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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 945 to 969 of 1242. Go back in thread:
Posted by Kacy on September 20, 2003, at 8:11:52
In reply to Re: Strattera and fatigue... patience, posted by ready for change on September 18, 2003, at 13:01:22
My doctor won't augment Strattera with a stimulant and insisted on evening dosing to get rid of the afternoon sedation that just won't end. He believes that eliminates the problem and anything else is all in my head. Well, it did end the problem, but it also eliminated the Strattera. With evening dosing, I don't get any effect during the day.
The drug doesn't last 24 hours at a therapeutic level for me. It lasts about 10 hours. The decline in the evening is easy to track by the return of anxiety. It keeps increasing from late afternoon on. The best thing Strattera has done for me has been to take that away. I don't think I realized how much anxiety I had and how much I must have always had until I began Strattera. Taking away anxiety, alone, helps some with add/inattentive problems. The kicker is killing me, though. I just went back to am dosing and the afternoon sedation is back full force.
I understood more when I saw that the drug's half-life was 5.15 hours. But, that is about the same half-life as Effexor. So, why would Effexor last 24 hours a day while Strattera lasts ten?
Do the rest of you who take it in the evening get the benefit of the drug during the day? Does anyone else experience what I do?
Posted by free wheelen on September 20, 2003, at 8:36:18
In reply to Re: Request Straterra side effects solutions?, posted by readyforchange on August 10, 2003, at 14:09:21
I have lived my life thinking that I was superior to most people. Why? because I able to work at 100 miles an hour for 14+ hours a day for weeks on end until I would crash for a day or two and then I would be right back to it. Because I could multi task,I couldn't figure out why no one else could or wanted to drive down the expressway at 80+ eating lunch,working on their laptop, talking on 2nextells and of course listening to the radio full volume. Because I loved drinking 3 to 4 44oz dietsodas(diet of course)a day along whith a couple of Metabo Life just to get me going, yea maybe I couldn't remember what my customers name was or where I left my pen, glasses,day planner,phone ect. Sound familiar?
Posted by Ritchie on September 20, 2003, at 8:49:37
In reply to Re: Strattera am or pm dose and response, posted by Kacy on September 20, 2003, at 8:11:52
> My doctor won't augment Strattera with a stimulant and insisted on evening dosing to get rid of the afternoon sedation that just won't end. He believes that eliminates the problem and anything else is all in my head. Well, it did end the problem, but it also eliminated the Strattera. With evening dosing, I don't get any effect during the day.
>
> The drug doesn't last 24 hours at a therapeutic level for me. It lasts about 10 hours. The decline in the evening is easy to track by the return of anxiety. It keeps increasing from late afternoon on. The best thing Strattera has done for me has been to take that away. I don't think I realized how much anxiety I had and how much I must have always had until I began Strattera. Taking away anxiety, alone, helps some with add/inattentive problems. The kicker is killing me, though. I just went back to am dosing and the afternoon sedation is back full force.
>
> I understood more when I saw that the drug's half-life was 5.15 hours. But, that is about the same half-life as Effexor. So, why would Effexor last 24 hours a day while Strattera lasts ten?
>
> Do the rest of you who take it in the evening get the benefit of the drug during the day? Does anyone else experience what I do?
I find the best way to get the benefits of Strattera is I take 40 mg in the a.m. and I take 40 mg around 12:30, it works for me. I don't have ADHD or ADD, I take it for depression, suicidal idealtions and anxiety and it works for me. I think the sleepiness will wear off with time as will the dry mouth. All I know is it works for me and it evens me out.
Posted by Kacy on September 20, 2003, at 9:55:55
In reply to Re: Strattera am or pm dose and response, posted by Ritchie on September 20, 2003, at 8:49:37
Thanks, Ritchie. I tried that, too. I took 60 in the morning and 40 after lunch for a while. Then, I took 60 at noon and 40 late afternoon. I ended up reducing my response to the drug and just moving the sedation around to different times.
I'm on my fourth month at 100 mg. I've always heard if the side effects are still there three months later, they're not going to pass. I hope that's not true. The thought of starting over with a new drug is tiring all by itself.
