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Dr. Bob is Robert Hsiung, MD,
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Posted by Cindylou on February 7, 2003, at 21:06:10
In reply to Straterra , posted by harper on February 7, 2003, at 18:30:16
Hi Harper,
I noticed in an earlier post that a teenager on Strattera also had increased moodiness ... it's so hard to tell with all those hormones raging what is causing what.I am taking Lexapro, and so far it is the only antidepressant I've been able to tolerate. My pdoc said the combo of Lexapro and Strattera is fine. (As for my experience, I have only taken Strattera for one day. I was extremely sedated and haven't had the guts to try it again. I am quite confident that the sedation didn't have anything to do with the combo of the meds, however, since I am very med-sensitive and I react strongly to medications across the board.)
Lexapro is an SSRI, like Prozac, but has much fewer side effects. It's quite new, so the drawback is that it's not as "tried and true" as Prozac.
Best of luck to you and your daughter. I had a tough time when I was 13 ... my heart goes out to her and to you!
cindy.
> My 13 year old daughter has been on 40 mg for the last month. The ADD is much better and she's had no side affects except for sleepiness and an upset stomach the first couple of days. The only problem now is her terrible and increasing moodiness.
>
> Even though I think puberty has something to do with the moodiness, I think she needs an antidepressant along with the Strattera.What antidepressants are others taking with this med? Since this is a new med, her doctor doesn't have any experience with this one (even though he is a big shot at NIMH in child psychiatry!), I want to give him suggestions.
> I understand some people are on Wellbutrin with this med. How much and how is it working?
> Please respond.
Posted by mom2mbcb on February 8, 2003, at 5:43:19
In reply to Re: Straterra » harper, posted by Cindylou on February 7, 2003, at 21:06:10
day 3 of straterra, I noticed slight ( very slight ability to focus , wasnt sure it was working , this was day 2 on 18 mg straterra on feb 6 , feb 7 i felt much beter in the a.m but by evening I felt wound up again..to a much higher degree than i thought i was prior to strattera, I read the drug doesnt cause rebound, would a higher dose make it last longer, seemed to last from about 6 am to about 2 am ...I dont want to be a roller coaster. what do you think. My adhd doc wants me to stay at 18 mg for a month..i thought titration was every 3 day to a week...
Deb
Posted by not exactly on February 8, 2003, at 11:25:42
In reply to Re: Straterra » Cindylou, posted by mom2mbcb on February 8, 2003, at 5:43:19
Deb,
Strattera half life is typically 5 hours. If the good effects wear off too quickly, going to b.i.d. or increasing the dose should help. Waiting a month before dose adjustment seems way too conservative.
- Bob
Posted by mom2mbcb on February 8, 2003, at 15:23:15
In reply to Re: Straterra » mom2mbcb, posted by not exactly on February 8, 2003, at 11:25:42
Thank you for your response. I was dissappointed as today day 4 I did not even have any positive effects and felt wound up all day as my usual adhd self does, also I noticed yesterday but more so today i get really sleepy on it, i took it a 6 am and absolutley had to sleep about 2:00 p.m. and wqas out to the world until 4:30 p.m. Is this a usual side effect. I really wanted this stuff to work as i couldnt tolerate side effects of stims. The adderral worked wonders for my focus but i felt realy driven. Iwould kill for that one thought and one thing at a time ability aderral gave me. Any advice would help as I am upsetting myself. I dont know if the pill is making me feel a little down in the dumps or my attitude.
Deb
Posted by not exactly on February 8, 2003, at 16:08:59
In reply to Re: Straterra, posted by mom2mbcb on February 8, 2003, at 15:23:15
How long has it been since you discontinued stim use? Some of your current negative symptoms could be due to stim withdrawal/rebound.
- Bob
Posted by mom2mbcb on February 9, 2003, at 4:11:58
In reply to Re: Straterra » mom2mbcb, posted by not exactly on February 8, 2003, at 16:08:59
well Its been quite a while at least 2 months. I hate to asound so negative, but I'm really trying to stick this one out.. But since I had posted about my feeling down in the dumps it had gradually increased by evening to an uncomfortable depression which I'm generally NOT ACCUSTOMEND TO EXCEPT ( EXCUSE ME MEN) around pms. And even then its not quite this bad. I dont want to quit thiS EARLY in the game if i can stand it . Does anyone know whether this pill is easy to get off If I find I need to. Also All my posts have been around 4 am I get to bed around 12 pm so I am waking up too early also. I normally only have anxiety like symptoms whivh really only show up with the adhd wind up or a too much to do at one time or to much over stimulation of outside necesseties.
