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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 743 to 767 of 1242. Go back in thread:
Posted by Ritchie on June 20, 2003, at 22:27:04
In reply to Re: Glad To Find This Group -- Starting Straterra » froggyanna, posted by bookgurl99 on June 20, 2003, at 22:20:55
> Froggy,
>
> hi. how are you?
>
> how are things going?
>
> booksSad to say I have to stop Stattera cold turkey because they say it has probably screwed up my liver enzymes. Since Strattera they have gone up 3x normal. I can't take any meds until they find the cause. I was taking it for depression. No discontinuation effects so far. I can't even take aspririn until the Cat scan results come back.
Well good luck, I liked it but it was just not for me.
Posted by Tootie on June 20, 2003, at 23:16:18
In reply to Re: Glad To Find This Group -- Starting Straterra, posted by Ritchie on June 20, 2003, at 22:27:04
I'm glad to find this group too. I first tried Wellbutrin for anxiety, but it did nothing for me. Then I switched to Paxil. Talk about packing on the weight! But it worked wonders for the anxiety. Switched to Paxil CR (supposed to not make appetite so healthy), but I felt more anxious on it. I switched to Zoloft about 6 months ago. I lost 10 pounds (which I needed to do) and I felt GREAT! However, I've recently been diag. with ADD. I'm trying Strattera for that and went off the Zoloft. This is only my 2nd day on Strattera and no Zoloft. I'm feeling easily aggitated this evening. I'm sure it will get better, but in the mean time, my 3 and 4 year old boys are really pushing my buttons. I don't want to give up too quickly on the Strattera, but I sure was feeling alot better on Zoloft. Any encouraging words?
Posted by Viridis on June 21, 2003, at 3:17:20
In reply to Re: Glad To Find This Group -- Starting Straterra, posted by Tootie on June 20, 2003, at 23:16:18
I just started Strattera too -- I'm on my fourth day at 25 mg, and will try 40 mg tomorrow. I also take low doses of Adderall and Klonopin (and Neurontin, which I don't think does much).
The Klonopin and Adderall have helped a lot with anxiety, depression, and ADD, but I've been under a lot of stress lately and am still having trouble with focus and concentration, as well as feeling burned out. Strattera really seems to help -- even at this low dose, I definitely feel a calming effect, and for the last few days have been better able to get things done without worrying so much.
It's supposed to take a while to kick in (my pdoc said most people start to notice the effects after 1-2 weeks), but I experienced a positive effect within an hour or two of the first dose. I'm quite sure it's not placebo effect, because I actually suspected it might make me feel anxious etc., and was somewhat apprehensive about trying it.
It's too early to draw any major conclusions, and I'll see how the higher doses go, but so far I'm very encouraged.
Posted by Lasagne on June 21, 2003, at 11:58:56
In reply to Re: Glad To Find This Group -- Starting Straterra, posted by Tootie on June 20, 2003, at 23:16:18
Tootie:
Maybe it's not a good idea to stop one medication and begin another at the same time. Maybe you can still take the Zoloft while getting used to the Strattera. I found in the beginning the Strattera had a lot of side effects but over time they have diminished. I am on week 7 of the medication and it took me a while to feel the full effects of the medication. It is definitely something you have to be patient with. When I started the Strattera my doctor didn't change my previous regimine of Prozac and Buspar. From my experience with my son who has ADHD we try to change only one variable at a time so we can adequately track the progress. Something to consider. When do you go back for a follow-up?
Lasagne
Posted by Lasagne on June 21, 2003, at 12:04:10
In reply to Re: Glad To Find This Group -- Starting Straterra, posted by Ritchie on June 20, 2003, at 22:27:04
Ritchie:
Is it common for doctors to check your liver function when you are taking Strattera? Do you have some another underlying condition that causes your doctor to check your liver periodically?
Lasagne
Posted by Ritchie on June 21, 2003, at 13:04:22
In reply to Re: Glad To Find This Group -- Starting Straterra » Ritchie , posted by Lasagne on June 21, 2003, at 12:04:10
> Ritchie:
> Is it common for doctors to check your liver function when you are taking Strattera? Do you have some another underlying condition that causes your doctor to check your liver periodically?
