An overwhelming majority of medications used to treat ADHD (attention-deficit/hyperactivity disorder) are classified as psychostimulants. Although psychostimulant drugs tend to have an immediate effect in reducing symptoms of attentional deficits and hyperactive behavior, they have a high potential for abuse. Furthermore, there is something to be said for the potential that long-term psychostimulant use may alter dopamine levels and receptor densities – specifically downregulating receptor count.
This has lead pharmaceutical giant Eli Lilly to develop a non-stimulant drug called Strattera to treat symptoms of ADHD. This drug functions by primarily targeting norepinephrine by inhibiting its reuptake. The reuptake inhibition tends to result in increased physiological stimulation and clinical studies indicate that treatment with Strattera is significantly more effective than a placebo.
Many doctors like the idea of prescribing Strattera (as opposed to a psychostimulant) due to the fact that it isn’t considered to have any potential for abuse. However, individuals considering Strattera for their ADHD often want to know how it stacks up when compared to Adderall (the most popular ADHD medication). Strattera and Adderall are radically different drugs with different mechanisms of action.
Strattera vs. Adderall Comparison Chart
Below is a general comparison of Strattera to Adderall. The chart will provide you with a rundown of some general obvious differences such as: drug type, ingredients, formats, dosing, and manufacturers. Strattera tends to provide relief for 24 hours, whereas those using Adderall XR can get relief for up to 12 hours; approximately half the time of Strattera.
|Drug type||Norepinephrine Reuptake Inhibitor (NRI)||Psychostimulant|
|Approved uses||ADHD||ADHD / narcolepsy|
|Ingredients||Atomoxetine||Mixed Amphetamine Salts: 75% Dextroamphetamine + 25% Levoamphetamine|
|Formats||LA (Long-acting)||IR (Immediate release) or XR (Extended release)|
|Dosages||10 mg/18 mg/25 mg/40 mg/60 mg/80 mg/100 mg||IR: 5 mg/7.5 mg/10 mg/12.5 mg/15 mg/20 mg/30 mg or XR: 5 mg/10 mg/15 mg/20 mg/25 mg/30 mg|
|Manufacturer||Eli Lilly & Company||Shire Pharmaceuticals|
|Legal Status||Prescription-only (Rx)||Schedule II (US)|
|Mechanism of action||Functions by primarily inhibiting reuptake of norepinephrine. It elicits a minor degree of serotonin reuptake inhibition and minimally affects dopamine. It also acts as an NMDA receptor antagonist and has a minimal affinity for "mu" and "kappa" opioid receptors as a partial agonist.||Functions by increasing levels and inhibiting reuptake of stimulatory neurotransmitters such as dopamine and norepinephrine. It acts as a TAAR1 agonist and VMAT2 inhibitor.|
|Half life||24 hours||11 to 13 hours|
|Common side effects||Appetite loss. Constipation. Dizziness. Dry mouth. Insomnia. Nausea. Sexual dysfunction. Sleepiness. Stomach aches. Weight loss.||Abdominal pain. Appetite loss. Diarrhea. Dizziness. Dry Mouth. Fever. Headache. Insomnia. Irritability. Nausea. Nervousness. Vomiting. Weight loss.|
|Date approved||November 26 (2002)||February 13 (1996)|
|Effect duration||LA: 24 hours||IR: 4 to 6 hours/XR: 12 hours|
|Investigational uses||Binge eating disorder. Pediatric bedwetting. Treatment-resistant depression. Weight loss.||Treatment-resistant depression (Read: Adderall for depression).|
Strattera vs. Adderall: What’s the difference?
There are an array of differences between Strattera (Atomoxetine) and Adderall (mixed amphetamine salts). Firstly, Adderall is classified as a psychostimulant and is listed as a “Schedule II” controlled-substance in the United States. This means that it has a high potential for abuse, largely as a result of its ability to inhibit reuptake of dopamine.
Strattera barely affects dopamine, and primarily targets norepinephrine – with secondary effects on inhibiting reuptake of serotonin. The focus improvements and reductions in hyperactivity as a result of using Strattera are a result of increasing norepinephrine levels in the brain. Furthermore, those using Strattera only need to take 1 long-acting capsule per day (it provides 24 hour relief), whereas Adderall users may require multiple doses throughout the day.