Deb
Posted by Phil on February 9, 2003, at 18:51:33
In reply to Re: Straterra » not exactly, posted by mom2mbcb on February 9, 2003, at 4:11:58
No tapering required to stop Straterra.
Posted by paulk on February 9, 2003, at 19:35:22
In reply to Re: Straterra » not exactly, posted by mom2mbcb on February 9, 2003, at 4:11:58
What dosage are you taking? I'm starting out on a very low dosage (10mg) all I notice so far is possibly some iritability and I wake up a bit earlier.
Posted by mom2mbcb on February 10, 2003, at 3:48:38
In reply to Re: Straterra, posted by paulk on February 9, 2003, at 19:35:22
well I started on only 18 mg. Fianl update. I will not take it this morning. Yesterday i was a mental mess and Slept off and on in a fog most of the day. Felt a bit better by 8:00 p.m up today at 4:00 a.m. I have decided this is NOT going to work, So I will do my best to educate myself on behavior and cognitive therapy. Restructuring, Since i started with meds I have had side effects much worse ( although i find adhd makes my life very difficult with a 2 yr old and a 1 year old and very hard in other aspects as well) But I cant deal with the added significant side effects. I am disappoint4ted as i did get a chance to enjoy mental singlemindedness on adderrall, justhad to many physical side effects
Thanks everyone
Deb
Posted by dancingdp on February 10, 2003, at 7:08:27
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 3:48:38
Hey Deb,
It sounds like you are ultra sensitive to meds in general. Here is my advise to you. If you really want to give the Stattera a fair try I suggest you take only 10 mg. to start for a week. Then I would increase the dose SLOWLY! You know your system the best. I know that it is supposed to go by weight but I have found that every one is different and if you are at all sensitive than it may take you longer to reach a thereputic level. Talk to your pdoc about it. Take it or leave it. This is my advise from much experience. Good luck!!! dancing
Posted by paulk on February 10, 2003, at 8:50:35
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 3:48:38
> well I started on only 18 mg. Fianl update. I will not take it this morning. Yesterday i was a mental mess and Slept off and on in a fog most of the day. Felt a bit better by 8:00 p.m up today at 4:00 a.m.
I just started on 10mg/day (at 200lbs) and think it would have been a big mistake to have started on a higher dosage. After the second day I was having sleep problems and felt shaky. If I had started at a higher dosage I would of been a mess.
from the monograph:
"... A fraction of the population (about 7% of Caucasians and 2% of African Americans) are
poor metabolizers (PMs) of CYP2D6 metabolized drugs. These individuals have reduced activity
in this pathway resulting in10-fold higher AUCs, 5-fold higher peak plasma concentrations,
and
slower elimination (plasma half-life of about 24 hours) of atomoxetine compared with people
with normal activity [extensive metabolizers (EMs)]..."Because of the wide difference in bloodlevel, I (I'm not a doc) would suggest anyone starting atomoxetine(Straterra) to think about starting with a very low dosage. I'm puzzled as to why the remmendations aren't different in the monagraph? Perhaps because it is only labled for children that would tend to be higher metabalizers?
Posted by mom2mbcb on February 10, 2003, at 10:37:40
In reply to Re: Straterra, posted by paulk on February 10, 2003, at 8:50:35
Thanks everyone. Yeah, I hate it that I am sensitive to meds.WOULD GIVE ANYTHING FOR THJE ADERRAL. i WOULD NEVER HAVE known how normal people think one thought at a time and then to have to go off of it and be like this again, Anyway it caused my usual 90/60 b/p to go to 156 /110 and My chest got tight and my arm went numb...tried lowering the dose to 7mg then to 5 still no relief form side effects. Man, I guess i just gotta get used to this and stop ther self pity and try to figure it out. Its hard because situation to situation daily changes and if i only had me to tend to i could do the routine thing, but since having 2 toddlers There is no predicatablity and i cannott sort all the calls for my attention and it changes daily and i get informTION, DEMAND FOR MY ATTENTION and sound overload. Sorry for the details. I'm just really discouraged. I didnt get this mood change thing with the stims that straterra did and THe thought of even taking 10 scares me, I dont want to add this moodiness on top of my anxiety/disorganized forgetful, butterfly ,pinball brain. I am glad to have yalll to discuss it with , i lurked for days before i decided to try straterra. i MUST BE A poor metabolizer I STILL FEEL STRUNG OUT /MOODY. HOPEFULLY THAT WILL IMPROVE
DEB
Posted by Peter S. on February 10, 2003, at 11:34:29
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 10:37:40
I started on Straterra at 10mg for 2 days and went up to 20mg. I've noticed an increase in irritability (also apparent at 10mg) which is extremely unpleasant- although I have had more energy. My mood has been pretty bad and I think worse than before. I really want to stop, but I want to make sure that I'm giving it a fair trial. I'm also taking Lamictal and Neurontin.
