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Dr. Bob is Robert Hsiung, MD,
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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
Posted by BekkaH on January 31, 2003, at 23:48:37
In reply to Re: desipramine instead of Strattera? » BekkaH, posted by not exactly on January 31, 2003, at 2:33:33
> 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.> Bob
>
***********************************************
Hi Bob,
Regarding your concern about "drug-seeking behavior," your doctor should know that Strattera is not a restricted drug. It's not a stimulant, and even if it were, most of the people I've met on this board take stimulants because they need them, and they don't abuse them.I hope your next med trial goes well. Let us know how you're doing. By the way, I'm interested to know what kind of chemist you are. Of course, you don't have to answer that because I know that privacy and confidentiality are very important issues here, but if you don't feel uncomfortable about it, I'm interested to know whether you are in organic chemistry or some other specialty.
Thanks.
Bekka
Posted by not exactly on February 1, 2003, at 3:57:07
In reply to desipramine instead of Strattera? - not exactly, posted by BekkaH on January 31, 2003, at 23:48:37
> Regarding your concern about "drug-seeking behavior"...
Sorry, I should have put a smiley face :-) after that comment - I wasn't *really* worried that he would perceive this to be a problem. However, I do want to save my assertiveness for issues that are truly important.
> I hope your next med trial goes well. Let us know how you're doing.
Saw my pdoc today, and he agreed that desipramine made sense to try at this point. I took my first dose just before I read your message, so I expect my depression to be in full remission by the time I finish posting this reply.
:-) :-) :-) :-) :-)
Yes, I'm joking about this too, but it *is* true that I usually respond quickly to psychotheraputic meds. The ones that have worked in the past took only a few days to kick in. With Effexor, I felt completely cured within 12 hours of my first dose! Unfortunately, it pooped out completely in less than a month - easy come, easy go, I guess.I will post again to let you know how it's going. But since I'm *not* taking Strattera (this time), most of my progress reports will be posted in the desipramine thread I started [http://www.dr-bob.org/babble/20030125/msgs/137808.html]. If I conclude that desipramine is a good ADHD med (rather than "just" an AD) and/or it's an attractive alternative to Strattera, then I will post that opinion here as well.
> By the way, I'm interested to know what kind of chemist you are.
I'm not a *professional* chemist, but it's been a life-long interest. After studying chemistry in college, I ended up with a career in computers (chemistry & computers are both popular fields for those of us with Asperger's Syndrome, fwiw). I still keep up with chemistry as a hobby (primarily thru internet research; no lab work recently). Originally, I was interested in inorganic (specializing in explosives & pyrotechnics) but later switched to organic (specializing in biochemistry & psychophamacology).
It's clear from your posts that you have an excellent understanding of neurochemistry yourself. Are you also a chemist?
And while I'm on the subject of prying into your private life :-) I've noticed that you have never mentioned taking Strattera despite your obvious interest in it. Are you planning to try it in the near future?
- Bob
Posted by CindyLou on February 1, 2003, at 8:24:17
In reply to Re: Straterra Updates? » harper, posted by nmk on January 30, 2003, at 10:03:55
Yesterday I took 25 mg. Strattera (my pdoc is starting me on a pediatric dose due to my med sensitivity.) After 5 hours, I was so sedated I had to sleep -- it felt like I had taken a couple sleeping pills -- I was virtually being PULLED into sleep. Very strange.
I'm wondering a few things:
1. Can I take Strattera at night? Would it continue to help with ADD symptoms and energy during the day?
2. Would a higher dose be LESS sedating?
Thanks for any input.
cindyP.S. I am also taking 5 mg. Lexapro at night, and 0.5 mg. Klonapin at night.
