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Dr. Bob is Robert Hsiung, MD,
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Posted by nmk on January 29, 2003, at 9:24:22
In reply to Re: Strattera--in comparison to Wellbutrin? » nmk, posted by disney4 on January 28, 2003, at 15:45:11
> How does the feeling of taking Straterra differ from taking Wellbutrin? Also is any one experiencing sexual side effects or an increased appetite, and/or weight gain? Does it increase, lower, or have no effect on anxiety?
I have never tried Wellbutrin so I can't respond to that one. As far as sexual side effects, I have not experienced any but this could be due to the low dose I am on. Initially, I noticed a decrease in my appetite but after about three weeks, my appetite has returned to normal....no weight gain though. The anxiety question is difficult to answer. The Strattera seems to energize and hype me up so I don't know if it is masking the anxiety or what. There are times where I have felt a tad on edge and needed to take 1 mg of ativan to calm me down, but the anxiety pales in comparison to when I was not on Strattera. Lately, I have been having difficulty falling asleep and will talk to my pdoc tomorrow about tweeking my meds.
Posted by nmk on January 29, 2003, at 9:34:19
In reply to Re:Strattera on sex ,weight,anxiety and depression, posted by tia on January 28, 2003, at 18:31:02
Tia,
I am also taking Strattera for anxiety/depression and although it has done wonders for the depression, it has not calmed me down by any means. I have much more energy and focus now, but at times, feel a little edgey. How did you do on 18mg? Do you know what the therapeutic dose is for depression/anxiety without ADD? I do not have ADD and from reading your posts, it looks like you do not either. Are you taking anything with it? Has it affected your sleep? Sorry for all of the questions but I want to pick someone's brain who is on it solely for depression.
Thanks,
Nicole
Posted by Dog Breath on January 29, 2003, at 10:08:50
In reply to Re:Strattera for anxiety/depression-TIA, posted by nmk on January 29, 2003, at 9:34:19
I would have to say I am taking this for depression. I have been crashing lately on Lexapro and felt I needed to do something different. I had an ADHD eval last summer and the psycologist said I didn't have classical ADHD(but had a lot of the symptoms). I think what I thought was ADHD was really just variations of the overall problem: Depression. Anyway, I'm on day 7 of Straterra and haven't felt anything except maybe a slight reduction in appetite. I'm on 50mg. Maybe I just need more time or a higher dose? I tried Wellbutrin a few years back and it put me into major anxiety after taking it about 2 weeks. It took a full week of hell to clear it out of my body.
D
Posted by bennett on January 29, 2003, at 10:33:10
In reply to Re: Strattera--in comparison to Wellbutrin? » nmk, posted by disney4 on January 28, 2003, at 15:45:11
I just started low dose of Strattera and discontinued Welbutrin 3 days ago. As soon as the strattera kicks in, I'll let you know what difference I feel. I hate to give up the Welbutrin though.
I was taking Welbutrin for a year for ADD. While it didn't do much for ADD sx. it was a great little happy pill ( a little purple happy-face). In addition, two months after start, one day I just forgot to smoke (I used to smoke maybe 1/2 pack/day). I wasn't trying to stop at all - I just forgot! Other cravings (obsessions, perhaps)also just disappeared. I could continue them if I wanted, but the obsessive quality did not seem to be driving it.
But ADD sx were not affected at all: tangents and disatractions, inability to focus... etc. all continued.
BTW-I don't know how I was able to complete the registration process for this board...
Posted by nmk on January 29, 2003, at 14:04:48
In reply to Re:Strattera for anxiety/depression-TIA » nmk, posted by Dog Breath on January 29, 2003, at 10:08:50
> I would have to say I am taking this for depression. I have been crashing lately on Lexapro and felt I needed to do something different. I had an ADHD eval last summer and the psycologist said I didn't have classical ADHD(but had a lot of the symptoms). I think what I thought was ADHD was really just variations of the overall problem: Depression. Anyway, I'm on day 7 of Straterra and haven't felt anything except maybe a slight reduction in appetite. I'm on 50mg. Maybe I just need more time or a higher dose? I tried Wellbutrin a few years back and it put me into major anxiety after taking it about 2 weeks. It took a full week of hell to clear it out of my body.
