Atomoxetine vs Wellbutrin Doctor Handout (PDF)

Atomoxetine vs. Bupropion in ADHD and AuDHD — The Comparative Review (PDF)

Two non-stimulants. Same prescription pad. Completely different brains they're good for — and if you're AuDHD, the choice matters more than your prescriber may realise.

This is the head-to-head that doesn't exist in the appointment: a full comparative review of atomoxetine (Strattera) and bupropion (Wellbutrin) — mechanisms, efficacy data, combination strategies with guanfacine, and the autism-specific considerations that change everything.

What's inside:

• The mechanistic difference that explains your lived experience: why atomoxetine's selective NET inhibition raises dopamine only in the prefrontal cortex (no reward-region surge, no abuse potential), while bupropion's dual DAT+NET action reaches subcortical regions — more activation, more motivation, more risk of wired-and-tired in sensitive systems
• The efficacy hierarchy, honestly: the Lancet Psychiatry network meta-analysis (133 RCTs, 18,000+ participants) and where each medication actually ranks — plus why that hierarchy ignores the symptom domains AuDHD women care most about
• Autism-specific evidence: why treatment response in ASD+ADHD is "remarkably heterogeneous," why side-effect sensitivity runs higher, and what Lilja et al. found about autistic traits predicting different medication responses
• The guanfacine combinations decoded: atomoxetine+guanfacine as the "signal + sensitivity" strategy vs. bupropion+guanfacine for depression-predominant profiles — and the triple-combination warning (why atomoxetine + bupropion + guanfacine together can produce excessive norepinephrine modulation, paradoxical fatigue, and cognitive fog)
• AuDHD starting-dose table: conservative doses and titration intervals for sensitive nervous systems (atomoxetine from 10–18 mg, not 40)
• A clinical decision framework table: which medication for which predominant symptom domain — emotional dysregulation/RSD, depression/anhedonia, sensory sensitivity, impulsivity+depression, stimulant intolerance
• Community-reported themes from AuDHD women who've actually run both — the front-loaded atomoxetine side effects that resolve, the bupropion "honeymoon," the missed-dose emotional rebound
• 10 full references — Lancet Psychiatry, network meta-analyses, ASD-specific trials

The short version: Atomoxetine for emotional regulation and 24-hour steadiness; bupropion when depression and low energy dominate; guanfacine as the autism-side partner to either — and a clear-eyed warning about stacking all three. Bring this to your psychiatrist and have the actual conversation.

Literature review and research compilation, not medical advice. Medication decisions belong to you and a prescriber who understands both autism and ADHD.