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Strattera (atomoxetine) is an SNRI (selective norepinephrine reuptake inhibitor) marketed in the United States since January of this year for the treatment of Attention Deficit Disorder in both children and adults. A similar medicine called reboxetine, also an SNRI, is marketed in Europe as an antidepressant, but has not yet reached the United States. Although we do not know much about the long-term effects of these drugs, we know a lot about the effects of norepinephrine reuptake inhibitors that had other effects and therefore could not be called selective. Specifically, I am referring to the tricyclic antidepressants desipramine (Norpramin) and nortriptyline (Pamelor). Extensive experience with these drugs indicates that they maintained their effectiveness for depression (and other disorders, such as panic disorder and ADD) for years, and there is no danger of reuptake abilities weakening. In fact, reuptake inhibition by the binding of a drug to a protein called a transporter, usually results in the body making more of the transporter protein, not less of it. I have been using Strattera in my practice this year, and find that it is generally better tolerated than tricyclic antidepressants, with fewer side effects. Tricyclics can have a negative effect on cognitive functioning because of anticholinergic properties. I consider Strattera to be a useful addition to the medications available for treating disorders of attention and cognition, and also for assisting in the treatment of certain forms of depression.
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