> Lasagne>I also use to take drugs for high blood pressure but no I don't have an underlying condition for the high liver enzymes. They just think it is a bad combo of meds. I am only on one med now for the blood pressure, they won't let me take anything else.
Posted by bookgurl99 on June 21, 2003, at 18:27:15
In reply to Re: ...Strattera updates, posted by MomofBoys on June 19, 2003, at 18:03:39
Hey momofboys,
You wrote:
I have lost the total energy surge that I used to get from taking it and I have also lost my ability to concentrate and focus. I think that varies from day to day, however.>.>>
I forget; are you taking strat for attention span or for anxiety/depression?
I'm thinking of giving it another try, as I am noticing more adhd type symptoms. The one strong thing I recall feeling on it was sort of a numbess emotionally and flashes of anger. Have those side effects gone away for you?
Posted by bookgurl99 on June 22, 2003, at 21:41:26
In reply to Re: Why are so many of us ADDers also depressed?, posted by Lasagne on June 16, 2003, at 15:02:54
I have been off of Zoloft for over a month. I feel better, less tired and sluggish. Weight still hasn't dropped, though. : )
Getting off solved some attentional problems, but I'm seeing problems with follow-through and motivation that I'm beginning to suspect are life-long. (For example, I remember at 13 my twin and I each waited until the night before to draw a map of the world for Geography class, for example -- we even had to make our mom drive us to the Osco Drug for supplies at like 9 pm!)
How can I tell if this is due to depression or ADD? I'm starting to wonder if I have been in denial about the ADD thing -- as friends around me are pushing me to consider that I have it.
I guess I have trouble believing it because I have no trouble learning -- I have a 'quick' mind -- but only in motivation and sustaining attention.
Posted by Viridis on June 22, 2003, at 22:58:38
In reply to how do i know if i have add versus 'depression', posted by bookgurl99 on June 22, 2003, at 21:41:26
You sound a lot like me -- could you get your doctor to try a mix of Klonopin and Adderall? That was the "magic bullet" for me (and now Straterra seems to complementing it).
BTW: SSRIs were awful for me, and Zoloft was definitely the worst.
Also: ADD has nothing to do with intelligence or ability to learn -- it's how you approach and finish tasks that really defines it. Many ADDers are highlly intelligent; it's more of a time/focus/deadline management issue.
Posted by bookgurl99 on June 22, 2003, at 23:33:27
In reply to Re: how do i know if i have add versus 'depression » bookgurl99, posted by Viridis on June 22, 2003, at 22:58:38
Viridis wrote:
> You sound a lot like me -- could you get your doctor to try a mix of Klonopin and Adderall? That was the "magic bullet" for me (and now Straterra seems to complementing it).
Interesting -- what's klonopin? I think I will stick to just one med if I go back on meds, as I may be moving soon and $200/month for _one_ med will be overwhelming.
> Also: ADD has nothing to do with intelligence
or ability to learn -- it's how you approach and finish tasks that really defines it. Many ADDers are highlly intelligent; it's more of a time/focus/deadline management issue.Yes; I think I need to get the stigma out of my head.
________________________________________________
--------SUBJECT CHANGE ALERT -------------------
Another thing; both on zoloft and off, I've been eating an unusual amount of sweets. I'm starting to wonder if this is a form of 'self-medication.' I've gained 4 pounds recently, and at 5'5" and 180, I really need to drop weight for my health. This frightens me, as it reminds me of my depressive, agoraphobic aunt who ate herself to 300 pounds and has yet to live up to her full potential.
I also noticed the other day I was hyper to the point of bouncing around when my friends visited. I calmed right down having a capuccino at a poetry reading with them.
------------------------------------------------
I guess I just have a fear of being 'med seeking,' of not taking responsibility for my own behavior. It would be so much easier if there was simple test for these disorders.
Did you notice anything like this pre-dx?
Posted by Viridis on June 23, 2003, at 6:48:16
In reply to self-medicating with food? , posted by bookgurl99 on June 22, 2003, at 23:33:27
I've never had much of a sweet tooth; I tend to go the other way when I'm anxious and/or depressed, and just lose my appetite (which isn't good either). Interesting that caffeine calms you down -- that's pretty common in ADD (calming influence of stimulants).
