Strattera vs Adderall
How atomoxetine and amphetamine compare for ADHD, a non-stimulant and a stimulant.
How they're similar
Atomoxetine and amphetamine have more in common than some pairs, because both treat the same condition.
- Both are FDA-approved for ADHD in children, adolescents, and adults.
- Both improve attention and reduce hyperactivity and impulsivity.
- Both are taken regularly, not just as needed. Even Adderall is taken on a routine rather than reached for in the moment.
- Both can reduce appetite, affect sleep, and modestly raise heart rate and blood pressure.
- Both can slightly slow growth in children, so height and weight are tracked over time.
The differences are in speed, legal status, how well they work, and how they feel across the day. They also reach attention through different chemical messengers. Amphetamine acts mainly on dopamine and norepinephrine and increases both by slowing their reuptake and increasing how much the cells release. Atomoxetine acts mainly on norepinephrine, slowing its reuptake so more stays available between cells. That difference in how they work is also why one is a controlled substance and the other is not.
How they differ
One medication is a stimulant and the other is a non-stimulant, and that difference shapes everything else. The table below sums up the core points, with more detail underneath.
| Atomoxetine (Strattera) | Amphetamine (Adderall) | |
|---|---|---|
| Drug type | Non-stimulant | Stimulant |
| Speed of effect | Several weeks of daily use to reach full effect | Works the same day |
| Controlled substance | No | Yes, Schedule II |
| Typical effectiveness | Often more modest | Generally effective for more people |
| Daily pattern | Steady, all-day coverage without peaks | Dose-by-dose rise and fall through the day |
They work on different timelines, and this is the difference people notice most. Adderall works fast, the same day it is taken, often within about an hour, and it wears off after a set number of hours. Atomoxetine takes several weeks of daily use to reach its full effect, more like an antidepressant than a fast-acting stimulant. It is normal to feel little change in the first weeks on atomoxetine, and that is not a sign it is failing. Because of that, atomoxetine is taken every day whether or not someone feels anything yet, and a missed day is not made up by taking a dose later.
Their legal status differs. Adderall is a Schedule II controlled substance, the strictest category for a prescription medication, and it carries an FDA boxed warning about misuse, abuse, and addiction. A boxed warning is the FDA's most serious warning. In practice, an Adderall prescription cannot be refilled the usual way, so a new prescription is needed each time and it takes planning ahead. Atomoxetine is not a controlled substance and has no abuse potential, so it is refilled like a routine medication. Atomoxetine does carry its own boxed warning, about a possible increase in suicidal thoughts in children and adolescents, especially early in treatment.
They differ in effectiveness. Stimulants are generally effective for more people, and atomoxetine's effect is often more modest. That is a general pattern across groups of people, not a rule for any one person. Some people do very well on atomoxetine.
Their daily pattern is different. Adderall has a dose-by-dose rise and fall through the day, with the effect building after a dose and easing later, and some people notice a dip in mood or a rise in irritability as a dose wears off, sometimes called rebound. Atomoxetine gives steady, all-day coverage without those peaks and without rebound, because it works gradually rather than dose by dose.
Side effects compared
Because both medications treat ADHD in part by affecting attention and arousal, they share a set of side effects. Both can reduce appetite, affect sleep, cause headache and dry mouth, and modestly raise heart rate and blood pressure. Many of the milder early effects ease as the body adjusts. With atomoxetine, taking the dose with food can help with nausea.
There are differences in the detail. Atomoxetine can cause nausea, tiredness or drowsiness, and dizziness, and in adults it can cause some urinary symptoms such as difficulty starting urination. Rare cases of liver injury have been reported with atomoxetine, so signs like dark urine, yellowing of the skin or eyes, or unexplained tiredness should be reported promptly. Adderall can cause the wear-off rebound described above, which switching formulations can sometimes smooth.
The risks that matter most are different. With Adderall, the main concern is its potential for misuse, abuse, and addiction, which is the basis for its controlled substance status, along with its cardiovascular effects in anyone with a serious heart condition. With atomoxetine, there is no abuse potential, and the boxed warning to know is about a possible increase in suicidal thoughts in children and adolescents. If a side effect is severe, or it is not improving, that is a conversation to have with a prescriber rather than a reason to stop on your own.
