Posted by bleauberry on November 20, 2009, at 5:08:17
In reply to curious: strattera experience?, posted by floatingbridge on November 16, 2009, at 21:14:12
I can't really explain it in convincing scientific detail, but I think when we create a norepinephrine reuptake inhibition scenario we set into a motion a chain of events affecting the adrenal glands, cortisol, and thyroid. The first thing that happens is feedback loops say "uh-oh, too much norepinephrine, slow down production". And thus tired. The adrenal glands have an enormous strain taken off their shoulders, they can now relax. That it turn calms down thyroid. Eventually adaptations take place, where the new exagerated amount of norepinephrine is seen as normal. Production returns to where it was pre-med. The adrenals being functioning better after a rest. Thyroid hitches a ride too. So in the end, there has been a cascade of events involving everything within the noradrenaline realm. Beginning with a slowdown, and later adapting to normalization.
It is the slowdown period, which can last from a few weeks to a few months, that is hard to tolerate. The tiredness can maybe be viewed as a good thing...it means healing is underway.
I went through the same with Milnacipran. On the other side of it was activity, more energy, more interest, motivation, creativity. But in the midst of it was tired, blah, lifeless.
I could be totally wrong in all this. I just think that once the feedback loops kick in (about 3 to 4 days after starting the med), a whole cascade of adaptations is set into motion which takes weeks or months to come out the other side. I talked with a couple people from clinical trials of NRIs. Some of the most successful cases were patients that had to wait 3 months to 6 months...and even one 9 months...before the strong benefits kicked in.
From hanging out at adrenal/thyroid forums, it is fairly well confirmed that normalizing the noradrenaline axis takes months, and is best done in tiny steps.
The best you can do is the lower the dose. Increase it after you have built up some tolerance. Don't be in a hurry to rush it, possibly overshooting your magic windown, and possibly ending your trial before benefits have had a chance to show.
poster:bleauberry
thread:925981
URL: http://www.dr-bob.org/babble/20091117/msgs/926298.html