From the Guidelines
Atomoxetine is not a first-line treatment for depression and anxiety, but it may provide some benefit for these conditions when they occur alongside attention-deficit/hyperactivity disorder (ADHD). According to the most recent evidence, atomoxetine's primary indication is for treating ADHD, and its effectiveness in treating depression and anxiety as primary disorders is not well-established 1.
Key Points to Consider
- Atomoxetine works by increasing norepinephrine levels in the brain, which can improve mood and reduce anxiety symptoms, but it is not as effective as other medications like SSRIs or SNRIs for primary depression or anxiety disorders 1.
- Typical dosing of atomoxetine starts at 40mg daily for adults, potentially increasing to 80-100mg daily based on response and tolerability, with treatment being ongoing rather than short-term 1.
- Side effects may include nausea, decreased appetite, fatigue, and increased blood pressure, and it carries a black box warning regarding increased suicidal thoughts in children and adolescents 1.
- For primary depression or anxiety disorders without ADHD, medications like SSRIs (such as sertraline or escitalopram) or SNRIs (like venlafaxine or duloxetine) are generally more effective and would be recommended first 1.
Clinical Decision Making
When considering atomoxetine for patients with depression and anxiety, it's essential to weigh the potential benefits against the risks and to consult with a healthcare provider for proper evaluation and monitoring. The evidence suggests that atomoxetine may have a role in treating ADHD with comorbid anxiety or autism spectrum disorder, but its use in primary depression or anxiety disorders is not supported by strong evidence 1.
Prioritizing Patient Outcomes
In prioritizing morbidity, mortality, and quality of life, the decision to use atomoxetine for depression and anxiety should be made with caution and careful consideration of the individual patient's needs and circumstances. The goal is to maximize benefits while minimizing risks, and this may involve selecting alternative treatments that have a stronger evidence base for these conditions 1.
From the FDA Drug Label
Atomoxetine hydrochloride is not approved for major depressive disorder Anxiety in patients with ADHD and comorbid Anxiety Disorders - In two postmarketing, double-blind, placebo-controlled trials, it has been demonstrated that treating patients with ADHD and comorbid anxiety disorders with atomoxetine does not worsen their anxiety
Atomoxetine is not indicated for the treatment of depression. However, it has been shown that atomoxetine does not worsen anxiety in patients with ADHD and comorbid anxiety disorders 2.
- Key points:
- Not approved for major depressive disorder
- Does not worsen anxiety in patients with ADHD and comorbid anxiety disorders It is essential to note that atomoxetine is primarily used for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) 2.
From the Research
Atomoxetine and Depression/Anxiety
- Atomoxetine has been studied in subjects with ADHD and comorbid oppositional defiant disorder, anxiety, depression, and substance use disorders 3.
- The mechanism of action of atomoxetine includes selective inhibition of the presynaptic norepinephrine transporter, which may have a positive influence on symptoms of comorbidities such as anxiety and depression 4, 5.
- A study found that adjunctive atomoxetine to SSRIs or SNRIs can be effective in treating adult ADHD patients with comorbid partially responsive generalized anxiety 6.
- Atomoxetine has been shown to be effective in treating adult ADHD, and issues related to dosing, treatment duration, safety, and use in the case of psychiatric comorbidity are summarized 7.
Efficacy of Atomoxetine
- Atomoxetine is effective and generally well tolerated in the treatment of ADHD symptoms, and may have a positive influence on symptoms of comorbidities such as anxiety and depression 5.
- Clinical trial data indicate that atomoxetine is safe and well tolerated for the treatment of ADHD, with adverse events mainly mild to moderate and transient in nature 4.
- A study found significant resolution of symptoms of anxiety and ADHD in adult patients with comorbid partially responsive generalized anxiety treated with adjunctive atomoxetine 6.
Use of Atomoxetine in Comorbid Conditions
- Atomoxetine can be used as an adjunctive treatment in adult patients with ADHD and comorbid partially responsive anxiety symptoms 6.
- The use of atomoxetine in patients with psychiatric comorbidity, including anxiety and depression, is summarized, and issues related to dosing, treatment duration, and safety are discussed 7.