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Old 05-30-05, 11:43 AM
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Gender Differences in ADHD Patients Treated with Atomoxetine

Gender Differences in ADHD Patients Treated with Atomoxetine
29 May 2005


Females with Attention- Deficit/Hyperactivity Disorder (ADHD) and treated with atomoxetine HCl showed no difference in core ADHD symptom improvement compared to men yet women displayed greater emotional symptom improvement when treated. The data is according to a retrospective analysis of two studies presented today at the 158th Annual Meeting of the American Psychiatric Association. Atomoxetine is approved for the treatment of adult ADHD.

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, M.D., University of Utah, Department of Psychiatry, Salt Lake City, UT. "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 Dr. 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."

Methods:

* Combined data from two identical placebo-controlled 10-week double- blind studies of atomoxetine in adults with ADHD (536 participants at 31 sites) were examined.

* The primary analysis of baseline measures and change from baseline measures was a comparison of gender-defined groups.

* Of the 188 females and 348 males in the analysis, 75 percent of females were diagnosed with a combined ADHD subtype (hyperactive/impulsive, inattentive), a significantly higher rate than males.

* Patients with depression, anxiety or other psychiatric diagnosis were excluded from the study.

About ADHD

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.(1) In addition, 60 percent of children with the disorder carry their symptoms into adulthood.(2) Experts estimate four percent of adults in the United States, more than eight million people, have ADHD.(3,4)

About Atomoxetine

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 (Pliska, 1996).

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.

About Lilly

Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers - through medicines and information - for some of the world's most urgent medical needs. Additional information about Lilly is available at www.lilly.com . P-LLY

For full prescribing information visit http://www.lilly.com.

(1) American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision, Washington, DC, American Psychiatric Association, 2000.

(2) Schweitzer JB, et al. Attention-deficit/hyperactivity disorder. Med Clin of North Am. 2001; 85(3): 757-777

(3) Murphy K, Barkley, RA. J Atten disord. 1996; 1:147-161.
(4) United States Census Summary File; 2000.

http://www.lillymedia.com

http://www.medicalnewstoday.com/medi...p?newsid=25268
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Old 08-21-06, 06:36 PM
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Gender Different ADHD Symptoms & Strattera Side-Effects

I am a male who was on Strattera for a while. I have the "innattentive" type of ADD (with comorbid abxiety) primarily and I beleive many woman also exhibit this form as well - which is why I think they are less diagnosed.... They don't come out aggressively or impulsively as many men do, rather they "turn it inward" and it turns to anxiety and depression instead of aggression. I beleive the aggressive type gets diagnosed more often because a) it is more apparent and b) aggression is more socially unacceptable and therefore there is more of a need to do something about the symptoms because OTHERS are being impacted.

Men tend to be raised in our culture to be over-assertive and women tend to be raised to be passive or under-assertive. I know this is slowly changing but this is still the collective unconscious primary "genderizing" we do in our culture. I beleive this is what predisposes us to react differently. Some of us are "uncontrolled" and "all over the field" (predominantly - though not entirely male) while others are "stuck inside" and paralyzed or afraid to "come out" (often as a dirrect result of being trapped in environments with the over-assertive types).

Being an un common "innattentive" rather than "hyperactive" male type, I needed a way to turn off my inner anxiety which Strattera seemed to do quite well. Unfortunatly, the sexual issues of retrograde orgasm, sperm coming out in the urine, and extreme urinary hestitancy (prostrate) issues caused me to have to stop the Strattera. In addition, they started me on way too high a dose for me (40 mg when I only needed about 10). FLowmax worked well for the urinary hesitancy issues but the retrograde orgasms and sperm in the urine issue was unresolvable.....

Women wouldn't have these male related issues so I feel many women in particular could benefit from Strattera. I do beleive that should start them on much lower doses however as I think many more people are slow-metabolizers of this drug than is realized... not to mention the fact that the way it metabolized makes the half life of this drug extremely long and if taken daily, it may be too frequently again causing too high a blood level to occur as doses may be taken too soon together.


I found the Strattera to work wonderfully on eliminating my anxiety - the first day I took it as a matter of fact. And I feel if it is refined it could be a wonderful drug for the "Innattentive" and "Anxious" type of person. Again, it's too bad there are so many sexual and urinary issues for men because I feel those of us who are the uncommon "inattentaive" male types would benefit from it as well.

By the way, European drug Reboxetine has been used for anxiety and depression in Europe for years (another Noradrenaline Reuptake Inhihitor). There is no other norepinepedrine reuptake inhibitor available in the USA and I feel more research should be done in this area. They have a couple of combined serotonin and norepinephedrine reuptake inhibitors like Effexor but I find it awfully curious that more straight NRI's like Strattera (such as Reboxetine) are not available here.

To sum up, I think more women with Innatentive (and comordibly anxious) types of ADD could benefit from Strattera provided doctors are a little more careful about starting low on the doses - and perhaps dosing every other day instead of daily due to the extremly long half-life (especially for slow metabolizers).

Blessings,

...Dan
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Old 11-17-06, 04:44 PM
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Is it just me, or does the title read like they were using Atomoxetine on ADHD patients to treat their gender differences?
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Old 11-17-06, 08:25 PM
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I found the Strattera to work wonderfully on eliminating my anxiety - the first day I took it as a matter of fact. And I feel if it is refined it could be a wonderful drug for the "Innattentive" and "Anxious" type of person. Again, it's too bad there are so many sexual and urinary issues for men because I feel those of us who are the uncommon "inattentaive" male types would benefit from it as well.

what gender diff are there then what dose strattera??? dose it couse diff????? confussed here dorm????????????
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Old 11-18-06, 03:39 AM
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Quote:
Originally Posted by DaVis
Is it just me, or does the title read like they were using Atomoxetine on ADHD patients to treat their gender differences?
LOL whole new area of ADHD psychiatry! Yeah, I suppose it could be read that way too!

Thanks, Andrew, for the post... very enlightening.
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