From the Guidelines
Atomoxetine can be a suitable treatment option for ADHD in patients with comorbid depression, although it is essential to note that evidence does not support its efficacy in treating depression as a standalone condition. The typical starting dose is 40mg daily for adults, gradually increasing to a target dose of 80-100mg daily (or 1.2mg/kg/day) over 2-4 weeks, as recommended by the manufacturer 1. For children and adolescents, dosing usually starts at 0.5mg/kg/day and increases to 1.2-1.4mg/kg/day. Atomoxetine works by inhibiting norepinephrine reuptake, which helps improve both ADHD symptoms and mood. Unlike stimulants, it doesn't carry a risk of abuse potential, making it suitable for patients with substance use concerns. It may take 2-4 weeks to see full benefits, unlike the immediate effects of stimulants. Common side effects include nausea, decreased appetite, fatigue, and initially increased blood pressure and heart rate. Atomoxetine should be taken consistently, either as a single daily dose or divided into morning and evening doses. It's crucial to monitor for rare but serious side effects, including liver problems, suicidal thoughts (particularly in young patients), and cardiovascular effects, as highlighted in the warnings by federal agencies and regulatory bodies 1. While atomoxetine can help with both ADHD and depression, severe depression may require additional treatment with an antidepressant or psychotherapy.
Some key considerations when prescribing atomoxetine include its potential benefits in patients with certain comorbidities, such as anxiety or autism spectrum disorder, as well as its relatively smaller effect sizes compared to stimulants 1. Additionally, atomoxetine may be considered as a first-line treatment option in patients with substance use disorders or those who cannot tolerate stimulants. However, it is essential to weigh the risks and benefits of treatment, particularly in pregnant or breastfeeding women, as atomoxetine has been shown to cross the placenta and may expose the developing fetus to potential risks 1.
In terms of dosing and administration, atomoxetine can be taken with or without food, and its capsules can be opened and mixed with water for patients who have difficulty swallowing pills 1. The medication should be stored at room temperature, away from moisture and heat. Patients should be advised to take their medication consistently and to report any changes in their symptoms or side effects to their healthcare provider. Regular monitoring of liver function, blood pressure, and heart rate is also recommended, particularly during the initial treatment period.
Overall, atomoxetine can be a valuable treatment option for ADHD in patients with comorbid depression, but its use should be carefully considered and monitored by a healthcare provider, taking into account the individual patient's needs and medical history.
From the FDA Drug Label
Atomoxetine hydrochloride is not approved for major depressive disorder
The FDA drug label does not answer the question.
From the Research
Efficacy of Atomoxetine in Treating ADHD with Depression
- Atomoxetine has been shown to be effective in treating ADHD in adults, with significant improvements in ADHD symptoms compared to placebo 2, 3.
- The presence of comorbid disorders, including depression, does not appear to adversely impact the efficacy of atomoxetine in treating ADHD symptoms 4.
- Atomoxetine has been found to be effective in treating ADHD in patients with comorbid depression, with no evidence of exacerbating the comorbid condition 4.
- In adults with ADHD and comorbid depression, atomoxetine may be a valuable treatment option, providing long-term and consistent symptom relief and functional improvement 5.
Safety and Tolerability of Atomoxetine
- Atomoxetine is generally well-tolerated, with common adverse events including nausea, dry mouth, decreased appetite, insomnia, and fatigue 2, 3, 5.
- Atomoxetine has a negligible risk of abuse or diversion, making it a useful option for patients at risk for substance abuse or who do not wish to take a controlled substance 2, 3.
- The use of atomoxetine in adults with comorbid ADHD and bipolar disorder may be effective, but requires careful evaluation and consideration of the potential risks and benefits 6.
Clinical Considerations
- Atomoxetine may be an important treatment option for adults with ADHD, particularly those with comorbid depression or other psychiatric disorders 4, 5.
- A hierarchical approach to treatment may be desirable, with mood stabilization preceding the treatment of ADHD symptoms in patients with comorbid bipolar disorder 6.
- Further research is needed to fully understand the efficacy and safety of atomoxetine in treating ADHD with depression and other comorbidities 4, 6.