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Dr. Bob is Robert Hsiung, MD,
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Posted by wowy on January 29, 2003, at 14:19:01
In reply to Re: Strattera--in comparison to Wellbutrin?, posted by bennett on January 29, 2003, at 10:33:10
Hi-
I have been lurking about but never posted before. I have been on 80 mg of strattera plus
40 mg of paxil for over a month now. The strattera has brightened my mood considerably.
Initially, I felt a sort of tingle and an exhileration that was just lovely. Now I just feel grounded and well. I was diagnosed with ADD a few months ago. Depression/anxiety has been a long term problem - which is why I was taking the paxil. I tried stimulants but really didn't like the rebound...The strattera is much more subtle in my opinion and I have experienced dry mouth and skin, but it is very tolerable. I hope this helps anyone interested in trying strattera. Best wishes to all
Posted by disney4 on January 29, 2003, at 14:30:58
In reply to Re: hypersensitivity, depression » disney4, posted by not exactly on January 28, 2003, at 20:13:16
The reason I couldn't tolerate almost all current AD's was because of intolerable side effects. I am trying to decide between Straterra and Buspar. I need a good AD effect though, but not added anxiety. I may have to turn to uplifting foods, until something comes out that really fits the bill. Have you heard of any one getting TD from Buspar? Also would you know if Wellbutrin and Straterra work on the same neurotransmitters?
Posted by disney4 on January 29, 2003, at 14:39:38
In reply to Re: Strattera--in comparison to Wellbutrin?, posted by bennett on January 29, 2003, at 10:33:10
Thanks for the input! I know many people who did wonderfully on Wellbutrin, but I was not one of them. I read one post of someone who had anxiety on Wellbutrin, but can tolerate Straterra, so I hope that will be the case for me. I still would like to hear your observations on how they differ, and in particular, if you notice any sexual difficulties. I always get those, even when I took Serzone, which is supposed to have a low incidence of sexual side effects!
Posted by Dog Breath on January 29, 2003, at 14:49:36
In reply to Re: Strattera, posted by wowy on January 29, 2003, at 14:19:01
How long did it take to "brighten" your mood? 7 days I still feel like I could crawl into a hole and sleep for 24hrs. But then I have zero anxiety as well.
D
Posted by wowy on January 29, 2003, at 15:09:06
In reply to Re: Strattera » wowy, posted by Dog Breath on January 29, 2003, at 14:49:36
Hey D-
The "brightening" effect was pretty immediate...However I did start with 80 mg...from
reading the posts here I see that's a fairly high dose...Also, that feeling was more pronounced the first few days...Now, I've gotten used to it. But still my office mate has noticed
the difference so...I am hopeful that it will continue to work. I have some room for additional dosage at some point down the line.
Posted by zenclear on January 29, 2003, at 16:09:17
In reply to Re: Strattera, posted by wowy on January 29, 2003, at 15:09:06
Do any of you notice any rebound effects, when the Strattera wears off? Say, any fatigue or mood dip?
I know most of you say you like it because there's rebound like stims; but do you notice any effects when the med wears off?
Posted by mshyper on January 29, 2003, at 16:29:05
In reply to Re: Strattera-Any rebound?, posted by zenclear on January 29, 2003, at 16:09:17
> Do any of you notice any rebound effects, when the Strattera wears off? Say, any fatigue or mood dip?
> I know most of you say you like it because there's rebound like stims; but do you notice any effects when the med wears off?Started Strattera 8:30 this am-18mg-have a little fatigue now, about 4:30, but not sure if that is due to initial med adjustment, or due to low starting dose. Felt absolutely great earlier today, few minor SE's
Posted by not exactly on January 29, 2003, at 17:09:11
In reply to Re: hypersensitivity, depression » not exactly, posted by disney4 on January 29, 2003, at 14:30:58
> Have you heard of any one getting TD from Buspar?
Nope. The PDR mentions it as a theoretical possibility (based on Buspar's receptor affinities), but claims it's never happened.
> would you know if Wellbutrin and Straterra work on the same neurotransmitters?
Strattera is very specific to norepinephrine (that's its claim to fame). My understanding about Wellbutrin is that it affects norepinephrine primarily, but also affects dopamine & serotonin to lesser extents.
