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Dr. Bob is Robert Hsiung, MD,
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Posted by jrbecker on December 28, 2002, at 11:22:33
In reply to Re: Straterra approval. » scoper, posted by viridis on December 28, 2002, at 2:52:55
look for Strattera coming out around the 15th of January. It's actually a NARI, not an SNRI, since it has no effect on the serotonin system. It has a mild affinity to some dopamine subreceptor types as well.
This will be a great adjunct for atypical depressive types as well as any ADHD types with comorbid depressive features. I myself am first in line to my doc to try it. The data looks very promising, especially for subjects with comorbid affect disrders. I have augmented with stimulants for years now to help my atypical symptoms as well as issues with focus. I'm quite confident that Strattera will probably be a better fit for me than the stimulants have been. Check out medscape or strattera.com for more info.
If you're awaiting a good new SNRI, look out for Cymbalta (duloxetine) -- which is also by Lilly --to be released in 3-4 months. It looks to be a fairly good improvement on Effexor.
Posted by noa on December 28, 2002, at 18:22:13
In reply to Re: Straterra approval., posted by jrbecker on December 28, 2002, at 11:22:33
I think by "SNRI", viridis was indicating "selective norepinephrine reuptake inhibitor", which is what you were saying, too (just using different initials). This is also how it was described to me by someon I had the good fortune to meet who happens to work at one of the research sites where the efficacy studies were done (comparison to other meds or no meds). This was about a month and a half ago. At that point, he told me it had been delyed (he thought until next spring) by frivolous legal attempts by the competitors to just delay the approval (the latest challenge was that the stimulant manufacturers wanted the FDA to classify the atomoxatine as a controlled substance--even though it contains nothing that should be controlled--just because it would be unfair to the competitors). So I'm glad the approval came through sooner than this guy expected. He said (and granted, he may be biased!) that there were very little signs of side effects because its action is highly selective and that it was shown to be effective.
In any event, it is nice to see an alternative to stims come out. There is not enough R&D on new meds (although this was, my understanding is, actually an old drug unburied from many years of not being used for anything.
I don't know if will help me as I take adderall not for ADHD but for depression, and augmentation of my antidepressants, although it does alleviate the symptoms that are ADHD-like. I asked my pdoc about it last week and he said he has not experience with it so he doesn't know if it would be better than adderall for me (I have no particular complaints about adderall anyway) but he said it is related to reboxetine, which is not approved in the US, although he has one patient who gets it from England. He just doesn't know how similar it is to Reboxetine or not.
Posted by Noelle on December 29, 2002, at 16:41:24
In reply to Re: Straterra approval., posted by jrbecker on December 28, 2002, at 11:22:33
Does this medication work by stimulating the frontal cortex only and not the central nervous system. I'm assuming this will help with executive functioning, yet without the rebound depression caused by stimulant use
Posted by Jim Boardman on January 5, 2003, at 19:02:49
In reply to Re: Straterra approval., posted by Noelle on December 29, 2002, at 16:41:24
I began taking Straterra last friday, Jan 3, 2003. I have been diagnosed with ADD comorbid with bi-polar. Adderall depressed me, Concerta put me to sleep. My pdoc has given me Gabitrol to control my highs, and has tried all standard ADD meds. Thus, the Straterra. Day 1: felt spacey and sleepy. Day 2: a bit sleepy and spacey. Today: feel ok, but still a bit foggy. I start the 2 cap a day med tomorrow. I do notice I am having some trouble peeing... otherwise, everything seems ok. I stay in touch. If you want to contact me, use jboardman@qtm.net.
