Efficacy and Safety of Atomoxetine in Adolescents with Attention-Deficit/Hyperactivity Disorder and Major Depression

This double-blind study examined efficacy and safety of atomoxetine (ATX; ≤1.8mg/kg per day) in adolescents aged 12–18 with Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses of both attention-deficit/hyperactivity disorder (ADHD) and co-morbid major depressive disorder (MDD). Diagnoses were confirmed by the Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children–Present and Lifetime Version and persistently elevated scores on the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV, Parent version, Investigator-administered and -scored (ADHDRS-IV-Parent:Inv, ≥1.5 standard deviations above age and gender norms) and Children's Depression Rating Scale–Revised (CDRS-R, ≥ 40). Patients were treated for approximately 9 weeks with ATX (n = 72) or placebo (n = 70). Mean decrease in ADHDRS-IV-Parent:Inv total score was significantly greater in the ATX group (−13.3 ± 10.0) compared with the placebo group (−5.1 ± 9.9; p < 0.001). Mean CDRS-R score improvement was not significantly different between groups (ATX, −14.8 ± 13.3; placebo, −12.8 ± 10.4). Rates of treatment-emergent mania did not differ between groups (ATX, 0.0%; placebo, 1.5%). ATX treatment was associated with significantly more nausea and decreased appetite (p = 0.002; p = 0.003). No spontaneously reported adverse events involving suicidal ideation or suicidal behavior occurred in either group. ATX was an effective and safe treatment for ADHD in adolescents with ADHD and MDD. However, this trial showed no evidence for ATX of efficacy in treating MDD.