![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 902 to 926 of 1242. Go back in thread:
Posted by zeugma on August 10, 2003, at 17:16:52
In reply to Re: Straterra approval., posted by jonk on August 10, 2003, at 16:02:21
> I have just started to take Strattera to treat ADD (No hyper) and reading through these messages I have become disheartened to hear that the effects wear off after a few months. How common is this? I am desperately looking for an alternative to amphetamines or other stimulants due to their addictive nature and high/lows. If these effects do wear off, is Wellbutrin the next thing I should go for? Thanks
Don't jump to conclusions based on the reports of a handful of people. Strattera is too new a drug for reliable judgments to be made about its long-term efficacy. But based on what is known about its pharmacology there is no reason to think that it has any more poop-out potential than other classes of drugs.
Posted by scubapro on August 10, 2003, at 18:04:54
In reply to Re: Adderall advise! » scubapro, posted by Lasagne on August 10, 2003, at 13:04:54
i started the adderall about 4 weeks ago after strattera failed. my doc said he wanted to start me slow so it did not set my bp wild. i weigh 250. i have only been on the geodon 5days not 3 weeks *typo. im not wanting to feel normal, but when im up i so manic i scare people and when im down i want to be dead. there has been no middle ground for me for the past year now. im working on some lifestyle changes that shound help and if i can get and keep a job that lets me sleep at night would be nice. i have had 26 jobs since i was 18 .only fired twice for inattention. others i got bored with after 4 to 6 months. i do very well with my son and feel he is the reason im still alive and on this plant in the first place. on top of all that after a strong religous faith as a child i have been betrayed by the religous socioty 3 times as a adult and now find myself with little to no faith in god. i guess i have always had a problem with blind faith. but when things got to the worst point i turned to the church for help and got told the old "everythng happenes for a reason" when all i wanted was someone to listen and sympathis with me. anyway i have started a mood chart to track my moods but my doc said to forget about studing why/ what is wrong and let him help me. imy ocd makes that hard ie thats why im here.
Posted by Lasagne on August 10, 2003, at 18:46:28
In reply to Re: Request Straterra side effects solutions?, posted by readyforchange on August 10, 2003, at 14:09:21
> HELP- I am new to the meds thing. I am on day three of my Straterra at 40mgs. I feel worse than I did before I took it. I feel flat in my personality, and in a state of disconnection. I want to do less, fall asleep, and be alone - completley the opposite of what i was hoping for, because I need to be on top of things right now. I have been very dizzy and flushed. I slept well the first two nights, I had taken the pill in the afternoon the first day, in the morning the second, and before bed last night (to ease the nauseousness feeling I was experiencing during the day)but last night I slept so lightly, every twenty minutes looking at the clock... it was insane. What am I doing on this stuff- is it really going to get better? I feel like an idiot on Straterra... any advise?
REPLY::
Hi, I had a similar experience in the beginning, but as each week went by things got better. I would say that week 6 was the point where the side effects diminished or went away and I had more clarity and focus and a huge reduction in anxiety.
Lasagna
Posted by fallsfall on August 10, 2003, at 21:16:19
In reply to Re: Request Straterra side effects solutions?, posted by readyforchange on August 10, 2003, at 14:09:25
The dizziness will last for a while (weeks), but will go away.
Sleep is weird, I have my own theory (not backed up by any data) that says that people with ADHD do better taking it in the AM, and people with depression do better taking it in the evening.
My personal opinion is that 40mg is a lot to start with. If the side effects are unbearable, try decreasing to 18 or 25mg until the side effects mostly go away, then you can increase back up to 40mg until that feels comfortable, etc. (with your doctor's approval, of course).
I found that Ginger capsules (550mg worked for me) worked really well on the nausea. You can find it in a health food store.
What is your diagnosis? What else are you taking? Strattera takes a little patience, but I really like it (I take it for depression).