Klonopin is a benzodiazepine (related to Xanax, Valium etc.). It's not an "ADD" drug, but has helped me a great deal with anxiety and focus. Benzos get a lot of bad press, but they're very safe and can be extremely helpful. Klonopin (clonazepam) is considered one of the least problematic in that it has very low abuse potential, few side effects, and tends to stay effective at the same dose indefinitely. And, if you're worried about costs, a month's supply of the generic is about $10-$15 in the U.S. Adderall (an amphetamine mix that's often used for ADD) is also off-patent and pretty inexpensive.
As far as med seeking goes, I was also very hesitant about medication initially. But now I just view it as a way of achieving and maintaining normal brain function. If you had diabetes and needed insulin, or high blood pressure and required drugs for that, I doubt you'd be agonizing over "med seeking". And typically (at least for people who post here) it takes quite a bit of trial and error to find the medication or combination that works. Combinations may be necessary -- I've never done really well on just one med, but seem to do best with a mix of small amounts of more than one.
Posted by MomofBoys on June 23, 2003, at 9:50:58
In reply to Re: ...Strattera updates » MomofBoys, posted by bookgurl99 on June 21, 2003, at 18:27:15
I have been taking Strattera for ADD symptoms but testing says I also have depression and anxiety. I don't feel depressed but I do feel the anxiety. My doc started me on Lexapro also and that makes me feel smoother, I guess. I don't know how to explain it really.
But I still lack my concentration and energy that I had at first when beginning the Strattera. I now take 100 mg at bedtime and 25 mg in the morning. I can actually take that 25 in the am without falling asleep like before. But I sleep way too well now but in the beginning I had restless sleep and woke up very early full of energy. I miss my energy.
K.> Hey momofboys,
>
> You wrote:
> I have lost the total energy surge that I used to get from taking it and I have also lost my ability to concentrate and focus. I think that varies from day to day, however.
>
> >.>>
>
> I forget; are you taking strat for attention span or for anxiety/depression?
>
> I'm thinking of giving it another try, as I am noticing more adhd type symptoms. The one strong thing I recall feeling on it was sort of a numbess emotionally and flashes of anger. Have those side effects gone away for you?
>
>
>
Posted by Lasagne on June 23, 2003, at 13:17:26
In reply to how do i know if i have add versus 'depression', posted by bookgurl99 on June 22, 2003, at 21:41:26
Dear Bookgurl99:
The only way to know if you are suffering from Depression or ADD is to go get an evaluation from a doctor who specializes in the treatment of both. You may want to consider reading a book that I just finished called "Driven to Distraction" by Drs. Hallowell and Ratey. The book has a section that talks about this. Sometimes ADD can co-exist with other mental health problems and sometimes the ADD symptoms are the cause of what they call secondary depression and of course it is possible to just have plain depression. The thing that distinguises the two is a proper evaluation of your life history.
I was recently diagnosed at age 33 and at first it was really difficult to believe it was true, but now that I have learned more by reading books I have come to accept the diagnosis.
Another thing to remember is that the way ADD/ADHD presents itself is different from one person to another. Some people like my brother have the impulisivity and hyperactivity to the point of extreme dysfunction, yet he is the smartest person I know. He can learn things better than anybody I have ever met. He has the potential to go further than the average person would go in life yet because of his ADHD symptoms he will probably never meet his full potential.
Then there are people like my husband who just turned 40 who has maintained a relatively stable life with several successes, yet he struggles on and off with being able to follow through on tasks. He is a big procrastinator unless it is something he is extremely interested in. He is also very forgetful. Because of his underlying frustration with his ADHD symptoms he has suffered on and off with depression. Now that he is receiving proper treatment he is doing so much better. I have been amazed at how the treatment has improved his follow through on tasks, plus other things.
Good luck!
Lasagna
Posted by Lasagne on June 23, 2003, at 13:42:11
In reply to self-medicating with food? , posted by bookgurl99 on June 22, 2003, at 23:33:27
Hi:
I have read that some people do self-medicate with food. It is also possible that your over eating is due to the impulsiveness associated with ADD/ADHD. As well, some people over eat as a means of calming their underlying anxieties. It's possible you have several things going on. The only way to know is to find a doctor who specializes in these disorders.