Posted by Kacy on September 20, 2003, at 11:11:48
In reply to Re: Strattera and fatigue: AM or PM dose?, posted by reba on September 3, 2003, at 9:39:36
Your point is excellent, Reba. I have been experimenting with that, too. It seems that eating lunch sets off the tiredness. I'm eating healthy foods, but maybe it's the kind of food. What changes did you make in your diet? Did you make any changes in the times you ate other than making sure you had breakfast?
Posted by cathal on September 24, 2003, at 9:20:08
In reply to Re: Adderall advise!, posted by reba on August 8, 2003, at 6:53:14
I am a psychiatric RN. you have too many diagnoses. i'm not a doctor but in my experience, which is not slim, the diagnoses you list conflict. you can't be bipolar and have depression because depression is one side of being bipolar, so get rid of that. i doubt you are even bipolar and ADD, more than likely one or the other. if you do some reading - especially in the DSM-IV about the diagnostic criteria for these disorders, you can begin to narrow it down. a bipolar person in a manic or hypermanic state certainly has attention deficits and other sx of ADD, but having an attention deficit doesn't mean automatically you have ADD. People with mental retardation often have attention deficits but it's not ADD, it's just a deficit existing alone and due to some other condition. And ADD can often mimic bipolar disorder. Many people with profound ADD cylce in ways similar to bipolar. See if this sounds familiar: you attempt something, sign up for a class, start a new project, etc. You can't stay focused on it and you mess it up or don't finish it. As a result parents, friends, spouses, teachers, bosses, etc get on your case, tell you you're unreliable, not effective, sloppy, etc. then you feel like shit. then you ruminate on it and get depressed and feel worthless and you're depressed. that's not bipolar disorder. bipolar disorder happens no matter whether you do a good job or bad job. bipolar is uncontrolled mood swings that aren't related to how well you perform at work or what a good husband your are, etc. but the process i described is not a mood swing, it's the sequelae of an existing condition, ADD. Just like the sequelae for someone with bad allergies is that they are exposed, they react, they have trouble breathing, they use an inhaler, the inhaler makes them hyper. Those other problems follow exposure to the allergen. And those terrible personality traits follow problems caused by ADD. I'd look for a shrink who specializes in ADD and finalize your diagnoses. Look for someone attached to a university or program that studies learning disabilities. And by the way, adults with ADD frequently also exhibit sx of OCD, phobic disorders, panic attacks, social anxiety, low self esteem, poor anger management and mood swings.
Posted by loolot on September 24, 2003, at 12:00:25
In reply to Re: Adderall advise!, posted by cathal on September 24, 2003, at 9:20:08
This is helpful. Sometimes I feel like Drs play fast and loose with the diagnosis thing.
My Dr just prescribed me some adderall. I was on Wellbutrin and at the highest does for a couple of years it pooped out, then I tried effexor which stunk. SSRIs are terrible with me-too many side effecs, robot feelings, etc
I have chronic depression but I also suspect I may have ADD,as I have always been really disorganized, avoid paying bills until power shuts off although I have money, tell people I can do stuff for work and dont do it, flake out on people, forget stuff, lose stuff, ALWAYS late.
But now that I read our post Im not sure. What are the real symtpoms of ADD? Im not asking you to make a diagnosis of me, just wondering what the actual symptoms are.
Posted by JMom on September 25, 2003, at 0:35:52
In reply to Re:adult addhd, posted by free wheelen on September 20, 2003, at 8:36:18
I can SO relate--a gazillion thoughts speeding around your head at one time, terrible CRS (can't remember shit)disease and insomnia. After talking to the doc, I have been on 40 mgs of Strattera for about a month and my life has been great. I can sleep, I can focus better, I am even happy. I wondered about ADD after my 6 yr old was diagnosed with ADHD a year ago. But, I wasn't hyper, I just couldn't stop my brain.( I took Wellbutrin to quit smoking, and I hated the nuetralness I felt. I didn't want to do much but watch t.v. and read). After reading Cathal's post describing symptoms of ADD I feel so much better about my diagnosis--I am now confident that it isn't all in my head!!
Posted by mhj on September 25, 2003, at 11:29:51
In reply to Re:adult addhd, posted by free wheelen on September 20, 2003, at 8:36:18
I've always strongly suspected that I have adult adhd. My doctor isnt' familiar with it and won't perscribe Stratera. Right now I'm on Zoloft. Does anyone in the Northern Virginia area (Fairfax County) know of a doctor who is familiar with and does perscribe Strattra?