Strattera isn’t regarded as having any degree of abuse potential. This is due to the fact that it functions as a norepinephrine reuptake inhibitor and doesn’t significantly affect dopamine. The drug was designed to increase extracellular levels of norepinephrine to improve concentration and reduce hyperactivity.
Significant increases in norepinephrine may result in increased energy and improve certain aspects of cognitive function, they aren’t associated with inducing psychological euphoria like Adderall. Adderall has a relatively high potential for abuse due to the fact that it is comprised of 75% dextroamphetamine and 25% levoamphetamine. These mixed amphetamine salts elevate dopamine concentrations, which can be very pleasurable for users – especially at high doses.
Those using Adderall also tend to experience a rapid building of tolerance, meaning the dosage they start on tends to “wear off” after awhile, requiring a dose increase to achieve the same desired effect. Others may become psychologically or physically dependent upon Adderall for academic performance, cognitive function, maintaining a pleasant mood, or even staying slim.
Many people seek out Adderall for non-medicinal uses, which often leads to abuse. Someone may use Adderall as a cognitive enhancer at work or in school and become so dependent on it for productivity, passing tests, or writing papers, that without it, the person cannot function. People don’t generally seek out Strattera to get high, but they will resort to activities like snorting Adderall.
Cost: Which is most expensive?
For many individuals diagnosed with ADHD, the cost of medications is the distinguishing factor regarding whether they’re able to take one or the other. If your doctor wants you to try Strattera, but you cannot afford it, you may have to explain that you don’t have the money, and may end up on a generic Adderall. Those without insurance to pick up the prescription tab for either Strattera or Adderall may not be able to afford either medication.
Strattera as a “brand name” drug costs between $290 and $350 for a 30 day supply and is usually more expensive with higher doses. For example, the 10 mg dose may cost more towards the lower end of the spectrum (e.g. $290) whereas the 100 mg dose may run you the full $350 for a single month supply. If you’re purchasing “brand name” Adderall IR (immediate-release) it’ll cost around $310 at most pharmacies for a 30 day supply.
Assuming you want to buy brand name Adderall XR (extended-release), you’ll probably end up paying over $220 for a 30 day supply. This means if we’re talking from a strictly “brand name” perspective, Adderall XR is the cheapest option. Lower doses of Strattera may be attained for lower prices than Adderall IR (immediate-release).
The cost of generic Adderall IR and XR are significantly cheaper than all of the aforementioned options. For a 30 day supply of generic Adderall (mixed amphetamine salts), the associated costs are as follows: between $30 and $50 for the IR version and between $75 to $150 for the XR version. Strattera will not be available as a generic drug until 2017, so its cost remains inflated and perhaps unaffordable to those without good insurance.
Dosage & Formats
Strattera is only manufactured in one dosing format of a “long-acting” (LA) capsule. This means that its active ingredient (atomoxetine) is immediately absorbed by the body. The drug tends to provide symptomatic relief for a full 24 hours. However, its design as a norepinephrine-reuptake inhibitor means that it may take a few days (or even weeks) before the drug “kicks-in.”
Strattera comes formatted in a variety of doses including: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, and 100 mg. The variety of dosing increments makes it relatively easy to titrate upwards or down with the dosing. Adderall comes in a variety of dosing options as well including 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, and 30 mg for the immediate-release.
For the extended-release Adderall, dosing options are 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, and 30 mg. From a dosing perspective, you have many more options with Adderall than you do with Strattera. Additionally, some people may prefer having multiple formats of Adderall, neither of which elicit a full 24-hour effect like Strattera. Due to the fact that Strattera is not a psychostimulant, dosage equivalencies are nearly impossible to estimate.
Efficacy: Which drug is more effective?
Most people looking to medicate their attention deficits and/or hyperactivity want to know the most effective pharmaceutical options available. From the perspective of treating ADHD symptoms, both Strattera and Adderall are significantly more effective than a placebo. A 2006 meta-analysis comparing various medications for ADHD attempted to determine whether certain drugs were more effective than others.
This meta-analysis concluded that there was a lack of uniformity in assessing medication efficacy and study designs. Therefore they couldn’t state with certainty whether one medication was superior to the other. That said, a study designed in 2007 compared and observed the efficacy of Adderall XR with Strattera among children diagnosed with ADHD.