Posted by bennett on February 1, 2003, at 11:23:58
In reply to Re: Sedation with Straterra - ok to take at night?, posted by CindyLou on February 1, 2003, at 8:24:17
Hi,
The first day I took Straterra I too felt "like I was pulled asleep" two hours after taking it. I slept soundly for a few hours (it was the middle of the afternoon)then got up and felt rested-
I'd been getting plenty of sleep before this.It happened again a day or so later but hasn't happened since then. By the end of the day now (day 6) I don't want to shut down ( -I never have until maybe 2-3 AM) so I continue with 5-7.5 Ambien to get to bed before midnite(which seems to hit much more quickly and demandingly than it did before) I suppose I can lower the Ambien dose a bit and see what happens..
I started with 18 mg Straterra for 3 days,(not feeling much) then 18 Am and PM. I feel most of the time now like I have a sock over my head, kind of groggy, more unfocussed than usual, but groggy instead of "speedy" - find myself getting angry and frustrated at little things not going right -- at the same time seem to put more quiet attention to things as I come upon them but in a floating sort of way - can't get on task to accomplish what I need to accomplish.
I stopped Wellbutrin before taking the straterra but I imagine that must be out of my system.
I imagine I'm not at a clinical dose yet, but still not sure how quickly to advance the dosage - not many side effects (except maybe scratchy eyes - which may be allergies...)
Doc has me on 18 mg bid for the first month.thanks
bennett
Posted by cybercafe on February 1, 2003, at 17:30:49
In reply to Re: Sedation with Straterra - ok to take at night?, posted by bennett on February 1, 2003, at 11:23:58
how do these drugs compare to wellbutrin?
Posted by HADD Enough on February 2, 2003, at 8:32:26
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
Hi All,
I've been reading this thread with avid interest for several days and this community looks to be really helpful and supportive...I'm looking forward to contributing...I'm a 50yr old male and I have had severe ADD for as long as I can remember. I was not diagnosed, however, until about two years ago. Since then I have tried Ritalin and Concerta and, while they helped a little, I did not like the jittery feelings I got on stims. Also, I have high blood pressure and the stims only make this worse.
My ADD has almost destroyed my marriage, mostly because of my moodiness, tuning out, and impulsive anger. I'm not depressed and have not really tried any other brain chemistry altering drugs other than the stims but my pDoc has heard good things about Strattera, and at my last appt. he gave me a sample pack. I'm a pretty reluctant drug-taker but saving my marriage is my main concern right now so I started on 40mg of Strattera yesterday.
I know that neurotransmitter altering drugs generally take a couple to several weeks to be fully effective, but I have to say that, as opposed to Ritalin which was much more "violent" when it kicked in, the Strattera was much more subtle...I have not felt this clear and focused in years! I hope this is not wishful thinking but it is as if all the "static" in my mind has been muted and I can begin to sort out my chaotic thoughts.
The only side effect I've noticed so far is a slight feeling of "spaceyness", but it is not a big deal. If this is the worst of it, hooray!! I will really try to reserve judgement for a few weeks, and I plan to try upping my dosage to 60 or 80mg/day in a couple of days. I'll post updates for as long as folks are interested. Thanks.
Cheers
HADD Enough
Posted by not exactly on February 2, 2003, at 12:07:59
In reply to Started Strattera Yesterday Woo-Hoo!, posted by HADD Enough on February 2, 2003, at 8:32:26
Glad to hear that you've had such good results with Strattera. Since you've been reading this thread, you must know that we've had mixed results. It hasn't helped everyone, and many that might have benefitted didn't like the side effects. But it sounds like it's a good match for your brain chemistry. Bravo!
> My ADD has almost destroyed my marriage, mostly because of my moodiness, tuning out, and impulsive anger.
Hmmm... Those don't sound like ADD symptoms to me. If you had said that your marriage was in trouble because your wife felt you didn't listen to her and you weren't acting like a responsible adult, then the ADD diagnosis would make more sense. But maybe there's something else going on.
You say you're not depressed. But depression takes many forms. Just because you don't feel sad and hopeless every day doesn't mean that all forms of depression can be ruled out. You may have a touch of atypical or bipolar depression.
BTW, I'm no doctor, and I apologize if my conjectures are making you uncomfortable. I'm just thinking out loud, and mostly trying to be supportive.