Posted by tia on January 29, 2003, at 19:00:35
In reply to Re:Strattera for anxiety/depression-DB, posted by nmk on January 29, 2003, at 14:04:48
This is my story: Hopefully shortI had been on 100mg of anafranil and 150mg of wellbutrin and was sweating to the point of dripping. I also did not feel my depression was controlled enough with the wellbutrin. However my anxiety was just fine because of the anafranil. I told my doctor to try to put me on one medication for both anxiety and depression. I started with 40mg of strattera for about 5 days and noticed that immediately i felt energy and my appetite diminish. I also know that i had some increase in anxiety too. I went and started taking 60mg on friday 24th of jan. On Monday the 27th I decreased my anfranil to 50mg. As of tuesday night the 28th i started with anxiety attacks and have lasted thru wednesday. I called my doctor and asked maybe if i should stay on the 100mg of anafranil and do the 80mg of strattera. I have not recv a call back. I am going to take a 50mg of anafranil tonight (wed) and 80mg of the strattera in the morning.
I dont like giving up on meds to early. Sometimes our body has to have time to adjust to certain meds. I am going to take the 80mg and see what happens the next few days.
Strattera side effects on the sexuall part, i personally think because i am in a better mood and more energetic i am more sexually stimulated too. The appetite thing i feel fuller than usual.
My dose of strattera is taken at 8am in the morning and by 10:30pm i am ready to hit the sack. I am not in a demanding office job either so i have moderate exercise during the day watching children.
I am always reading posts so i will post back if anyone has questions.
Tia
Posted by wowy on January 29, 2003, at 19:25:14
In reply to Re: Strattera-Any rebound?, posted by zenclear on January 29, 2003, at 16:09:17
> Do any of you notice any rebound effects, when the Strattera wears off? Say, any fatigue or mood dip?
>
> I know most of you say you like it because there's rebound like stims; but do you notice any effects when the med wears off?I don't feel any rebound or wearing off effects with strattera...
Posted by mshyper on January 29, 2003, at 20:30:58
In reply to Re: Strattera-Any rebound?, posted by wowy on January 29, 2003, at 19:25:14
> > Do any of you notice any rebound effects, when the Strattera wears off? Say, any fatigue or mood dip?
> >
> > I know most of you say you like it because there's rebound like stims; but do you notice any effects when the med wears off?
>
> I don't feel any rebound or wearing off effects with strattera...what is your dosage of strattera?
Posted by not exactly on January 30, 2003, at 5:52:12
In reply to Re: Strattera-Any rebound? » wowy, posted by mshyper on January 29, 2003, at 20:30:58
Strattera is the first "selective" norepinephrine reuptake inhibitor to be approved in the US, but there are other "mostly" norepinephrine reuptake inhibitors available. Desipramine (a tricyclic AD) is perhaps the best example of this. It's been around so long that it is available as a generic.
I had been planning to try Strattera, but when I found out that it is not (yet) covered by BC/BS (and of course it's expensive), I decided that desipramine might be a reasonable alternative. BTW, my main problem is depression (chronic atypical) with some ADD symptoms, rather than classic ADHD by itself. Does anyone have any experience w/ desipramine? Thoughts about effectiveness, side effects? Any reason to suspect it might not be an acceptable substiture for Strattera?
Note that I've already started another thread about desipramine [http://www.dr-bob.org/babble/20030125/msgs/137808.html], so if you plan to reply regarding the use of desipramine as an AD, you may want to post in that thread instead of here. However, messages that compare desipramine to Strattera, or discuss the suitability of desipramine as an ADHD treatment, probably belong in this Strattera thread.
BTW, if you're curious about my previous medication successes & failures, see http://www.dr-bob.org/babble/20030125/msgs/137593.html.
- Bob
Posted by harper on January 30, 2003, at 9:50:08
In reply to Re: Straterra Updates? » Peter S., posted by not exactly on January 27, 2003, at 14:35:04
This is my experience with Strattera for my daughter after 3 weeks:
My 13 year old daughter who has ADHD and depression has been on Strattera for almost 3 weeks. She was previously on Concerta (54mg) and Zoloft. She didn't seem to be doing well on the Zoloft and her teachers reported that she was very agitated and unfocused. She's very difficult with me (I take so much!), so a lot of times it's hard to tell what her real mood is. She's tried lots of different SSRI's over the years and they all seem to lose their affect after awhile. In anticipation of the Strattera, her doctor stated having her taper off the Zoloft about 10 days before I got the Strattera.
She switched cold turkey from just Concerta to Strattera. Initially, in the first few days of 25mg. of Strattera, I noticed a very positive affect. She seemed happier and sweeter. Her doctor upped her to 40 mg after 4 days and it all in all, everything seemed positive. She did vomit one morning about 1 week after she started the med and then 2 days later, but I just assumed it was a stomach virus. However, after reading lots of posts on MANY different boards, I now realize that vomiting was probably a side effect.