Jim
Posted by BekkaH on January 5, 2003, at 20:59:43
In reply to Re: Straterra approval., posted by Jim Boardman on January 5, 2003, at 19:02:49
Hi. Thanks for letting us know how you are doing. Please keep us informed. I thought that your feelings of sleepiness during the first few days might have been due to stimulant withdrawal (assuming you are no longer on the stimulants) and may not be directly related to the Atomoxetine. In "ESSENTIAL PSYCHOPHARMACOLOGY," Stephen Stahl discusses the "pseudo-anticholinergic" side effects (such as urinary retention) often caused by norepinephrine reuptake inhibitors. He says, "Stimulation of the noradrenergic receptors in the sympathetic nervous system may also cause a net reduction of parasympathetic cholinergic tone, since these systems often have reciprocal roles in peripheral organs and tissues. Thus increased norepinephrine may produce symptoms reminiscent of anticholinergic side effects. This is not due to direct blockade of muscarinic cholinergic receptors but to indirect reduction of net parasympathetic tone resulting from increased sympathetic tone." In addition, he says that these "pseudo-anticholinergic" symptoms are usually milder and not as long-lasting as true anticholinergic effects.
Posted by Jim Boardman on January 6, 2003, at 14:04:55
In reply to Re: Straterra approval - Jim Boardman, posted by BekkaH on January 5, 2003, at 20:59:43
Day four Straterra: A little flakey feeling, but I seem to be able to concentrate a bit more closely. I am still having trouble urinating, and I have developed a bit of diarrhea. Last night I awoke at about 2AM with some really strong panic feelings. This could still be withdrawal from the Concerta - don't know. I have important business tomorrow out of town, so I'll let you know how I perform.
FYI, I didn't mention all the pshyc meds I take. I take a remeron at night with the two gabitrol, and in the morning a 10 mg Lexpro with the two gabitrol and the straterra (80 mg).
stay tuned.
Jim
Posted by nmk on January 6, 2003, at 15:00:47
In reply to Re: Straterra approval., posted by Jim Boardman on January 5, 2003, at 19:02:49
Hi Jim,
I start Straterra tomorrow and will keep up with your posts and keep others posted as well. Has the dizziness gone away? I rememeber the horrible dizziness I experienced with Effexor and I hope it is not similar. Please keep us informed.
Nicole
Posted by Peter S. on January 6, 2003, at 18:38:46
In reply to Re: Straterra approval., posted by nmk on January 6, 2003, at 15:00:47
Thanks to both of you for keeping us up to date. I'm curious as to whether Straterra has anti-depressant effects along with attentional effects.
Posted by BekkaH on January 6, 2003, at 19:35:14
In reply to Straterra updates, posted by Peter S. on January 6, 2003, at 18:38:46
> I'm curious as to whether Straterra has anti-depressant effects along with attentional effects.
***********************************************Hello Peter,
I've read that it IS an antidepressant; it just hasn't been marketed as one yet. So far, it has been approved only for ADD. In order to be marketed as an antidepressant, Lilly will probably have to run clinical trials to prove its efficacy as an antidepressant and then try to get FDA approval for that purpose.
Posted by Jim Boardman on January 6, 2003, at 19:40:37
In reply to Re: Straterra approval., posted by nmk on January 6, 2003, at 15:00:47
Nicole,
The dizzyness passed almost right away. I still feel a little flakey, but I think that will pass as well. It is nothing like the drugged out feeling I experienced when I took Elivil years ago.Jim
Posted by nmk on January 7, 2003, at 10:49:58
In reply to Re: Straterra approval., posted by Jim Boardman on January 6, 2003, at 19:40:37
> Nicole,
> The dizzyness passed almost right away. I still feel a little flakey, but I think that will pass as well. It is nothing like the drugged out feeling I experienced when I took Elivil years ago.
>
> JimJim,
What dose are you taking? Today is my first day and I am taking 18 mg. I have noticed an improvement in my depression but I feel a little hyped-up. Let's keep each other posted.
Nicole
Posted by Christina on January 7, 2003, at 14:16:15
In reply to Re: Straterra approval., posted by nmk on January 7, 2003, at 10:49:58
I'm currently taking Adderall XR, and my doc mentioned the possibility of trying Straterra in the future since Adderall quits working at the end of the day.