Sleep, weight, and sexual effects
For sleep and weight, the two are broadly similar. Both can affect sleep, and both can reduce appetite, which can lead to some weight loss, an effect worth watching especially in children. With both, height and weight are tracked in children because growth can slow slightly. Atomoxetine's effect on sleep goes both ways, causing trouble sleeping for some people and drowsiness for others, so a prescriber may adjust the timing or split the dose. Adderall can make it harder to fall asleep, so it is generally not taken late in the day.
Sexual effects are not a central feature of either medication in the way they are for many antidepressants. Atomoxetine can be associated with some sexual side effects in adults, such as lower sex drive or difficulty with arousal or orgasm. Amphetamine is not a notable cause of sexual side effects. Any troubling effect in this area is worth raising with a prescriber.
Why a clinician might choose one over the other
Both treat ADHD, so the choice comes down to fit.
A stimulant like Adderall is first-line for most people with ADHD. It works fast and tends to be effective for more people, so it is the usual starting point. The trade-offs are its controlled substance status, the need for a new prescription each time, and the dose-by-dose rise and fall across the day.
A clinician might choose atomoxetine in several specific situations. One is when a stimulant is not well tolerated, for example when stimulant side effects are hard to live with. Another is when there are concerns about misuse, such as a personal or household history of substance use, since atomoxetine has no abuse potential. Atomoxetine can also be preferred when steady, all-day coverage without peaks is the goal, or when someone simply wants a medication that is not a controlled substance and does not require a new prescription each refill. It can also be a fit when a stimulant has worked but worsened anxiety, since some people find atomoxetine's steadier profile easier on that front. Atomoxetine is sometimes added to a stimulant rather than used instead of one, when a stimulant helps but does not cover the whole day.
The trade-off with atomoxetine is patience. It takes several weeks to reach its full effect, and its effect is often more modest. Someone who needs reliable coverage quickly may be better served by a stimulant.
The bottom line
Stimulants like Adderall are first-line for most people with ADHD and tend to be more effective, working the same day. Atomoxetine is the main alternative for when a stimulant is not the right fit, whether because of side effects, concerns about misuse, a preference for steady all-day coverage, or a preference to avoid a controlled substance. Atomoxetine asks for patience, since it builds over weeks. The choice is made with a prescriber, and it is reasonable to revisit it if the first option does not fit well.
Common questions
Why would someone choose Strattera over Adderall if stimulants work better? Because effectiveness is only one factor. Atomoxetine is chosen when a stimulant is not well tolerated, when there are concerns about misuse, when steady all-day coverage without peaks is preferred, or when someone wants to avoid a controlled substance. For those situations, atomoxetine's profile can be the better fit even though stimulants are generally more effective across groups of people.
How long does Strattera take to work compared with Adderall? Adderall works the same day, often within about an hour. Atomoxetine takes several weeks of daily use to reach its full effect, more like an antidepressant. It is normal to feel little change in the first weeks on atomoxetine.
Can Strattera and Adderall be taken together? Sometimes. Atomoxetine is occasionally added to a stimulant when the stimulant helps but does not cover the whole day. Any combination is set and monitored by a prescriber, who will watch the combined effect on sleep, appetite, heart rate, and blood pressure.
Is Strattera a controlled substance? No. Atomoxetine is not a controlled substance and has no abuse potential, so it is refilled like a routine medication. Adderall is a Schedule II controlled substance, which means a new prescription is needed each time rather than a standard refill.
Sources
This guide draws on current prescribing information and public health references. It is reviewed for clinical accuracy and updated as guidance changes.
Some clinicians and practices don't prescribe controlled substances like these. Why some practices don't prescribe these at shrinkMD.
Managing a medication needs a prescriber
Any psychiatric medication has to be started and adjusted by a clinician who can follow you over time. If you don't have a prescriber, our guides section explains the options, including in-person care and telepsychiatry, and how to choose between them.