The Difference Between Strattera and Adderall

Understanding the Pros and Cons of Using These Drugs to Treat ADHD

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Strattera and Adderall are medications prescribed to help treat attention-deficit/hyperactivity disorder (ADHD), a neurodevelopmental disorder characterized by difficulty with regulating attention and controlling impulses and hyperactivity. Both drugs improve attention span and decrease hyperactivity and impulsiveness; however, they are very different medications. The most striking difference between the two is that Strattera is a non-stimulant, while Adderall is a psychostimulant medication.

How They Work

These drugs are from different drug classes and work in distinct ways in the body.

Strattera

Strattera is a brand name for a drug that contains atomoxetine. It was approved by the U.S. Food and Drug Administration (FDA) in 2002 and became the first non-stimulant medication to receive approval for ADHD. It was also the first medication to be approved for treating adults with ADHD. It can be prescribed for people 6 years of age and older.

Strattera is a norepinephrine reuptake inhibitor, which means it allows the neurotransmitter norepinephrine to be available to the brain’s neurons for longer. It also raises the quantity of the neurotransmitter dopamine in the prefrontal cortex of the brain.

Adderall

Adderall is a brand name for the combination drug dextroamphetamine/amphetamine. It belongs to the amphetamine drug family. The FDA approved this medication in 1996. In addition to ADHD, Adderall is also approved to treat narcolepsy. It can be prescribed to people ages 6 and up.

Adderall acts on the central nervous system by boosting the number of neurotransmitters in the brain. This increase in dopamine and norepinephrine boost your ability to focus and pay attention while decreasing hyperactivity and impulsive behavior.

Treatment Choices

ADHD medication is divided into two categories: first-line medications and second-line medications. Stimulant medications like Adderall are known to be the most effective treatment for ADHD, and as such are considered first-line medication.

Non-stimulant medications like Strattera are second-line medications. While not as effective as stimulants, they do still help ADHD symptoms. For example, studies found that Strattera reduced hyperactive inattentive symptoms in adults compared to a placebo. However, 40 percent of the participants still reported significant ADHD symptoms.

Although stimulants are the most effective medication, they don't work for everyone. In addition, sometimes people experience severe side effects with stimulants or have an underlying medical condition that increases the risks of taking a stimulant, such as a history of addiction, a psychiatric condition like bipolar disorder, or a heart condition or sleep disorder.

In these cases, a non-stimulant medication like Strattera is an option. Strattera has also been found to sometimes help with conditions that often co-exist with ADHD like anxiety and oppositional defiant behavior, a pattern of aggression, disobedience, and a lack of respect for authority.

Forms, Dosages, and Efficacy

Strattera is available in an oral capsule that comes in seven doses ranging from 10 to 100 milligrams (mg). Generic versions of the drug are available in the United States, Canada, and other countries.

Adderall IR (immediate release) is available in tablets from 5 mg to 30 mg. Adderall XR (extended release) is available in six doses, from 5 mg to 30 mg. There are generic medications available (amphetamine salt combination), but sometimes people report these aren't as effective for them as the brand versions.

It can take four to six weeks before Strattera reaches its maximum therapeutic effect. Once therapeutic levels have been reached, the effects of the medication last 24 hours. In contrast, the effects of Adderall IR and Adderall XR can be felt as quickly as 30 minutes to one hour. The effects of Adderall IR begin to wear off after four hours, and after 12 hours for Adderall XR.

Taking a break from the medication (a "drug holiday") is an option with Adderall. After discussing it with your doctor, you might not take Adderall on the weekend or over holidays. Strattera needs to be taken every day.

Side Effects

For both medications, doctors usually prescribe a low dose to begin with and gradually increase it until the right therapeutic dose is found for you and your symptoms. This usually means you'll have fewer side effects as your body adjusts to the medication.

The side effects of Strattera include dry mouth, dizziness, upset stomach and reduced appetite, constipation, reduced libido, and sweating. Men may experience some erectile dysfunction.

The side effects of Adderall include loss of appetite, diarrhea, dizziness, dry mouth, fever, headache, insomnia, nausea, nervousness, sleep issues, vomiting and weight loss, and erectile dysfunction. More serious, but rare side effects are increased heart rate, high blood pressure, hallucinations, paranoia, shortness of breath, heart attack, and stroke.

Cardiac Concerns

Research has found that the likelihood of cardiac problems with the use of stimulant medications like Adderall is very low in healthy people. For example, one study found that people on stimulant medications for ADHD did not have an increased risk for cardiac events like heart attack, stroke, or sudden cardiac death.

In the past, patients had electrocardiography (EKG) screenings if a stimulant medication was going to be prescribed. With new research findings, these screenings are no longer required unless you, or someone in your family, has a history of cardiac problems. If you're taking a stimulant and notice any unusual signs, contact your doctor immediately.

For Women

Both medications are category-C drugs, which means they're considered unsafe to take during pregnancy or while breastfeeding. Talk to your doctor if you're pregnant or planning to become pregnant.

Risk of Abuse

Adderall is a schedule-II controlled substance. This means there's the potential for abuse and that extended use might cause dependence. Because Adderall’s mode of action is to increase the activity of the dopamine, it could be misused and inhaled or injected to create a high. Surges of dopamine cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.

That said, it's reassuring to note that studies show that people taking a prescription stimulant have a lower rate of substance abuse compared to those not taking this type of medication. This could be because when ADHD is being treated safely, people are less likely to self-medicate and use non-prescription methods to manage their condition.

When stimulant medications are prescribed at appropriate doses and taken as prescribed, the risk of potential addiction is low. Always store your medication safely away from other people, and don't share your medication.

As a non-stimulant medication, Strattera is not a controlled substance and doesn't carry the potential risk for abuse. It works by inhibiting norepinephrine uptake, rather than significantly affecting dopamine. Because it takes several weeks for the medication to take effect, it would be difficult to abuse.

Black Box Warning

The FDA places a black-box warning on some prescription drug labels to bring attention to possible serious or life-threatening risks that people need to be aware of.

Strattera has a black box warning for the possible increased risk of suicidal thoughts or actions in children, teens, and young adults. Parents and caregivers are encouraged to monitor possible changes in their child’s behavior and keep in close contact with the child’s doctor.

Adderall has two black box warnings. The first is to highlight the potential for abuse. The second is to warn about cardiac events.

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