"Helping you take controlby
Anthony Kane, MD
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1 - Strattera is not a stimulant
Strattera is categorized as a non-stimulant and therefore isn’t classified as a controlled substance under the Controlled Substances Act. I know this sounds very significant, but stop a second. Go ask your seven-year old if it bothers him that the Ritalin he is taking is listed as a controlled substance. If he is smart, he will tell you that as long as it works, the societal legal ramifications of taking a controlled substance doesn’t really bother him; which, by the way is the correct answer.
Even though it sounds like Strattera has a major advantage in that it’s not a “controlled substance,” the only real significance is one of convenience. Your doctor can call in the prescription re-fills to the pharmacy for you instead of you having to go his office to pick it up the piece of paper. That’s it! It’s hardly a reason to change medications.
Strattera is the first drug specifically approved for adults with ADHD. This sounds very important. It means that all you adults out there who have been happily taking Ritalin, Adderral or anything else for your ADHD are taking a drug not specifically approved for adult ADHD. Now I bet you won’t be able to sleep tonight.
Don’t despair. If the drug you are taking is working and you can endure whatever side effects you have, this is certainly not a reason to switch.
3 - Strattera has milder side effects
Another advantage of Strattera is that it is better tolerated. Most notably, people taking Strattera have less of a problem with insomnia.
This milder side effect profile is something, but it is not really as significant as it sounds. As I wrote in How to Help the Child You Love, all but one side effect of stimulant medication can be eliminated by adjusting the dose or by switching to a different stimulant. True, this does require a bit of sophistication on the part of your doctor. That’s one of the reasons psychiatrists do a much better job at treating ADHD than family physicians or pediatricians.
There is only one side effect of the stimulants that we can’t eliminate. That is loss of appetite. However, loss of appetite is a side effect of Strattera, also. The children who were in Lilly’s initial studies did not eat as well and didn’t grow as well as the control group children who were taking placebo. This is the same profile that we see with the stimulants. So, in the only medication side effect that is really significant, Strattera is no better than the stimulants.
4 - Strattera is longer acting
This is the big one! The major advantage that Strattera has over all the other ADHD medications available today is that it is long acting. Stimulants typically work for about four hours. If you play around with the delivery system you can stretch the effects to 8-12 hours. Strattera is a 24-hour a day medication. This is important because your child has ADHD 24 hours a day.
How significant is this? It is clear that this is important, but I think most people don’t appreciate how important it might be. ADHD children suffer a lot from the way people respond to them when they are “expressing” their ADHD. The psychological damage that this inflicts is clearly significant and might be more devastating than the actual ADHD symptoms. A number of studies show that when ADHD children are on their medication, they function better and those around them treat them in a more positive way. The problem is that the stimulants are short acting. As a result, ADHD children spend a significant part of their day without the help of medication.
Strattera lasts all day. Since Strattera lasts longer, it is possible that people might view children who take Strattera more positively. This would serve to eliminate much of the negativity ADHD children usually must endure. This might mitigate much of the psychological damage that goes along with having ADHD. Is this true? Will Strattera eliminate much of the psychological damage that ADHD child suffer? It’s hard to say. Lilly didn’t test for this yet. However, if the 24-hour a day dosing does make this a possibility, even for a minority of children, it would put Strattera in a class by itself.
What are we to Conclude about Strattera?Preface
Before I give my final recommendation I want to make a short preface. Eli Lilly is going all out to market Strattera, and for good reason. If it is received properly, Strattera has the potential of becoming the treatment of choice for ADHD. Lilly owns the patent for this medication and Strattera may become their flagship product. Therefore, Lilly has their marketing experts out everywhere examining how well Strattera is received. Sooner or later, someone from Lilly is going to read this article. Before I go further, I have a brief message for the Lilly representative that comes across this article.
Everyone else can skip the next paragraph.
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