Does atomoxetine aggravate mood problems?

ATX chemical compoundA 13 year old boy with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) comes to the clinic with his mother for a review. He was started on atomoxetine 6 weeks prior to this visit for hyperactive/impulsive symptoms and poor concentration. The boy was admitted in the hospital one week ago for changed behaviour, disorientation, irrelevant speech and self-harming behaviour. He was reported as very aggressive and hostile towards other children and adults. In past use of stimulant medication was not considered because of the risk of abuse and drug diversion. Mother correlates this hospitalization due to side effect of atomoxetine. She asks your opinion about increased aggression and hostility related to atomoxetine .

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Report by

Somnath Banerjee Associate Specialist in Community Paediatrics, School & Child Health, Ramsgate, Kent.

Hani F Ayyash Consultant Paediatrician, Doncaster Royal Infirmary, Doncaster, South

Ahmed Shakir Mohammed F2, Queen Elizabeth the Queen Mother Hospital Margate Kent.

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  • Timothy Brown

    The vignette doesn’t say whether he has any comorbidity, in particular, conduct disorder or a substance use disorder, although this is implied. The disorientation in particular suggests an organic aetiology needs to be ruled out. So the $64K question has to be – has he been taking anything else? I’m impressed that you could get an inpatient bed this quickly – have they done a tox screen?
    Timothy Brown
    Specialist nurse, ADHD care package, NHS Tayside CAMHS
    ARCHI ADDS: The cases are all amalgams of various individuals, and as such do not refer to a single individual. Remembering to check for other causes of pathology – such as urine toxicology – is a useful point.

  • Emere

    It certainly would seem that there is a differential diagnosis of autism here possibly AspergerÅ› or some form of higher functioning. autism. Particularly the age of presentation when HFA’s become most noticeable.

    There is some evidence that some people on the autistic spectrum are prone to Serotonin Syndrome at a sub-clinical level. Insomnia, jaw clenching, twitching, headaches, suicidal ideation, aggression and unresolved depression. There are some reports of autistic people having an already high level of serotonin, contrary to logic this does not make such people immune to depression especially if the depression is a manifestation of Adjustment Disorder.