>
> DThanks DB. I hope a higher dose will work for you... I know some folks on the board have had success with 80 mg. Has the Strattera made your anxiety worse? I love the antidepressant properties of it but would like to feel more calm throughout the day. It almost gives me too much energy and I find it difficult to relax and turn my mind off, especially at night. I will see what my doctor says tomorrow.
Posted by wowy on January 29, 2003, at 14:19:01
In reply to Re: Strattera--in comparison to Wellbutrin?, posted by bennett on January 29, 2003, at 10:33:10
Hi-
I have been lurking about but never posted before. I have been on 80 mg of strattera plus
40 mg of paxil for over a month now. The strattera has brightened my mood considerably.
Initially, I felt a sort of tingle and an exhileration that was just lovely. Now I just feel grounded and well. I was diagnosed with ADD a few months ago. Depression/anxiety has been a long term problem - which is why I was taking the paxil. I tried stimulants but really didn't like the rebound...The strattera is much more subtle in my opinion and I have experienced dry mouth and skin, but it is very tolerable. I hope this helps anyone interested in trying strattera. Best wishes to all
Posted by disney4 on January 29, 2003, at 14:30:58
In reply to Re: hypersensitivity, depression » disney4, posted by not exactly on January 28, 2003, at 20:13:16
The reason I couldn't tolerate almost all current AD's was because of intolerable side effects. I am trying to decide between Straterra and Buspar. I need a good AD effect though, but not added anxiety. I may have to turn to uplifting foods, until something comes out that really fits the bill. Have you heard of any one getting TD from Buspar? Also would you know if Wellbutrin and Straterra work on the same neurotransmitters?
Posted by disney4 on January 29, 2003, at 14:39:38
In reply to Re: Strattera--in comparison to Wellbutrin?, posted by bennett on January 29, 2003, at 10:33:10
Thanks for the input! I know many people who did wonderfully on Wellbutrin, but I was not one of them. I read one post of someone who had anxiety on Wellbutrin, but can tolerate Straterra, so I hope that will be the case for me. I still would like to hear your observations on how they differ, and in particular, if you notice any sexual difficulties. I always get those, even when I took Serzone, which is supposed to have a low incidence of sexual side effects!
Posted by Dog Breath on January 29, 2003, at 14:49:36
In reply to Re: Strattera, posted by wowy on January 29, 2003, at 14:19:01
How long did it take to "brighten" your mood? 7 days I still feel like I could crawl into a hole and sleep for 24hrs. But then I have zero anxiety as well.
D
Posted by wowy on January 29, 2003, at 15:09:06
In reply to Re: Strattera » wowy, posted by Dog Breath on January 29, 2003, at 14:49:36
Hey D-
The "brightening" effect was pretty immediate...However I did start with 80 mg...from
reading the posts here I see that's a fairly high dose...Also, that feeling was more pronounced the first few days...Now, I've gotten used to it. But still my office mate has noticed
the difference so...I am hopeful that it will continue to work. I have some room for additional dosage at some point down the line.
Posted by zenclear on January 29, 2003, at 16:09:17
In reply to Re: Strattera, posted by wowy on January 29, 2003, at 15:09:06
Do any of you notice any rebound effects, when the Strattera wears off? Say, any fatigue or mood dip?
I know most of you say you like it because there's rebound like stims; but do you notice any effects when the med wears off?
Posted by mshyper on January 29, 2003, at 16:29:05
In reply to Re: Strattera-Any rebound?, posted by zenclear on January 29, 2003, at 16:09:17
> Do any of you notice any rebound effects, when the Strattera wears off? Say, any fatigue or mood dip?
> I know most of you say you like it because there's rebound like stims; but do you notice any effects when the med wears off?Started Strattera 8:30 this am-18mg-have a little fatigue now, about 4:30, but not sure if that is due to initial med adjustment, or due to low starting dose. Felt absolutely great earlier today, few minor SE's
Posted by not exactly on January 29, 2003, at 17:09:11
In reply to Re: hypersensitivity, depression » not exactly, posted by disney4 on January 29, 2003, at 14:30:58
> Have you heard of any one getting TD from Buspar?
Nope. The PDR mentions it as a theoretical possibility (based on Buspar's receptor affinities), but claims it's never happened.
> would you know if Wellbutrin and Straterra work on the same neurotransmitters?
