Expert: Dr. Ravindra Bhaskar Ghooi - 3/1/2004

Question
Dear Dr. Bhaskar-Ghooi:

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
Hi Morad,
Your logic is sound but drugs dont always follow the logic. Weelbutrin (Bupropion) is a weak inhibitor of serotonin and norepinephrine  reuptake. It possibly has some other effects on the neuronal system which are not yet understood. Strattera is an inhibitor of norepinephrine transport at the presynaptic sites and again the exact mechanism of action in ADD is not unknown.
There is therefore a possibility that if you dont respond to wellbutrin you may not respond to Strattera also, this is logical. However since we do not know if these drugs have other effectsand what they could be,such an assumption may not be valid.It would be better to try the drugs before rejecting them.For example many people respond well  to one calciumchannel antagonist but not to others. The same holds good for a variety of classes of drugs.
I however,do agree with your comment on the side effect of adrenergic agents. Side effects seem to be quite ubiquitous.
Regards
Ravi Ghooi