I would be interested to see if Straterra increases appetite or causes weight gain like most of the other meds I've tried.
Posted by nmk on January 7, 2003, at 17:19:47
In reply to Straterra: Weight/appetite issues. » nmk, posted by Christina on January 7, 2003, at 14:16:15
> I'm currently taking Adderall XR, and my doc mentioned the possibility of trying Straterra in the future since Adderall quits working at the end of the day.
>
> I would be interested to see if Straterra increases appetite or causes weight gain like most of the other meds I've tried.
>
Christina,When I asked my doc about side effects, he said Straterra has a tendency to decrease appetite. This is good news for me since I need to lose a few.
Posted by nmk on January 8, 2003, at 9:50:56
In reply to Re: Straterra approval - Jim Boardman, posted by Jim Boardman on January 6, 2003, at 14:04:55
> Day 2: Despite feeling very hyped-up yesterday, I was able to sleep through the night with my seroquel/remeron combo. Today I don't feel as hyped but I am experiencing some dizziness...nothing compared to effexor though. The depression is better, little anxiety, and no need to take the ativan today. I just hope the dizziness passes.
Posted by Jim Boardman on January 8, 2003, at 9:55:00
In reply to Re: Straterra: Weight/appetite issues., posted by nmk on January 7, 2003, at 17:19:47
Ok, day 5 of Straterra. I had a really important business meeting. Lots of stress, travel 2000 in one day, etc. The Straterra works wonderfully! Not only does it decrease my appetite (a good side effect for me), but it increases my ability to concentrate AND seems to calm me down! The only lingering side effect is the awful taste in my mouth and dry throat. I think these should pass as did my having a hard time peeing. I'm at 80 mg per day and this stuff seems to work orders of magnitude better than did Aderall or Concerta for me. But remember, I was a drugged out hippy inthe late 60s and early 70s and my brain doesn't exactly react predictably when in comes to psych meds. More as things develop.
Jim
Posted by Noa on January 8, 2003, at 16:34:34
In reply to Re: Straterra approval., posted by Jim Boardman on January 8, 2003, at 9:55:00
I really appreciate your updates on Straterra. Kind of exciting--the "inside scoop" on a newly approved med.
Posted by BekkaH on January 8, 2003, at 21:37:25
In reply to Re: Straterra approval., posted by Jim Boardman on January 8, 2003, at 9:55:00
Hi. I agree with Noa -- I really appreciate your letting us know how you're doing. It's a great help. Until now, the only information we had on this med was what the drug company chose to provide to the public. By the way, you certainly don't come across as a drugged up hippie.
Posted by Jim Boardman on January 9, 2003, at 9:05:21
In reply to Re: Straterra approval., posted by Jim Boardman on January 6, 2003, at 19:40:37
Straterra, day 7: I woke up this AM feeling GREAT! If this keeps up, I'm sold on this stuff. I'm still a bit spacey/dizzy on and off, but I feel good otherwise. Again, here's the meds I take for my ADD and bipolar: 8 mg gabitrol in the morning, 80 mg (2 caps) of straterra in the morning, 20 mg lexpro in the morning, 1 remeron b4 bed, 8 mg gabitrol b4 bed. I'll keep you posted. I don't think that I am peaking on a mood swing - I think this might be my answer to a long standing condition.
Jim
Posted by nmk on January 9, 2003, at 14:18:00
In reply to Re: Straterra approval., posted by Jim Boardman on January 5, 2003, at 19:02:49
I don't want to get my hopes up but today I feel great! No depression, little anxiety, and the dizziness has diminished greatly. Typically, I sleep through the night but I did wake up at 5 am and found it difficult to get back to sleep. Other than that, no problems today. I will report back again.
Nicole
Posted by Jim Boardman on January 9, 2003, at 14:39:36
In reply to Re: Straterra approval-Day 3., posted by nmk on January 9, 2003, at 14:18:00
Bravo Nicole! Stay with it... I think you will be happy if you get anywhere near the results I am seeing. BTW, maybe you don't need as much sleep. I find I can get by with less since I started the straterra.