Posted by Kacy on September 25, 2003, at 13:23:38
In reply to Re:adult addhd, posted by mhj on September 25, 2003, at 11:29:51
Here's a chart distinguishing bi-polar and adhd. You'll note that although the add people have the same symptoms as bi-polar, the percentages of people with those same problems amongst adhders are much lower. One deal breaker for add is 'racing thoughts'. Bi-polar - 48% have it. Add- 0 %. Another is 'Suicidal thoughts with plan or intent', emphasizing the word "with". Bi-polar - 27 % have had a plan or intent. Adhd - 0 %.
http://www.psycheducation.org/PCP/handouts/ADHD.htm
Scroll down on this page to "What is attention deficit disorder (ADD / ADHD)?" for the DSM-IV definition for the different types. I found it a little confusing trying because of the "meet requirements 1 and 2" bit. There is other useful information there.http://user.cybrzn.com/~kenyonck/add/add_legal_public.htm
This link has the actual page in the DSM-IV.http://aafp.org/afp/20001101/2077.html
Suggested criteria:http://www.adders.org/info7.htm
Posted by Kacy on September 25, 2003, at 13:32:52
In reply to Re:differences in Add and Bi-polar , posted by Kacy on September 25, 2003, at 13:23:38
…will work.
Here they are again in order for less irritating copying (i.e. not dragging carefully to avoid the quote marks or getting the bad links):
http://www.psycheducation.org/PCP/handouts/ADHD.htm
http://user.cybrzn.com/~kenyonck/add/add_legal_public.htm
http://aafp.org/afp/20001101/2077.html
http://www.adders.org/info7.htm
How do you make a link?
Posted by Kacy on September 25, 2003, at 13:35:44
In reply to Couldn't make links above work. (?) Copy and paste, posted by Kacy on September 25, 2003, at 13:32:52
Posted by KimberlyDi on September 25, 2003, at 15:34:17
In reply to Re: Adderall advise!, posted by cathal on September 24, 2003, at 9:20:08
"And by the way, adults with ADD frequently also exhibit sx of OCD, phobic disorders, panic attacks, social anxiety, low self esteem, poor anger management and mood swings."
That's ME minus the phobic disorders.
KDi in Texas
and Strattera is FANTASTIC. I never want to give it up. I feel intelligent again and stammer less.
Posted by JMom on September 25, 2003, at 22:09:19
In reply to Re:adult addhd, posted by JMom on September 25, 2003, at 0:35:52
> I can SO relate--a gazillion thoughts speeding around your head at one time, terrible CRS (can't remember shit)disease and insomnia. After talking to the doc, I have been on 40 mgs of Strattera for about a month and my life has been great. I can sleep, I can focus better, I am even happy. I wondered about ADD after my 6 yr old was diagnosed with ADHD a year ago. But, I wasn't hyper, I just couldn't stop my brain.( I took Wellbutrin to quit smoking, and I hated the nuetralness I felt. I didn't want to do much but watch t.v. and read). After reading Cathal's post describing symptoms of ADD I feel so much better about my diagnosis--I am now confident that it isn't all in my head!!
Oops, my bad, I am taking 80mgs not 40.
Posted by alwaysblue on September 25, 2003, at 22:45:03
In reply to Re: Strattera and fatigue: AM or PM dose? » Trixie, posted by Lasagne on August 29, 2003, at 14:59:56
I just gor a prescription today for strattera. I suffer from, STUBBORN, STUBBORN, DEPRESSION. I have been fighting depression for the last 7 or so years, it has hit me again FULL SWING. No one in my family understands, I have NO oNE to talk to.
I had a bad accident in the summer and I went OFF ALL MEDS. I wanted to try to do it the "natural way", to NO AVAIL. I even went the spiritual route, but depression will not leave. Today, I finally went to the doctors, after cancelling a couple of appointments, which I like to blame on depression. None of the other anitdepressents work.
