Lenard A Adler M.D.
Professor
Departments of Psychiatry (VA) and Child and Adolescent Psychiatry, Langone Medical Center
Phone: (212)263-3580
Fax: (212)263-3581
Rivergate, 4, 427,
403 East 34th Street
New York, NY, 10016
Publications1. Adler L.A.; Ciranni M.; Shaw D.M.; Paunikar P.. "ADHD screening and follow-up: Results from a survey of participants 2 years after an adult ADHD screening day". Primary Psychiatry. 2010; 17: 32 (#J0187382)
2. Durell, Todd; Adler, Lenard; Wilens, Timothy; Paczkowski, Martin; Schuh, Kory. "Atomoxetine Treatment for ADHD: Younger Adults Compared with Older Adults". Journal of attention disorders. 2010; 13: 401 (#J0180779)
3. Goodman D.; Faraone S.V.; Adler L.A.; Dirks B.; Hamdani M.; Weisler R.. "Interpreting ADHD rating scale scores: Linking ADHD rating scale scores and CGI levels in two randomized controlled trials of lisdexamfetamine dimesylate in ADHD". Primary Psychiatry. 2010; 17: 44 (#J0187794)
4. Goodman, David; Faraone, Stephen V; Adler, Lenard A; Dirks, Bryan; Hamdani, Mohamed; Weisler, Richard. ""Interpreting ADHD rating scale scores: Linking ADHD rating scale scores and CGI levels in two randomized controlled trials of lisdexamfetamine dimesylate in ADHD": Erratum". Primary Psychiatry. 2010; 17: 18 (#J0190855)
5. Reimherr, Frederick; Amsterdam, Jay; Dunner, David; Adler, Lenard; Zhang, Shuyu; Williams, David; Marchant, Barrie; Michelson, David; Nierenberg, Andrew; Schatzberg, Alan; Feldman, Peter. "Genetic polymorphisms in the treatment of depression: speculations from an augmentation study using atomoxetine". Psychiatry research. 2010; 175: 67 (#J0189504)
His page lists over 100 publications, almost all about "Adult ADD". He is very fond of this drug called "Atomoxetine"
Important Warning:
Studies have shown that children and teenagers with attention-deficit hyperactivity disorder (ADHD; more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age) who take atomoxetine are more likely to think about killing themselves than children and teenagers with ADHD who do not take atomoxetine.
While your child is taking atomoxetine, you should watch his or her behavior very carefully, especially at the beginning of treatment and any time his or her dose is increased or decreased. Your child may develop serious symptoms very suddenly, so it is important to pay attention to his or her behavior every day. Ask other people who spend a lot of time with your child, such as brothers, sisters, and teachers to tell you if they notice changes in your child's behavior. Call your child's doctor right away if your child experiences any of these symptoms: acting more subdued or withdrawn than usual; feeling helpless, hopeless, or worthless; new or worsening depression; thinking or talking about harming or killing him- or herself or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; irritability; aggressive or violent behavior; acting without thinking; extreme increase in activity or talking; frenzied, abnormal excitement; or any other sudden or unusual changes in behavior.
Your child's doctor will want to see your child often while he or she is taking atomoxetine, especially at the beginning of his or her treatment. Your child's doctor may also want to speak with you or your child by telephone from time to time. Be sure that your child keeps all appointments for office visits or telephone conversations with his or her doctor.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with atomoxetine and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (
http://www.fda.gov/Drugs) or the manufacturer's website to obtain the Medication Guide.
Talk to your doctor about the risks of giving atomoxetine to your child, of using other treatments for your child's condition, and of not treating your child's condition.
Why is this medication prescribed?Atomoxetine is used as part of a total treatment program to increase the ability to pay attention and decrease impulsiveness and hyperactivity in children and adults with ADHD. Atomoxetine is in a class of medications called selective norepinephrine reuptake inhibitors. It works by increasing the levels of norepinephrine, a natural substance in the brain that is needed to control behavior.
What side effects can this medication cause?Atomoxetine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
* heartburn
* nausea
* vomiting
* loss of appetite
* weight loss
* constipation
* stomach pain
* gas
* dry mouth
* excessive tiredness
* dizziness
* headache
* mood swings
* decreased sex drive or ability
* difficulty urinating
* painful or irregular menstrual periods
* muscle pain
* sweating
* hot flashes
* unusual dreams
* burning or tingling in the hands, arms, feet, or legs
Some side effects can be serious. If you experience any of the following symptoms, or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS section, call your doctor immediately:
* fast or pounding heartbeat
* chest pain
* shortness of breath
* slow or difficult speech
* dizziness or faintness
* weakness or numbness of an arm or leg
* swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
* hoarseness
* difficulty swallowing or breathing
* hives
* rash
* abnormal thoughts
* hallucinating (seeing things or hearing voices that do not exist)
* erection that lasts for several hours or longer
* seizures
Atomoxetine may cause sudden death in children and teenagers with heart defects or serious heart problems. This medication also may cause sudden death, heart attack or stroke in adults, especially adults with heart defects or serious heart problems. Talk to your doctor about the risks of taking this medication or of giving this medication to your child.
Atomoxetine may slow down children's growth or weight gain. Your child's doctor will probably monitor your child carefully during his or her treatment with atomoxetine. Talk to your child's doctor about the risks of giving this medication to your child.
