Adderall vs. Strattera for ADHD
Usage, Dosage, and Side Effects
Medically reviewed by Daniel B. Block, MD
You should not take Adderall or Strattera if:
you have taken an MAOI in the previous 14 days; or
you are allergic/hypersensitive to amphetamine or atomoxetine; or
you have glaucoma.
You should also not take Adderall if you have cardiovascular disease, high blood pressure, hyperthyroidism, or a history of substance use.
Adderall and Strattera are medications prescribed to treat attention disorders, including attention-deficit/hyperactivity disorder (ADHD). Both drugs improve attention span and decrease hyperactivity and impulsiveness; however, the medications are very different. The main difference is that Adderall is a stimulant, and Strattera is not.
This article discusses how Adderall and Strattera work, how they are used to treat attention disorders, and their potential side effects. It also covers how they compare in terms of efficacy and risk for abuse.
Hosted by Editor-in-Chief and therapist Amy Morin, LCSW, this episode of The Verywell Mind Podcast, featuring Amishi Jha, PhD, a psychology professor, shares how to improve your attention span amid daily distractions. Click below to listen now.
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Adderall vs. Strattera
Strattera
Non-stimulant
2nd-line ADHD treatment
Generic available
Dose: 10mg to 100mg, oral capsule
After reaching therapeutic levels, effects last 24 hours
Must be taken continuously
Adderall
Stimulant
1st-line ADHD treatment
Generic available
Dose: 5mg to 30mg, tablet
Effective almost immediately, lasts 4 hours (Adderall IR) to 12 hours (Adderall XR)
Drug holidays are possible
Potential for abuse or dependence
How Strattera and Adderall Work
Adderall and Strattera are from different drug classes and work in distinct ways in the body.
Strattera
Strattera is a brand name for a drug that contains atomoxetine. It was approved by the U.S. Food and Drug Administration (FDA) in 2002. It was the first non-stimulant medication to receive approval to treat ADHD.
Strattera was also the first medication to be approved for treating adults with ADHD. It can be prescribed for people 6 years of age and older.
Strattera is a norepinephrine reuptake inhibitor, which means it allows the neurotransmitter norepinephrine to be available to the brain’s neurons for longer.
Adderall
Adderall is a brand name for the combination of drugs dextroamphetamine and amphetamine. It belongs to the amphetamine drug family. The FDA approved this medication in 1996. In addition to ADHD, Adderall is also approved to treat narcolepsy. It can be prescribed to people ages 6 and up.
Adderall acts on the central nervous system by blocking the reuptake of two specific neurotransmitters in the brain: dopamine and norepinephrine. This increases the amount of these neurotransmitters in the space between nerve cells. This can help improve the ability to focus while decreasing hyperactivity and impulsive behavior.
Adderall is a stimulant medication that works by blocking the reuptake of dopamine and norepinephrine in order to increase their availability in the brain. Strattera also affects the reuptake of norepinephrine, but it is a non-stimulant medication.
ADHD Treatment Choices
ADHD medication is divided into two categories: first-line medications and second-line medications. Stimulant medications like Adderall are known to be the most effective treatment for ADHD. As such, they are considered first-line medication.
Non-stimulant medications like Strattera are second-line medications. While not as effective as stimulants, they can still be effective for ADHD symptoms.
Research has shown that compared to a placebo, Strattera reduced hyperactive and inattentive symptoms in adults. However, 40% of the research participants still reported significant ADHD symptoms.
Although stimulants are the most effective medication for ADHD, they don't work for everyone. People may also experience severe side effects when taking stimulants or have a medical condition that increases the risks of taking a stimulant (such as a history of addiction, a psychiatric condition like bipolar disorder, or a heart condition or sleep disorder).
In some cases, a non-stimulant medication like Strattera is an option. However, in cases of bipolar disorder, Strattera can precipitate mania since it has antidepressant effects. It can also increase blood pressure in people with cardiac conditions.
Strattera has also been found to help with conditions that often co-exist with ADHD, like anxiety and oppositional defiant disorder (a pattern of aggression, disobedience, and a lack of respect for authority).
Because stimulants are known for their efficacy in the treatment of ADHD, Adderall is considered a first-line treatment. While second-line treatments such as Strattera may be less effective, they can still be helpful for relieving symptoms.
Forms and Dosages
Always take prescription medicine as directed. Strattera and Adderall come in a few different forms and dosage options.
Doses
Strattera is available in an oral capsule that comes in seven doses ranging from 10 to 100 milligrams (mg).
Adderall IR (immediate-release) is available in tablets from 5 mg to 30 mg. Adderall XR (extended-release) is available in six doses, from 5 mg to 30 mg.
Generics
There are generics for Adderall (amphetamine salt combination), but people sometimes report these medications are not as effective as the brand name drug. Generic versions of Strattera are also available in the United States, Canada, and other countries.
Timeline
It can take four to eight weeks for Strattera to reach the maximum therapeutic effect. Once therapeutic levels have been reached, the effects of the medication last 24 hours.
In contrast, the effects of Adderall IR and Adderall XR can be felt as quickly as 30 minutes to one hour. The effects of Adderall IR start to wear off after four hours (after 12 hours for Adderall XR).
Your doctor might approve taking a break from Adderall (a "drug holiday" where you do not take the medication for a weekend or over a holiday). By contrast, Strattera needs to be taken every day.