Posted by MomofBoys on August 10, 2003, at 23:48:24
In reply to Re: Request Straterra side effects solutions?, posted by readyforchange on August 10, 2003, at 14:09:25
Zula--I suffered the consequences of starting Strattera because it made me feel like a totally new person overall. When I took the med in the morning, I was sleepy and on the couch all day long, very lethargic. When I took the med before bed, I slept horribly but was able to wake up early and work and was extremely productive. I work at home doing medical transcription. I am able to just go downstairs in my PJs and work and I was more productive in those early morning hours than I have been in years! But then I would crash after lunch and nap until 3 or so.
Unfortunately, I got used to the med, and the restless sleep went away and I no longer have early morning awakening. But after five months or so on Strattera, I have been able to transition to taking 40 mg in the morning and 25 mg in the afternoon or bedtime, whenever I remember. My doc has added Ritalin to this which has done wonders for my day and productiveness. I can't believe how much housework PLUS money-making work I can get done in such little time. I stuck with it and it has worked, even tho it was a difficult time......
Kim> HELP- I am new to the meds thing. I am on day three of my Straterra at 40mgs. I feel worse than I did before I took it. I feel flat in my personality, and in a state of disconnection. I want to do less, fall asleep, and be alone - completley the opposite of what i was hoping for, because I need to be on top of things right now. I have been very dizzy and flushed. I slept well the first two nights, I had taken the pill in the afternoon the first day, in the morning the second, and before bed last night (to ease the nauseousness feeling I was experiencing during the day)but last night I slept so lightly, every twenty minutes looking at the clock... it was insane. What am I doing on this stuff- is it really going to get better? I feel like an idiot on Straterra... any advise?
Posted by Mike Oxsbig on August 11, 2003, at 12:58:19
In reply to Re: promises, promises » Mike Oxsbig, posted by Lasagne on August 9, 2003, at 12:12:03
Lasagna
For some reason I feel like making something Italian for dinner. Don't know why
My doc started me out on Lexapro before I took anything specific for ADD. Just to let you know I am innattentive with that tendency to over focus. He felt that I had some anxiety issues. My own diagnosis is that the ADD causes me to fail at work which is causing the anxiety and stress. If I didn't have any financial concerns I would not have any anxiety or stress.
I will be going back on 36mg of concerta. I have taken the 54mg in the past. One of the things that I realized after going off of concerta was that I became a caffeine addict while I was taking it. I think the caffeine had a negative impact on my functioning at work. When I stopped the concerta I couldn't handle much caffeine due to hypoglycemic reactions shortly after consumption. I feel much more in control since cutting out all caffeine.
The compulsive question is a good one. The over focus, I believe and my formere ADD coach concurred that it is my way of task avoidance. I procrastinate and if I am doing something that seems productive then I'm not procrastinating until the day is over and I've spent the day doing something that makes me no money nor helps me reach any goals. I would say impulsive over compulsive.
I do get stuck and my ADD coach discussed this at length. He mentioned that it is hard for me/us to just switch back to the things we need/should do. For instance, he told me that if I find myself in a rut that instead of just trying to change focus to get out of the office, take a walk, etc.. to clear my head and to refocus.
I would actually like to stop taking the lexapro while on Concerta. I almost feel that the lexapro makes me too happy. I think that some anxiety and stress would help motivate me at least in the short term. However, I do like the fact that when I wake up in the middle of the night and start thinking about all the things I didn't get done, I am able to turn it off and go back to sleep. Prior to lexapro it was routine for me to have to get up and read or watch tv for a couple of hours once my mind got racing.
Addrall may be another good option to try.
> Hey Mike:
> My husband had the same sexual side effect when taking the Strattera. The doctor then switched him to Concerta. He also takes Wellbutrin. The combo seems to really help him. He was having depression problems with his ADHD. The Wellbutrin is also used to help the impulsiveness that ADHDers experience.
> What dose of Concerta are you taking? Do you feel like your over-focusing is of the compulsive nature? Do you feel like your brain gets stuck and you feel anxiety if you don't continue?
> If so, then you need to talk to your doctor and see if he can prescribe you something to take along side the Concerta. There may be a co-existing anxiety problem. A lot of times there is more going on than just simple ADD/ADHD. I am in that category and so is my oldest son. I take Strattera, Prozac, and Buspar. My son takes Strattera, Celexa, and Zyprexa, and Adderall XR when he is in school. Also, you might want to consider switching your stimulant medication to Adderall XR to see if you experience the same feelings that you have on the Concerta.
