Atomoxetine For Anxiety: What Do We Know?

Atomoxetine is well-known as a second-line ADHD medication. What does science say about its role in anxiety?

Atomoxetine For Anxiety

Atomoxetine is a commonly used medication for attention deficit and hyperactivity disorder (ADHD). It is most famously known under the brand Strattera. It works mainly as a noradrenaline reuptake inhibitor, much like the antidepressant Reboxetine. However, calling Atomoxetine an antidepressant would be incorrect, as there has been no significant evidence proving its efficiency in reducing depressive symptoms. 

While it may not be used in relieving patients of depression, there are studies indicating the effectiveness of Atomoxetine for anxiety in patients with ADHD. Anxiety is one of the most common psychiatric comorbidities in patients with ADHD, present in more than a fifth of all children living with the neurodevelopmental disorder.

Key Points

• Atomoxetine shows promise in alleviating anxiety in children and adolescents with ADHD.
  
  
• Research suggests that Atomoxetine, as opposed to stimulants, does not increase anxiety symptoms in individuals with ADHD with comorbid anxiety.
  
  
• Further investigation into Atomoxetine's potential for managing anxiety in individuals without ADHD is necessary.
  
  
• It's unclear through what mechanism Atomoxetine reduces anxiety, but it may potentially be connected to the noradrenergic paradox. 

What is Anxiety

Anxiety is a complex psychological state characterized by heightened apprehension and unease, functioning as a natural response to stressors. Consider, for instance, a student facing an impending exam, whose worry escalates to an overwhelming level, affecting their ability to concentrate and perform.

When anxiety becomes excessive, it transforms into clinical disorders, such as generalized anxiety disorder (GAD). However, it can also coexist with many other psychiatric disorders, such as depression and ADHD. Patients with anxiety may experience persistent, irrational worry about various aspects of their lives, hindering their day-to-day functioning.

How Atomoxetine Works

Atomoxetine works by inhibiting the reuptake of norepinephrine (noradrenaline) and dopamine in the brain. It primarily targets the prefrontal cortex. Atomoxetine has shown effectiveness in treating ADHD symptoms, especially in children with various comorbidities. 

It is generally well tolerated and Atomoxetine can be administered once or twice daily. It may be taken in the morning if it makes you feel alert and activated, or it may be taken in the evening in case it causes you to feel tired and drowsy. Atomoxetine also carries a low risk of abuse.

Atomoxetine is metabolized by the enzyme CYP2D6, therefore, it may interact with a lot of other commonly used medications, such as Fluoxetine and Bupropion. Recent guidelines recommend dosing Atomoxetine based on both CYP2D6 genotype and peak concentration. Note that this option may not be available in all countries or hospitals. 

Evidence for Atomoxetine in Anxiety

In 2022, Khoodoruth et al. published a systematic review looking at the evidence for using Atomoxetine in anxiety in children and adolescents with ADHD. The scientific paper found that Atomoxetine, as opposed to stimulants like Methylphenidate and Dexamphetamine, does not seem to increase anxiety in those with ADHD.

In fact, there is research indicating that using Atomoxetine for anxiety will effectively reduce the symptoms in this particular patient group. Nonetheless, they were not able to conduct a meta-analysis because of the limited amount of studies available on the topic and concluded that more research is needed on the topic. As for the effectiveness of Atomoxetine in people without ADHD, there has been little research done on the topic.

The precise mechanism by which Atomoxetine mitigates anxiety symptoms remains unclear. However, it is plausible that the effect is related to the noradrenergic paradox. This phenomenon posits that the inhibition of the reuptake of noradrenergic neurotransmitters leads to a reduction in anxiety symptoms. This perspective contrasts with the monoaminergic hypothesis, which anticipates an opposing effect, i.e. activation of the fight-or-flight system through increased presence of norepinephrine in the brain and thus great anxiety. 

Common Side Effects

• Taking Atomoxetine may lead to gastrointestinal issues like upset stomach and nausea, along with a decrease in appetite and potential weight loss. 
  
  
• Other common side effects include sleep disturbances, such as difficulties falling asleep or waking up during the night. On the other hand, it can also cause drowsiness.
  
  
• Atomoxetine may increase the blood pressure and heart rate, which is why monitoring these is advised when taking the medication. 
  
  
• Atomoxetine carries the same black box warning as other antidepressants, warning about the risk of increased suicidal ideation in children and adolescents. 

Suffering From Anxiety?

Consult with your healthcare provider if you suspect that you may be suffering from anxiety to a degree that is affecting your everyday life. Seeking professional support is an essential part of managing anxiety and enhancing your overall health. Seek immediate help if you are struggling with suicidal thoughts. 

Cover image by Freepik

Author: J. Martin, M.D.
Last update: January 22, 2024

Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness, seek immediate medical attention.