> I have not felt this clear and focused in years! I hope this is not wishful thinking but it is as if all the "static" in my mind has been muted and I can begin to sort out my chaotic thoughts.
I've had positive reactions to some antidepressants that could have been described in those exact words. Since Strattera can act as an antidepressant, perhaps that is its true benefit for you. The important part is, its working. If your troubling symptoms are being relieved, the "reason" may be moot.
> The only side effect I've noticed so far is a slight feeling of "spaceyness"
How long has it been since you took Ritalin or Concerta? If you discontinued a stimulant recently, that can produce "spacey" feelings for a while.
Another possibility is that it's an "adjustment" phenomenon. Strattera may have changed your perceptions of reality just enough to make the world seem a bit "unfamiliar". If so, this feeling will disappear once you get used to it.
Again, congratulations on discovering the "magic bullet" so quickly. This sort of success usually takes a lot more trial & error.
> I'll post updates for as long as folks are interested.
Please do. Your success is encouraging.
- Bob
Posted by SLynn on February 2, 2003, at 12:35:18
In reply to Started Strattera Yesterday Woo-Hoo!, posted by HADD Enough on February 2, 2003, at 8:32:26
> Hi All,
>
> I've been reading this thread with avid interest for several days and this community looks to be really helpful and supportive...I'm looking forward to contributing...I'm a 50yr old male and I have had severe ADD for as long as I can remember. I was not diagnosed, however, until about two years ago. Since then I have tried Ritalin and Concerta and, while they helped a little, I did not like the jittery feelings I got on stims. Also, I have high blood pressure and the stims only make this worse.
>
> My ADD has almost destroyed my marriage, mostly because of my moodiness, tuning out, and impulsive anger. I'm not depressed and have not really tried any other brain chemistry altering drugs other than the stims but my pDoc has heard good things about Strattera, and at my last appt. he gave me a sample pack. I'm a pretty reluctant drug-taker but saving my marriage is my main concern right now so I started on 40mg of Strattera yesterday.
>
> I know that neurotransmitter altering drugs generally take a couple to several weeks to be fully effective, but I have to say that, as opposed to Ritalin which was much more "violent" when it kicked in, the Strattera was much more subtle...I have not felt this clear and focused in years! I hope this is not wishful thinking but it is as if all the "static" in my mind has been muted and I can begin to sort out my chaotic thoughts.
>
> The only side effect I've noticed so far is a slight feeling of "spaceyness", but it is not a big deal. If this is the worst of it, hooray!! I will really try to reserve judgement for a few weeks, and I plan to try upping my dosage to 60 or 80mg/day in a couple of days. I'll post updates for as long as folks are interested. Thanks.
>
> Cheers
> HADD Enough
Hello...I am so glad that the Strattera is working for you! I am thrilled so far with this new ADD medication myself.
My son (he is 9) started it yesterday. He weighs 65 pounds and they started him on 18 mg...he is to take it for 4 days then increase to 25mg. He was pretty tired all day, but he was not near as "figity". He seemed pretty alert, but the tiredness really got to him. However, he had "tics" on the stimulants and they are now stopping! I am so relieved. Also, he did not get sick...which from what I have read, is a sign of an allergic reaction. They say that the Strattera takes time, so if you are feeling this much better already, just think how you will feel after the next 7 days or so. Also, the "spaciness" that you are feeling seems to be pretty normal the first few days (from everything that I have read...my son is doing the same thing). How did you sleep while on the Strattera compared to the stimulants? My son fell asleep on the floor at 8:30 last night and I had to get him up at 9:45 this morning. I could not believe it! Usually, I cannot get him to go to sleep or sleep peacefully all night. He had the best sleep last night than he has had in years! Please keep us all posted on your progress...this medication is so new that is nice to read about what others are going through. I am so glad to get my son off of stimulants (he has been on them for 3 years)...they have really messed him up. I am praying this new drug will work for everyone out there who is sensitive to the stimulant medications. Congratulations and keep us informed!!!
