Treating ADHD with Strattera
Before giving her 8-year-old son the newest medication for attention deficit-hyperactivity disorder (ADHD), Cindy H. felt helpless much of the time. Drug after drug that her son tried brought on various side effects, from lethargy to extreme loss of appetite to vicious mood swings. Even worse, she says, was what happened when the drugs wore off. "It was awful – he was 10 times worse than he ever was when he was on the meds," says the Florida mom.
These days, however, Cindy says she's seeing a whole new boy. Colton has been taking Strattera, the first new drug in three decades for treatment of symptoms of ADHD, which includes inattention, hyperactivity and impulsiveness. FDA-approved since 2002, Strattera is a selective norepinephrine reuptake inhibitor, which is different from the standard medications used for ADHD in that it is not a stimulant.
"It's a new medication which may offer clinical advantages for some children," says Dr. Andrew Adesman, director of the Division of Developmental and Behavioral Pediatrics at Schneider Children's Hospital in New Hyde Park, N.Y. "Strattera has a potential and promise, and undoubtedly, there will be some children and adolescents who are going to respond more positively to this medication than stimulants."
Cindy considers her son to be one of these children. After seeing Colton struggle on stimulant drugs, she couldn't be more pleased with his progress since starting Strattera. His moods have leveled out, and both his sleeping and eating have improved dramatically. She's also noticed a change in how he interacts with others. "He seems like a normal child," she says. "With the other drugs, I don't know if it's because they were stimulants or what; he seemed to be not as outgoing – he would have a tendency to play by himself. With this drug he's more social."
Karran R., whose 16-year-old son has been on Strattera for two months, is also noticing positive changes. "I see that he is nicer, not as moody and more focused," the New Orleans, La.-mother says. "I feel that he's able to react better to minor irritants now. Before, it seemed as if every little thing set him off."
For Karran's son, who was diagnosed with ADHD at age 9, using Strattera came after trying counseling, Ritalin and, for a time, a combination of the two. After a while, though, Ritalin stopped working for him, Karran says, "and we have struggled for the right fit ever since. We finally feel like we may be on the right tract with Strattera and Zoloft. I can now say that my son is nice, almost sweet more and more ... my son is also in counseling again."
Karen Siegel says her 10-year-old son, Wesley, "has been doing wonderfully in school since starting Strattera and has been mainstreamed into the regular classroom except for math." This is exciting for the Flemington, N.J.-mother, considering her son has tried several different stimulant medications, without significant changes, to treat his ADHD. As he continues to take Strattera, while at the same time slowly decreasing his doses of Concerta, Wesley is feeling better about his ADHD, his mom says.
On the Right Track?
According to Dr. Adesman, while it's not yet clear exactly how Strattera compares with its stimulant counterparts, out of 100 ADHD patients, at least 75 or 80 percent would likely respond to stimulants, while perhaps 65 percent would respond to Strattera. He points out, however, that there is some overlap, meaning some kids will respond to both types of drugs. There are also the groups that would benefit from only one or neither, he says.
Strattera comes in capsule form like some stimulants. But it must be swallowed, meaning that parents of children who don't know how to swallow (or have a tough time doing so) should keep this aspect of the medication in mind. Some stimulants come in capsule form as well but can be opened, and its contents can be sprinkled over food for easier ingestion.
As a non-controlled substance, Strattera provides the convenience of physician samples and phone-in refills, according to the drug's manufacturer, Eli Lilly and Company. While this is a great convenience, some experts believe that there is the potential for patients to not be followed closely enough by their physicians if they can get a six- or 12-month supply of medication through refills. These experts say the prescribing convenience should not compromise the closeness of the follow-up.
Unlike stimulants, which generally work immediately, Strattera takes longer to take effect initially, Dr. Adesman says. "It sometimes takes a little bit of patience to see the full benefit of the medicine," he says. Although some benefits may be seen within the first few days, it generally takes three to four weeks to see the full effect.
While the medical community and families applaud this new option in treating ADHD and recognize its potential benefits, parents should realize that it is new and therefore doesn't yet have the track record the stimulant drugs have, says Dr. Adesman, who is a recognized expert in the treatment of ADHD. "I don't have any reason at this point to doubt the safety of this medicine, but reality is the medicine hasn't had widespread use for [that long], compared to stimulants that have been used for decades," he says. "Most children respond quite well to a stimulant medication."
If a child has been successful on a stimulant medication, Dr. Adesman says, the availability of Strattera shouldn't change their prescription. Stimulants should remain the first option in treating most children with ADHD. Should they not work, families may want to explore with their health care provider how Strattera could help. "Until we have more clinical research and experience, Strattera should generally be considered a promising second line treatment for ADHD," says Dr. Adesman.
Like anything, Strattera can have drawbacks, some parents have found. "His appetite is still somewhat poor. I really hoped that this wouldn't show up in him," Karran says of her son. "Being that we live in New Orleans, food is a way of life, not just for nourishment. He wants to be able to eat more."
"He seems more quiet, sometimes withdrawn," says Siegel, whose son began taking Strattera in February 2003. Still, Siegel and others whose children are trying this new treatment, say the good outweighs the bad. And in Siegel's case, trying this new medication is a family affair of sorts – she also is on Strattera, having lived with ADHD herself for a long while. "My son is open to trying something new. He wants to be 'normal,'" says Siegel. "I am also open to trying something new. The fact that this drug is stimulant free is one of the reasons I did not hesitate trying it. It definitely helps to try it together."
Time will tell just how successful Strattera is in treating individuals with ADHD. Within a couple of years, experts expect to know more about which type of medication works better in certain cases of ADHD. Two recent studies have been conducted comparing Concerta, the most widely-prescribed medication for children with ADHD, and Strattera. "With time we'll know more about the medicine and how it compares to the stimulants with respect to safety, side effects and effectiveness," says Dr. Adesman.