Strattera is very specific to norepinephrine (that's its claim to fame). My understanding about Wellbutrin is that it affects norepinephrine primarily, but also affects dopamine & serotonin to lesser extents.
Posted by tia on January 29, 2003, at 19:00:35
In reply to Re:Strattera for anxiety/depression-DB, posted by nmk on January 29, 2003, at 14:04:48
This is my story: Hopefully shortI had been on 100mg of anafranil and 150mg of wellbutrin and was sweating to the point of dripping. I also did not feel my depression was controlled enough with the wellbutrin. However my anxiety was just fine because of the anafranil. I told my doctor to try to put me on one medication for both anxiety and depression. I started with 40mg of strattera for about 5 days and noticed that immediately i felt energy and my appetite diminish. I also know that i had some increase in anxiety too. I went and started taking 60mg on friday 24th of jan. On Monday the 27th I decreased my anfranil to 50mg. As of tuesday night the 28th i started with anxiety attacks and have lasted thru wednesday. I called my doctor and asked maybe if i should stay on the 100mg of anafranil and do the 80mg of strattera. I have not recv a call back. I am going to take a 50mg of anafranil tonight (wed) and 80mg of the strattera in the morning.
I dont like giving up on meds to early. Sometimes our body has to have time to adjust to certain meds. I am going to take the 80mg and see what happens the next few days.
Strattera side effects on the sexuall part, i personally think because i am in a better mood and more energetic i am more sexually stimulated too. The appetite thing i feel fuller than usual.
My dose of strattera is taken at 8am in the morning and by 10:30pm i am ready to hit the sack. I am not in a demanding office job either so i have moderate exercise during the day watching children.
I am always reading posts so i will post back if anyone has questions.
Tia
Posted by wowy on January 29, 2003, at 19:25:14
In reply to Re: Strattera-Any rebound?, posted by zenclear on January 29, 2003, at 16:09:17
> Do any of you notice any rebound effects, when the Strattera wears off? Say, any fatigue or mood dip?
>
> I know most of you say you like it because there's rebound like stims; but do you notice any effects when the med wears off?I don't feel any rebound or wearing off effects with strattera...
Posted by mshyper on January 29, 2003, at 20:30:58
In reply to Re: Strattera-Any rebound?, posted by wowy on January 29, 2003, at 19:25:14
> > Do any of you notice any rebound effects, when the Strattera wears off? Say, any fatigue or mood dip?
> >
> > I know most of you say you like it because there's rebound like stims; but do you notice any effects when the med wears off?
>
> I don't feel any rebound or wearing off effects with strattera...what is your dosage of strattera?
Posted by not exactly on January 30, 2003, at 5:52:12
In reply to Re: Strattera-Any rebound? » wowy, posted by mshyper on January 29, 2003, at 20:30:58
Strattera is the first "selective" norepinephrine reuptake inhibitor to be approved in the US, but there are other "mostly" norepinephrine reuptake inhibitors available. Desipramine (a tricyclic AD) is perhaps the best example of this. It's been around so long that it is available as a generic.
I had been planning to try Strattera, but when I found out that it is not (yet) covered by BC/BS (and of course it's expensive), I decided that desipramine might be a reasonable alternative. BTW, my main problem is depression (chronic atypical) with some ADD symptoms, rather than classic ADHD by itself. Does anyone have any experience w/ desipramine? Thoughts about effectiveness, side effects? Any reason to suspect it might not be an acceptable substiture for Strattera?
Note that I've already started another thread about desipramine [http://www.dr-bob.org/babble/20030125/msgs/137808.html], so if you plan to reply regarding the use of desipramine as an AD, you may want to post in that thread instead of here. However, messages that compare desipramine to Strattera, or discuss the suitability of desipramine as an ADHD treatment, probably belong in this Strattera thread.
BTW, if you're curious about my previous medication successes & failures, see http://www.dr-bob.org/babble/20030125/msgs/137593.html.
