Is Strattera (atomoxetine) more effective than Adderall (amphetamine and dextroamphetamine) for treating Attention Deficit Hyperactivity Disorder (ADHD)?

Adderall is More Effective Than Strattera for ADHD Treatment

Stimulant medications like Adderall (amphetamine and dextroamphetamine) are more effective than non-stimulant medications like Strattera (atomoxetine) for treating ADHD, with stimulants having an effect size of approximately 1.0 compared to atomoxetine's effect size of approximately 0.7. 1

Comparative Efficacy of ADHD Medications

Evidence for Stimulants vs. Non-Stimulants

• Stimulant medications (including Adderall) are considered first-line treatment for ADHD due to their superior efficacy 1, 2
• The American Academy of Child and Adolescent Psychiatry guidelines support stimulants as first-line therapy with a response rate of 70-75% compared to placebo (5-30%) 2
• Direct comparison studies show that amphetamine-based medications like Adderall are more effective than atomoxetine (Strattera) 3
• In head-to-head studies, mixed amphetamine salts (Adderall) demonstrated greater therapeutic efficacy than atomoxetine in children with ADHD 4

Effect Size Comparison

• Stimulant medications have an effect size of approximately 1.0 1
• Atomoxetine (Strattera) has a smaller effect size of approximately 0.7 1
• Extended-release guanfacine and extended-release clonidine also have effect sizes of approximately 0.7 1

Treatment Algorithm Based on Age

For Children (6-11 years)

1. First-line: FDA-approved stimulant medications (methylphenidate or amphetamine-based like Adderall)

   • Evidence is particularly strong for stimulant medications 1
   • Consider combining with behavioral therapy for optimal outcomes 1

2. Second-line: If stimulants are contraindicated or poorly tolerated:

   • Atomoxetine (Strattera)
   • Extended-release guanfacine
   • Extended-release clonidine
   • Note: Evidence is sufficient but less strong for these options compared to stimulants 1

For Adolescents (12-18 years)

1. First-line: FDA-approved stimulant medications with the assent of the adolescent 1
2. Second-line: Non-stimulant options as listed above
3. Consider combining with behavioral therapy, though evidence for behavioral therapy is weaker in this age group (quality of evidence C) 1

For Adults

1. First-line: Amphetamine-based medications (like Adderall) are preferred based on efficacy and tolerability 3
2. Second-line: Atomoxetine or other non-stimulants 5

Important Considerations When Choosing Between Medications

Advantages of Adderall

• Higher efficacy with larger effect size (1.0 vs 0.7) 1
• More effective for core ADHD symptoms based on clinician ratings 3
• May be more effective for immediate symptom control 4

Advantages of Strattera

• Not classified as a controlled substance; negligible risk of abuse 6
• Particularly useful for patients at risk of substance abuse 6
• Better for patients with co-morbid anxiety or tics 6
• Less likely to cause insomnia than stimulants 6
• Once-daily dosing option 6

Side Effect Profiles

• Adderall (stimulants): Common side effects include appetite loss, abdominal pain, headaches, sleep disturbance, and potential growth effects 1
• Strattera: Common side effects include somnolence, gastrointestinal symptoms, decreased appetite, and rare but serious concerns about suicidal ideation and liver injury 6

Drug Interactions and Special Considerations

Important Adderall Interactions

• Vitamin C and citrus can decrease absorption and accelerate elimination of amphetamines 2
• Patients taking Adderall should avoid vitamin C or citrus fruits within 1 hour before and after taking medication 2

Monitoring Requirements

• Regular assessment of symptom control for both medications 2
• For stimulants: Monitor vital signs, weight, and growth 1, 2
• For atomoxetine: Monitor for signs of suicidal ideation and liver function 6

Conclusion

While both Adderall and Strattera are effective treatments for ADHD, the evidence clearly shows that stimulant medications like Adderall have superior efficacy with larger effect sizes. The choice between medications should consider factors such as comorbid conditions, risk of substance abuse, and side effect profiles, but from a pure efficacy standpoint, Adderall is the more effective option for most patients with ADHD.