Drug of the Month:

An antidepressant masquerading as an ADD drug

Atomoxetine structure

This medication is a norepinephrine reuptake inhibitor, initially developed as an antidepressant.  It was brought to the market as the first drug for adult ADD, rather than one of the last for depression. It differs notably from other “stimulants” though in its mechanism and risks. 

Clinical efficacy and inefficacy

In early clinical trials, this agent was found to be effective in major depressive episodes.  It was noted that it shared its basic mechanism of pure norepinephrine effects with desipramine, which had been proven effective in childhood ADD. Eli Lilly, the company which was developing atomoxetine, made an economic decision to shift to ADD, rather than major depressive disorder (MDD), but even in ADD, there were multiple other agents, mostly amphetamines, that were FDA-indicated in children. However, no agents were FDA-indicated in adults for ADD.  Indeed, the whole concept of adult ADD was not used much, and it was not part of DSM-IV. 

After obtaining academic support, Eli Lilly convinced the FDA to provide the first indication for ADD in adults.  The latter designation was then added to DSM-5.  

To read the complete article, including a description of relevant clinical facts and side effects, please click here or subscribe

PL Reflection

And what goal could be more sacred than that of caring for a brother in distress, especially when the affliction is distinctly human and therefore more obvious than others, and when it respects neither reason nor rank nor riches?

R Emil Kraepelin

One Hundred Years of Psychiatry

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