Atomoxetine is a non-stimulant medication primarily used for Attention-Deficit/Hyperactivity Disorder (ADHD). While its main purpose is to address ADHD, atomoxetine may also influence anxiety symptoms through its unique mechanism of action in the brain.
Atomoxetine’s Primary Purpose
Atomoxetine, sold under brand names like Strattera, is classified as a selective norepinephrine reuptake inhibitor (SNRI). It primarily acts by blocking the presynaptic norepinephrine transporter (NET), which prevents the reuptake of norepinephrine back into nerve cells. This action leads to an increased concentration of norepinephrine in the synaptic cleft, the spaces between neurons.
Norepinephrine is a neurotransmitter that plays a significant role in regulating attention, arousal, and mood, functions often disrupted in individuals with ADHD. Atomoxetine also indirectly increases dopamine levels specifically in the prefrontal cortex, a brain region involved in executive functions like planning and impulse control. This targeted increase in dopamine differs from stimulant medications, which can elevate dopamine in other brain areas associated with abuse potential. Atomoxetine is approved by the U.S. Food and Drug Administration (FDA) for treating ADHD in children aged six and older, adolescents, and adults. Unlike stimulant medications, atomoxetine is not a controlled substance and carries little abuse potential.
How Atomoxetine Might Affect Anxiety
While atomoxetine is not a primary medication for anxiety disorders, it can indirectly influence anxiety symptoms, particularly in individuals with co-occurring ADHD. Improving core ADHD symptoms like inattention, impulsivity, and hyperactivity can naturally lead to a reduction in secondary anxiety. For example, experiencing fewer difficulties with focus and organization can lessen performance anxiety or social anxieties that stem from ADHD-related challenges.
The medication’s action on norepinephrine can also contribute to a calming or stabilizing effect. Studies have indicated that atomoxetine can reduce anxiety symptoms in children with co-occurring ADHD and anxiety. One study reported a 32% reduction in anxiety symptoms, such as excessive worry and trembling, in children diagnosed with both conditions. This effect results from overall improvement in brain regulation rather than a direct anti-anxiety action like traditional anxiolytic medications.
When Atomoxetine is Considered for Anxiety
Healthcare professionals may consider atomoxetine when individuals have both ADHD and an anxiety disorder. This is particularly relevant if anxiety symptoms appear to be a consequence of unmanaged ADHD, where struggles with attention and impulsivity create anxious feelings.
Atomoxetine also serves as an important option if stimulant medications, typically first-line for ADHD, are not well-tolerated or are contraindicated. Stimulants can sometimes worsen anxiety, making a non-stimulant like atomoxetine a preferred choice. It may also be considered for those who wish to avoid traditional anxiety medications, such as benzodiazepines or certain antidepressants. However, atomoxetine is generally not prescribed as a first-line treatment for primary anxiety disorders when ADHD is not present.
What to Discuss With Your Doctor
Before starting any new medication, have a thorough discussion with a healthcare professional. Share all your symptoms, including both ADHD and anxiety, along with your complete medical history. Disclose any other medications you are currently taking, including over-the-counter drugs and supplements.
Atomoxetine can cause side effects that should be discussed with your doctor. Common side effects may include nausea, dry mouth, decreased appetite, fatigue, or dizziness. More serious, though less common, side effects can include liver problems, increased heart rate or blood pressure, and in rare cases, suicidal thoughts, particularly in children and adolescents, requiring close monitoring. Your doctor will monitor your blood pressure and heart rate regularly. Never self-medicate or change your prescribed dosage without explicit guidance from your healthcare provider, as individual responses to medication can vary significantly.