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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by bige on August 25, 2003, at 22:04:44
In reply to Re: Response to Lasagna » ben12, posted by Lasagne on August 16, 2003, at 22:57:46
I had been on Ritalin for ten yrs with anxiety developing lately.I heard about Strattera and Mr. Dr. gave me the free samples and set me out on my own. I ahve learned alot in these threee weeks I am currently on 25 and going up to 40 tommorow. I have more clairty and I have lost around 15 pounds. But I feel like I have narcolepsy. I have to sleep for at least 10 min every day in the afternoon or I am zombie like. I stare off into space for minutes for what seems like an eternity. I am entering into my third year of LAw School and I hope that this drug helps my grades but I have to stay awake for class. I am 40 yrs old and 240 lbs it seems like I am not taking nearly enough but I dont want to go up on thedose even through I feel it working. I also take Wellbutrin and Lexapro. How long till these side effects wear off does anyone know?
Posted by Mike Oxsbig on August 26, 2003, at 12:02:06
In reply to Re: Response to Lasagna, posted by bige on August 25, 2003, at 22:04:44
Bige
As noted I started on 40 and went to 80 the first week. I stayed at 80 for a month then went to 120 for a month or so. I was falling asleep for about a week, then the symptoms went away. I am 6'3 and weigh about 220 and am 37. I have gone back to Concerta because the Straterra while not a bad experience did not give me enough benefits over stimulants. I am also working my way off of lexapro. For the last week I have been taking half of a 10mg tablet. So far so good.
Don't know what to tell you other than sharing my experience. The only bad side effects I had were in the sexual department.
Good luck
Posted by Trixie on August 29, 2003, at 14:25:13
In reply to Re: What Strattera dose is too low/high, help.., posted by lessismore on August 21, 2003, at 12:39:29
I started Strattera 40 mg in the AM a week ago and am experiencing a tremendous degree of fatigue. I'm exhausted by noon and if left to my own devices, would sleep for the rest of the afternoon. I am also experiencing insomnia; I can fall asleep if I take an Ambien but as soon it wears off, around 4 am, I cannot get back to sleep.
I can't tolerate this for much longer b/c it is destroying my ability to perform at work.. .I was wondering whether anyone has been able to overcome this side effect through evening or night dosing, and whether anyone has had this side effect resolve in time.
This is my first posting here - I was recently diagnosed with ADD and this is the first ADD med I have tried.
Thanks.
Posted by Lasagne on August 29, 2003, at 14:59:56
In reply to Strattera and fatigue: AM or PM dose?, posted by Trixie on August 29, 2003, at 14:25:13
> I started Strattera 40 mg in the AM a week ago and am experiencing a tremendous degree of fatigue. I'm exhausted by noon and if left to my own devices, would sleep for the rest of the afternoon. I am also experiencing insomnia; I can fall asleep if I take an Ambien but as soon it wears off, around 4 am, I cannot get back to sleep.
>
> I can't tolerate this for much longer b/c it is destroying my ability to perform at work.. .I was wondering whether anyone has been able to overcome this side effect through evening or night dosing, and whether anyone has had this side effect resolve in time.
>
> This is my first posting here - I was recently diagnosed with ADD and this is the first ADD med I have tried.
>
> Thanks.
>Response to above:
Hi: I began the Strattera in the morning and I experienced the same as you are. The doctor advised me to switch to the evening. It helped resolve the daytime sleepiness, but after about a week or so I began having several wakeful periods in the middle of the night. It seems like every two hours I would awaken instead of just sleeping all the way through the night. My doctor then put me on a small dose of Flexeril 10 mgs (a muscle relaxer) at bedtime. That resolved the sleep issues. After about 5-6 weeks on the Strattera most of the obnoxious side effects reduced or completely went away. I can understand your frustration especially if you have to work a full time job. Luckily when I started the Strattera I was a stay at home mom and had flexibility with my schedule. I didn't seem to get much done during the foginess, nausea, lethargic period, but now I do get a lot accomplished and I can go without a nap more often than before my ADD treatment. So all I can say is be patient. If the Ambien doesn't do the trick for you, then you might want to consider a small dose of a muscle relaxer. It really makes a huge difference in how I sleep.
Good luck, Lasagna
Posted by lessismore on August 29, 2003, at 15:14:42
In reply to Strattera and fatigue: AM or PM dose?, posted by Trixie on August 29, 2003, at 14:25:13
I take it at 11:00 or so at night, and I also experience fatigue, but not as much as if I took it in the morning. I am about to start my third week, I'm at 40mg, and have noticed a big improvement. Side effects suck, but it's worth it if I can get organized! And they'll go away.