Atomoxetine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
ADHD Drug May Require More StudySeptember 23rd, 2002
INDIANAPOLIS (AP) - Eli Lilly and Co. on Wednesday said regulators may require more study of an experimental treatment for attention deficit hyperactivity disorder before it can be marketed. However, Indianapolis-based Lilly said it had received an "approvable letter" from the U.S. Food and Drug Administration, which usually indicates the FDA is prepared to approve a drug but only once certain conditions are met.
Lilly said it hoped to introduce Strattera next spring, but at least one analyst said that might be overly optimistic. Approval hinges on discussions on the drug's label and submission of additional data or analyses from either existing studies or a potential new study, Lilly said. Unlike Ritalin and other drugs to treat ADHD, Strattera is not a stimulant - a factor Lilly hopes will make the medication more convenient to pick up from pharmacies.
Because stimulants carry potential for abuse, pharmacies require written prescriptions and do not allow refills. Lilly spokesman David Shaffer and FDA spokeswoman Laura Bradbard both declined to comment on the agency's clinical concerns. An industry analyst said Lilly may be too optimistic in its timeline for the drug, given that a new study may be required. "Almost certainly it is going to cause a delay," said Hemant K. Shah, an independent analyst from Warren, N.J. "It's a little surprising that the FDA is asking for this."Strattera's market potential is large at a time when Lilly needs a new drug to offset recent setbacks, Shah said. Those include last summer's loss of patent protection for the anti-depressant Prozac, Lilly's former best-seller, and manufacturing problems at Lilly plants in Indianapolis that could delay approvals of three other new drugs.
Lilly's Shaffer said Strattera will be produced at plants in Ireland and Puerto Rico, so its approval will not hinge on the success of Lilly's efforts to resolve the FDA's concerns in Indianapolis. Lilly shares rose 4 percent on Wednesday, closing up $2.28 to $58.24 on the New York Stock Exchange.
While many associate ADHD only with children, the condition exists in about 4 percent of adults, said
Dr. Leonard Adler, a clinical psychiatrist at New York University who conducted an adult study of Strattera and
has received research grants from Lilly. Symptoms include short attention span, impulsive behavior and difficulty focusing and sitting still. Strattera works by blocking reabsorption of a neurotransmitter that moves messages between brain cells. "The studies so far have shown the medicine to be very well-tolerated, and
side effects are limited," including a slight increase in a patient's blood pressure and pulse, Adler said.
Strattera - A New ADHD MedicationStrattera is a Non-Stimulant Drug for ADHD
By Vincent Iannelli, M.D., About.com Guide
Updated September 30, 2005
While a lot of 'new' medications for treating ADHD have been introduced recently, like Adderall XR, Concerta, Focalin, Ritalin LA, etc., they are still all stimulants.
The FDA has now approved Strattera (atomoxetine), a new non-stimulant drug to treat ADHD in adults and children over age 6. This is not the first non-stimulant medication for ADHD though. Antidepressants, including Wellbutrin (bupropion hydrochloride) and tricyclics, like Desipramine and Imipramine, have long been considered second line medications, and are sometimes used when two or more stimulants don't work, are contraindicated, or cause too many side effects. Antidepressants are usually not considered to be as effective as stimulants though. And these medicines aren't FDA approved to treat ADHD, so Strattera's claim of being 'the first non-controlled medication that's FDA-approved to treat ADHD' is technically true.
The introduction of Strattera (pronounced Stra-tair-a) is going to be welcome news for most parents. Although widely known to be safe and effective, stimulants like Adderall and Ritalin, have long had a bad reputation and many parents are anti-Ritalin and hesitant to put their kids on a stimulant. So if it isn't a stimulant, how does Strattera work? It is thought to be 'a potent inhibitor of the presynaptic norepinephrine transporter,'1 which causes more norepinehrine to be available to increase attention and control hyperactivity and impulsivity. Like the stimulants, it is not yet known exactly how Strattera works though.
Although a new medicine, six research studies have already been done that show that Strattera is safe and effective.
One of these studies, Atomoxetine and methylphenidate treatment in children with ADHD: a prospective, randomized, open-label trial,1 compared Strattera and Ritalin. These children with ADHD, 228 in all, received either Strattera or Ritalin for 10 weeks, and those who took Strattera were found to have 'symptom reduction' and 'tolerability' that were 'comparable to that observed with' Ritalin.
Strattera Suicide Warning
Although infrequent, the FDA has warned about an increased risk of suicidal thinking in children and adolescents being treated with Strattera. Specifically, like many other psychiatric medications, the FDA states that Strattera 'may increase thoughts of suicide or suicide attempts in children and teens,' and that parents should call their child's doctor if their child has:
* new or increased thoughts of suicide
* changes in mood or behavior including becoming irritable or anxious
This warning doesn't mean that your child can't be prescribed Strattera or that he should stop taking Strattera if it is doing a good job managing his ADHD symptoms and not causing side effects. Instead, the benefit of taking Strattera should be weighed against the possible risks of the drug. And children taking Strattera should be 'observed closely for clinical worsening, suicidal thinking or behaviors, or unusual changes in behavior,' especially in the first few months of starting treatment or when the dosage is changed.
