Atomoxetine, known by its brand name Strattera, is a non-stimulant medication prescribed for ADHD. While it is not classified as an addictive substance, discontinuing this medication can lead to a temporary set of physical and psychological changes. These experiences are often referred to as withdrawal or discontinuation syndrome.
The Discontinuation Syndrome
Atomoxetine’s mechanism of action explains withdrawal experiences. It functions as a selective norepinephrine reuptake inhibitor (SNRI). It works by blocking the reabsorption of norepinephrine, a neurotransmitter, back into the nerve cells after it has been released. This action leads to an increased concentration of norepinephrine in the synaptic cleft, the space between neurons, particularly in the prefrontal cortex, which is associated with attention and focus.
When atomoxetine is taken regularly, the brain adapts to these elevated levels of norepinephrine. If the medication is stopped, especially suddenly, the brain needs time to adjust to functioning without the drug. This period of neurochemical readjustment, where the brain attempts to restore its natural balance of neurotransmitters, is the underlying cause of the physical and psychological symptoms.
Common Withdrawal Symptoms
Physical symptoms reported include dizziness, headaches, and fatigue. Some individuals may also experience nausea, vomiting, or other gastrointestinal upset, along with flu-like sensations, body aches, and chills.
Beyond physical discomfort, psychological and mood-related symptoms are also common. These can manifest as increased irritability, anxiety, and noticeable mood swings. Sleep disturbances are frequently reported, including difficulty falling or staying asleep and experiencing vivid dreams.
Distinguishing between discontinuation symptoms and ADHD symptom “rebound” is important. While withdrawal refers to new symptoms arising from the body’s adjustment to medication absence, a rebound effect means the return or temporary worsening of the ADHD symptoms the medication was treating, such as inattention, hyperactivity, and impulsivity. Both can occur when atomoxetine is stopped, but they stem from different physiological processes.
Timeline and Duration
The onset and duration of symptoms vary among individuals. Typically, symptoms may begin within 24 to 72 hours after the last dose, as the medication’s half-life ranges approximately from 5 to 24 hours. The intensity of these symptoms often peaks during the first week of discontinuation.
Following this initial peak, symptoms usually begin to gradually subside. For most individuals, symptoms resolve over a period of one to three weeks. However, some psychological symptoms, like depression or anxiety, may persist for several weeks or potentially longer. The overall duration and severity of the discontinuation process are influenced by factors such as the dosage of atomoxetine, the length of time the individual was taking the medication, and unique physiological responses.
Safely Stopping Atomoxetine
Consult a healthcare professional before making any changes to an atomoxetine regimen. Abruptly stopping atomoxetine can increase the likelihood and severity of potential discontinuation symptoms. While some studies suggest atomoxetine can be discontinued without tapering, and that discontinuation-emergent adverse events are low, tapering is generally considered best practice.
The primary strategy to minimize or prevent discontinuation symptoms is a medically supervised tapering plan. This involves gradually reducing the dosage over several weeks or even months, allowing the brain time to adapt to decreasing levels of norepinephrine. This controlled reduction contrasts with stopping “cold turkey,” which is more likely to induce more pronounced and uncomfortable symptoms. Supportive strategies, such as ensuring adequate rest for fatigue or employing relaxation techniques for anxiety, can help manage any emergent symptoms during the tapering process.