I wish there was more data on whether the irritablity goes away in time. I really have difficulty tolerating it. Sounds like some other people are having same effect. Has anyone noticed it going away?
Any psychopharmacologists know why Straterra might cause irritability? Does norepinephrine cause irritability? I was thinking that maybe if it's not balanced out with other neurotransmitters (like serotonin)it might do this. What about combining it with an SSRI? God I hate brain chemistry!
Posted by not exactly on February 10, 2003, at 12:43:38
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 10:37:40
Deb,
I agree with the posts by dancingdp and paulk. It's very likely you are one of those "poor metabolizers", and need to reduce your dosage accordingly [see http://www.dr-bob.org/babble/20030119/msgs/137299.html]. This might also explain the problems you've had with other meds. I, too, am very sensitive to most drugs, and have found that my optimal dosage is usually 1/2 (and sometimes as low as 1/10!) the amount that "normal" folks require.
Since Adderall helped but had serious s/e problems, you might want to try good ol' plain dexedrine instead. The l-amphetamine isomers (present in Adderall but not dex) can rub some people the wrong way (myself, for example) and may have been responsible for the high BP. But whatever you do, start with TINY doses. I find that as little as 1 mg/day of dexedrine can be a big help.
Another med you might want to try (in tiny doses, of course) is Ritalin.
BTW, your "usual" BP of 90/60 seems REALLY LOW. What does your pcp think of this?
- Bob
Posted by Dog Breath on February 10, 2003, at 14:53:10
In reply to Re: Straterra, posted by paulk on February 10, 2003, at 8:50:35
It amazes me how people react so differntly to meds. I must be at the far end of the scale. I am on day 19 of Straterra along w/20mg Lexapro and I can't say I have felt anything! I've heard others talk about a "brightening" of mood and increased focus. I'm at 80mg for the last 7 days but It hasn't made any difference. Has anyone else had this reaction? Is 19 days not long enough?
D
Posted by paulk on February 10, 2003, at 17:00:20
In reply to Straterra irritablity, posted by Peter S. on February 10, 2003, at 11:34:29
> I started on Straterra at 10mg for 2 days and went up to 20mg. I've noticed an increase in irritability (also apparent at 10mg) which is extremely unpleasant- although I have had more energy. My mood has been pretty bad and I think worse than before. I really want to stop, but I want to make sure that I'm giving it a fair trial. I'm also taking Lamictal and Neurontin.
>
> I wish there was more data on whether the irritablity goes away in time. I really have difficulty tolerating it. Sounds like some other people are having same effect. Has anyone noticed it going away?
>
> Any psychopharmacologists know why Straterra might cause irritability? Does norepinephrine cause irritability? I was thinking that maybe if it's not balanced out with other neurotransmitters (like serotonin)it might do this. What about combining it with an SSRI? God I hate brain chemistry!
>
Why not go back to 10mg/day - at least until the iritability goes away?
Norepinephrine can do that - you may want to take it with food to limit the peak blood level a bit - smooth things out. I take it you read how for 10% of the population it is 5 times more powerful.This is my first day at 20mg - Seems to be pretty good.
Posted by paulk on February 10, 2003, at 17:04:51
In reply to Straterra-Nothing » paulk, posted by Dog Breath on February 10, 2003, at 14:53:10
As is in the earlier posts - It appears that this drug has a wide range on blood level depending on your genes. You may just need more. I would say if you can't tell you are taking it after 2 - 5 days you probably arn't taking enough. I could tell it was doing something the second day on 10mg. For you, that same blood level could be the same at 50mg.
Posted by Peter S. on February 10, 2003, at 17:38:27
In reply to Re: Straterra, posted by paulk on February 10, 2003, at 17:00:20
paulk- thanks for the advice- I'll probably give the lower dose a try. I'm wondering how often people are taking straterra- once or twice per day?
Thanks!> > I started on Straterra at 10mg for 2 days and went up to 20mg. I've noticed an increase in irritability (also apparent at 10mg) which is extremely unpleasant- although I have had more energy. My mood has been pretty bad and I think worse than before. I really want to stop, but I want to make sure that I'm giving it a fair trial. I'm also taking Lamictal and Neurontin.
> >
> > I wish there was more data on whether the irritablity goes away in time. I really have difficulty tolerating it. Sounds like some other people are having same effect. Has anyone noticed it going away?
> >
> > Any psychopharmacologists know why Straterra might cause irritability? Does norepinephrine cause irritability? I was thinking that maybe if it's not balanced out with other neurotransmitters (like serotonin)it might do this. What about combining it with an SSRI? God I hate brain chemistry!