Posted by manyparts2001 on August 29, 2003, at 16:26:32
In reply to Strattera and fatigue: AM or PM dose?, posted by Trixie on August 29, 2003, at 14:25:13
I never experienced drowsiness with Straterra, but did have wakefulness during the night, so I took an herbal supplement of melatonin which is not habit forming and doesn't leave me feeling drowsy in the morning.
After being on it since April at 80mg/day divided twice/day I finally stopped taking it because of all of the side effects, aggressive behavior, rapid heart beat, profuse sweating and a lot of anger. The benefits were not worth it to me even thoughI was able to concentrate so much better. Oh yes, I also, supplemented with Ritalin 2-3 times /day, and that is what I am on now, with none of the able side effects. Good luck. I hope it works out for you.
Posted by Trixie on August 29, 2003, at 20:19:53
In reply to Re: Strattera and fatigue: AM or PM dose?, posted by manyparts2001 on August 29, 2003, at 16:26:32
Thanks, everyone, for sharing your experiences.
Posted by keffrey on September 1, 2003, at 7:29:01
In reply to Re: Strattera and fatigue: AM or PM dose?, posted by Trixie on August 29, 2003, at 20:19:53
Does anyone have any experience with Wellbutrin and strattera? My 12 year old son has been on Wellbutrin for over a year with pretty good social skills related results. However, Wellbutrin has done nothing for pretty severe attention issues. We are now considering Strattera for those.
Thanks
Posted by bige on September 1, 2003, at 7:36:30
In reply to Re: Strattera and fatigue: AM or PM dose?, posted by Trixie on August 29, 2003, at 20:19:53
In regards to wellbutrin and strattera. I have been on wellbutrin for 2 years along with Ritalin. Worked ok for me but I am 40 yrs old. Just switchedabout a month ago to strattera and Wellbutrin and it works great so far.
Posted by keffrey on September 1, 2003, at 9:55:16
In reply to Re: Strattera and fatigue: AM or PM dose?, posted by bige on September 1, 2003, at 7:36:30
> In regards to wellbutrin and strattera. I have been on wellbutrin for 2 years along with Ritalin. Worked ok for me but I am 40 yrs old. Just switchedabout a month ago to strattera and Wellbutrin and it works great so far.
ThanksHas your doctor mentioned the possibility of eliminating the Wellbutrin?
Posted by bige on September 1, 2003, at 16:33:05
In reply to Re: Strattera and fatigue: AM or PM dose?, posted by keffrey on September 1, 2003, at 9:55:16
No he hasnt mentioned going off Wellbutrin but I also was on Lexapro and I took myself off of that.
Posted by Lasagne on September 2, 2003, at 14:27:56
In reply to Re: strattera and wellbutrin, posted by keffrey on September 1, 2003, at 7:29:01
> Does anyone have any experience with Wellbutrin and strattera? My 12 year old son has been on Wellbutrin for over a year with pretty good social skills related results. However, Wellbutrin has done nothing for pretty severe attention issues. We are now considering Strattera for those.
>
> ThanksReply to above post: We don't have experience with Wellbutrin and Strattera combined, but my son does take Celexa (another antidepressant) with the Strattera. Right now he is having great results on both medications. He is 11 years old and he takes 25 mgs. of Strattera in the a.m. and 50 mgs. of Strattera in the evening along with his Celexa.
My husband takes Wellbutrin and it does have some effect on the impulsiveness of ADD, yet alone it doesn't give enough control so my husband takes Concerta (time release Ritalin) with it. The Wellbutrin mostly helps keep my husband's mood stabilized and the Ritalin helps keep him focused and not so impulsive or hyper.
Good luck!
Lasagna
Posted by utopizen on September 2, 2003, at 19:19:11
In reply to Re: Strattera and fatigue: AM or PM dose?, posted by bige on September 1, 2003, at 16:33:05
Well, when I started on Abilify, I was extremely tired just 20 minutes after taking it, it may as well have been a sleeping pill I was so slowed down, I really had to sleep when I took it. Luckily, I started taking it at night.
A few days later, however, I noticed I could take it in the AM, and that it didn't make me tired at all (it might have even made me less tired). So I think it's always good to try starting for the first week or two on a low-dose in the PM on meds, then if you notice you can still be awake like 2 hours later after taking it, take it in the AM if you want.
My sleep doc suggested Straterra as one of the options for me (I'm a bit tired during the day, and have ADD). Right now I take Desoxyn, but it is annoying to have to take it every 4 hours. I'd like to at least augument it with it if I respond well to it, it's something my doc's had in mind for me to try out for a few months.
But no one here has noticed feeling less tired than they did before after taking Straterra?
Provigil didn't do anything for me, even at 500mg.
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