After about 10 more days I upped her dosage from 40 to 65.
I did this because of all the reading I have done and also I had talked extensively to the manager of a clinical trial here in my area. This trial has been going on for about 6 years. The mgr said the optimal dose for her weight was about 72 mg. based on their experience. Anyway, on 65 mg. my daughter's mood has become horrible. She has become tearful, verbally combative and moody. She has never been an easy child by any means, but this behavior is about as bad as I've seen in a very long time. I was so hopeful with the Strattera. I am going to reduce her dosage down to 40 mg again and hope for an improvement.By the way, her teachers report a calmer, focused and less hyper child. Maybe she just takes out all her aggressions on me. Also, it is hard to separate out the 13 year stuff from the efficacy of the med. She has delayed puberty and just started developing in the last couple of months. Maybe it's the hormones?
Anyone heard of mixing Strattera with an SSRI?
Posted by nmk on January 30, 2003, at 10:03:55
In reply to Re: Straterra Updates?, posted by harper on January 30, 2003, at 9:50:08
>
> Anyone heard of mixing Strattera with an SSRI?
>Yes. I am currently taking 18 mg of strattera with 75 mg of zoloft, which has worked wonders for my depression (I do not have ADHD). Since the zoloft works solely on serotonin and the Strattera on norepinephrine, I guess it is the balance of both that is giving me relief. I know this now because I tried weaning off the zoloft this past week and noticed that my mood was not as elevated. After a few days back on zoloft, I am feeling better again.
Posted by disney4 on January 30, 2003, at 10:39:53
In reply to Re: Strattera, Buspar, Wellbutrin » disney4, posted by not exactly on January 29, 2003, at 17:09:11
>> Strattera is very specific to norepinephrine (that's its claim to fame). My understanding about Wellbutrin is that it affects norepinephrine primarily, but also affects dopamine & serotonin to lesser extents.
That is very interesting, because I thought norepinephrine could add to anxiety, yet some people are reporting less anxiety with Straterra than Wellbutrin. I know we are all wired differently, but I wonder if the mechanism of action has more to do with the Straterra causing less anxiety, rather than the neurotransmitter it affects.
Have any other previous Wellbutrin users felt less anxiety on Straterra?
Posted by Ritch on January 30, 2003, at 11:38:25
In reply to desipramine instead of Strattera?, posted by not exactly on January 30, 2003, at 5:52:12
> Strattera is the first "selective" norepinephrine reuptake inhibitor to be approved in the US, but there are other "mostly" norepinephrine reuptake inhibitors available. Desipramine (a tricyclic AD) is perhaps the best example of this. It's been around so long that it is available as a generic.
>
> I had been planning to try Strattera, but when I found out that it is not (yet) covered by BC/BS (and of course it's expensive), I decided that desipramine might be a reasonable alternative. BTW, my main problem is depression (chronic atypical) with some ADD symptoms, rather than classic ADHD by itself. Does anyone have any experience w/ desipramine? Thoughts about effectiveness, side effects? Any reason to suspect it might not be an acceptable substiture for Strattera?
>
> Note that I've already started another thread about desipramine [http://www.dr-bob.org/babble/20030125/msgs/137808.html], so if you plan to reply regarding the use of desipramine as an AD, you may want to post in that thread instead of here. However, messages that compare desipramine to Strattera, or discuss the suitability of desipramine as an ADHD treatment, probably belong in this Strattera thread.
>
> BTW, if you're curious about my previous medication successes & failures, see http://www.dr-bob.org/babble/20030125/msgs/137593.html.
>
> - Bob
>
I tried desipramine once and it worked remarkably well for ADHD symptoms, espcially concentration and task follow-through. If you can tolerate TCA side effects OK, it would likely be the best one of all of them (the TCA's) for ADHD. It has a tendency to have more cardiac side effects than some of the other TCA's, though. The main reason I stopped it was elevated heart rate (but Straterra can do that too), and postural hypotension (dizziness-Straterra can do that one too, but probably much less so).
Posted by not exactly on January 30, 2003, at 14:25:04
In reply to Re: Straterra Updates? » harper, posted by nmk on January 30, 2003, at 10:03:55
> I am currently taking 18 mg of strattera with 75 mg of zoloft, which has worked wonders for my depression
Please clarify. Did you mean that Zoloft worked wonders, or the combination?
