Adderall vs. Strattera for ADHD

Adderall and Strattera are medications prescribed to treat attention disorders, including attention-deficit/hyperactivity disorder (ADHD). Both drugs improve attention span and decrease hyperactivity and impulsiveness; however, the medications are very different. The main difference is that Adderall is a stimulant, and Strattera is not.

This article discusses how Adderall and Strattera work, how they are used to treat attention disorders, and their potential side effects. It also covers how they compare in terms of efficacy and risk for abuse.

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Adderall vs. Strattera

How Strattera and Adderall Work

Adderall and Strattera are from different drug classes and work in distinct ways in the body.

Strattera

Strattera is a brand name for a drug that contains atomoxetine. It was approved by the U.S. Food and Drug Administration (FDA) in 2002. It was the first non-stimulant medication to receive approval to treat ADHD.

Strattera is a norepinephrine reuptake inhibitor, which means it allows the neurotransmitter norepinephrine to be available to the brain’s neurons for longer.

Adderall

Adderall is a brand name for the combination of drugs dextroamphetamine and amphetamine. It belongs to the amphetamine drug family. The FDA approved this medication in 1996. In addition to ADHD, Adderall is also approved to treat narcolepsy. It can be prescribed to people ages 6 and up.

Adderall acts on the central nervous system by blocking the reuptake of two specific neurotransmitters in the brain: dopamine and norepinephrine. This increases the amount of these neurotransmitters in the space between nerve cells. This can help improve the ability to focus while decreasing hyperactivity and impulsive behavior.

ADHD Treatment Choices

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. As such, they are considered first-line medication.

Non-stimulant medications like Strattera are second-line medications. While not as effective as stimulants, they can still be effective for ADHD symptoms.

Although stimulants are the most effective medication for ADHD, they don't work for everyone. People may also experience severe side effects when taking stimulants or have a 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 some cases, a non-stimulant medication like Strattera is an option. However, in cases of bipolar disorder, Strattera can precipitate mania since it has antidepressant effects. It can also increase blood pressure in people with cardiac conditions.

Strattera has also been found to help with conditions that often co-exist with ADHD, like anxiety and oppositional defiant disorder (a pattern of aggression, disobedience, and a lack of respect for authority).

Forms and Dosages

Always take prescription medicine as directed. Strattera and Adderall come in a few different forms and dosage options.

Doses

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

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.

Generics

There are generics for Adderall (amphetamine salt combination), but people sometimes report these medications are not as effective as the brand name drug. Generic versions of Strattera are also available in the United States, Canada, and other countries.

Timeline

It can take four to eight weeks for Strattera to reach the 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 start to wear off after four hours (after 12 hours for Adderall XR).

Your doctor might approve taking a break from Adderall (a "drug holiday" where you do not take the medication for a weekend or over a holiday). By contrast, Strattera needs to be taken every day.

Adderall and Strattera Side Effects

For both medications, doctors usually start by prescribing a low dose and gradually increasing it until the right therapeutic dose is found for a specific person. This usually means fewer side effects as the body adjusts to the medication.

Side effects of Strattera include:

• Constipation
• Dizziness
• Dry mouth
• Reduced appetite
• Reduced libido and/or erectile dysfunction
• Sweating

Rare but serious side effects of Strattera include liver toxicity, suicidal thoughts, swelling, and heart problems.

Side effects of Adderall include:

• Diarrhea
• Dizziness
• Dry mouth
• Emotional detachment
• Erectile dysfunction
• Fever
• Headache
• Insomnia
• Loss of appetite
• Nausea
• Nervousness
• Sleep issues
• Vomiting

Rare but serious side effects of Adderall include increased heart rate, high blood pressure, hallucinations, paranoia, shortness of breath, heart attack, and stroke.

Both Strattera and Adderall can cause weight loss.

Cardiac Concerns

Research has found that the likelihood of cardiac problems with the use of stimulant medications like Adderall is very low in healthy people. One study found that people taking stimulant medications for ADHD did not have an increased risk for cardiac events like heart attack, stroke, or sudden cardiac death.

In the past, patients had electrocardiography (EKG) screenings if a stimulant medication was prescribed. With new research findings, these screenings are no longer required unless the person taking the drug (or someone in their family) has a history of cardiac problems.

Pregnancy and Breastfeeding

Both Adderall and Strattera are category-C drugs, which means they're considered unsafe to take during pregnancy or while breastfeeding. Talk to your doctor if you're pregnant or planning to become pregnant.

Risk of Abuse

Adderall is a schedule-II controlled substance. This means there's the potential for abuse and that extended use might cause dependence.

Adderall’s mode of action is to increase the activity of dopamine, which affects the brain's reward system and can lead to dependence and mis. Surges of dopamine cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.

When stimulant medications are prescribed at appropriate doses and taken as prescribed, the risk of potential addiction is low. However, you should always store your medication safely and you should never share your medication with other people.

As a non-stimulant medication, Strattera is not a controlled substance and doesn't carry the potential risk for abuse. It works by inhibiting norepinephrine uptake, rather than significantly affecting dopamine. It takes several weeks for the medication to take effect, making it difficult to abuse.

Withdrawal

Because Strattera is not a stimulant, it does not lead to physical dependence or withdrawal symptoms if you stop taking it. People who are concerned about the use of stimulants or the potential for abuse may choose to treat their ADHD symptoms with Strattera for this reason.

Adderall can lead to dependence, which means you may experience symptoms of withdrawal if you stop taking it. This can happen for people who have been using Adderall to treat their attention disorder, but it can also occur among people who use the medication without a prescription.

When you stop taking Adderall, norepinephrine and dopamine levels in the brain suddenly decrease. Dopamine is a neurotransmitter that activates the brain's reward system, while norepinephrine plays a role in regulating cognitive functions, attention, and mood. 

The sudden reduction in these neurotransmitters can lead to problems with mood, alertness, sleep patterns, and concentration. Other common symptoms of Adderall withdrawal include:

• Depression
• Low energy
• Anxiety
• Sleep too much or too little
• Brain fog
• Headaches
• Drug cravings

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.

Strattera has a black box warning for the possible increased risk of suicidal thoughts or actions in children, teens, and young adults. Parents and caregivers of kids taking Strattera are encouraged to monitor possible changes in the child's behavior and keep 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.

Summary

Adderall and Strattera can both be effective for managing symptoms of attention disorders. While Adderall is considered a first-line treatment, it may not be the right choice for everyone.

People who are sensitive to stimulants or who have concerns about the potential for dependence and abuse with stimulant medications may want to try a non-stimulant, such as Strattera. Talk to your doctor about your options to decide which medication may be right for you.