He prescribed Strattera. I was hopefull to find relief with my depression and morning sluggishness and lethargy. However, after reading all of these messages, I am feeling discouraged. I will start in the A.M tomorrow. I JUST WANT THE DEPRESSION TO END............. Good luck to everyone, I know how awful you feel
Posted by lessismore on September 25, 2003, at 23:58:11
In reply to Re: Adderall advise!, posted by KimberlyDi on September 25, 2003, at 15:34:17
I have been on Strattera for 6 weeks now, and I love it too! I am becoming the person I always wanted to be. I closed a house today (Realtor) and for probably the second time in my career I had all the paperwork in the file. I still hate paperwork, but when I sit down to it, it doesn't seem impossible anymore. And I'm getting up 1/2 an hour early to read the paper and get ready slowly, instead of rushing out of the house. I do things instead of just thinking about them. I don't have insurance, and am paying $193 a month out of pocket, but it's worth it!
Posted by cathal on September 26, 2003, at 11:29:41
In reply to Re:adult addhd, posted by mhj on September 25, 2003, at 11:29:51
stratera is a fairly new drug and i've gotten 50/50 responses from my anecdotal research: some men report more sexual dysfunction than with zoloft, a drug used with great effect for adult ADD. who is your "doctor"? your family physician? just ask for a referal to a clinical psychologist or psychiatrist and they can prescribe you ANYthing (within reason of course)
Posted by cathal on September 26, 2003, at 11:37:14
In reply to Re: Adderall advise! » cathal, posted by loolot on September 24, 2003, at 12:00:25
the real symptoms of ADD are somewhat confusing to people who don't have it or don't live with someone who has it. they think it's all controlable and behavioral personality stuff
there are three types recognized in the DSM-IV, ADHD (attention deficit hyperactivity disorder), ADD, (no hyperactivity) and combined type (just what it says, half the time you are hyper, the other half not). people often miss plain ADD because it's the hyperactivity and running around that tips off most parents. plain ADD is kids who just daydream and stare out the window and do all the same stuff as ADHD but without the running around. SOME of the symptoms of adult ADD/ADHD include:-inability to organize thoughts
-losing things, misplacing things
-low tolerance for frustration, easily upset
-short fuse, explosive temper
-ability to hyperfocus at times and ignore all around you
-high level of what we call novelty seeking behavior (sometimes thrill seeking) such as downloading porn at work and risking getting caught, driving recklessly, promiscuity, petty crime
-leaving lots of messes and projects lying around, never finishing them
-feeling self doubt and insecurity because you can't finish things and you must be 'defective' or otherwise people wouldn't be mad at you
-finishing people's sentences, talking over them in conversationhmmmm, i'd be looking at the depression more than the ADD and you might not have ADD at all. it's true ADD can co-exist with depression, but consider two things.
1. everybody focuses on the 'classic' symptoms of depression: being suicidal, hopeless, etc. Other common symptoms we use in depression screening include irritibility, restlessness, disrupted sleep patterns, lack of ability to focus or pay attention.
2. people get mad at health care professionals for using esoteric terms but keep in mind that you can have an attention deficit without having ADD. you can have chronic headaches without having a brain tumor, you know? and a woman can throw up in the morning and not be pregnant. one is a condition the other is a SYMPTOM of the condition. lots of people have an attention deficit, that just means they have trouble paying attention and it can be for a variety of reasons which is why all those reasons have to be screened out before diagnosing ADD. ADD is a cluster of symptoms, not just attention deficit, but attention deficit coupled with things like (i'm reaching for my DSM-IV and quoting here) : "often fails to give close attention to details or makes careless mistakes in work or other activities...often has difficulty organizing tsks...often loses things necessary for tasks...often talks excessively..."