Have you ever tried just Zoloft by itself?
- Bob
Posted by nmk on January 30, 2003, at 17:03:02
In reply to Re: Straterra Updates? » nmk, posted by not exactly on January 30, 2003, at 14:25:04
> > Please clarify. Did you mean that Zoloft worked wonders, or the combination?
>
> Have you ever tried just Zoloft by itself?
>
> - BobSorry....the zoloft alone didn't seem to do anything, even at 125 mg. When I went down to 75 mg and added the Strattera, this seemed to be the right combo. I thought the Strattera was solely responsible for the change in my mood but proved myself wrong when I weaned off the zoloft. I am back on both and doing well again.
>
Posted by BekkaH on January 31, 2003, at 1:10:22
In reply to desipramine instead of Strattera?, posted by not exactly on January 30, 2003, at 5:52:12
> > I had been planning to try Strattera, but when I found out that it is not (yet) covered by BC/BS (and of course it's expensive), I decided that
*************************************************
Hi Bob,
Don't take "No" for an answer from BC/BS. I've had problems like that with my insurance company, and my pdoc has contacted them by phone and in writing, explaining why it is necessary for me to take the medications they don't want to cover. So far, my doctor's efforts have paid off, although it took a lot of persistence. Since you haven't taken Strattera yet, you might have to try it first without reimbursement. Then, if you respond well to it, your doctor should contact your insurance company and explain that you've responded well to this medication and you need it, etc. Are you absolutely certain BC/BS doesn't cover it? It's so new; perhaps it's just not listed in the formulary yet.Bekka
Posted by not exactly on January 31, 2003, at 2:33:33
In reply to desipramine instead of Strattera? - not exactly, posted by BekkaH on January 31, 2003, at 1:10:22
Bekka,
I called the BC/BS member services dept., and they informed me that Strattera was not yet covered because it was so new. However, they reassured me that it was "under review". When I asked how long this process usually took, they were unwilling to give me even a ballpark guesstimate.
They did tell me about "form 434" [http://www.bcbsma.com/common/en_US/pdfs/30001-PriorAuthReferral.pdf] which my pdoc can use to request an exception. Acceptable reasons for granting an exception include "Treatment Failure with all Covered Drugs in Class" and "Documented Adverse Reaction to all Covered Drugs in Class". I would hope that "Absence of any Covered Drugs in Class" also qualifies. :-)
I'm assuming my pdoc would be willing to submit this form, but I haven't mentioned it to him yet. Back when Strattera was approved, he seemed to agree that it made sense for me to try. But when I recently sent him an email informing him that it was finally available for Rx, he simply replied that we'd "discuss it" in our next session. I don't want to be too persistent at this point, for fear of exhibiting "drug seeking behavior". The best solution, of course, would be for him to obtain free samples for me to try (although he's been unwilling to do this with other meds in the past). If Strattera really helped, then he and I would surely do whatever it took to make it possible for me to afford to continue it.
However, I'm starting to think that desipramine might be a better choice for me anyway. After all, I really want an AD, not an ADHD med. I feel that my lack of motivation and focus are just symptoms of my depression. Anyway, I will "discuss it" tomorrow when I see my pdoc. I expect to leave his office with a Rx for *something*, and it better not be another goddamn SSRI!
Wish me luck. I'll report back as soon as I start my new med, whatever it might be.
- Bob
Posted by BekkaH on January 31, 2003, at 23:48:37
In reply to Re: desipramine instead of Strattera? » BekkaH, posted by not exactly on January 31, 2003, at 2:33:33
> I don't want to be too persistent at this >point, for fear of exhibiting "drug seeking >behavior". The best solution, of course, would >be for him to obtain free samples for me to try >(although he's been unwilling to do this with >other meds in the past). If Strattera really >helped, then he and I would surely do whatever >it took to make it possible for me to afford to continue it.> Bob
>
***********************************************
Hi Bob,
Regarding your concern about "drug-seeking behavior," your doctor should know that Strattera is not a restricted drug. It's not a stimulant, and even if it were, most of the people I've met on this board take stimulants because they need them, and they don't abuse them.I hope your next med trial goes well. Let us know how you're doing. By the way, I'm interested to know what kind of chemist you are. Of course, you don't have to answer that because I know that privacy and confidentiality are very important issues here, but if you don't feel uncomfortable about it, I'm interested to know whether you are in organic chemistry or some other specialty.
Thanks.