Yes, it's too bad that they don't have a simple test to tell you conclusively whether you have ADD or not. From the Driven to Distraction book I learned that a proper diagnosis is put together via a self-evaluation survey (there are several kinds out there that doctors use) and a full history. The doctor should ask you specific questions about your childhood that are key indicators of the disorder as well as other questions that deal with your current functioning. You might want to do a search on the Internet. At one point I found a web-site that had a proposed list of the type of things/questions the doctors should ask you in order to piece together an adequate history on you.
Also, since cappucino has caffeine, it works like a stimulant, which explains the calming effect it had on you. My brother who was having a difficult time finding the right stimulant medication actually self medicated through coffee and tea products for quite a while. Plus, he has experiemented with illegal drugs as well. In my opinion it is better to use prescription drugs according to your doctor's advice. They have better formulas out now that have give you controlled release so that you aren't having to recharge your focus during the day by drinking caffeinated beverages. The right antidepressant will also give you some 24 hour control of ADD symptoms. After witnessing with my brother how out of control self-medicating can become, I am a firm believer in using proper medical treatment and having close monitoring by your doctor. Sometimes it takes a while to find the right combination of prescription medications, but I think this reduces the liklihood of forming addictions that is so common with self medicating.
Lasagna
Posted by bookgurl99 on June 23, 2003, at 15:50:19
In reply to Re: how do i know if i have add versus 'depression' » bookgurl99, posted by Lasagne on June 23, 2003, at 13:17:26
I have a meeting with my psychiatrist in about two weeks: I'm going to talk to him about being formally tested for this -- that way I don't have to agonize.
I'm starting to think about it in terms of: my partner has an auditory processing disorder -- there's nothing wrong with her ears, but her brain itself has trouble separating out certain kinds of sounds. She has developed other skills to compensate for this, but it would be great if she could take a pill with no long-term side effects to give her that slightly better quality of life. I'm realizing that I don't have to be ashamed -- if I do have ADD, it's not a 'character problem,' just a neuropsych-biological issue that can be 'corrected.'
Posted by Viridis on June 23, 2003, at 23:39:59
In reply to Re: how do i know if i have add versus 'depression' » Lasagne, posted by bookgurl99 on June 23, 2003, at 15:50:19
Really, don't feel inferior if you turn out to have ADD. One therapist I saw (who urged medication, but wasn't licensed to prescribe) insisted on calling it "attention difference disorder". His point was that it had nothing to do with with intelligence, creativity, etc.; it's just a different way of viewing the world that doesn't always mesh with highly structured environments. I tend to agree.
I once asked my pdoc if I'd be considered "ADD" if I were in a different line of work that required less attention to long-term detail. He said something like, probably not, but you've made these choices and I'm medicating you for your situation -- that's all I can do.
So, you can radically change your life, or take meds that help you fit in, or find some compromise in between. I've chosen the compromise approach -- moderate med use (avoiding the ones that really change my personality, by trial and error), which allows me to focus better on a career that allows a lot of freedom and imagination.
Posted by Dr. Bob on June 23, 2003, at 23:49:08
In reply to Re: how do i know if i have add versus 'depression' » bookgurl99, posted by Lasagne on June 23, 2003, at 13:17:26
> You may want to consider reading a book that I just finished called "Driven to Distraction" by Drs. Hallowell and Ratey.
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though, and doesn't *have* to be used. If people *choose* not to use it, I'd be interested why not, but I'd like that redirected to Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
Posted by gouda on June 24, 2003, at 2:13:07
In reply to Re: Thoroughly annoyed at Strattera » gouda, posted by Lasagne on June 20, 2003, at 10:45:25
Lasagne,
Thanks for checking up on me. I'm an ADD - Inattentive Type, so my problem is different from Hyperactives. I cannot focus and get distracted easily.
I'm having the same "cannot relax" problem as you!! I totally feel your annoyance at the sleepiness compounded with being tense!
I'm having the similar problem, I take Strattera at night to help me fall asleep.
However what I run into is ... my mind is racing like 100 mph, I'm obsessively thinking about "things I forgot to do" ... "what I should have said to someone" ... "what I need to get done" ... etc etc ....
My body is calling to me to sleep.
My mind is calling to me to get up and get stuff done!Is your "inability to relax" caused by your thoughts as well??