so just having an attention deficit doesn't mean one has ADD. personally, i'd focus more on treating your depression. too bad SSRIs seem tohave a bad effect on you. have you tried Lexapro? this is the latest miracle drug and, from my experience, seems to be quite effective in treating people with atypical depression or who can't take SSRI's
Posted by cathal on September 26, 2003, at 11:40:52
In reply to Re:differences in Add and Bi-polar , posted by Kacy on September 25, 2003, at 13:23:38
all true and for me, one of the keys to a diagnosis of bipolar over ADD are the EMOTIONAL swings, not mental problems. bipolar disorder is classified as a mood disorder which is why when someone is on an "up" we see a lot of giddiness, silliness, laughing, ecstatic excited moods REGARDLESS of what their thoughts are and when they cycle down we see depression, hopelessness, bleak outlook, crying unhappiness, despondency no matter waht they are thinking
Posted by bige on September 26, 2003, at 14:24:44
In reply to Re:adult addhd, posted by cathal on September 26, 2003, at 11:29:41
I have a question for those guys out there who are on Strattera. I seem to be having difficulty having an orgasam, but I have a lot of semen coming out at the begining of the "activity" rather than at the end when it is supposed to. Sorry for the question but it is easier on here than at the Dr.
Posted by loolot on September 26, 2003, at 22:52:44
In reply to Re: Adderall advise!, posted by cathal on September 26, 2003, at 11:37:14
>
> so just having an attention deficit doesn't mean one has ADD. personally, i'd focus more on treating your depression. too bad SSRIs seem tohave a bad effect on you. have you tried Lexapro? this is the latest miracle drug and, from my experience, seems to be quite effective in treating people with atypical depression or who can't take SSRI's
Thanks a lot for the info! Sounds like a lot of people are having similar problems. I actually have started taking cytomel, and it seems to be helping a little, esp with energy.
I am going to try the adderall next and then Ill figure out if I should try something else instead.
I have heard of Lexapro. What is it exactly (what does it work on in the brain). Are there side effects?
Posted by sailor on September 28, 2003, at 21:04:36
In reply to Re: Adderall advise!, posted by loolot on September 26, 2003, at 22:52:44
Have been taking Strattera 80mg for 1 month, along with 50 mg lamotrigine (lamictal) for long-term major, treatment resistand depression. Noticed a strong positive initial response to the Strattera (at that time the lamictal was only a small starter dose). Am taking the 80 mg Str. in the AM. Lately, feel that the effect is waning, though I'm still definitely less depressedx and more alert than when I started. See my NP tomorrow, and after reading others' posts, will suggest my going to 100 mg. Also don't know if the lamictal is really doing anything, though it is supposed to augment the Str. Of course, when you're in a drug combo, there's no sure way to know which is doing what, and/or what the synergistic effects might be. More art than science to psych Rx ? Have experienced urinary retention (swollen prostate?) and some constipation, but otherwise am hopeful about the Strattera. Thanks everyone for the posts. Regards, sailorman.
Posted by cathal on September 29, 2003, at 11:34:37
In reply to Re:adult addhd, posted by cathal on September 26, 2003, at 11:29:41
that happens to me on zoloft. other things i have experienced on zoloft re: sexual side effects:
- difficulty getting an erection
- difficulty maintaining an erection
- penis feels desensitized
- orgasm is less intense
- difficulty achieving an orgasmand there's no pattern to it. i was with a woman where i had NO problem getting a very full erection and it would stay for an hour but i couldn't achieve orgasm easily - great for her.
Posted by Doug E on September 29, 2003, at 17:13:39
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
I was just prescribed Straterra today. For a long time I thought I just had Dysthymia (chronic low-grade depression)and several months ago I decided to give anti-depressants a try. First was Paxil. After 5 or 6 weeks there was little result. Then Zoloft. Again, after 6 weeks I saw little improvement. A month ago saw a therapist who specializes in Adults with ADD and I realized that all the "daydreaming, procrastination, trouble focusing, difficulty with repetetive tasks, etc." that I have experienced since childhood have been a major stumbling block.
So today I have started with Stratera. I am encouraged by what Jim Boardman and Nicole have posted. I am starting with 25g for 4 days, then 40g for 5 days, with a taget dosage of 40g 2Xday.
I have a question: Do I need to taper off of Zoloft while I am starting the Stratera or do I just stop?
Thanks,
Doug
Posted by frustratedmom on September 30, 2003, at 16:27:49
In reply to Re: promises, promises, posted by Nachoman on August 11, 2003, at 21:03:16
> > Lots of people are telling me to be patient with
> > Strattera, and it's probably good advise. I'm
> > worried about struggling through school when I
> > start in September, though. There's quite a bit
> > of pressure to find a medicine that works ASAP.