> Lasagna
Posted by Lasagne on August 11, 2003, at 14:00:12
In reply to Re: promises, promises, posted by Mike Oxsbig on August 11, 2003, at 12:58:19
Hi Mike:
Sounds like you are stuck between a rock and hard place. I understand your dilemma, the unpredictability between over-focus, procrastination, and anxiety. In spite of the improvements I have had on the Strattera, I still have that tendency to over-focus, which puts me behind on numerous things I need to get done around the house and with caring for my family. I do like the feeling of no or less anxiety eventhough it means I don't always get everything done. I suppose being a homemaker affords me this luxury. I can imagine how this calmness about the tasks you need to get done in a workplace could be problematic with the unproductivity. Have you ever thought of discussing your ADD with your boss or supervisor? Maybe with some communication and understanding they would be willing to break your tasks into smaller pieces and check in with you more often to make sure you are hitting milestones and if you are stuck they can help guide you into the next task. Another option is to keep a timer with you at work. When you have a task, give yourself so much time to complete it and try to beat the timer. With it ticking right by your side maybe it will give you the push you need to stay on track. Sometimes when I get in the over-focus mode I give myself time limits. If I don't complete what I am doing before my limit, then I just put the task down and move on. It's not easy, but setting limits for myself helps.
Overall, I think the procrastination is a difficult thing to overcome. I have made improvement in this regard with the Strattera, but I am not 100% cured. Through my years of experience with my oldest son, I have learned that improvement has to be the goal, not perfection. There is no pill that will make us ADDers behave perfect in all arenas. Some people respond to medication better than others. Attentional problems vary so much from person to person. My oldest son is very difficult to keep stable with his meds and my 2nd son rarely needs a dose adjustment.
I applaude you for kicking the caffeine habit. It's not an easy one to kick and it seems like every good dessert has chocolate in it. I too am very sensitive to it's effects in that it has huge ramifications for my sleep quality. I find if I don't get a good nights sleep then the benefits of all the medications I take are diminished.
This is just my opinion, but I don't think it's a good idea for you to go off of your Lexapro. Your sleep will get all out of whack again and then it will make it even more difficult for you to focus at work.
Good luck!
Sonya Lasagna
Posted by Lasagne on August 11, 2003, at 14:59:28
In reply to Re: promises, promises, posted by Mike Oxsbig on August 11, 2003, at 12:58:19
Mike:
Here is a link to a web-site that has good tips for people with ADD/ADHDhttp://www.addresources.org/article_50_tips_adult.php
Lasagna
Posted by Nachoman on August 11, 2003, at 21:03:16
In reply to Re: promises, promises, posted by Lis on August 8, 2003, at 22:23:56
> 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.
Posted by Mike Oxsbig on August 12, 2003, at 9:42:53
In reply to Re: promises, promises, posted by Nachoman on August 11, 2003, at 21:03:16
Nachoman
I understand the frustration with waiting on Straterra. I couldn't wait any longer. I just started back on Concerta this morning. One of the biggest differnces is the energy level that I have on Concerta which makes sense because it's a stimulant. But it's different than being wired. It's the difference between being lathargic and normal. I don't recall much of a crash in the evening when the Concerta wears off.
I too gave up alcohol when I started on stimulants (Concerta), basically a week after I started on it. After I switched to Straterra I started drinking a little here and there on weekends. Not much because a glass of wine can now give me a headache the next day. Prior to quiting last December, it would be common for me to finish off a bottle of wine with dinner on the weekend.
One of the things that I noticed while on Concerta before straterra was the number of projects started around the house. While on Concerta I had one project which I would see to completion. Right now I have about 10 unfinished projects laying around. It drives me nuts. Now that I'm back on Concerta I will see if I can knock them all out.
I still have a bunch of straterra left and am considering taking it with the Concerta. Straterra was not on the list with my Health Insurance so it was costing me about $85 per month. My sister is a pharmaceutical rep and got a couple of months worth of samples from a lily rep.
