Atomoxetine can significantly improve psychosocial function in children and adolescents with attention deficit hyperactivity disorder (ADHD) and an anxiety disorder, according to a presentation at the annual meeting of the American Psychiatric Association.

The assessment of function was part of a larger 12-week trial that examined atomoxetine's ability to treat ADHD in children and adolescents with ADHD and anxiety disorders. To be eligible, patients had to meet diagnostic criteria for ADHD and separation anxiety, generalized anxiety or social phobia.
Of 176 patients, 87 were randomized to atomoxetine (dosage increased from 0.8 mg/kg/day to a target dose of approximately 1.2 mg/kg/day, not exceeding 120 mg/day), and 89 were randomized to placebo. A total of 66 patients in each group completed the study.

In six visits over approximately 12 weeks, patients were assessed according to the 18-item ADHDRS-IV-PI scale and total patient- and parent-reported PARS score. The secondary analysis examined patient functioning on the MASC, LPS-ADHD-R and CHQ-PF50 scales. This study was designed to examine atomoxetine's ability to improve symptoms of ADHD and comorbid anxiety in children with both ADHD and anxiety. It was not designed to study the effects of atomoxetine on ADHD or anxiety alone.

At the end of the study, atomoxetine significantly reduced core disorder symptoms such as inattention, hyperactivity and impulsivity by 39 percent compared with a 4 percent improvement with placebo. Atomoxetine also significantly reduced anxiety symptoms like excessive worry, sweating and trembling by 32 percent compared with 19 percent for placebo.

The secondary analysis examined atomoxetine's affect on patient functioning. At the end of the study, patients taking atomoxetine saw a significant improvement in functioning on the Multidimensional Anxiety Scale for Children (MASC), 9 percent improvement for atomoxetine vs. 4 percent loss for placebo; Life Participation Scale for ADHD-Revised (LPS-ADHD-R), 31 percent improvement for atomoxetine vs. 10 percent improvement for placebo and the Child Health Questionnaire-Parent Completed Full Length (CHQ-PF50) 23 percent improvement for atomoxetine vs. 11 percent improvement for placebo.

"Treating ADHD in children is challenging because of the complexity of the disease and the presentation of underlying issues such as anxiety," said Daniel Geller, MD, director of the Pediatric Obsessive Compulsive Disorder program at Massachusetts General Hospital in the Division of Pediatric Psychopharmacology. "This study suggests that atomoxetine improved ADHD and anxiety symptoms in children with both ADHD and anxiety disorders."

Up to 35 percent of children with ADHD also suffer from anxiety disorders like separation anxiety, generalized anxiety or social phobia. Children with ADHD and anxiety report more school, family and social/peer problems than children who only have ADHD. Children with ADHD accompanied by anxiety are less likely to appear hyperactive and disruptive, but instead appear more slowed down or inefficient.
Atomoxetine, a selective norepinephrine reuptake inhibitor, is the first FDA-approved non-stimulant to treat ADHD. It is not known precisely how atomoxetine reduces ADHD symptoms, but scientists believe it works by blocking or slowing reabsorption of norepinephrine.