It is clear that Strattera is potentially a very significant advancement in ADHD treatment. Does mean you should run out and get it?
There are two consideration that no one seems to be discussing which I feel are very significant.
First, almost all the studies compare Strattera to placebo. That means Lilly has proven that Strattera works better than doing nothing. How well does Strattera do when compared to Ritalin or Dexedrine? So far I have found only one study that addressed this question.
The study examined 228 children over a ten-week period to compare the effectiveness of Strattera with that of Ritalin. The researchers report that they did not find a statistically significant difference between the Strattera group and the Ritalin group. But there is a weakness in this study. They only placed 44 children in the Ritalin test group. What this type of group disparity does is that it skews the data to make it harder to find differences between the two groups. So in effect, the experiment was designed to hide results that might be harmful to Strattera. Was this their intention? Of course, not! What a cynical thing to think! Still, it would have been better if the experiment had been designed to find differences between the medications rather than to hide them. So, even though everyone is claiming Strattera works as well as Ritalin, I am not convinced.
There is a more significant consideration, which is actually a consideration with any new drug. Ritalin and Dexedrine have been around for almost a century. Of all psychiatric medications, nothing else has been studied and tested so thoroughly. Many people have very strong opinions about these drugs and their effects. Some people like them, some people hate them, but everyone agrees to one thing. There are going to be no major surprises. We are not going to find out that Ritalin has some catastrophic side effect that nobody could have predicted. It has been around too long. Whatever is going to happen already has happened.
You cannot make the same statement about Strattera. The FDA is very stringent about its requirements before allowing a new drug on the market. Most people think they are too conservative and are blocking people from receiving effective medication. But the FDA is not infallible, and medicines with dangerous effects do get through the screening process.
Seldane was one of the main drugs that I used in residency. At the time, no one knew that when combined with erythromycin it caused a fatal reaction in some people. A few years after that, there was another new drug on the market that ran into problems. A new class of antibiotics, called Quinolones came onto the market in the 1980's. One company, developed it's own Quinolone in order to get a piece of this market. The drug was called Omnifloxin, and it seemed like the other five or six drugs that were available at that time. We soon found out there was a difference. Omnifloxin had fatal side effects in some people. It was taken off the market soon after its introduction.
Will this happen with Strattera? Sure, it was tested in 1000 people for a year. But say, for example, that Strattera would cause some catastrophic problem after year in as few as 1 in 5000 patients. It is unlikely the testing that was done would pick this up. And now we start to give it to millions of our children- well, I don't have my calculator on me, but it seems we would be in for big problems with a lot of children.
Do I really think this will happen? Probably not. But with Ritalin or Dexedrine I am sure it won't happen.
My Recommendation
So what should you do? My opinion is as follows:
If you are happy with what your child is taking, there is no reason to switch to Strattera. If your child is going on medication for the first time, Strattera should not be your first choice. The only time I think you should consider Strattera is if your child has tried the available stimulant medications at various dosages and they didn't work.
In another year or so, after we know more about the long-term effects of Strattera, I will probably change my recommendations. But that is how I see it now.
What if your child is on Strattera already? Should you worry? First of all, the physicians of a million children seem to disagree with me, so you can always rely on their assessment. More importantly, if Strattera is working for your child, then I feel that you should keep your child on it and hope for the best. The concerns I have are very remote. If you found something that definitely helps your child, this outweighs the concern for possible undetected problems.
Whatever you decide to do, I wish for your success.
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