Good luck and let us know how it goes
> > 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.
Posted by Nachoman on August 12, 2003, at 12:26:20
In reply to Re: promises, promises, posted by Mike Oxsbig on August 12, 2003, at 9:42:53
Wow -- it sounds like your recent experiences are a mirror-image of my own. The stories about missing your client's 5:30 appointment and the multiple, unfinished projects around the house sound very familiar.
I too started to drink again after switching to Strattera. And I'm back up to 4-5 cups of coffee per day. Luckily I haven't started smoking again, but I've been seriously thinking about it. Oh, and video games occupy a lot of my spare time. Before Adderall I would play games *a lot*, then while on Adderall I cut my play time down to almost nothing, and now I'm back to playing a lot. I wonder how many ADD folks turn to video games to stimulate their minds...
Maybe I should just cut my losses now and switch back to Adderall. I was so hoping that Strattera would work for me.
Thank you and everyone else on this board for sharing your experiences. It's been a big help in trying to understand and cope with my symptoms.
Aside: I refilled my coffee cup twice while writing this short post. So frustrating. :)
Posted by ben12 on August 16, 2003, at 13:39:23
In reply to Re: Adderall advise!, posted by scubapro on August 10, 2003, at 0:46:38
I am a 20 year old college student. I have been on Ritalin my entire life and have had to decrease dosage gradually throughout the years as my body chemistry changed. My current dosage is 7.5mg. Recently, I noticed that ritalin is responsible for psychological tension (anxiety), which builds up and ironically inhibits my studying. Additionally, exercising seems to be the only way to quell the psychological tension for a period of 3-4 hours. Tired of exercising in order to maximize focus, I have decided to go on stratera. Now, on a a dosage of about 40 (i was on 25 mg for 3 days then moved on), i feel extremely fatigued and hyperfocused. Here are my questions: Does anyone have any information on my particular situation or experience? Does anyone know if one dosage of ritalin corresponds to a particular dosage of ritalin (i know they work on different neurotransmitters) but perhaps there is some correlation of dosage? Any thoughts about my situation or recommendations would be unbelievably appreciated. Thank you
Ben
Posted by Lasagne on August 16, 2003, at 14:51:13
In reply to Ritalin/Anxiety/--Stratera , interesting dilemna, posted by ben12 on August 16, 2003, at 13:39:23
> I am a 20 year old college student. I have been on Ritalin my entire life and have had to decrease dosage gradually throughout the years as my body chemistry changed. My current dosage is 7.5mg. Recently, I noticed that ritalin is responsible for psychological tension (anxiety), which builds up and ironically inhibits my studying. Additionally, exercising seems to be the only way to quell the psychological tension for a period of 3-4 hours. Tired of exercising in order to maximize focus, I have decided to go on stratera. Now, on a a dosage of about 40 (i was on 25 mg for 3 days then moved on), i feel extremely fatigued and hyperfocused. Here are my questions: Does anyone have any information on my particular situation or experience? Does anyone know if one dosage of ritalin corresponds to a particular dosage of ritalin (i know they work on different neurotransmitters) but perhaps there is some correlation of dosage? Any thoughts about my situation or recommendations would be unbelievably appreciated. Thank you
> BenHi Ben:
From my personal experience it is possible that the onset of your tension/anxiety is not due to the Ritalin. College and entering into adulthood is an extremely stressful time, esp. for people with ADD. It's very common for people with attentional disorders to have depression or anxiety arise as a secondary effect of the ADD/ADHD. When I went away to college years ago the demands of keeping on top of an average work load (12 units/credits/semester) was all I could handle. I went in and out of periods of anxiety and depression. Finally when I got married and had my first child I got so desperate that I went in to see my doctor about these feelings. That's when I started on Prozac. A few years later I began to have panic attacks and the doctor had to put me on Buspar. Just a few months ago I finally got an official diagnosis to my lifelong struggles: ADD. My doctor began me on Strattera in combination with what I was already taking. At first I had the drowsiness and lethargic feelings. As each week went by I improved. The most remarkable one was an overwhelming feeling of calmness. It made my brain function at the right speed and I could sit and focus on something without an overriding urge to get up and move around. By the 6th week all the yukky side effects went away and now I feel great.