Jim
Posted by nmk on January 10, 2003, at 14:27:19
In reply to Re: Straterra approval., posted by Jim Boardman on January 5, 2003, at 19:02:49
I am on a roll....still no depression, little anxiety, and the dizziness is completely gone. I did experience some vivid nightmares last night and early morning awakening again but other than that, no complaints.
Posted by Jim Boardman on January 10, 2003, at 14:33:23
In reply to Re: Straterra approval., posted by Jim Boardman on January 9, 2003, at 14:39:36
Day 10 for me. I feel GREAT! The only problem I see is that I still have a terrible taste in my mouth, dry throat, etc., and I occasionally still have a problem urinating. Nothing I cant handle, however. Also, I wake up after about 4 hours of sleep and have a hard time getting back to sleep. Looking forward to Nicole's ongoing success.
Jim
Posted by ZenClear on January 10, 2003, at 16:20:12
In reply to Re: Straterra approval., posted by Jim Boardman on January 9, 2003, at 14:39:36
A question for those on Strattera:
Any problems with sexual dysfunction, as the PI warns? If so, what type?
Any skin rashes?
Water retention?
Any other side effects?
Many thanks! Good luck.
Posted by Sur5orType on January 10, 2003, at 19:26:08
In reply to Re: Straterra approval - Jim Boardman, posted by Jim Boardman on January 6, 2003, at 14:04:55
I am the father of an 8 year old child who helped to get Strattera approved. He has been part of the open label study for almost two years.
He takes 25m in the am and 25 again at night.
Before that, he took adderol, which I COULD NOT STAND. I hated the way it made him seem like a zombie.
His reaction to this new drug is enough to make me real encouraged for Jim, Christina and Nicole.
His improvement over the last couple of years has been great.
He has been concentrating and has been a lot less hyper, though, like a normal 8 year old, he still is a fidgeter.
A word to the wise for you, (this is kind of cool, being able to speak from experience for all of you) Make sure you take your dose when you are supposed to. It is not a long-lasting effect from what I can tell. If he did not get his dose in the afternoon, he tends to wind up pretty fast.
I know what you mean about the dry throat and the appetite. He was a real two-fisted eater (like me, his father) when he started. He was even a little chunky and now has a normal, if not a spare appetite.
I try to get him to eat before or at the same time as his evening dose, and it has never been a severe disinterest in food, just that he ate less.
He complains occasionaly about a dry throat, but never about a funny taste in his mouth. An 8 year old might not see it that way.
I wish all of you a lot of luck. I think it has done wonders for my son.
I can not say how happy I was to see him off of adderol. I still remember VIVIDLY the first few months on Strattera (we called it Tomoxetine) and how happy I was to have him improve so far, and fast.
I heard some comments about people that "prefer" adderol. Well, this is one person that did not prefer to see his son take adderol. I don't want to see him hyper, but making a zombie out of him was not the answer. I could not stand the tics. Someone asked that question, and I can tell you, it doesn't seem to give him tics, or anything like that.
So, you can have your adderol. I am glad my son got the opportunity to use something with side effects that would still allow him to function.
Again, good luck all.
Posted by Sur5orType on January 10, 2003, at 19:31:45
In reply to Re: Straterra approval., posted by ZenClear on January 10, 2003, at 16:20:12
> A question for those on Strattera:
>
> Any problems with sexual dysfunction, as the PI warns? If so, what type?
>
> Any skin rashes?
>
> Water retention?
>
> Any other side effects?
>
> Many thanks! Good luck.My son is 8 and has been on Strattera for almost 2 years.
Sex, LOL sorry, can't answer that one.
Skin rashes... He has had a couple of skin rashes, but they go away with cream usually. They only came on with winter, and might be unrelated.
Water retention is probably moreof a case-by-case thing. Hasn't affected him. Being a growing boy, he has lost no weight, but has slimmed down some (see my other post.)
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