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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by 10derheart on October 10, 2012, at 18:10:16
Okay, first don't faint - I know I **never** start posts on this board. But I do read a lot so I feel like I kinda, sorta know some of you. And boy do I have a head full of random info about meds and conditions...it comes in handy sometimes :-)
I've been taking Strattera 80 mg daily for over eight years. I'm beginning to wonder if I need a dose increase. I'm having a lot of trouble concentrating and organizing my thoughts and some tasks, enough to where it is affecting my life negatively.
At first I thought this was more about bad sleep, low confidence, some pure laziness and plain old anxiety. I'm sure those probably do play a role. But even on days when I'm well rested, like what I;m reading or studying, calm....I still can't sustain things like before. I don't seem to be functioning, in the executive function area, all that well. I am in a new school working on my B.A. (about two months) and things have slowly slipped downhill in the stick-to-it-ness department. I need to see if meds are part of the problem because just talking to my T. (MSW-no prescribing) about anxiety and stress isn't helping one bit. She is highly in favor of me checking out the option of increasing meds.
I have not felt any need to augment the atomoxetine for all these years, I even tried to reduce it to 60 mg daily just to see if I could. But I went back up to 80 within a week because it just felt...weird, for lack of a better word. Not sure about increase in symptoms then, but frankly, I had a no stress life where I wasn't working or in school and could do as I pleased, so it was hard to discern.
The thing is....(I hate this part since I have to be honest) I weigh 50-60 pounds more than I did when the 80 mg was prescribed. The FDA max appears to be 100 mg a day, but I understand that is because of lack of efficacy over 100, not from any danger to me, correct?
Would it be reasonable to try 120 mg a day for a couple days as an experiment? I have a whole bottle of 60 mg, perfect for this. Obviously, it makes sense to try 100 since I am on 80 now, but I'm not quite sure about opening capsules and approximating a dose like that. Guess I could since i have the 60s. I am pretty heavy and charts out there would put me at 120 mg daily, not 100, if you disregard the FDA max.
Another lovely unintended consequence to being overweight - needing more of a med. :-((
I'm also wondering about adding some IR Ritalin. That was my first ADD med and it worked well with Prozac years ago. I got up to 20 mg x 4 daily. Is there any problem augmenting Strattera with MPH - say 5 or 10 mg x 2 daily, or less as the situation calls for? The problem is....I have HBP, totoally controlled with meds, but I have had docs in the past frown on *any* stimulants for someone with hypertension issues. My old pdoc of years ago trusted me checking my BP and noting the Ritalin didn't change one thing, so he continued to script it even when the PCP got all huffy with him. He is such a cool guy....
Few pdocs in my area any more and none that take my insurance (yikes!) so I'd have to propose this to my regular doc. He's nice enough, but it makes me nervous.....
I dunno. Got to try something before this college thing spirals out of control.....
Thanks for reading. All replies welcome (yes, you, too Lou) - 10der
Posted by phillipa on October 10, 2012, at 18:32:40
In reply to ADD issues/Strattera dosing questions (long), posted by 10derheart on October 10, 2012, at 18:10:16
10der I'm sorry this is happening to you as you are one of the only babblers that has seemed through the years to be in remission.
Sounds like you could be handling a heavy load with the school. Is this for working or to increase your knowledge and just get a higher degree? Can you take less classes? Would it be possible to lose a bit of the weight. Think this would also lower BP and allow the med to work as before? Not having taken a stimulant not much advise I can offer. Phillipa
Posted by rjlockhart37 on October 11, 2012, at 14:42:06
In reply to ADD issues/Strattera dosing questions (long), posted by 10derheart on October 10, 2012, at 18:10:16
usally when the mind changes under conditions the chemistry and the mental process, can change. Over time...strattera can lose the original effect it had for 8 years you said, and begin to become more indirect in its actions.
A suggestion besides Ritilin which is high recommended by me...is Provigil with Namanda which is smart drug...also used for decline in thought process...usally in the elderly, but still it can work for adults. It could vary well be tolerance starting with strattera...you can take l-tyrosine at a low dose and that should boost the NE levels that strattera increases. Dopamine is good for thought structure and motivation....another recomend is Dexedrine, that will definetly help your problem...belive me. An SNRI could be added to help the strattra with NE...but your doctor may avoid that suggestion, in that in sounds ineffective. Aricept also would be a good option with Provgil or you could just try the provigil with strattera.
If you increase your dose....really if not tolerant completly to it, it will increase NE levels...but anything higher than 120mg is not recommended, excess NE. Get with a dopamine enhancing medication...it will improve your thoughts and motivation.
Keep us updated
r
Posted by phidippus on October 12, 2012, at 18:19:53
In reply to ADD issues/Strattera dosing questions (long), posted by 10derheart on October 10, 2012, at 18:10:16
>Would it be reasonable to try 120 mg a day for a couple days as an experiment?
20 mg of difference isn't going to be noticeable.
I can't tell if you're on a stim. Are you?
Eric
Posted by Christ_empowered on October 13, 2012, at 12:31:16
In reply to Re: ADD issues/Strattera dosing questions (long) » 10derheart, posted by phidippus on October 12, 2012, at 18:19:53
I had a friend on adderall plus straterra, and that seemed to work better than either alone did. Ritalin might be a good call. Maybe Vyvanse? I'm just throwing that out there because its new and cleaner and smoother and....basically, if you ask for a stimulant, vyvanse might come up, is what I guess I'm saying.I don't know what to tell you about HBP. They used to give amphetamines out like candy to obese people, even when there was mild to moderate hypertension on board, so it can't be that big a deal. But, you know...21st century. Amphetamines for full grown adults is still kinda frowned on, and there are liability concerns.
You may just want to talk to your doc. Provigil, Nuvigil...I guess those could work. I don't know how they did in studies w/ ADD/ADHD.
There's also (I know you saw this one coming) Orthomolecular Medicine. They have combos for attention issues. I have no idea if they actually work, but it might be a good first step before asking for a controlled substance. Also, then you can tell your doc "Look! I've tried EVERYTHING but the Rx speed!" and he might be more accommodating.
Orthomolecular is usually cheap. Depending on your insurance, though, an amphetamine might be cheaper.
Posted by phidippus on October 13, 2012, at 17:21:48
In reply to Re: ADD issues/Strattera dosing questions (long), posted by Christ_empowered on October 13, 2012, at 12:31:16
>Maybe Vyvanse?
I take Vyvanse and love it. I prefer it to Concerta, Adderrall, Ritalin and Dextroamphetamine.
>Provigil, Nuvigil...I guess those could work.
Nope. I've taken em and they didn't help with the ADHD. Several studies back me up.
>There's also (I know you saw this one coming) Orthomolecular Medicine.
Orthomolecular Medicine, huh? Fascinating.
Look, nothing performs like a stim when it comes to treating ADHD. Why waste time with anything else?
Eric
This is the end of the thread.
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