My advice to you is to realize that adulthood brings so many more responsiblities and the ADD brain doesn't function very well with the type of executive decisions that are necessary to keep on top of things as an adult, thus the feelings of anxiety are taking over you. Be patient with the Strattera and keep in mind that you may have to combine the Strattera and Ritalin if after a certain point you don't feel you are getting the benefits you need to complete your school work and studying. Strattera and Ritalin are so different and people's bodies respond differently to meds and doses and so it's imposible to say that a certain dose of Strattera is equivalent to a certain dose of Ritalin. My oldest son has had to combine the Strattera with a stimulant med. Also, 40mgs. of Strattera is not the average adult dose. I take 80 mgs. So you may need to increase your dose and then wait to see if it is necessary to take a small dose of Ritalin with it too.
Good luck!
Lasagna
Posted by ben12 on August 16, 2003, at 15:49:07
In reply to Re: Ritalin/Anxiety/--Stratera , interesting dilemna » ben12, posted by Lasagne on August 16, 2003, at 14:51:13
Thank you for replying to my post. I feel you have a good understanding of the issues I am dealing with. I seem to have general anxiety that is exacerbated by the ritalin. Working out brings me the calming effect you mentioned. Would you think that strattera in combination with ritalin would bring me to the point where working out was not a necessary means to achieving that calm state? I have been on the strattera for a week and am overfocused, yet the medicine is much more friendly to me than the ritalin. Do you think that the dose is too high or will the overfocused feelings lessen as my body adjusts to the medication and what about anxiety? I am pre-med at Northwestern so that alone brings me a good bit and the constant exercise (twice a day) in order to bring about efficient stud is wearing me down. Thanks
Posted by Lasagne on August 16, 2003, at 22:57:46
In reply to Response to Lasagna, posted by ben12 on August 16, 2003, at 15:49:07
> Thank you for replying to my post. I feel you have a good understanding of the issues I am dealing with. I seem to have general anxiety that is exacerbated by the ritalin. Working out brings me the calming effect you mentioned. Would you think that strattera in combination with ritalin would bring me to the point where working out was not a necessary means to achieving that calm state? I have been on the strattera for a week and am overfocused, yet the medicine is much more friendly to me than the ritalin. Do you think that the dose is too high or will the overfocused feelings lessen as my body adjusts to the medication and what about anxiety? I am pre-med at Northwestern so that alone brings me a good bit and the constant exercise (twice a day) in order to bring about efficient stud is wearing me down. Thanks
>Hi Again:
Does this anxiety seem to arise as your ritalin is wearing off? My son was recently taking Adderall and in the evenings he would have terrible emotional outbursts and meltdowns when the Adderall was wearing off. Since he isn't in school right now I decided to take him off the Adderall temporarily to see if increasing his Strattera dose works to control his ADHD. We are about a week into this new experiment and so far my son seems to be improving on 75mgs. daily of Strattera. (Previously he was only taking 50 mgs. of Strattera with the Adderall XR 60 mgs.) By the way he is 11 years old and about 85 lbs. and takes 75 mgs. So that should answer your question as to whether you are on a high enough dose. The recommended adult dose is 80 mgs. daily. Although, from many postings I have read on this web-site, it seems to be a good idea to slowly work up to that level. I started at 40mgs. and then after 4 days increased to 80 mgs. (quick route) and I experienced a lot of uncomfortable side effects in the beginning. About a week into my Strattera treatment I had to switch to taking the Strattera in the evenings instead of the day, so I didn't have the uncontrollable drowsiness during the day. By week 6 my body adjusted to the Strattera and the obnoxious side effects went away. I still have a tendency at times to over-focus (it's the nature of the ADD beast), but at least when I do tasks that take focus I can follow-through without making a bunch of errors. I have also found the Strattera helps me to focus better on reading. I have become quite a book worm since starting the Strattera. I also don't procrastinate nearly as much. I am not perfect, yet improved.