Gouda
> gouda:
> Are you taking Strattera for ADD/ADHD?
> If so that doesn't sound right if you brain feels like it is racing 100 mph. The correct ADD treatment should calm your hyperactive brain so you can focus better.
> Just this last week I have been experiencing on and off wakefulness during the night with the Strattera. At first the medication made me so sleepy during the day, then I switched to taking it at 7 p.m. and it helped me to relax and have a good nights sleep. Now I am having a difficult time relaxing even though the Strattera calms my brain down and I want to sleep. Plus, I have been getting up 3-4 times a night to go to the bathroom. When I wake up in the morning my back feels all wrenched even though I have a very nice mattress that wasn't giving me problems before. It's driving me crazy. I even have a hard time relaxing during my daily naps. Yesterday I tried taking a shorter nap to see if it would help, but instead I felt unrested and then when it was time to go to bed I still couldn't relax and it seems like I woke up every couple of hours. I am hoping that this passes because I was really loving it when I would just melt into my bed and sleep so well.
> Lasagne
Posted by Lasagne on June 24, 2003, at 11:02:10
In reply to Re: Thoroughly annoyed at Strattera » Lasagne, posted by gouda on June 24, 2003, at 2:13:07
Lasagne,
>
> Thanks for checking up on me. I'm an ADD - Inattentive Type, so my problem is different from Hyperactives. I cannot focus and get distracted easily.
>
> I'm having the same "cannot relax" problem as you!! I totally feel your annoyance at the sleepiness compounded with being tense!
>
> I'm having the similar problem, I take Strattera at night to help me fall asleep.
>
> However what I run into is ... my mind is racing like 100 mph, I'm obsessively thinking about "things I forgot to do" ... "what I should have said to someone" ... "what I need to get done" ... etc etc ....
>
> My body is calling to me to sleep.
> My mind is calling to me to get up and get stuff done!
>
> Is your "inability to relax" caused by your thoughts as well??
>
> Gouda
>
*********RESPONSE:Hi Gouda:
I find that my tendency to have obsessive thoughts has decreased overall on the Strattera, but since I started having this nighttime sleeplessness I find that I go through spells at night where I go over the conversations I had with others. It seems to happen around 3 a.m. and sometimes lasts for 1-2 hours. Then I finally fall back asleep but my back and shoulders are still tense so I don't sleep very well. I have also noticed that I have dreams where I have some kind of conflict with different people. I wake up and really feel anger toward whoever I had a conflict with in my sleep.
Yesterday I got so sick of feeling so tense while trying to sleep that I called my doctor to see if it was okay for me to take my Flexeril (muscle relaxer again). He told me to take 5 mgs. 3 times a day for a few days to see if my muscle spasms and soreness in my back and shoulders ease up. I was diagnosed with Fibromyalgia about 7 years ago and sometimes go through "flare ups" with the syndrome. Why this is happening right now is a mystery to me. For the first 5 weeks the Strattera had such a calming affect on me and I slept so well. Plus, my stress level dramatically decreased during the last few weeks. Go figure! I usually only flare up during times of extreme emotional stress or exhaustion. Then if I rest my body somehow bounces back and I feel fine.Last night I had to wake up about 2:30 a.m. to take some more muscle relaxer. I did sleep better, but my back was still a little tense. This morning my back still feels out of whack. I am tired but I know if I lay down my back and shoulders will bother me. If I could only sleep standing up!
Posted by Viridis on June 24, 2003, at 20:35:31
In reply to Re: Thoroughly annoyed at Strattera » gouda, posted by Lasagne on June 24, 2003, at 11:02:10
Interesting -- I started Strattera last week, and 25 mg immediately made me feel calmer and more focused. Since going up to 40 mg, I've noticed mild stiffness in my neck and shoulders. I used to get this from tension, and it disappeared with Klonopin. I'm still on that, but I wonder if the Strattera is causing this?
I also feel a bit sick to my stomach and my eyes and mouth are dry. None of these side effects are really pronounced, but I'm quite sure they're from the Strattera, since these aren't things I normally experience.
I'm hoping these will subside, since this seems like a good med otherwise. And maybe 25 mg is enough? I'm going to stay at 40 mg for a while to see if the side effects diminish. They're not debilitating, just annoying, but I'm hesitant to go up any more at this point.
