Atomoxetine Use in Children with ADHD and Family History of Bipolar Disorder

Introduction to Atomoxetine Treatment

• The American Academy of Child and Adolescent Psychiatry recommends starting atomoxetine at a dose of 40 mg daily, titrated every 7-14 days to 60-80 mg/day, with maximum dosing at the lesser of 1.4 mg/kg/day or 100 mg/day in children with ADHD, regardless of family history of bipolar disorder 1, 2

Treatment Approach for Children with Both ADHD and Bipolar Disorder

• The American Academy of Child and Adolescent Psychiatry suggests that mood stabilizers, such as lithium or valproate, or atypical antipsychotics must be initiated and optimized before treating ADHD symptoms in children with both conditions, as the probability of ADHD symptom improvement is 7.5 times greater after initial mood stabilization 3, 4
• Attempting to treat ADHD before mood stabilization leads to poor outcomes and high relapse rates, according to the American Academy of Child and Adolescent Psychiatry 3

Monitoring Requirements

• The American Academy of Child and Adolescent Psychiatry recommends watching for mood destabilization, such as agitation, irritability, hostility, impulsivity, restlessness, or mania, especially in the first 24-48 hours after initiation or dose changes, when using atomoxetine in children with ADHD and family history of bipolar disorder 2