Strattera Does Not Improve Inattentive ADHD as Much as Combined ADHD

Short Changed
Strattera Does Not Improve Inattentive ADHD as Much as Combined ADHD

Treating the inattention component of Inattentive ADHD (ADHD-PI) is proving more difficult than treating the hyperactive and impulsive symptoms of Combined type ADHD. When Strattera (atomoxetine) became available, the hope was that this long acting ADHD medication might be a good treatment of the inattentive type ADHD. Initial studies had found that atomoxetine helped anxiety as well as ADHD and since many people with ADHD-PI also had anxiety symptoms (that were made worse, not better, by the stimulants), this seemed like it might be an ideal drug for this subtype.

Unfortunately, subsequent studies including one just published in the Attention Deficit Hyperactivity Disorder Journal, have found that atomoxetine treats the symptoms of combined type ADHD better than it treats the symptoms of ADHD-PI.

Russell Barkley recognized almost five years ago that only a subset of people with ADHD would benefit most from Strattera.  The subset he identified were people with ADHD symptoms and coexisting:

Tic Disorders
Substance Abuse Problems
Anxiety
Oppositional Symptoms
Insomnia

Way back in May of 2009 Barkley published a report in ADHD Report, his monthly newsletter, entitled; What is the role of Atomoxetine in the management of ADHD? In this report he essentially outlined the benefits and limitations of Strattera and advised that this drug would best be used only in certain patients.

In the 2009 report Barkley made no mention of the benefits of Atomoxetine for the inattentive subtype of ADHD but he did report that it seemed that 25% to 35% of people with ADHD might respond only to Atomoxetine while not responding well to the stimulants. He termed this subset of people "Unique Responders" and speculated that people with ADHD and a combination of the other coexisting problems  mentioned might be the ideal candidates to receive treatment with Strattera.

This new study reports that the "Unique Responders" that Barkley described are likely a subset of people with Combined type symptoms not people with primarily inattentive symptoms. From previous posts you know that people with Combined type symptoms and oppositional symptoms also get a better response from the stimulants and given that Intuniv, the other non-stimulant ADHD treatment, also appears to be more tailored to those with Combined type symptoms, it is hard, if you are a person with ADHD-PI, to not feel short changed.

Ercan ES, Akyol Ardic U, Kabukcu Basay B, Ercan E, Basay O
Atomoxetine response in the inattentive and combined subtypes of attention deficit hyperactivity disorder: a retrospective chart review.Attention Deficit Hyperactivity Disorder 2013 Jun 5.