This was considered a randomized, double-blind, parallel-group study with children ages 6 to 12. Results demonstrated that Adderall XR was more effective than Strattera in every evaluated domain (attention, math problem solving, clinical functioning) after 3 weeks of treatment. Researchers suggest that the increased efficacy of Adderall XR over Strattera is likely to be upheld in future weeks.
The fact that Strattera takes longer to “kick-in” and in some cases may take 3 to 4 weeks to elicit its full effect means that the comparative study in children may be flawed. However, other sources suggest that Strattera is equally as effective as immediate-release methylphenidate, but significantly less effective than extended-release methylphenidate (e.g. Concerta) and extended release mixed amphetamine salts (e.g. Adderall XR).
While Strattera may have a lower potential for abuse when compared to Adderall, it is regarded as being significantly less effective. The fact that many consider Adderall to be more effective than Concerta for ADHD treatment means that Strattera may be one of the least effective ADHD medications on the market. From a clinical perspective, Strattera is still considered an effective treatment option.
- Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868385/
- Source: http://www.ncbi.nlm.nih.gov/pubmed/16371674
- Source: http://www.ncbi.nlm.nih.gov/pubmed/17606774
- Source: http://www.ncbi.nlm.nih.gov/pubmed/19445548
Mechanisms of action
Strattera provides a radically different mechanism of action compared to Adderall. It primarily works as a norepinephrine reuptake inhibitor (NRI), resulting in increased extracellular concentrations and neurotransmission of norepinephrine. Norepinephrine is considered a stimulatory neurotransmitter in that it speeds up activity in the central nervous system.
Strattera elicits the norepinephrine reuptake inhibition within your frontal and prefrontal corticies, which leads to improvements in attentional capacity and reductions in hyperactivity. Although it has a weak affinity for dopamine, some speculate that greater increases in dopamine may be triggered as a cascade effect of stemming from norepinephrine increases in the frontal lobes. It may take a gradual adaptation phase of several days or weeks before symptomatic reduction is experienced from the norepinephrine reuptake inhibition.
Strattera also affects serotonin and has a nearly undetectable affinity for various opioid receptors (mu and kappa). Like Strattera, the drug Adderall also increases norepinephrine, but unlike Strattera it significantly elevates dopamine as a reuptake inhibitor. Furthermore, the mixed amphetamine salts within Adderall trigger the presynaptic release of dopamine and norepinephrine from presynaptic neurons.
Adderall IR tends to work for approximately 4 to 6 hours, and Adderall XR contains a mixture of 50% immediate-release beads and 50% delayed-release beads, leading to symptom reduction for 12 hours. Strattera is manufactured in a long-acting capsule, meaning it is capable of providing symptom reduction for a full 24 hours. The differences in mechanisms of action and delivery systems may lead some people to prefer one drug over the other.
From a medical perspective, Strattera and Adderall are considered first-line agents for the treatment of ADHD. However, Strattera is limited to treating ADHD, whereas Adderall is also approved to treat narcolepsy. Both medications are capable of increasing attentional abilities and speed up activity within the CNS.
Both are considered effective antidepressant augmentation strategies among individuals dealing with treatment-resistant depression. Many psychiatrists favor Strattera for depression as an adjunct among individuals with comorbid ADHD due to the fact that it has a low potential for abuse. Additionally, some anecdotal evidence suggests that Strattera is effective as a standalone option for reversing a low norepinephrine-induced depression.
Investigational studies have tested Strattera for conditions such as binge eating disorder, pediatric bedwetting, and weight loss. In fact, some doctors may prescribe Strattera for weight loss among those who are overweight with ADHD and/or depression. Adderall has been investigated as an intervention for stroke rehabilitation and a counterintuitive anxiety treatment. (Read: Adderall for anxiety disorders).
Due to the fact that the patent for Adderall has expired, it is now available in generic formats of both IR and XR. From a generic perspective, Adderall (mixed amphetamine salts) are far and away the most popular medications for ADHD. It is estimated that of all prescriptions for ADHD, approximately 35% in 2012 were for variants of Adderall.
Although Strattera was initially very popular in 2005 (several years after its inception), it never gained the same level of popularity as Adderall. As of now, Strattera is considered among the least popular ADHD medications. Estimates from 2012 indicate that of all drugs used to treat ADHD, Strattera accounted for less than 5% of all prescriptions.
