Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies


Objective: The objective of this selective EBM review of three composite studies is to determine whether or not atomoxetine improves inattentiveness in adults with attention-deficit hyperactivity disorder (ADHD)?

Study Design: A systematic review of three blinded randomized controlled trials (RCTs) published between 2011 and 2021.

Data Sources: Research was gathered from PubMed and Embase in December 2020-February 2021 for the three RCTs, and supplemental articles were found in September through November 2021 from PubMed. All three RCTs were published in English and found in peer-reviewed journals and were chosen based on their relevance to the topic question.

Outcome Measured: A reduction in inattentiveness while taking atomoxetine vs. placebo. This was measured by the Conners’ Adult ADHD Rating Scale Investigator-Rated/Self-Report Screening Version: Inattention Subscale (CAARS-Inv/S:SV IS)3,5 and Brown Attention-Deficit Disorder Scale (BADDS)4 for Adults before and after P.O. administration of placebo or atomoxetine. The scales range from 0-27 with lower scores indicating milder symptoms and higher scores suggesting greater severity of inattention.

Results: In all three RCTs, atomoxetine resulted in a significant reduction in inattentiveness compared to placebo evidenced by symptom scales (p value < 0.001 in Durell et al.3 and Upadhyaya et al.5, and p value < 0.05 in Brown et al.4). Mean changes from baseline inattentiveness scores maintained 4.4 points of difference between atomoxetine and placebo groups in the article by Durell et al.,3 2.2 points in Brown et al.4, and 1.9 points of difference in the RCT by Upadhyaya et al.5 All p-values were statistically significant and all three RCTs had a moderate treatment effect.

Conclusions: All three reviewed studies show that atomoxetine resulted in significantly reduced inattentiveness in adults with ADHD. The findings suggest atomoxetine is more effective than placebo for improving focus in the mature ADHD brain. Future studies may cover the recommended treatment duration for atomoxetine in adults, the sufficiency of atomoxetinemonotherapy for the treatment of ADHD in adults, and long-term side effects of chronic atomoxetine use in people aged ≥ 18 years old.