Strattera, Simplified
Once an ADHD diagnosis is made, your doctor should work with you to explore the full range of treatment options. One of the first decisions often involves choosing between a stimulant and a non-stimulant medication.
While stimulant medications remain the first-line pharmacologic treatment for ADHD, non-stimulants like atomoxetine (brand name: Strattera) provide an important alternative—particularly for patients with contraindications to stimulants, co-occurring conditions, or concerns about misuse.
History and Approval
Atomoxetine was originally researched as a potential antidepressant but was repurposed and developed by Eli Lilly as a treatment for Attention-Deficit/Hyperactivity Disorder (ADHD). It received FDA approval in 2002 for the treatment of ADHD in children aged 6 and up, adolescents, and adults.
It was the first non-stimulant to be FDA-approved for ADHD and remains the only NRI specifically indicated for this use.
Mechanism of Action
Strattera is a selective norepinephrine reuptake inhibitor (NRI). It works by blocking the presynaptic norepinephrine transporter (NET), leading to increased norepinephrine availability in the prefrontal cortex—a region associated with attention, impulse control, and executive function.
Atomoxetine does not significantly increase dopamine in the nucleus accumbens (a key area in the brain’s reward system), which likely accounts for its low abuse potential.
It has minimal serotonergic activity, though indirect effects may occur in some patients due to downstream monoaminergic interactions.
It is not a controlled substance, which can simplify prescribing logistics and reduce monitoring burdens.
Indications and Clinical Use
FDA-approved indication:
ADHD in children ≥6 years, adolescents, and adults
Clinical scenarios where atomoxetine may be preferred:
History of substance use disorder or concerns about stimulant misuse
Presence of tics, anxiety disorders, or insomnia that may worsen with stimulants
Poor tolerance to stimulant-related side effects, such as appetite suppression or emotional lability
Desire for 24-hour coverage (as atomoxetine is generally taken once daily and provides continuous symptom control)
Atomoxetine may also be used adjunctively with other agents in select cases, although monotherapy is standard.
Summary
Atomoxetine (Strattera) is a non-stimulant, non-addictive alternative for the treatment of ADHD across the lifespan. Its unique mechanism, low misuse potential, and once-daily dosing make it particularly useful in select populations.
While slower to take effect than stimulants, it offers steady, 24-hour symptom control and may be especially appropriate for individuals with coexisting anxiety, tics, or concerns about stimulant side effects.
I always remind patients that medication is just one part of an effective ADHD treatment plan. While medications can significantly reduce symptoms, ADHD is not something that can be "cured" with medication alone.
A comprehensive treatment approach often includes:
Behavioral strategies
Psychoeducation
Executive functioning skills training
Parent coaching or therapy, when working with children
Sleep, nutrition, and exercise support
Medication can help create the mental bandwidth for these tools to work better—but the best outcomes typically come from a multimodal approach tailored to each individual’s needs.