The popularity discrepancies between Strattera and Adderall are significant. In part this could be due to the fact that Strattera may not be as effective as Adderall. Additionally, Strattera isn’t considered a drug with potential for abuse, ultimately leading less people to seek out the drug with non-medicinal motives. Finally, the popularity may also be related to the fact that Strattera is not available in generic formats, making it a costly option by comparison to Adderall.
The side effects of Strattera and Adderall are largely subject to individual variation. As a result of radically different mechanisms of action, different side effects may be experienced. Those using either drug may notice appetite reduction, dizziness, dry mouth, insomnia, nausea, or weight loss. The weight loss experienced on Adderall may be more extreme than that experienced on Strattera due to its dopaminergic effect.
Adderall increases dopamine, which is thought to suppress appetite more than Strattera. This is why many people resort to using Adderall for weight loss. A common reaction that some people experience as a side effect from Strattera is sleepiness. Sleepiness is extremely uncommon among those taking Adderall. Strattera is also capable of causing sexual dysfunction, likely due to the fact that it inhibits reuptake of serotonin.
Those using Adderall may experience stunted growth and appear lighter than others. That said, the growth stunting is considered temporary and isn’t thought to affect a person’s final adult height. Strattera isn’t thought to affect height or weight as severely as Adderall. Neither has a “better” side effect profile than the other, but the potential for sleepiness and sexual dysfunction may lead certain individuals to avoid Strattera.
The withdrawal associated with Adderall is noticeably more severe and debilitating than the withdrawal associated with Strattera. Those discontinuing Strattera are often told from medical professionals that there’s “no withdrawal.” Anecdotal experiences and alternative reports generally highlight that there often are clear Strattera withdrawal symptoms.
These symptoms are generally less severe than discontinuation of Adderall due to the fact that dopamine levels and receptors aren’t as severely affected, especially over the long-term. Long-term Adderall usage can lead to tolerance, psychological dependence, low dopamine levels, and downregulation of dopamine receptors. The low dopamine and reduced receptor count can exacerbate ADHD symptoms – making them temporarily worse than prior to using the medication.
In some cases it can take months or years for dopamine function to be fully restored; especially if Adderall is abused or taken at supratherapeutic doses. Adderall is also more potent than Strattera, which contributes to discontinuation difficulties. Many users of mixed amphetamine salts notice Adderall crashes as their dose wears off even prior to full discontinuation.
Adderall does come standard in a variety of doses, potentially making the tapering process easier than Strattera. Strattera comes in 24-hour long-acting capsules, making it more complicated to taper down the dosing. While both drugs may be difficult to continue after long-term usage at high doses, the Adderall withdrawal symptoms are thought to be of greater severity.
Similarities (Recap): Strattera vs. Adderall
Highlighted below are some general similarities of Strattera and Adderall. As you can see, there are very few similarities, and a vast number of differences.
- ADHD: The most obvious and notable similarity shared between Strattera and Adderall is that they’re both utilized to treat ADHD. They are each considered first-line options by some medical professionals.
- Side effects: Due to the fact that both drugs can be stimulating, their side effect profiles are somewhat similar. Examples of shared side effects include: appetite suppression, weight loss, insomnia, nausea, and dizziness. One notable difference is that in certain individuals, Strattera can induce sleepiness whereas Adderall does not.
Differences (Recap): Strattera vs. Adderall
Strattera and Adderall are very different medications. Their major commonality is that they’re more effective than a placebo for treating symptoms of ADHD. Adderall is considered to be of greater potency and superior efficacy by comparison.
- Abuse potential: Strattera is considered to have no potential for abuse or dependence. Adderall has a high potential for abuse and dependence, making doctors less likely to prescribe it. Those abusing Adderall may experience “stimulant psychosis,” whereas Strattera users aren’t likely to have that experience.
- Cost: Strattera remains “brand name” only until 2017, making it a significantly more expensive option than generic Adderall (mixed amphetamine salts). For a 30 day supply of brand name Adderall IR, you may be paying slightly more or slightly less than you would for Strattera; this is contingent upon the Strattera dose. Adderall XR is considered cheaper than Strattera for a 30 day supply.
- Drug type: Strattera is a norepinephrine-reuptake inhibitor, whereas Adderall is regarded as a psychostimulant.
