From the Guidelines
Atomoxetine and vortioxetine can be used together for ADHD with comorbid anxiety, but this combination requires careful medical supervision due to potential additive side effects and drug interactions, as evidenced by studies such as 1 and 1. When considering the use of atomoxetine and vortioxetine for ADHD with anxiety, it's essential to weigh the potential benefits against the risks. Atomoxetine, a norepinephrine reuptake inhibitor, is FDA-approved for ADHD and has shown efficacy in treating core ADHD symptoms, as well as improving functional impairment and quality of life 1. Vortioxetine, on the other hand, is approved for depression but may help with anxiety symptoms through its multimodal action on serotonin receptors.
Some key points to consider when using this combination include:
- Typical dosing for atomoxetine ranges from 40-100 mg daily, while vortioxetine is typically prescribed at 5-20 mg daily
- The combination makes pharmacological sense as they target different neurotransmitter systems - atomoxetine primarily affects norepinephrine while vortioxetine works on serotonin pathways
- Potential concerns include additive side effects such as nausea, dry mouth, insomnia, or sexual dysfunction
- Blood pressure and heart rate should be monitored regularly, especially when initiating treatment
- Some patients may experience drug interactions affecting metabolism, as both medications are processed by liver enzymes
It's crucial to consult with a psychiatrist before starting this combination, as individual factors including other medications, medical conditions, and specific symptom profiles will influence whether this approach is appropriate for your situation. According to 1, the SNRI class, which includes medications like venlafaxine and duloxetine, has been shown to be effective in treating anxiety disorders, and atomoxetine, although not primarily used for anxiety, may have some anxiolytic effects. However, the evidence for atomoxetine's use in anxiety is limited, and more research is needed to fully understand its potential benefits and risks in this context.
From the FDA Drug Label
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 In a 12-week double-blind, placebo-controlled trial, 176 patients, aged 8 to 17, who met DSM-IV criteria for ADHD and at least one of the anxiety disorders of separation anxiety disorder, generalized anxiety disorder or social phobia were randomized. In a separate 16-week, double-blind, placebo-controlled trial, 442 patients aged 18 to 65, who met DSM-IV criteria for adult ADHD and social anxiety disorder (23% of whom also had Generalized Anxiety Disorder) were randomized.
Atomoxetine can be used in patients with ADHD and anxiety as it does not worsen anxiety in these patients, as determined by the Pediatric Anxiety Rating Scale (PARS) and the Liebowitz Social Anxiety Scale (LSAS) 2. However, there is no information about the use of vortioxetine with atomoxetine in the provided drug labels. Key points:
- Atomoxetine does not worsen anxiety in patients with ADHD and comorbid anxiety disorders.
- No information is available about the use of vortioxetine with atomoxetine.
From the Research
Atomoxetine and Vortioxetine in ADHD with Anxiety
- Atomoxetine has been studied for use in the treatment of attention-deficit/hyperactivity disorder (ADHD) and has shown a positive response in clinical trials 3.
- The efficacy of atomoxetine in the treatment of ADHD in patients with comorbid psychiatric disorders, including anxiety, has been reviewed in several studies 4, 5.
- These studies suggest that atomoxetine does not exacerbate anxiety symptoms and can be an effective treatment option for ADHD in patients with comorbid anxiety disorders 4, 6, 5.
- One study found that atomoxetine reduced anxiety symptoms in young patients with comorbid ADHD and anxiety disorder 6.
- Another study found that atomoxetine was effective in improving anxiety symptoms in children and adolescents with ADHD, with a significant reduction in anxiety symptoms as measured by the Hamilton Anxiety Scale (HAM-A) 5.
- Atomoxetine has also been used as an adjunctive treatment in adult patients with ADHD and comorbid partially responsive generalized anxiety, with significant resolution of symptoms of anxiety 7.
- However, there is limited information on the use of vortioxetine in ADHD with anxiety, and no studies were found that directly address the use of both atomoxetine and vortioxetine in this population.
- Therefore, while atomoxetine may be a viable treatment option for ADHD with anxiety, the use of vortioxetine in this context is not well supported by the available evidence.