- Bob
Posted by harper on January 30, 2003, at 9:50:08
In reply to Re: Straterra Updates? » Peter S., posted by not exactly on January 27, 2003, at 14:35:04
This is my experience with Strattera for my daughter after 3 weeks:
My 13 year old daughter who has ADHD and depression has been on Strattera for almost 3 weeks. She was previously on Concerta (54mg) and Zoloft. She didn't seem to be doing well on the Zoloft and her teachers reported that she was very agitated and unfocused. She's very difficult with me (I take so much!), so a lot of times it's hard to tell what her real mood is. She's tried lots of different SSRI's over the years and they all seem to lose their affect after awhile. In anticipation of the Strattera, her doctor stated having her taper off the Zoloft about 10 days before I got the Strattera.
She switched cold turkey from just Concerta to Strattera. Initially, in the first few days of 25mg. of Strattera, I noticed a very positive affect. She seemed happier and sweeter. Her doctor upped her to 40 mg after 4 days and it all in all, everything seemed positive. She did vomit one morning about 1 week after she started the med and then 2 days later, but I just assumed it was a stomach virus. However, after reading lots of posts on MANY different boards, I now realize that vomiting was probably a side effect.
After about 10 more days I upped her dosage from 40 to 65.
I did this because of all the reading I have done and also I had talked extensively to the manager of a clinical trial here in my area. This trial has been going on for about 6 years. The mgr said the optimal dose for her weight was about 72 mg. based on their experience. Anyway, on 65 mg. my daughter's mood has become horrible. She has become tearful, verbally combative and moody. She has never been an easy child by any means, but this behavior is about as bad as I've seen in a very long time. I was so hopeful with the Strattera. I am going to reduce her dosage down to 40 mg again and hope for an improvement.By the way, her teachers report a calmer, focused and less hyper child. Maybe she just takes out all her aggressions on me. Also, it is hard to separate out the 13 year stuff from the efficacy of the med. She has delayed puberty and just started developing in the last couple of months. Maybe it's the hormones?
Anyone heard of mixing Strattera with an SSRI?
Posted by nmk on January 30, 2003, at 10:03:55
In reply to Re: Straterra Updates?, posted by harper on January 30, 2003, at 9:50:08
>
> Anyone heard of mixing Strattera with an SSRI?
>Yes. I am currently taking 18 mg of strattera with 75 mg of zoloft, which has worked wonders for my depression (I do not have ADHD). Since the zoloft works solely on serotonin and the Strattera on norepinephrine, I guess it is the balance of both that is giving me relief. I know this now because I tried weaning off the zoloft this past week and noticed that my mood was not as elevated. After a few days back on zoloft, I am feeling better again.
Posted by disney4 on January 30, 2003, at 10:39:53
In reply to Re: Strattera, Buspar, Wellbutrin » disney4, posted by not exactly on January 29, 2003, at 17:09:11
>> Strattera is very specific to norepinephrine (that's its claim to fame). My understanding about Wellbutrin is that it affects norepinephrine primarily, but also affects dopamine & serotonin to lesser extents.
That is very interesting, because I thought norepinephrine could add to anxiety, yet some people are reporting less anxiety with Straterra than Wellbutrin. I know we are all wired differently, but I wonder if the mechanism of action has more to do with the Straterra causing less anxiety, rather than the neurotransmitter it affects.
Have any other previous Wellbutrin users felt less anxiety on Straterra?
Posted by Ritch on January 30, 2003, at 11:38:25
In reply to desipramine instead of Strattera?, posted by not exactly on January 30, 2003, at 5:52:12
> Strattera is the first "selective" norepinephrine reuptake inhibitor to be approved in the US, but there are other "mostly" norepinephrine reuptake inhibitors available. Desipramine (a tricyclic AD) is perhaps the best example of this. It's been around so long that it is available as a generic.
>
> I had been planning to try Strattera, but when I found out that it is not (yet) covered by BC/BS (and of course it's expensive), I decided that desipramine might be a reasonable alternative. BTW, my main problem is depression (chronic atypical) with some ADD symptoms, rather than classic ADHD by itself. Does anyone have any experience w/ desipramine? Thoughts about effectiveness, side effects? Any reason to suspect it might not be an acceptable substiture for Strattera?
>
> Note that I've already started another thread about desipramine [http://www.dr-bob.org/babble/20030125/msgs/137808.html], so if you plan to reply regarding the use of desipramine as an AD, you may want to post in that thread instead of here. However, messages that compare desipramine to Strattera, or discuss the suitability of desipramine as an ADHD treatment, probably belong in this Strattera thread.