The Strattera also has had a huge calming effect on me and this is the least amount of anxiety that I have felt in years. If your anxiety does not improve soon, I would talk to your doctor about starting you on some type of anti-anxiety med (Buspar has been good to me) in combination with your Strattera. It's good to excercise, but the amount that you are having to do to is obsessive and obviously takes away from the time you need to be studying or just having fun once in a while. I applaude you for doing pre-med. That is a huge thing to take on and so you need to pace yourself and realize that you do have some limitations with your ADD. You might want to go on the internet and read some information/tips on dealing with ADD while in college. They talk alot about special services that are available to students with attentional problems. You need to learn how to advocate for yourself so you can survive pre-med and med school without having a nervous breakdown. My first two years of college I went year round with practically no breaks. My dad put a lot of pressure on me to take a heavy work load and was pretty uncompassionate of my limitations. All he knew was that he was able to get straight A's in college taking a full load and while working a job too, and so everybody else should be able to do the same exact thing (He's a true egocentric). Granted I didn't have my diagnosis at that point, but my dad didn't see that everybody has different capabilities. At any rate, after two years of pushing myself hard, I fell into a deep depression and shut down and had to come home. After a summer of being home I was paralized with anxiety and could not go back to school at BYU. My dad just about had a coronary at this news. I ended up taking an 8 month break from school and then transferring to Cal State Northridge. From there on I paced myself and eventually graduated with a bachelors in business admin. It was a long road, but now when I consider how I really persevered through ADD symptoms, I am quite proud of myself. So keep up the good work and pace yourself so you can survive the journey.
Lasagna
Posted by ben12 on August 17, 2003, at 14:01:53
In reply to Re: Ritalin/Anxiety/--Stratera , interesting dilemna » ben12, posted by Lasagne on August 16, 2003, at 14:51:13
The ritalin, i believe, causes the anxiety push. I am aware when the ritalin wears off and at that point there is no extra anxiety. Are there times when strattera works better or is not as effective throughout the day? The whole trial period is making me very nervous because i have only known myself on or off ritalin but i have noticed that the ritalin provides some anxiety. Furthermore, my psychiatrist is loath to put me on anti-anxiety medication because he feels that would sedate me to the point where studying is more difficult. Im having a lot of difficulty finding the 'correct' balance between strattera and ritalin and the struggle has definitely made me a little depressed. Do you have any other thoughts or answers to the questions above, thanks again for replying, you've been a huge help.
Ben
Posted by Lasagne on August 17, 2003, at 22:36:51
In reply to Re: Back to you, lasagna, posted by ben12 on August 17, 2003, at 14:01:53
> The ritalin, i believe, causes the anxiety push. I am aware when the ritalin wears off and at that point there is no extra anxiety. Are there times when strattera works better or is not as effective throughout the day? The whole trial period is making me very nervous because i have only known myself on or off ritalin but i have noticed that the ritalin provides some anxiety. Furthermore, my psychiatrist is loath to put me on anti-anxiety medication because he feels that would sedate me to the point where studying is more difficult. Im having a lot of difficulty finding the 'correct' balance between strattera and ritalin and the struggle has definitely made me a little depressed. Do you have any other thoughts or answers to the questions above, thanks again for replying, you've been a huge help.
> BenHi Again:
Since you have been on and off Ritalin most of your life, maybe now your body is changing and so you aren't getting the same benefits anymore. You may want to consider changing the type of stimulant you are taking. My son has been back and forth between Ritalin and Adderall over the last 3 years. Especially now that he is entering puberty, the meds stopped working as well, which is why we stopped the Adderall and decided to go full time with the Strattera at a higher dose. Strattera does take time to really hit maximum benefits. You may be a few weeks away from knowing if that is true for you. In the meantime it wouldn't hurt to switch stimulants and possibly increase your Strattera dose again, then in 3-4 weeks take a weekend off from the stimulant to see if the Strattera gives you enough focus. My son is getting really good results on the higher dose of Strattera. I am really amazed at the improvement in his behavior without him taking the Adderall.
