Strattera vs. Adderall: What Is the Difference?

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Strattera and Adderall are both medications prescribed to help treat ADHD. They improve attention span and decrease hyperactivity and impulsiveness. However, they are very different medications. The most striking difference between the two is that Strattera is a non-stimulant, while Adderall is a psycho-stimulant (stimulant) medication.

Strattera

Strattera is a brand name for a drug that contains atomoxetine.

It was approved by the Food and Drug Administration (FDA) in 2002, and became the first non-stimulant medication to receive approval for ADHD. It was also the first medication to be approved for treating adults with ADHD. It can be prescribed for people 6 years of age and older.

Strattera is a norepinephrine reuptake inhibitor (NRI), which means it allows the neurotransmitter norepinephrine to be available to the brain’s neurons for longer. It also raises the quantity of dopamine in the prefrontal cortex of the brain.

Adderall

Adderall is a brand name for a drug that is made of dextroamphetamine and amphetamine. It belongs to the amphetamine drug family. The FDA approved this medication in 1996. In addition to ADHD, it is also approved to treat narcolepsy. It can be prescribed to people 6 years of age and older.

Adderall acts on the central nervous system by boosting the quantity of neurotransmitters in the brain.

The increase in dopamine and norepinephrine assists a person in their ability to focus and pay attention, while decreasing hyperactivity and impulsive behavior.

Two Categories of Medication for ADHD

ADHD medication is divided into two categories; first line medications and second line medications.

Stimulant medications like Adderall are known to be the most effective treatment for ADHD, and so they are considered first line medication.

Non-stimulant medications like Strattera are second line medications. While they are not as effective as stimulants, they do still help ADHD symptoms. For example, studies found that Strattera reduced hyperactive inattentive symptoms in adults compared to a placebo However, 40 percent of the participants still reported significant ADHD symptoms.

Although stimulants are the most effective medication, they do not work for everyone. In addition, sometimes a person experiences severe side effects, or has an underlying medical condition that increases the risks of taking a stimulant such as a history of addiction, a psychiatric condition like bipolar disorder, or a heart condition or sleep disorder.

In these cases, a non-stimulant medication like Strattera is an option. Strattera has also been found to sometimes help with conditions that often co-exist with ADHD like anxiety and oppositional defiant behavior.

Is Strattera Safer Than Adderall?

Adderall is a Schedule II controlled substance. This means there is the potential for abuse, and extended use might cause dependence. Because Adderall’s mode of action is to increase the activity of dopamine in the brain, it could be misused and inhaled or injected to create a high.

Interestingly, studies have shown that when someone is taking a prescription stimulant they have a lower rate of substance abuse compared to someone not taking this type of medication. This could be because when ADHD is being treated safely, people are less likely to self-medicate and use non-prescription methods to manage their ADHD.

When stimulant medications are prescribed at appropriate doses, and if taken as prescribed, the risk of potential addiction is low. Always store your medication safely away from other people, and do not share your medication.

As a non-stimulant medication, Strattera is not a controlled substance and does not carry the potential risk for abuse.

It works by inhibiting norepinephrine uptake, rather than significantly affecting dopamine. Because it takes several weeks for the medication to take effect, it would be difficult to abuse.

Another common safety concern people have regarding taking a stimulant medication like Adderall is a potential negative effect it might have on the heart. Research has found that the likelihood of cardiac problems with the use of stimulant medications is very low in healthy individuals. For example, one study found that people on stimulant medications for ADHD did not have an increased risk for cardiac events like heart attack, stroke, or cardiac death.

In the past, patients had electrocardiography (EKG) screening if a stimulant medication was going to be prescribed. With new research findings, these screenings are no longer a requirement unless you, or someone in your family, have a history of cardiac problems. If you are taking a stimulant and notice any unusual signs, contact your doctor immediately.

Forms and Dosages

Strattera is available in an oral capsule that comes in seven doses ranging from 10 to 100 milligrams (mg).

