Is Strattera a Stimulant?
No, Strattera (atomoxetine) is definitively not a stimulant—it is a selective norepinephrine reuptake inhibitor and is classified as a non-stimulant ADHD medication. 1, 2
Mechanism and Classification
Atomoxetine is a highly selective inhibitor of the presynaptic norepinephrine transporter with minimal affinity for other neurotransmitter receptors or transporters, distinguishing it mechanistically from stimulant medications like methylphenidate and amphetamines. 3, 4
The FDA explicitly states that atomoxetine is not a controlled substance, as it was not associated with a pattern of response suggesting stimulant or euphoriant properties in abuse-potential studies. 2
Drug discrimination studies in rats and monkeys showed inconsistent stimulus generalization between atomoxetine and cocaine, further confirming its non-stimulant profile. 2
Clinical Guidelines Classification
Current ADHD treatment guidelines consistently categorize atomoxetine alongside clonidine and guanfacine as non-stimulant medications, in contrast to stimulants (methylphenidate, amphetamines, lisdexamfetamine). 1
The American Academy of Pediatrics guidelines specifically identify atomoxetine as having "no abuse potential" and explicitly state it is "not a stimulant" when discussing medication options for adolescents at risk for diversion. 1
Guidelines recommend non-stimulants like atomoxetine as second-line treatment due to smaller effect sizes compared to stimulants, though they serve as first-line options in specific populations including those with substance use disorders, tic disorders, or anxiety. 1
Key Clinical Distinctions from Stimulants
Abuse Potential
Atomoxetine carries negligible risk of abuse or diversion and is not a controlled substance, making it particularly useful for patients at risk for substance abuse or who do not wish to take controlled medications. 4, 5, 6
Clinical study data in over 2,000 children, adolescents, and adults showed only isolated incidents of drug diversion or inappropriate self-administration, with no evidence of symptom rebound or withdrawal syndrome. 2
Onset of Action
- Treatment effects with atomoxetine are not usually observed until 6-12 weeks after initiation, differing significantly from stimulants which have rapid onset of treatment effects. 1
Duration of Effect
- Atomoxetine provides "around-the-clock" effects without the need for multiple daily dosing, unlike many immediate-release stimulant formulations. 1
Side Effect Profile
Atomoxetine shows lower effects on appetite suppression and consequently fewer growth/height problems compared to stimulants, though it has similar cardiovascular effects. 1
Somnolence appears more common with atomoxetine while insomnia appears more common with stimulants. 4
Common Pitfalls to Avoid
Do not confuse atomoxetine's noradrenergic mechanism with stimulant activity—while both affect catecholamine systems, atomoxetine selectively inhibits norepinephrine reuptake without the dopaminergic effects characteristic of stimulants. 3, 7
Do not expect immediate symptom improvement—patients and families should be counseled that full therapeutic effects may take 6-12 weeks, unlike the rapid response seen with stimulants. 1
Do not assume atomoxetine is appropriate for all patients requiring non-controlled substances—while it avoids abuse potential, its smaller effect size compared to stimulants means some patients may require stimulant therapy for adequate symptom control. 1