ADHD Questions
Questions
Can someone with Bipolar Disorder take Strattera?
Charles Li, MD
December 15, 2022
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Strattera is a safe and effective non-stimulant medication for ADHD.
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However, there have been some cases linking Strattera with hypomanic episodes.
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These cases are not common, and more research is needed. Strattera remains a treatment option to consider for ADHD in those with Bipolar Disorder.
Unlike Ritalin or Adderall, Strattera is not a stimulant medication. It has a mechanism more similar to some antidepressant medications.
It is an effective and commonly prescribed treatment for ADHD. However, like Adderall and Ritalin, there are some concerns for individuals with Bipolar Disorder.
Strattera is an SNRI commonly prescribed for ADHD. It comes in a capsule with doses ranging from 10mg to 100mg. It can increase the risk of suicidal ideation in children and adolescents. The side effects of Strattera include nausea, fatigue, constipation, decreased appetite, and sleep dysfunction.
Strattera’s warning on Bipolar Disorder
Strattera carries a warning label for Bipolar Disorder, that cautions prescribers to the risk of manic episodes from taking Strattera.
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In general, particular care should be taken in treating ADHD in patients with comorbid bipolar disorder because of concern for possible induction of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with STRATTERA, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.
This risk is exclusive to individuals who already have Bipolar Disorder. There’s no evidence of Strattera causing Bipolar Disorder.
However, there is a risk that someone who may not know they have Bipolar Disorder can experience worsened manic episodes because of Strattera. As a result, the warning recommends that those with depressive symptoms should be screened for Bipolar Disorder.
A manic episode is a distinct period where one experiences an abnormally elevated or irritable mood and goal-directed behavior, for at least one week, nearly every day.
Studies on Strattera and Bipolar Disorder
There have not been many studies on Strattera and Bipolar Disorder. Much of what we know about this topic comes from case reports and reviews.
Both of the case studies above are regarding potential cases of hypomania caused by Strattera in patients with bipolar disorder.
While these case studies provide helpful information on the potential risks of Strattera, they don’t provide information on this link's frequency or statistical significance.
We have evidence that this link exists, we just don’t know how strong the link is.
Conclusion: Strattera and Bipolar Disorder
In conclusion, there is evidence of a small risk of worsening bipolar symptoms in patients who take Strattera.
However, for some individuals, the benefits of Strattera may outweigh the risks.
If you are considering trying Strattera, be sure to talk to your doctor to see whether Strattera or another ADHD treatment is suitable for you.
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Although systematic trials on the use of stimulants and ATX in ADHD-BD comorbidity in adulthood are necessary, both treatments should be considered possible options to be carefully evaluated once the patient has been stabilized.