Bekka
Posted by not exactly on February 1, 2003, at 3:57:07
In reply to desipramine instead of Strattera? - not exactly, posted by BekkaH on January 31, 2003, at 23:48:37
> Regarding your concern about "drug-seeking behavior"...
Sorry, I should have put a smiley face :-) after that comment - I wasn't *really* worried that he would perceive this to be a problem. However, I do want to save my assertiveness for issues that are truly important.
> I hope your next med trial goes well. Let us know how you're doing.
Saw my pdoc today, and he agreed that desipramine made sense to try at this point. I took my first dose just before I read your message, so I expect my depression to be in full remission by the time I finish posting this reply.
:-) :-) :-) :-) :-)
Yes, I'm joking about this too, but it *is* true that I usually respond quickly to psychotheraputic meds. The ones that have worked in the past took only a few days to kick in. With Effexor, I felt completely cured within 12 hours of my first dose! Unfortunately, it pooped out completely in less than a month - easy come, easy go, I guess.I will post again to let you know how it's going. But since I'm *not* taking Strattera (this time), most of my progress reports will be posted in the desipramine thread I started [http://www.dr-bob.org/babble/20030125/msgs/137808.html]. If I conclude that desipramine is a good ADHD med (rather than "just" an AD) and/or it's an attractive alternative to Strattera, then I will post that opinion here as well.
> By the way, I'm interested to know what kind of chemist you are.
I'm not a *professional* chemist, but it's been a life-long interest. After studying chemistry in college, I ended up with a career in computers (chemistry & computers are both popular fields for those of us with Asperger's Syndrome, fwiw). I still keep up with chemistry as a hobby (primarily thru internet research; no lab work recently). Originally, I was interested in inorganic (specializing in explosives & pyrotechnics) but later switched to organic (specializing in biochemistry & psychophamacology).
It's clear from your posts that you have an excellent understanding of neurochemistry yourself. Are you also a chemist?
And while I'm on the subject of prying into your private life :-) I've noticed that you have never mentioned taking Strattera despite your obvious interest in it. Are you planning to try it in the near future?
- Bob
Posted by CindyLou on February 1, 2003, at 8:24:17
In reply to Re: Straterra Updates? » harper, posted by nmk on January 30, 2003, at 10:03:55
Yesterday I took 25 mg. Strattera (my pdoc is starting me on a pediatric dose due to my med sensitivity.) After 5 hours, I was so sedated I had to sleep -- it felt like I had taken a couple sleeping pills -- I was virtually being PULLED into sleep. Very strange.
I'm wondering a few things:
1. Can I take Strattera at night? Would it continue to help with ADD symptoms and energy during the day?
2. Would a higher dose be LESS sedating?
Thanks for any input.
cindyP.S. I am also taking 5 mg. Lexapro at night, and 0.5 mg. Klonapin at night.
Posted by bennett on February 1, 2003, at 11:23:58
In reply to Re: Sedation with Straterra - ok to take at night?, posted by CindyLou on February 1, 2003, at 8:24:17
Hi,
The first day I took Straterra I too felt "like I was pulled asleep" two hours after taking it. I slept soundly for a few hours (it was the middle of the afternoon)then got up and felt rested-
I'd been getting plenty of sleep before this.It happened again a day or so later but hasn't happened since then. By the end of the day now (day 6) I don't want to shut down ( -I never have until maybe 2-3 AM) so I continue with 5-7.5 Ambien to get to bed before midnite(which seems to hit much more quickly and demandingly than it did before) I suppose I can lower the Ambien dose a bit and see what happens..
I started with 18 mg Straterra for 3 days,(not feeling much) then 18 Am and PM. I feel most of the time now like I have a sock over my head, kind of groggy, more unfocussed than usual, but groggy instead of "speedy" - find myself getting angry and frustrated at little things not going right -- at the same time seem to put more quiet attention to things as I come upon them but in a floating sort of way - can't get on task to accomplish what I need to accomplish.
I stopped Wellbutrin before taking the straterra but I imagine that must be out of my system.
I imagine I'm not at a clinical dose yet, but still not sure how quickly to advance the dosage - not many side effects (except maybe scratchy eyes - which may be allergies...)
Doc has me on 18 mg bid for the first month.thanks
bennett
Posted by cybercafe on February 1, 2003, at 17:30:49
In reply to Re: Sedation with Straterra - ok to take at night?, posted by bennett on February 1, 2003, at 11:23:58
how do these drugs compare to wellbutrin?
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