Methylphenidate) are widely used, which provide a rapid and powerful effect through the inhibition of norepinephrine and dopamine reuptake/secretion. This effect provides the high concentration, immersion, elevation, and strong motivation necessary for the ultra-competitive society in the United States.
Stimulant medications have a high possibility of side effects like insomnia, anxiety, and grandiosity, and due to prematurely utilizing future dopamine reserves, withdrawal symptoms may occur for 2 weeks to 3 months upon discontinuation of the medication. The biggest drawback is that because they directly affect the compensatory dopamine mechanism, dependency and abuse are serious concerns.
Non-stimulant medication Strattera (Atomoxetine) takes 4 to 6 weeks to show effects and cannot provide the level of elevation, immersion, and motivation as stimulant medications; however, its effectiveness in treating attention concentration, memory, planning and execution in the prefrontal cortex and impulsivity and hyperactivity in the limbic system is not significantly diminished.
Both Concerta and Strattera work on the AMPA and NMDA receptors linked to glutamate in the prefrontal cortex and hippocampus, showing neuroplastic effects that allow the formation of new perspectives in thinking and memory. In other words, through these medications, what has been careless, impulsive, and hyperactive in life with ADHD can suddenly be recognized as the self-observational ability of the prefrontal cortex improves, allowing patients to fix existing maladaptive impulsive neural circuits or create more cautious and reliable new neural circuits, reducing the repetition of mistakes and offering a chance to improve thoughts and behaviors. This is reminiscent of mindfulness meditation (Vipassana).
Moreover, pinpoint levels of concentration and immersion like those provided by amphetamines or Concerta are not always advantageous in every task. A slight relaxation of focus can allow simultaneous recognition of multiple things on one screen, which can be beneficial in scientific innovation and artistic creativity.
In the treatment process of ADHD, Strattera may be less effective and slower than Concerta; however, the physical and emotional costs are lower, and it might be preferred depending on work and profession.
Adult ADHD often coexists with conditions such as depression, anxiety, and obsessive-compulsive disorder due to prolonged self-blame, criticism, loss, or ostracism by oneself or others. Strattera does not amplify anxiety and sensitivity like Concerta and may actually reduce anxiety. However, it is ineffective for depression, and in cases where adult ADHD coexists with depression or seasonal affective disorder, a dosage-adjusted NDRI antidepressant bupropion may be used.
The biggest advantage of Strattera is that it can be discontinued immediately without tapering. Additionally, since it does not directly affect dopamine, there is very little risk of dependency and abuse.
Adult ADHD presents with symptoms such as careless mistakes, ongoing difficulty with attention, inability to focus when others are speaking, difficulty following instructions and completing tasks, losing things, and failing to keep appointments. Symptoms of hyperactivity and impulsivity may include being unable to remain still, leaving one's seat, running, climbing, excessive talkativeness, interrupting others, and inability to wait for one's turn. Some of these symptoms may have been present before age 12 and continue in two or more locations/situations, leading to social, academic, or occupational issues. A diagnosis may be considered if these symptoms are not due to schizophrenia or other psychotic conditions.
Strattera exhibits ADHD treatment effects through norepinephrine selective reuptake inhibition, and there have been very few reports of severe liver damage in children and adults. Therefore, it is contraindicated for patients with hypersensitivity to this medication, those taking MAO inhibitors, patients with angle-closure glaucoma, pheochromocytoma, severe hypertension, or cardiovascular diseases. Caution should be exercised if QT prolongation is seen on ECG, if there are liver function abnormalities, or if the patient has a history of psychosis, mania, or seizures.
Gendak Family Medicine Clinic