As for your doctor's concern that the anti-anxiety meds may sedate you too much, it is possible to start at a really low dose at bedtime. That way if you do experience drowsiness it will be while you should be sleeping. When I began the Buspar I don't remember having any sedation from it. My doctor started me on a lower dose and then increased after a week or so. Within a few days the panic attacks/anxiety went away and I felt great. Almost all of the psychotropic drugs cause an initial side effect of drowsiness, but with time it does improve. If you take them at bedtime then by the morning hopefully you would feel alert and be able to function for school and studying. Another thing to consider is that everybody reacts differently to meds, so maybe you won't have the sedative effect. If you have any vacation time coming up before Fall semester starts then you may want to use that time as your adjustment period with your meds. Unfortunately these things take time. We have spent the whole summer getting to where we are at with my son. He was doing terrible when school went out in June and now things are looking hopeful for a new school year. Depending on your ability to keep up with your school studies, you may want to discuss these matters with some of your professors. Maybe they would be willing to make some adjustments to help you be more successful. I know you must be studying hard so you can get good grades to get into med school, but I found back when I was in school that sometimes a "C" grade was equivalent to somebody elses "A" grade, because I had to put in so much painful effort. Now when I look back at what I had to do in order to learn class material I am absolutely amazed that I even made it through college.
As for a time of day when the Strattera seems to work best, I would say the morning. In the evenings as a mother of 3 boys, I am often pooped out and then when I take my Strattera it seems to calm me down for bedtime. When I wake up I feel alert and ready to go. Whereas before the Strattera I struggled to get out of bed and would want to go back to bed after my boys were off to school. It really has changed my life in numerous ways. My functionality is greatly improved.
So please don't give up. I know it's frustrating waiting for results. The first 3-4 weeks of Strattera were tough. The side effects hit me hard and I wasn't sure if I was going to endure them.
Well, I suppose I have gone on and on again.
Take care,
Lasagna
Posted by ben12 on August 20, 2003, at 20:56:16
In reply to Re: Back to you, Ben » ben12, posted by Lasagne on August 17, 2003, at 22:36:51
Does anybody know what symptoms indicate a low/high Strattera dose? I have been on the 40mg dose for about 8 days and feel spacy. The fatigue has mostly gone away as well as other side effects. However, I constantly catch myself staring blankly at objects for short periods. Does this mean my dose is too high or too low? I was on ritalin for 12 years before this and i could definitely tell what dose was too low or high with the ritalin, but with the strattera it seems much harder to gauge.
Thanks
Posted by Viridis on August 20, 2003, at 23:54:15
In reply to What Strattera dose is too low/high, help.., posted by ben12 on August 20, 2003, at 20:56:16
I've been taking Strattera for a couple of months, and each time I increased the dose I had a few days to a week or so of side effects -- mild nausea, tense neck and shoulders, dry mouth, a sort of spaced-out feeling etc.
I started at 25 mg (which was fine); when I went to 40 I had these side effects for about a week and then they disappeared; then I tried 50-65 mg and had the same side effects for a short while. This is pretty consistent with what my pdoc predicted -- for most of his patients it takes about a week or two to get used to it, and he encourages gradual dosage increases.
For me, 60 mg/day seems about right and I no longer have side effects, except slight dry mouth. I may try going a bit higher (the suggested "typical" dose is 80 mg/day), but I'm in no rush.
I think you just have to find your comfort zone -- some people here report success at 18 mg, some need over 100, and some just can't tolerate it at all. Like almost all of these meds, it's a trial-and-error thing. Your doctor may have some 25 mg samples that he or she could give you -- this "starter" dose seems pretty common in the free sample packs and, in combination with the 40 mg pills, allows you to try 25, 50, 65, or more mg.
Good luck!
Posted by lessismore on August 21, 2003, at 0:45:56
In reply to Re: What Strattera dose is too low/high, help.. » ben12, posted by Viridis on August 20, 2003, at 23:54:15
I started Straterra 5 days ago. My MD gave me 4 4packs of 18 mgs, and a jar of 40 mgs. He really didn't give me dosages. Sort of take these, then take these. I have taken 18 mgs a night for 5 nights. The dry mouth is gone, and most of the bitchy/impatient feeling, and sleepiness is gone. I'm thinking of going to 40 for my second ( and maybe third, depending on side effects) week, then up to 58, I guess for 9 days, cause I'll have 9 18mgs left, then up to 80. I guess the idea is to get accustomed to each increase, meaning have fewer side effects. Any opinions? And yes, I know I should call the DR., but I'll bet he knows less about the stuff than I do at this point, and since I don't have insurance I'm not willing to pay him for advice he seems to pick out of thin air. Thanks in advance for your advice.
