How do I know if Strattera is working?

In this article:

• How to tell if Strattera is working
• Efficacy
• How it works
• What to do if it is not working

In this article

• How to tell if Strattera is working
• Efficacy
• How it works
• What to do if it is not working

Atomoxetine, better known by the brand name Strattera, is a non-stimulant medication used to treat attention deficit hyperactivity disorder (ADHD) in adults and children older than 6. It belongs to a class of drugs called selective norepinephrine reuptake inhibitors (SNRIs). Unlike well-known stimulant medications that treat ADHD, such as Ritalin and Adderall, Strattera takes some time to work. You may see small improvements within two weeks, but it can take four to eight weeks for it to significantly alleviate ADHD symptoms.  Here’s what to expect and how to know if it’s working for you.

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How to tell if Strattera is working

“When taking Strattera, you should feel less ‘scattered,’ more focused, and better organized,” says Rachela Elias, MD, psychiatrist and medical director of Rivia Mind. In other words, it should alleviate the hallmark symptoms of ADHD: inattention, hyperactivity, and impulsivity.

Strattera is a capsule taken once or twice daily that is thought to work by increasing the levels of norepinephrine and dopamine, two neurotransmitters that help the brain regulate attention, alertness, and arousal. When it’s effective, people taking Strattera report feeling more attentive, calmer, possibly less impulsive, and better able to focus. Tracking changes in how you feel and are functioning in a symptom diary can help you and your provider determine how well the medication is working for you.

Non-stimulant medications take longer to start working than stimulants. A research review found that while some benefits show up as quickly as one to two weeks, the effects build over time. Typical Strattera dosing starts with an initiation dose for at least three days and then a gradual dose increase to achieve the desired effect. It can take four to eight weeks to have a “robust” response, where most symptoms are alleviated. 

What is the success rate of Strattera?

Stimulants and non-stimulants are the two main types of medication used to treat ADHD, and within each category, there are many different options. 

Stimulants are widely considered the first-line, most effective treatment option, alleviating symptoms for 70% of adults and 70% to 80% of children. Most stimulants contain a version of either methylphenidate or amphetamine. Commonly prescribed stimulant medications include: Adderall (amphetamine dextroamphetamine),  Ritalin (methylphenidate), Vyvanse (lisdexamfetamine), and Focalin (dexmethylphenidate). 

Straterra falls into the non-stimulant category. It is the first nonstimulant also considered a first-line treatment for ADHD, according to the American Academy of Pediatrics (AAP). That’s because “Strattera stacks up well in comparison to the controlled substances for ADHD,” says Dr. Elias. In other words, it’s considered nearly as effective as stimulant medication, with studies finding a success rate of 60% to improve ADHD symptoms.

Other non-stimulant options include Intuniv (guanfacine), Kapvay (clonidine), and Qelbree (viloxazine). These medications are often used for patients who can’t take stimulants or have a coexisting condition, such as anxiety or tics.

How Strattera works 

Strattera affects the chemical messengers, or neurotransmitters, that allow the different parts of your brain to communicate and work together. It is thought to work by boosting levels of norepinephrine, which is known to help with alertness, attention, and focus. At the same time, it raises dopamine levels in the prefrontal cortex, the part of your brain that’s responsible for planning, decision-making, and controlling your behavior. In combination, these effects are thought to decrease inattention and impulsivity. Stimulant medications affect brain chemistry in a similar way to alleviate symptoms.

Strattera may take longer to start working than a stimulant medication, but it also lasts longer. While even long-acting stimulants wear off within three to 12 hours, Strattera works “around the clock.” In fact, non-stimulants can work for as long as 24 hours. 

“Strattera is a more stable medication compared to stimulants,” notes Ryan Sultan, MD, psychiatrist and medical director of Integrative Psych, a mental health clinic in New York City. “It doesn’t ‘kick in’ like Adderall and Vyvanse.” Strattera is also not a controlled substance, so there’s not the potential for addiction, diversion,  or abuse that accompanies stimulants.

While this medication does tend to be well-tolerated, it can cause side effects, such as: 

• Dry mouth
• Upset stomach
• Nausea
• Headache
• Poor appetite

These side effects often go away after a few months. Taking the medication exactly as prescribed can help minimize side effects. “Additionally, although Strattera and controlled substances for ADHD have similar potential side effects, like increased heart rate and blood pressure, decreased appetite, or insomnia, these side effects are generally less common and less pronounced with Strattera,” says Dr. Elias. 

Rare, but more serious side effects may occur. It’s especially important to monitor the behavior of anyone starting or changing the dosage levels of atomoxetine because research suggests that suicidal ideation is more common in children or teens who take atomoxetine than in children or teens who don’t. Also, it is important to rule out mania, hypomania, or a personal or family history of bipolar disorder before taking Strattera.

What to do if Strattera is not working

ADHD medications affect everyone differently, so it may take some time for you and your healthcare team to find the right medication and the right dose for you. One meta-review even noted that children’s bodies can absorb Strattera at different rates, depending on the activity of an enzyme called CYP2D6, which may affect the treatment of ADHD symptoms.

When starting Strattera, your provider may advise you not to expect instant results, but you should eventually notice some symptom improvement. “A common problem I see with patients is that they will stop taking their medications before it has a chance to reach full efficacy,” says Dr. Sultan. “Then we can’t tell if it’s the medication that doesn’t work or poor compliance.”

However, if you don’t notice any effect after two weeks, contact your healthcare provider. In that case, it may be time to consider other options, such as:

• Adding cognitive behavioral training. “It’s important to understand that all medications for ADHD work best in combination with skills training for ADHD,” says Dr. Elias. “So my first step would be to add executive skills training to the treatment plan.”
• Changing the dosage. “If this combination isn’t working, I would first increase the dose,” says Dr. Elias. Most people start on a low dose and may increase after a few weeks. Typically, 40 mg once per day is the starting dose for adults, adolescents, and children older than 6 years of age who weigh at least 70 kg (154 pounds). If that doesn’t alleviate symptoms, your provider may increase the dose up to 80 mg, which can be taken once or divided in half and taken twice a day. 
• Changing medications. “After about six weeks (after increasing the dose), if symptoms aren’t improving, I would switch to another medication, like bupropion, guanfacine, or a controlled substance stimulant,” says Dr. Elias.

It’s essential to be in touch with your provider on a regular basis when taking this medication. In some cases, bloodwork may be necessary. 

The bottom line

Strattera helps many people control impulsive behavior and stay focused on important tasks. As a non-stimulant medication, it may take a little longer to start working than a stimulant drug. However, when it does begin to take effect, you’ll know it’s working because ADHD symptoms, such as distractibility, restlessness, and impulsivity, gradually improve. For many people, those benefits outweigh the initial wait.

As with any medication for ADHD, it’s important to communicate regularly with the healthcare professional who is prescribing Strattera. Let them know if your symptoms aren’t improving as expected, or if you experience side effects that interfere with daily life. Tracking changes in focus, self-control, and overall daily functioning can help both you and your provider evaluate how well the medication is working.