> >
> Why not go back to 10mg/day - at least until the iritability goes away?
> Norepinephrine can do that - you may want to take it with food to limit the peak blood level a bit - smooth things out. I take it you read how for 10% of the population it is 5 times more powerful.
>
> This is my first day at 20mg - Seems to be pretty good.
>
Posted by ShelliR on February 10, 2003, at 17:41:26
In reply to Straterra-Nothing » paulk, posted by Dog Breath on February 10, 2003, at 14:53:10
well, I've been at 40mg of straterra for a week and feel nothing either. Nothing good; nothing bad. I don't want to go from 40mg to 80mg overnight; I've got to get some of those gel capsules to fill so I can split one 40 into a 20, then proceed with 60mg of straterra next.
Feeling really bad OR feeling nothing have not been good indicators for me in the past. In the hopes that there might be a first time, I'll continue up until at least 80mg for a week. At least it's not making me feel bad.
Shelli
Posted by mom2mbcb on February 11, 2003, at 3:10:38
In reply to Re: Straterra » mom2mbcb, posted by not exactly on February 10, 2003, at 12:43:38
Good thought on Dex, Thanks .
All my docs arent worried about b/p normally being 90/60 as Im only 110 lbs. But it normally in illness has gone to 78/48 and then i got pumped with I.V fluids so the High B/P was more of a concern outta my norm,. I am going to ask the doc about dex. I tried it before but then again I had the Normal dose also.
Deb
Posted by mshyper on February 11, 2003, at 17:07:24
In reply to Re: Straterra, posted by mom2mbcb on February 11, 2003, at 3:10:38
Hi all,
Today is day 14 for me (1st 9 on 18mg-next 5 on 40mg) I take my dose once a day in the morning. Sleepiness finally went away on Sunday (day 12), nausea appears to be gone too. Have been taking with food since experience on Friday and have not had another blood sugar drop. Still have some dizziness, but blood pressure is great! Strattera actually taking care of my anxious stress. Top number dropped 10 and bottom 20. Current # is 140/66. Seem to have clarity most of the day with a couple little daydream sidetrips here and there, but not nearly as bad as before. Will check back in later in the week.
Posted by val on February 16, 2003, at 12:49:09
In reply to Re: Straterra » Cindylou, posted by mom2mbcb on February 8, 2003, at 5:43:19
my son started to take strattera, 18 mg, now on
25 mg. he used to take 54 mg concerta
+ 10 mg ritalin in am.
I haven't noticed the ritalin rebound so much,
but an overall hyperactiveness still, almost like
a regualr kid again. (he is 9rs old) school seems to
be going well, and homework hasn't changed much,
still a bit of a struggle, but am willing to see
if it improves. He is moody, but always is when he
isn't feeling well (flu season). I am hoping that
his ticks will subside, as they seem to be getting
worse with the increase of ritalin. He has been on
strattera for a week now...time will tell. We tried
Adderall, but it made him VERY emotional....
Posted by disney4 on February 17, 2003, at 13:34:06
In reply to Re: Straterra, posted by val on February 16, 2003, at 12:49:09
Could I hear from people who have taken Straterra or Wellbutrin SR for ADHD or ADD? My son has ADHD, and for 19 years we have tried stims-worked well, but caused tics, Desipramine--didn't do enough, and now Wellbutrin SR and Catapress. He hasn't been taking the Catapress recently, and has been on a sub-therapeutic dose of the Well SR. His dose of the Well SR will be increased to the 2 150 tabs, from one a day. I am wondering if it would be better to switch him to Straterra. Does it work better for focus and concentration than the Wellbutrin? My son also has anxiety, and may be smoking pot at times too. We also tried him on Neurontin and Depakote with not much benefit seen.
Posted by essence on February 18, 2003, at 7:05:41
In reply to Re: Straterra or Wellbutrin Sr for ADHD, posted by disney4 on February 17, 2003, at 13:34:06
My son starts Wellbutrin today for ADD - inattentive type,he also has depression and an anxiety disorder, he's 15. It would have been nice to have had some feedback....good luck to you and your son, hope things get resolved.
Posted by SLS on February 18, 2003, at 7:21:17
In reply to I hope you get replies, I didn't when I asked.!!! » disney4, posted by essence on February 18, 2003, at 7:05:41
> My son starts Wellbutrin today for ADD - inattentive type,he also has depression and an anxiety disorder, he's 15. It would have been nice to have had some feedback....
Hi.Don't take it personally.
Perhaps no one here can answer your question for lack of knowledge or experience.
It appears that Strattera is a much better drug for ADD/ADHD than Wellbutrin. You might want to look into adding a psychostimulant to either drug.
- Scott
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