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Gender differences in ADHD patients treated with Atomoxetine


Females with Attention- Deficit/Hyperactivity Disorder ( ADHD ) and treated with Atomoxetine ( Strattera ) showed no difference in core ADHD symptom improvement compared to men yet women displayed greater emotional symptom improvement when treated.

At the start of the study, females displayed greater core ADHD symptoms ( e.g., disorganization, inattention, and impulsivity ) than males and showed no difference in symptom improvement over males at the end of the study using the Conner's Adult ADHD Rating Scale Investigator Total ADHD Symptom Score ( CAARS-INV ).
Similar results were seen using the Wender-Reimherr Adult Attention Deficit Disorder Scale ( WRAADDS ), a secondary analysis, in the overall symptom improvement, as well as the hyperactivity/impulsivity and the attention/disorganization subscales. In the WRAADDS emotional impairment subscale ( measuring elements like: irritability, brief periods of depression, mood fluctuation, inability to handle stress ), females exhibited greater emotional symptom improvement compared to their male counterparts by study's end. Both male and female participants showed improvement with treatment with Atomoxetine compared to placebo.

"ADHD is often believed to be a male disorder yet epidemiological studies demonstrate that there are many more women living with the condition than generally believed. Unfortunately, as symptoms of ADHD often manifest themselves differently, many women are undiagnosed," said Fred W. Reimherr, University of Utah, Department of Psychiatry, Salt Lake City. " We are encouraged by the results of this analysis as it highlights Atomoxetine's ability to significantly reduce all symptoms of ADHD in women, who are typically more difficult to assess, as they are more likely to have been diagnosed with other conditions including depression or anxiety."

Data highlights:


- At baseline, women were rated more impaired on every measure of ADHD symptoms compared to men ( 18.2 +/- 4.4 female vs. 16.7 +/- 5.2 male, p=0.001 ) when using the WRAADDS Total score which measures the severity of the target symptoms of adults with ADHD.

At the end of the study, on the WRAADDS Total score, both genders demonstrated significant symptom improvement with Atomoxetine ( improvement of 5.6 on WRAADDS or 30 percent overall symptom improvement among females vs. 2.8 on placebo or 16 percent; improvement of 4.6 on WRAADDS or 27 percent among males vs. 2.9 on placebo or 18 percent ). There were no significant differences between genders in benefit of treatment with Atomoxetine over placebo.

Emotional symptoms improved significantly more in females ( improvement of 2.1 on WRAADDS or 35 percent vs. placebo .4 or 7 percent ) after receiving Atomoxetine than in males ( improvement of 1.3 on WRAADDS or 25 percent vs. placebo 1.0 or 20 percent ). The benefit of Atomoxetine over placebo was greater in females than in males, p=0.011.

Additional sub-scales on the WRAADDS included: attention/ disorganization and hyperactivity/impulsivity. Scores on these sub-scales showed no difference between males and females.


- At baseline, females showed more impairment than males ( 35.4 +/- 7.6 female vs. 33.2 +/- 7.1 male, p=0.001 ) on every measure of ADHD symptoms when using the CAARS-INV, which is designed to help assess, diagnose, and monitor treatment of ADHD in adults.

On the CAARS Total ADHD Symptom Score, both genders demonstrated significant symptom improvement with Atomoxetine (improvement of 14.1 on CAARS or 36 percent overall symptom improvement among females vs. 25 percent placebo; 12.8 on CAARS or 35 percent among males vs. 26 percent placebo). There were no significant differences between genders.

" Not only does ADHD affect adults differently than children, there are studies in children that show ADHD presents itself differently in boys and girls, and we wanted to extend that research into adults to improve patient care," said Reimherr. " We hope that this analysis will help physicians better diagnose and treat women who may not present the typical childhood symptoms of ADHD. It's clear that proper treatment can have a substantial positive impact on patients' lives. We hope that future studies will clarify our knowledge regarding these particular gender differences."


ADHD affects three - seven percent of school-age children and manifests itself in levels of attention, concentration, activity, distractibility and impulsivity that are inappropriate to the child's age.
In addition, 60 percent of children with the disorder carry their symptoms into adulthood.
Experts estimate four percent of adults in the United States, more than eight million people, have ADHD.


Atomoxetine, a selective norepinephrine reuptake inhibitor, is approved to treat ADHD in children aged six and over, adolescents, and adults.
It is not known precisely how Atomoxetine reduces ADHD symptoms, but scientists believe it works by blocking or slowing reabsorption of norepinephrine, a chemical in the brain considered important in regulating attention, impulsivity and activity levels.
This keeps more norepinephrine at work in the spaces between neurons in the brain.
Improved efficiency in the norepinephrine system is associated with improvement in symptoms of ADHD.

Atomoxetine should not be taken at the same time as, or within two weeks of taking, a monoamine oxidase inhibitor ( MAOI ) or by patients with narrow angle glaucoma.
Patients with a history of high or low blood pressure, increased heart rate, or any heart or blood vessel disease should tell their doctor before taking Atomoxetine.
Atomoxetine has not been tested in children less than 6 years of age or in geriatric patients.
Some children may lose weight when starting treatment with Atomoxetine.
As with all ADHD medications, growth should be monitored during treatment. Atomoxetine can cause liver damage in rare cases. Patients should tell their doctor right away if they have itching, dark urine, yellow skin/eyes, upper right-sided abdominal tenderness, or unexplained "flu-like" symptoms.

Most people in clinical studies who experienced side effects were not bothered enough to stop using Atomoxetine. The most common side effects in children and adolescents in medical studies were upset stomach, decreased appetite, nausea and vomiting, dizziness, tiredness and mood swings.
In adults, the most common side effects were constipation, dry mouth, nausea, decreased appetite, dizziness, problems sleeping, sexual side effects, problems urinating and menstrual cramps.

Source: 158th Annual Meeting of the American Psychiatric Association, 2005

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