Posted by The Bean on October 24, 2003, at 9:20:58
In reply to Switching from Adderall to Straterra, posted by Plucky on October 23, 2003, at 17:32:21
I've posted a longer version of the whole med history rollercoaster which you can read if you want too - I'll focus on the Strattera/Adderall part.
My experience with Strattera - as it has been very positive overall - albeit difficult to get to the optimal dosage.
I was diagnosed with ADD - Inattentive Type about 5 years ago as an adult, at age 37. Have tried a million different combinations of things . . .
I'm currently taking 75mg Adderall XR in the morning after breakfast and just started on a low dosage of Strattera at 10 mg/day and I take it at bedtime. I wake up more alert, and sleep about 1 hour longer than I did with just Adderall XR alone, so I'm now getting a decent 6.5 hours a night. Usually a much higher dose of Strattera is recommended, but that didn't work for me.
I started with short acting Adderall, years ago and it was good, but didn't last through my whole day. Started Adderall 40mg in the am and Ritalin 20mg in the afternoon for about 2 years. Adderall's 1/2 life kept me awake too long at night, and for some reason, when I started the day with Adderall and took the Ritalin later in the day, I didn't get the "anxious/paranoid" feeling I get when I take Ritalin alone.
Started on Adderall XR when it came out and it was REALLY great for several years, but over the whole 5 years I've been on medication, I've lost about 15-20 lbs (I am NEVER hungry and have to remind myself to eat - and I do - about 6 small meals a day). When I got down to about 110 lbs (I'm only 4'11", so it's not as thin as it sounds!) the Adderall XR began to make me feel quite edgy and impatient all the time. It was always MUCH worse in the week before my menstrual cycle.
We tried adding different anti-depressants to help with the "mood dysregulation" and depression issues around my cycle. Effexor, which was great for the first week, but seemed to build up in my system and I got progressively sleepier and more sluggish the longer I took it. Then Wellbutrin - and on the Wellbutrin, I didn't sleep for 4 days straight, got MORE depressed and actually felt suicidal. I stopped the Wellbutrin at that point : - )
So we stopped Adderall and tried Dextrostat, thinking it might take that "edge" off, (which it did) but I never felt like I had the mental clarity I got with the Adderall XR, and it didn't change the "hell week" experience before my period all that much, so I went back to Adderall XR and added the support of Celexa tablets.
Taking Celexa all the time was too much (it makes me VERY sleepy - even at low dosages) similar to Effexor. So we tried LIQUID Celexa which I now take 1/2 tsp of ONLY the 10 days before my period is supposed to start. (I just count 19 days from the start of my last cycle, as I have a 29 day cycle and start taking it). That low of a dosage is technically not a "therapeutic" level and shouldn't have any effect - but it TOTALLY evens out the "witch" behavior and crying hysteria that I used to have, for what it's worth!
Six weeks ago, we decided to try Straterra, since I was still feeling the "edgy" with Adderall XR and clearly I'm OK about "tinkering" with meds.
I started at 18 mgs, and was supposed to increase the Strattera while decreasing the Adderall XR over a period of 6-8 weeks. I was advised NOT to cold turkey on the stimulant, but to ramp up the Strattera and ramp down the stim.
The FIRST DAY on 18 mgs and my full dose of Adderall XR was good, but days 2 & 3 were AMAZING!! I had the 3 most productive, happy and "smart" days I've had in 20 years. I suddenly had a vocabulary and was really excited at my ablity to focus even better!
Then, I started the ramp down process and decreased the Adderall and it went to hell in a handbasket! 24 mgs of Strattera and 75 of Adderall and I was MEAN. 24 mgs of Strattera and 50 of Adderall and I was fuzzy and slow. 40 mgs of Strattera and 50 mgs of Adderall and I was sluggish and "dopey" - like I feel on antihistamines (like I can't put two sentences together, very clumsy and sleepy, etc.) 60 mgs Strattera and 50 of Adderall was even worse for the sluggish/dopey feeling, so we stopped the Strattera to start over again and get feeling of the 3 good days back. It took about 3-4 days for all the effects of the Strattera to clear my system.
I started over and after a week at 18 Strattera/75 Adderall, I was not sleeping well and was getting more impatient and snippy - and OVER focused. First time around, I didn't take the Celexa for those 10 days before my period and that was a BIG MISTAKE!
I dropped the dosage to 18 mgs every OTHER night before bed and found that day 1 was still edgy and tending to overfocus, but day 2 was not edgy, AND I still had the increased clarity from beore without the OVER focusing.
I took the Celexa this time for the 10 days in my cycle and it worked well - except I think I need to keep taking Celexa a little longer. I finally put it together that when I stop taking it on the day my flow starts it often triggers a migraine (too fast a drop in my Seratonin level, I suspect!)
My doc tells me I'm a "statistical outlayer" (which I suppose is just a polite way to say that I'm a wierdo) but apparently using Strattera at such a low dosage is not the "norm". I realize that nothing I've ever tried that has worked really is, so I'm just delighted to have what feels like the best combination I've ever had.
Hope that gives some insight!
poster:The Bean
thread:133458
URL: http://www.dr-bob.org/babble/20031021/msgs/272662.html