There is not a generic version of Strattera available in the U.S. at the moment, although that could change soon as the patent ends in 2017. There are generic versions of Strattera available in Canada and other countries.

Adderall IR (immediate release) is available in tablets from 5 mg to 30 mg. Adderall XR (extended release) is available in six doses, from 5 mg to 30 mg. There are generic medications available (amphetamine salt combination). Sometimes people report these are not as effective for them as the brand versions.

Side Effects

For both medications, doctors usually prescribe a low dose to begin with and gradually increase it until the right therapeutic dose is found for you and your symptoms. This usually means you will have fewer side effects as your body adjusts to the medication.

The side effects of Strattera include dry mouth, dizziness, upset stomach and reduced appetite, constipation, reduced libido, and sweating. Men may experience some erectile dysfunction.

The side effects of Adderall include loss of appetite, diarrhea, dizziness, dry mouth, fever, headache, insomnia, nausea, nervousness, sleep issues, vomiting and weight loss, and erectile dysfunction. More serious, but more rare side effects are increased heart rate, high blood pressure, hallucinations, paranoia, shortness of breath, heart attack, and stroke.

Black Box Warning

The FDA places a black box warning on some prescription drug labels to bring attention to possible serious or life threatening risks that the patient needs to be aware of.

Strattera has a black box warning for the possible increased risk of suicidal thoughts or action in children, teens, and young adults. Parents and caregivers are encouraged to monitor possible changes in their child’s behavior, in addition to keeping in close contact with the child’s doctor.

Adderall has two black box warnings. The first is to highlight the potential for abuse. The second is to warn about cardiac events.

For Women

Both medications are a Category C drug, and are considered unsafe to take during pregnancy or while breastfeeding. Talk to your doctor if you are pregnant or planning to become pregnant.

How Long Does the Medication Take to Work?

It can take four to six weeks before Strattera reaches its maximum therapeutic effect. Once therapeutic levels have been reached, the effects of the medication last 24 hours. In contrast, the effects of Adderall IR and Adderall XR can be felt as quickly as 30 minutes to one hour. The effects of Adderall IR begin to wear off after four hours, and after 12 hours for Adderall XR.

Drug holidays are an option if you, or your child, take Adderall. After discussing this with your doctor, you might not take Adderall on the weekend or over holidays. Strattera needs to be taken every day.

A Word From Verywell

Both Adderall and Strattera are effective ADHD treatments. However, while Strattera is helpful for some people living with ADHD, its effectiveness does not occur with the same regularity as would occur with a stimulant medication like Adderall. This is why it is a second line treatment option.

If you are considering either Adderall or Strattera as part of ADHD treatment for you or your child, discuss it with your doctor or pediatrician. The doctor will be able to help you decide if either medication is a good option for you.

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Biederman, J., M.C. Monuteaux, T. Spencer. T.E. Wilens, H. A Macpherson, and S.V. Faraone. 2008. Stimulant Therapy and Risk For Subsequent Substance Use Disorders in Male Adults With ADHD: A Naturalistic Control 10-Year Follow-Up Study. American Journal of Psychiatry 165(5)): 597 -603.

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Molina, B.S.G., S.P. Hinshaw, L. E. Arnold, J. M Swanson, W. E. Pelham, L. Hechtman et al, 2013. Adolescent Substance Use in The Multimodal Treatment Study of Attention Deficit/Hyperactivity Disorder (ADHD) (MTA) as a Function of Childhood ADHD, Random Assignment to Childhood Treatments, and Subsequent Medication. American Academy of Child and Adolescent Psychiatry 52(3): 250-263.

Schwarz, S., and C. U. Correll, 2014. Efficacy and Safety of Atomoxetine in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Results From a Comprehensive Meta-Analysis and Metaregression. Journal of the American Academy of Child and Adolescent Psychiatry. 55(2): 174-187

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