Expert: Dr Billy Levin - 3/1/2004

Question
Dear Dr. Levin:

I am an adult recently diagnosed with A.D.D. innatentive type. Recently I have come accross some liturature about Strattera...the new non-stimulant medication for A.D.D.
My experience with stimulents was very bad. They caused a lot of anxiety.  My question is as follows.  I have read that Strattera acts as a norepinephrine/noradrenaline re-uptake inhibtor. In the past I have been prescribed Wellbutrine, which is also a noradrenaline re-uptake inhibitor. My response to wellbutrine was quite weak. Therfore My question is, since my response to wellbutrine was very weak, does it follow that I would be a poor candidate for response to Strattera given that they act on the same neuro transmitter?  I assume that they may have different mechanisms of action, and that may have some differing effect, but I guess I'm wondering if they are basically similar medications, in the same way that One SSRI is quite similar to another. IE, is  Strattrera to Wellbutrine as Prozac is to Zoloft...and if so, would my reponse to one likely be similar to my response to the other.

Thank you for your time, and have a pleasant day.

Morad.

Answer
Firstly ,very few patients react badly to the stimulants unless they have been used incorrectly.How did you use, what did you use ,what dose,what timing and how many doses, for how long? Was any method employed to monitor the effect?
Next, you are quite right about your info re Strattera. However, the consensus is it is not very effective. I certainly would not suggest using it when so many other possibly more effective products are available.Please don't forget although the SSRI's have similarities they are most certainly not the same and do not always have the same effect on all patients. I would be keen to know more about your experience with stimulants before advising you.