Posted by zeugma on June 24, 2003, at 21:20:52
In reply to Re: Thoroughly annoyed at Strattera » Lasagne, posted by Viridis on June 24, 2003, at 20:35:31
Side effects on Strattera are definitely dose-dependent. At 25 mg I had some dryness of the skin and sun sensitivity which didn't bother me much, similar to what i have experienced on nortriptyline. And some unpleasantly 'wired' feelings after drinking caffeine. Ingesting caffeine caused a lot of muscular tension in my neck and back- are you taking any stimulants with the Strattera? It's strange, on nortriptyline I could drink all the coffee I wanted to- in fact, I HAD to, because nortriptyline didn't touch the core ADHD symptoms. It makes me suspect that Strattera's pharmacology is a little different than advertised. i'm not complaining about it- in fact it is boosting my performance tremendously at work and on my own academic projects, but it is curious that even adding a little Strattera to nortriptyline should have caused so much alertness and sensitivity to stimulants.
Posted by Viridis on June 24, 2003, at 22:43:14
In reply to Re: Thoroughly annoyed at Strattera » Viridis, posted by zeugma on June 24, 2003, at 21:20:52
Thanks -- I take 10 mg/day of Adderall per day as well, so I am using a stimulant with Strattera (totally OK with my pdoc). I use very little caffeine (typically one-two cups of tea and about half a cup of coffee per day). Do you really think this could be causing the side effects? Adderall really helps, so I don't want to discontinue it. But I like the Strattera as well, if the side effects would just go away.
Posted by zeugma on June 24, 2003, at 23:17:44
In reply to Re: Thoroughly annoyed at Strattera » zeugma, posted by Viridis on June 24, 2003, at 22:43:14
> Thanks -- I take 10 mg/day of Adderall per day as well, so I am using a stimulant with Strattera (totally OK with my pdoc). I use very little caffeine (typically one-two cups of tea and about half a cup of coffee per day). Do you really think this could be causing the side effects? Adderall really helps, so I don't want to discontinue it. But I like the Strattera as well, if the side effects would just go away.
Viridis,
I find the timing of caffeine to be key to how I can tolerate. I make a small pot of coffee (about 2+ cups) first thing in the morning, and it's fine. I take the Strattera with breakfast, usually while I'm still drinking the coffee. I've had no problems with that. If I have any more caffeine after that, my back and neck knot up and I get a tension headache and nervousness.
I guess what puzzles me a little (about Strattera) is that it FEELS so much like a stimulant. i haven't taken stims in years, but this seems to have a 'kick' like I'd imagine an amphetamine would. Do you find this also?
The thing is that my pdoc must really like this med- he gave me a YEAR to titrate up to a therapeutic dosage of nortriptyline, and every increase in dosage was my idea. I've been on the Strattera for about five weeks, and I've gone through several sample bottles at steadily-increasing dosages. I was running out of 60mg capsules so I called him and he asked me if I had any 40 mg caps left- he wanted me to try 80 mg. I tried it today and felt really organized at work. The drug seems to have a clarity-inducing effect that I wasn't expecting at all. So I feel that it actually complements the nortriptyline I also take (at night). Its' strange though that two drugs that supposedly have the same mechanism of action should feel subjectively so different. I worry about pharmacological redundancy, but my ADHD is severe enough to put up with a few s/e. Plus there's always fiber capsules to 'help things along.'
Posted by fallsfall on June 25, 2003, at 8:45:45
In reply to Re: Thoroughly annoyed at Strattera » Viridis, posted by zeugma on June 24, 2003, at 23:17:44
I found that each increase in dose increased the side effects, but that they went down over time. Increasing the dose slowly seems to be the key. Eventually they all pretty much go away. Patience!
Posted by Lasagne on June 25, 2003, at 11:04:59
In reply to Re: Thoroughly annoyed at Strattera » Viridis, posted by zeugma on June 24, 2003, at 23:17:44
Hi:
Here is a link you can go to to read about Strattera (whether it is a stimulant).http://www.prozactruth.com/strattera.htm
Just cut and paste this link into your browser if for some reason clicking on it in this post doesn't work.
Lasagne
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