>
> BTW, if you're curious about my previous medication successes & failures, see http://www.dr-bob.org/babble/20030125/msgs/137593.html.
>
> - Bob
>
I tried desipramine once and it worked remarkably well for ADHD symptoms, espcially concentration and task follow-through. If you can tolerate TCA side effects OK, it would likely be the best one of all of them (the TCA's) for ADHD. It has a tendency to have more cardiac side effects than some of the other TCA's, though. The main reason I stopped it was elevated heart rate (but Straterra can do that too), and postural hypotension (dizziness-Straterra can do that one too, but probably much less so).
Posted by not exactly on January 30, 2003, at 14:25:04
In reply to Re: Straterra Updates? » harper, posted by nmk on January 30, 2003, at 10:03:55
> I am currently taking 18 mg of strattera with 75 mg of zoloft, which has worked wonders for my depression
Please clarify. Did you mean that Zoloft worked wonders, or the combination?
Have you ever tried just Zoloft by itself?
- Bob
Posted by nmk on January 30, 2003, at 17:03:02
In reply to Re: Straterra Updates? » nmk, posted by not exactly on January 30, 2003, at 14:25:04
> > Please clarify. Did you mean that Zoloft worked wonders, or the combination?
>
> Have you ever tried just Zoloft by itself?
>
> - BobSorry....the zoloft alone didn't seem to do anything, even at 125 mg. When I went down to 75 mg and added the Strattera, this seemed to be the right combo. I thought the Strattera was solely responsible for the change in my mood but proved myself wrong when I weaned off the zoloft. I am back on both and doing well again.
>
Posted by BekkaH on January 31, 2003, at 1:10:22
In reply to desipramine instead of Strattera?, posted by not exactly on January 30, 2003, at 5:52:12
> > I had been planning to try Strattera, but when I found out that it is not (yet) covered by BC/BS (and of course it's expensive), I decided that
*************************************************
Hi Bob,
Don't take "No" for an answer from BC/BS. I've had problems like that with my insurance company, and my pdoc has contacted them by phone and in writing, explaining why it is necessary for me to take the medications they don't want to cover. So far, my doctor's efforts have paid off, although it took a lot of persistence. Since you haven't taken Strattera yet, you might have to try it first without reimbursement. Then, if you respond well to it, your doctor should contact your insurance company and explain that you've responded well to this medication and you need it, etc. Are you absolutely certain BC/BS doesn't cover it? It's so new; perhaps it's just not listed in the formulary yet.Bekka
Posted by not exactly on January 31, 2003, at 2:33:33
In reply to desipramine instead of Strattera? - not exactly, posted by BekkaH on January 31, 2003, at 1:10:22
Bekka,
I called the BC/BS member services dept., and they informed me that Strattera was not yet covered because it was so new. However, they reassured me that it was "under review". When I asked how long this process usually took, they were unwilling to give me even a ballpark guesstimate.
They did tell me about "form 434" [http://www.bcbsma.com/common/en_US/pdfs/30001-PriorAuthReferral.pdf] which my pdoc can use to request an exception. Acceptable reasons for granting an exception include "Treatment Failure with all Covered Drugs in Class" and "Documented Adverse Reaction to all Covered Drugs in Class". I would hope that "Absence of any Covered Drugs in Class" also qualifies. :-)
I'm assuming my pdoc would be willing to submit this form, but I haven't mentioned it to him yet. Back when Strattera was approved, he seemed to agree that it made sense for me to try. But when I recently sent him an email informing him that it was finally available for Rx, he simply replied that we'd "discuss it" in our next session. I don't want to be too persistent at this point, for fear of exhibiting "drug seeking behavior". The best solution, of course, would be for him to obtain free samples for me to try (although he's been unwilling to do this with other meds in the past). If Strattera really helped, then he and I would surely do whatever it took to make it possible for me to afford to continue it.
However, I'm starting to think that desipramine might be a better choice for me anyway. After all, I really want an AD, not an ADHD med. I feel that my lack of motivation and focus are just symptoms of my depression. Anyway, I will "discuss it" tomorrow when I see my pdoc. I expect to leave his office with a Rx for *something*, and it better not be another goddamn SSRI!
Wish me luck. I'll report back as soon as I start my new med, whatever it might be.
- Bob
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