- Duration of effect: Strattera is long-acting, meaning the drug is effective for a full 24-hours. Adderall XR is effective for up to 12 hours and Adderall IR is effective for approximately 4 to 6 hours.
- Efficacy: Adderall is notably more effective than Strattera, especially within the first month of treatment. In part this is due to the fact that Strattera can take weeks to become fully effective. That said, even after Strattera becomes effective, Adderall is the more potent drug, leading to greater improvements in measures of attention and cognitive function.
- Formats: Strattera is manufactured in one format of a long-acting capsule. Adderall is manufactured in multiple formats of IR (immediate-release) and XR (extended-release).
- Generic availability: Strattera is not yet available in generic format, whereas Adderall is sold generically as “mixed amphetamine salts.”
- Half-life: The half-life of Strattera is approximately 24 hours, whereas the half-life of Adderall is estimated to range between 11 and 13 hours. This means it takes nearly double the time for Strattera to get eliminated from the body.
- Ingredients: The active ingredient in Strattera is “atomoxetine” whereas Adderall consists of mixed amphetamine salts (75% dextroamphetamine and 25% levoamphetamine).
- Interactions: Exact contraindications differ due to the fact that Strattera consists of different ingredients than Adderall. Both medications are thought to interact with MAOIs and tricyclic antidepressants.
- Investigational uses: Strattera and Adderall have both been investigated for refractory depression, but they differ in numerous other investigational uses. Strattera has been studied for binge eating disorder and pediatric bedwetting, whereas Adderall has been investigated for cognitive rehabilitation among stroke patients.
- Legal status: Strattera is available as a prescription medication and is refillable. Adderall is classified as a “Schedule II” controlled-substance, meaning that anyone possessing it without medical consent is subject to legal penalization. Adderall prescriptions are non-refillable without signed consent from a doctor.
- Manufacturers: Strattera is manufactured by Eli Lilly & Company and Adderall is manufactured by Shire Pharmaceuticals.
- Mechanisms of action: The mechanisms of action differ significantly in that Strattera primarily inhibits reuptake of norepinephrine and Adderall increases levels of both dopamine and norepinephrine. Strattera also affects serotonin levels significantly more than Adderall.
- Medical uses: Both substances are approved for ADHD, but Adderall has an additional use in that it is prescribed for the treatment of narcolepsy.
- Popularity: Adderall is significantly more popular than Strattera, especially when considering the generic version (mixed amphetamine salts).
- Withdrawal: It is considered much tougher to discontinue Adderall than it is Strattera. In fact some medical professionals believe there is no such thing as withdrawal from Strattera. While there are clearly withdrawal periods associated with both, discontinuation from Adderall tends to be more debilitating and protracted.
Which drug is better for ADHD? Strattera vs. Adderall.
Those considering a medication for ADHD are likely trying to find the most effective option. Upon comparison, Adderall appears to be significantly more effective than Strattera at treating symptoms of ADHD. There are some advantages to using Strattera over Adderall such as: reduced potential for abuse, 24-hour symptom relief, an easier withdrawal period, and no significant dopamine receptor downregulation.
The side effect profile of each drugs is relatively mild, but Adderall may be advantageous in that it is less likely to induce sleepiness or sexual dysfunction. Many doctors prefer to test Strattera over Adderall due to the fact that it isn’t a “Schedule II” substance in the United States, meaning prescriptions are refillable without written confirmation and abuse potential is unlikely. Some people may prefer the longer-lasting symptomatic relief associated with Strattera over Adderall.
That said, many have found that Strattera tends to “poop out” or completely stop working over time. Adderall doesn’t generally stop working, but can become less effective as a result of cumulative tolerance. Some people may prefer Adderall due to the fact that they need a more potent substance to alleviate their ADHD and they would rather be medicated for a shorter duration (e.g. IR = 4 to 6 hours / XR = 12 hours) than the entire day.
Which drug do you prefer? Strattera or Adderall?
If you have experimented with Strattera and Adderall for treating symptoms of attention-deficit/hyperactivity disorder, be sure to mention whether you prefer one drug over the other in the comments section below. Even if you have used either substance to treat an off-label condition (e.g. as an adjunct), feel free to chime in with your personal experience. Discuss whether you believe one drug was more potent than the other and any advantages/disadvantages you noticed with each substance.