> >
> > If there's anyone out there who has the
> > inattentive type of ADD - feeling spacey,
> > disorganized, and tired all the time. I'd like
> > to hear what medicine, if any, is working for
> > you.
>
> **** REPLY ****
>
> I was diagnosed with ADD just over a year ago -- I believe the inattentive type.
>
> I started on Adderall 20mg and the improvement was dramatic and immediate. Literally the day I started taking it I was able to focus on one thing for a long period of time. Actually, it was a little scary how focused I was -- I've never before been so productive. I also stopped drinking alcohol (used to have 1 or 2 drinks/day), stopped drinking coffee (4-5 cups/day) and stopped smoking (only ~5/day) -- all cold-turkey. I just didn't crave them anymore. Now instead of going out for a smoke and pacing to help think through a problem, I could just think about it at my desk and get things done.
>
> The next 6 months were great. I was taking 10mg in the morning and 10mg at noon. The problem was that it wore off by 5pm or so, and so I was back to my regular ADD-self (sans the cravings) by the time I got home from work. I didn't *feel* a difference -- I just had a hard time concentrating again.
>
> I then switched to Adderall XR 20mg (10 in the morning, 10 at noon) in an attempt to extend the effects into the evening. It generally worked, but overall I didn't notice as much of an improvement as with the regular Adderall. It was a little frustrating, so even though I didn't like the idea of it, I started to think about asking my doc if I could increase the dose to 30mg.
>
> Before I did, however, my doc told me about Strattera. I did a bunch of research on it, including reading through all the posts in this thread (thank you everyone) and it sounded great. I started with a sample pack (25mg for 4 days, then 40mg for a week, then 80mg) while continuing to take Adderall XR, 10mg only.
>
> It's been about 2 months with Strattera 80mg (once in morning) and over a month since I stopped Adderall altogether.
>
> As far as I can tell, the Strattera is having no (or very little) positive effect on me. I'm back to my old-self, constantly flipping between various things and never really concentrating on one thing at a time. There are some times when it feels like my ADD symptoms are lessened, but it usually only lasts for a couple of hours. The good majority of the time, I feel like it's doing almost nothing for me. The one exception is that I don't feel incredibly tired in the afternoon like I used to before I started Adderall.
>
> I had some side effects when I first started (insomnia, dry-mouth/eyes, itchy scalp) but those were short-lived and are pretty much gone now. I still have two side effects: no appetite and a sexual side effect, but I'm willing to live with those to see if Strattera can work for me eventually.
>
> It's quite frustrating having to deal with my ADD symptoms after knowing what it's like without them, but I really want to give Strattera a chance. I've heard that in some cases it can take 3 or more months for it to really take effect. I'm also going to ask my doc if I can increase the dose to 100 or 120. I don't weigh a lot, but I have a very high metabolism, so perhaps my effective dose is higher than the average. I'm willing to give Strattera up to 3 months before I decide to go back to Adderall.
>
> Anyways, I just wanted to share my experience with you. The quick fix for me was Adderall -- I'm hoping Strattera can work just as well, but it sure is taking a lot longer, if it ends up working at all.***REPLY***
I am the mother a a 15 year old boy who started on Adderall XR last August. The results were amazing. It was light flipping a light switch... finally he could focus and complete his school work.
This summer, we saw a tv ad promoting Straterra. We decided to give it a try, as we had heard so many negative associations with Adderall (potential side effects, stigma of being a controlled substance, turning our child into a drug addict). We were excited at the prospect of a non stimulant medicine having the same results.
We started the Straterra over the summer and he has been taking 54 mg daily (in the morning). It wasn't until school started up that he was able to observe the lack of benefit concerning real concentration. He notices a huge difference in the way he was able to perform on the Adderall as opposed to how he is performing or more accurately not performing on the Straterra.
Our Dr. has recommended increasing the dosage, again in 18mg increments. We are frustrated to learn of the level you have been taking, still showing no significant improvement.
How long do we wait and hope, while we watch his grades slip? It is frustrating knowing that the Adderall worked so well, and yet we have been made to feel bad about having him on that particular medicine. We would love to hear from others who are taking the same medicines and whether they have had positive results from Straterra and if so, how long did it take and what dosage are you taking. Thanks for listening.
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Dr. Bob is Robert Hsiung, MD,
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