From the Guidelines
Strattera (atomoxetine) can cause psychiatric side effects, including increased risk of suicidal thoughts, as noted by an FDA black box warning 1. These psychiatric side effects may include mood changes, such as irritability, agitation, anxiety, and depression. Key points to consider when prescribing Strattera include:
- Monitoring for new or worsening psychiatric symptoms, particularly during the initial weeks of treatment or after dose changes
- Being aware of the potential for emotional lability, sleep disturbances, and rarely, psychotic or manic symptoms
- Weighing the risk of these side effects against the benefits of treatment
- Scheduling regular follow-up appointments to assess the medication's effects The mechanism of action of atomoxetine, which affects norepinephrine levels in the brain, may contribute to these psychiatric side effects 1. It is essential for patients and caregivers to be aware of these potential side effects and report any concerning changes in behavior, mood, or thoughts to a healthcare provider immediately. In clinical practice, the benefits and risks of Strattera should be carefully evaluated, and alternative treatments should be considered if psychiatric side effects occur or worsen 1.
From the FDA Drug Label
- 1 Suicidal Ideation Atomoxetine hydrochloride increased the risk of suicidal ideation in short-term studies in children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) The following symptoms have been reported with atomoxetine hydrochloride: anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania and mania Psychiatric disorders — Depression and depressed mood; anxiety, libido changes.
Psychiatric side effects of Strattera (atomoxetine) include:
- Suicidal ideation
- Anxiety
- Agitation
- Panic attacks
- Insomnia
- Irritability
- Hostility
- Aggressiveness
- Impulsivity
- Akathisia (psychomotor restlessness)
- Hypomania
- Mania
- Depression and depressed mood
- Libido changes 2, 2
From the Research
Psychiatric Side Effects of Strattera
- Strattera (atomoxetine) is a nonstimulant medication used to treat attention-deficit/hyperactivity disorder (ADHD) in both children and adults.
- According to the studies, atomoxetine can be safely used in patients with ADHD and comorbid psychiatric disorders, such as anxiety, depression, and substance use disorder 3, 4.
- The presence of comorbidity did not adversely impact the efficacy of atomoxetine in the treatment of ADHD symptoms in both children and adults 3.
- Atomoxetine did not appear to exacerbate any of the comorbid conditions and could be an important therapy choice for the treatment of ADHD in the presence of comorbid disorders 3.
- However, atomoxetine may have some undesirable side effects, such as nausea, decreased appetite, insomnia, dry mouth, irritability, dizziness, and dyspepsia, which were reported significantly more often with atomoxetine than with placebo 5.
Specific Psychiatric Side Effects
- Anxiety: atomoxetine appeared to be effective in diminishing the presence of symptoms for those with comorbid anxiety 4.
- Depression: there are mixed or limited results for individuals with ADHD and comorbid depression 4.
- Substance use disorder: there are mixed or limited results for individuals with ADHD and comorbid substance use disorders 4.
- Other psychiatric side effects, such as irritability and insomnia, were reported in some studies 5.
Important Considerations
- Atomoxetine should not be given to patients with known cardiovascular problems, and all adult patients who receive atomoxetine should be monitored for changes in blood pressure throughout treatment 6.
- Atomoxetine should be closely monitored or avoided in patients with a history or risk of narrow angle glaucoma, epileptic seizures, Tourette's syndrome, a history of urinary outflow obstruction, or who are pregnant or lactating 6.