Both Strattera and Adderall are available in different dosing ranges as well as in brand name and generic forms. Adderall tends to work quickly to relieve symptoms, while Strattera can take several weeks to reach its full efficacy.
Adderall and Strattera Side Effects
For both medications, doctors usually start by prescribing a low dose and gradually increasing it until the right therapeutic dose is found for a specific person. This usually means fewer side effects as the body adjusts to the medication.
Side effects of Strattera include:
Constipation
Dizziness
Dry mouth
Reduced appetite
Reduced libido and/or erectile dysfunction
Sweating
Rare but serious side effects of Strattera include liver toxicity, suicidal thoughts, swelling, and heart problems.
Side effects of Adderall include:
Diarrhea
Dizziness
Fever
Headache
Insomnia
Loss of appetite
Nausea
Nervousness
Sleep issues
Vomiting
Rare but serious side effects of Adderall include increased heart rate, high blood pressure, hallucinations, paranoia, shortness of breath, heart attack, and stroke.
Both Strattera and Adderall can cause weight loss.
Cardiac Concerns
Research has found that the likelihood of cardiac problems with the use of stimulant medications like Adderall is very low in healthy people. One study found that people taking stimulant medications for ADHD did not have an increased risk for cardiac events like heart attack, stroke, or sudden cardiac death.
In the past, patients had electrocardiography (EKG) screenings if a stimulant medication was prescribed. With new research findings, these screenings are no longer required unless the person taking the drug (or someone in their family) has a history of cardiac problems.
If you're taking ADHD medication and experience any severe or unusual signs or symptoms, contact your doctor immediately.
Pregnancy and Breastfeeding
Both Adderall and Strattera are category-C drugs, which means they're considered unsafe to take during pregnancy or while breastfeeding. Talk to your doctor if you're pregnant or planning to become pregnant.
Risk of Abuse
Adderall is a schedule-II controlled substance. This means there's the potential for abuse and that extended use might cause dependence.
Adderall’s mode of action is to increase the activity of dopamine, which affects the brain's reward system and can lead to dependence and mis. Surges of dopamine cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.
Studies show that people taking a prescription stimulant medication have a lower rate of substance abuse compared to those who were not taking the medication.
This could be because when ADHD is being treated safely and effectively, people with the condition are less likely to self-medicate and use non-prescription methods to manage their symptoms.
When stimulant medications are prescribed at appropriate doses and taken as prescribed, the risk of potential addiction is low. However, you should always store your medication safely and you should never share your medication with other people.
As a non-stimulant medication, Strattera is not a controlled substance and doesn't carry the potential risk for abuse. It works by inhibiting norepinephrine uptake, rather than significantly affecting dopamine. It takes several weeks for the medication to take effect, making it difficult to abuse.
Withdrawal
Because Strattera is not a stimulant, it does not lead to physical dependence or withdrawal symptoms if you stop taking it. People who are concerned about the use of stimulants or the potential for abuse may choose to treat their ADHD symptoms with Strattera for this reason.
Adderall can lead to dependence, which means you may experience symptoms of withdrawal if you stop taking it. This can happen for people who have been using Adderall to treat their attention disorder, but it can also occur among people who use the medication without a prescription.
When you stop taking Adderall, norepinephrine and dopamine levels in the brain suddenly decrease. Dopamine is a neurotransmitter that activates the brain's reward system, while norepinephrine plays a role in regulating cognitive functions, attention, and mood.
The sudden reduction in these neurotransmitters can lead to problems with mood, alertness, sleep patterns, and concentration. Other common symptoms of Adderall withdrawal include:
Depression
Low energy
Anxiety
Sleep too much or too little
Brain fog
Headaches
Drug cravings
Black Box Warning
The FDA places a black box warning on some prescription drug labels to bring attention to possible serious or life-threatening risks.
Strattera has a black box warning for the possible increased risk of suicidal thoughts or actions in children, teens, and young adults. Parents and caregivers of kids taking Strattera are encouraged to monitor possible changes in the child's behavior and keep in close contact with the child’s doctor.
Adderall has two black box warnings. The first is to highlight the potential for abuse. The second is to warn about cardiac events.
If your child is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Summary
Adderall and Strattera can both be effective for managing symptoms of attention disorders. While Adderall is considered a first-line treatment, it may not be the right choice for everyone.
People who are sensitive to stimulants or who have concerns about the potential for dependence and abuse with stimulant medications may want to try a non-stimulant, such as Strattera. Talk to your doctor about your options to decide which medication may be right for you.
Frequently Asked Questions
How long do the side effects of Strattera and Adderall last?
Side effects often gradually go away within a few days or a couple of weeks. If your side effects last longer or are severe, talk to your doctor. In some cases, you might need to try a different dosage or a different medication, but you should never change your dosage or stop your medication without talking to your doctor first.
Are there any withdrawal symptoms when stopping Strattera or Adderall?
Strattera should not cause withdrawal symptoms. Adderall can lead to physical dependence, so you may experience withdrawal symptoms when you stop taking it, particularly if you have been taking high doses for an extended period of time. Common withdrawal symptoms include fatigue, mood changes, nausea, and difficulty sleeping.
How effective are Strattera and Adderall for ADHD?
Adderall is a first-line treatment as is considered effective in the treatment of ADHD. Strattera is considered a second-line treatment, but it is still effective for the treatment of ADHD symptoms.