Posted by blondegirl47 on August 21, 2003, at 7:30:19
In reply to Re: What Strattera dose is too low/high, help.., posted by lessismore on August 21, 2003, at 0:45:56
Do a search on strattera dosing, I have seen a site that breaks it down by weight.
Blondegirl
Posted by Ponder on August 21, 2003, at 12:00:29
In reply to Re: Metabolizing » Lexxey, posted by PuraVida on April 17, 2003, at 1:46:26
My physician says that the combination of Stattera and Lexapro is equivalent in its mode of action to Effexor. When Effexor first came out it was touted as a drug that did not cause weight gain, and, in fact, showed some weight loss. As it turns out, the weight loss in the clinical trials is not an accurate reflection of what happens over the long run. Many people have gained significant weight on Effexor.
I see that Strattera is associated with weight loss and Lexapro is supposed to be relatively weight neutral. Am I off-base to be skeptical?
I am bipolar (I or II depending on which evaluation you believe) and got very fat, and later, severely depressed while on a combination of Effexor and Wellbutrin.
Now that I've lost that 50 pounds, I'm nervous about this Stattera/Lex combo that my doctor wants to try.
Any comments will be appreciated. Thanks.
Posted by lessismore on August 21, 2003, at 12:39:29
In reply to Re: What Strattera dose is too low/high, help.., posted by blondegirl47 on August 21, 2003, at 7:30:19
Thanks, I did, and that's what I'm using for my goal of 80, but it's the timing I'm working on.
Posted by Mike Oxsbig on August 21, 2003, at 14:42:21
In reply to Potential weight gain over time?, posted by Ponder on August 21, 2003, at 12:00:29
I was only on Strat/lex combo for a month and a half, but didn't experience any weight change or diet change. I have been on Lexapro since last October. I've actually lost about 10 lbs since then. I wouldn't worry.
> My physician says that the combination of Stattera and Lexapro is equivalent in its mode of action to Effexor. When Effexor first came out it was touted as a drug that did not cause weight gain, and, in fact, showed some weight loss. As it turns out, the weight loss in the clinical trials is not an accurate reflection of what happens over the long run. Many people have gained significant weight on Effexor.
>
> I see that Strattera is associated with weight loss and Lexapro is supposed to be relatively weight neutral. Am I off-base to be skeptical?
>
> I am bipolar (I or II depending on which evaluation you believe) and got very fat, and later, severely depressed while on a combination of Effexor and Wellbutrin.
>
> Now that I've lost that 50 pounds, I'm nervous about this Stattera/Lex combo that my doctor wants to try.
>
> Any comments will be appreciated. Thanks.
Posted by Kacy on August 21, 2003, at 20:59:41
In reply to Re: Potential weight gain over time?, posted by Mike Oxsbig on August 21, 2003, at 14:42:21
I use Effexor and Straterra. I only use 75 mg of Effexor. I use 100 mg of Straterra.
Even when I went up to 225 mg of Effexor where the NE effects are supposed to have started, I never had the same affect as Straterra, so I think the two drugs are different and am skeptical about the Lexapro/Straterra combo being the equivalent of Effexor.
I started at 40 mg of Straterra for four days and then went to 80 mg for three months. The third month the effects waned some so I went to 100. I didn't have nausea except for the first day. I only had a queasy stomach. (I took it when my stomach was empty.) After a week or so, I could take it on an empty stomach with coffee and have no problems. That's what I do everyday.
I'm having trouble getting over the sedation,though, with the 100 mg. dose. I got over it at the 80 mg. dose. How long has it taken some of you to get over that effect? It is lasting all afternoon. Taking it in the evening brought back some of the anxiety that Straterra decreased, so I don't want to do that. Taking it twice a day didn't help, either.
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