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Psychopharmacology book

Atomoxetine (STRATTERA)

Atomoxetine (STRATTERA)

Strattera straightens out your attention. Atomoxetine (Strattera) is a norepinephrine reuptake inhibitor (NRI) with the sole FDA-approved indication of ADHD. Although atomoxetine is not properly referred to as an antidepressant, it resides in the antidepressant chapter because its mechanism is similar to some antidepressants used off-label for ADHD including bupropion (Wellbutrin) and TCAs such as desipramine, nortriptyline, and protriptyline. 

Atomoxetine (STRATTERA) mnemonic by Dr Jason Cafer MD psychiatry

Although it has stimulating properties, atomoxetine is referred to as a “non-stimulant” to contrast it with the Schedule II ADHD stimulants (amphetamine, methylphenidate). Atomoxetine is not a controlled substance. 


By inhibiting the norepinephrine transporter (NET), atomoxetine indirectly increases dopamine (DA) transmission in the prefrontal cortex (which is underactive with ADHD) without increasing DA in the nucleus accumbens (reward center). Therefore, atomoxetine has no abuse potential because it does not increase DA in the nucleus accumbens.

Atomoxetine STRATTERA indications and interactions by Dr Jason Cafer MD psychopharm

When used to augment an SSRI, atomoxetine has the potential to improve anxiety and depression. Atomoxetine appears to improve reading skills in children with dyslexia (Shaywitz et al, 2017).


Atomoxetine poses a risk of suicidality in children/adolescents with ADHD, especially during the first months of treatment. Average risk of suicidal thoughts was 0.4% with atomoxetine vs 0% with placebo, but no suicides were reported. All antidepressants have a similar warning about suicide, which is another reason atomoxetine resides in this chapter. Other treatments for ADHD (Adderall, Ritalin, Tenex, Intuniv, etc) do not have this boxed warning. 

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