Is Strattera (atomoxetine) effective in treating anxiety?

From the Guidelines

Strattera (atomoxetine) is not established as an effective treatment for anxiety disorders as its primary indication. According to the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1, atomoxetine, a selective norepinephrine reuptake inhibitor, has not been established as effective for the treatment of anxiety as the primary disorder.

Key Points to Consider

• The guideline mentions that medications from the SNRI class, such as venlafaxine and duloxetine, have been shown to be effective in the treatment of anxiety disorders 1.
• Duloxetine is the only SNRI with an FDA indication for the treatment of generalized anxiety disorder in children and adolescents 7 years old 1.
• The choice of medication for anxiety within the SNRI class may be governed by considerations such as pharmacokinetics, pharmacodynamics, tolerability, cost, insurance formularies, and unique risks leading to warnings or precautions 1.

Treatment Alternatives

For patients with anxiety disorders, first-line treatments typically include selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), along with cognitive behavioral therapy. While Strattera may help with anxiety symptoms in some patients, particularly those with both ADHD and anxiety, its primary use is for attention and impulse control rather than anxiety specifically.

Important Considerations for Strattera Use

If Strattera is considered for treating anxiety, particularly in the context of ADHD, patients should be aware of its potential side effects, including nausea, decreased appetite, fatigue, and sometimes increased heart rate or blood pressure, as well as the timeframe for it to take effect, which is typically 2-4 weeks 1. The dosage should always be determined by a healthcare provider based on individual needs.

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. Atomoxetine did not worsen anxiety in these patients as determined by the Pediatric Anxiety Rating Scale (PARS). 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 did not worsen anxiety in these patients as determined by the Liebowitz Social Anxiety Scale (LSAS).

Strattera (atomoxetine) is not shown to be effective in treating anxiety, but it also does not worsen anxiety in patients with ADHD and comorbid anxiety disorders, as determined by the Pediatric Anxiety Rating Scale (PARS) and the Liebowitz Social Anxiety Scale (LSAS) 2.

• Key points:
  • Atomoxetine does not worsen anxiety in patients with ADHD and comorbid anxiety disorders.
  • There is no evidence that atomoxetine is effective in treating anxiety.
  • The drug may be used in patients with ADHD and comorbid anxiety disorders without worsening their anxiety.

From the Research

Efficacy of Strattera in Treating Anxiety

• Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor primarily used to treat attention-deficit hyperactivity disorder (ADHD) 3, 4.
• Research suggests that atomoxetine can be effective in reducing anxiety symptoms in patients with ADHD, particularly when used as an adjunctive treatment to selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) 5, 6.
• A systematic review of clinical trials found that atomoxetine did not exacerbate anxiety symptoms and, in fact, reduced them in children and adolescents with comorbid ADHD and anxiety disorders 6.
• Studies in adults with ADHD have also shown that atomoxetine can be an effective treatment, with a lack of abuse potential being a significant advantage 4, 7.

Mechanism of Action and Tolerability

• The exact mechanism of action of atomoxetine in reducing anxiety symptoms is unclear, but it is thought to be related to its selective inhibition of presynaptic norepinephrine reuptake in the prefrontal cortex 3.
• Atomoxetine has been found to be generally well-tolerated, with common adverse events including headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea 3, 4.
• The majority of adverse events are mild or moderate, and few patients discontinue treatment due to adverse events 3, 4.

Clinical Implications

• Atomoxetine may be a useful treatment option for patients with ADHD and comorbid anxiety disorders, particularly those who are at risk of substance abuse or do not wish to take a controlled substance 3, 4.
• Further studies are needed to fully understand the efficacy of atomoxetine in reducing anxiety symptoms in patients with ADHD and to explore its potential as a treatment for anxiety disorders in general 6.