SLynn
Posted by noa on February 2, 2003, at 13:32:14
In reply to Re: is strattera the same thing as reboxetine??, posted by cybercafe on February 1, 2003, at 17:30:49
I don't think it is the same as reboxetine, but my pdoc said it is related. It is atamoxetine.
Posted by not exactly on February 2, 2003, at 13:34:49
In reply to Re: Started Strattera Yesterday Woo-Hoo! » HADD Enough, posted by SLynn on February 2, 2003, at 12:35:18
How recently did your son discontinue stimulant medication? The tiredness may be due to stimulant withdrawal rather than a Strattera s/e.
- Bob
Posted by not exactly on February 2, 2003, at 14:26:13
In reply to Re: is strattera the same thing as reboxetine??, posted by noa on February 2, 2003, at 13:32:14
> I don't think it is the same as reboxetine, but my pdoc said it is related. It is atamoxetine.
They are different, but in the same "family" ( pharmacologically and chemically). They are both selective norepinephrine reuptake inhibitors. The atomoxetine (Strattera) molecule [see http://pi.lilly.com/us/strattera-pi.pdf] is a hybrid of reboxetine [http://biopsychiatry.com/reboxetine] and fluoxetine [http://biopsychiatry.com/fluoxetine], which makes sense when you consider that Strattera's manufacturer (Lilly) also makes fluoxetine (better known as Prozac).
Atomoxetine is only available in the US (so far) as the brand name Strattera, and is approved/marketed only for treating ADHD (even though it has antidepressant qualities). Reboxetine, on the other hand, is available in Europe (as Edronax), but not the US, and is approved/marketed for treating depression (although it would probably also help with ADHD). Apparently, Lilly fought hard to prevent reboxetine from gaining FDA approval (in order to protect its antidepressant sales), then chose to market its own variant in the US as an ADHD med instead, hoping to create market share as the only ADHD drug which is not a "controlled substance" (Schedule II).
People who have tried both atomoxetine and reboxetine claim that they noticed some minor differences in action and side effects. Interestingly enough, many believe that atomoxetine is a more effective antidepressant than reboxetine!
hope this helps
- Bob
Posted by Phil on February 2, 2003, at 16:25:35
In reply to Re: is strattera the same thing as reboxetine??, posted by not exactly on February 2, 2003, at 14:26:13
I should hope so, Reboxetine was a big flop with, I think, everyone on this site who tried it.
Posted by cybercafe on February 2, 2003, at 16:34:06
In reply to Re: is strattera the same thing as reboxetine?? » not exactly, posted by Phil on February 2, 2003, at 16:25:35
> I should hope so, Reboxetine was a big flop with, I think, everyone on this site who tried it.
a flop just for depression, or ADD as well?
i'm in canada, and i think we have reboxetine but not strattera :(
Posted by Phil on February 2, 2003, at 17:03:11
In reply to Re: is strattera the same thing as reboxetine??, posted by cybercafe on February 2, 2003, at 16:34:06
I honestly don't remember anyone staying on it for any condition. If the search starts working, you can see all the excitement the drug generated but it just didn't work very well.
I've heard more positive posts on Straterra already than I ever saw vith Rebox.
Posted by HADD Enough on February 2, 2003, at 17:50:53
In reply to Re: Started Strattera Yesterday Woo-Hoo! » HADD Enough, posted by not exactly on February 2, 2003, at 12:07:59
Hi Bob,
Thanks for your encouragement and observations.
> Hmmm... Those don't sound like ADD symptoms to me. If you had said that your marriage was in trouble because your wife felt you didn't listen to her and you weren't acting like a responsible adult, then the ADD diagnosis would make more sense. But maybe there's something else going on.
Actually, it was not really clear from the way I described the issues, but you pretty much clarified it. Yes, I don't/couldn't focus enough to listen to her, and I've not been acting as a responsible adult for most of my adult life. And I have also been unable to control my moving from one topic to another, my drifting off in the middle of a conversation, my intolerance of frustration, and my inappropriate anger when I do get frustrated. And, I don't mean to do any of these things...I just can't control them. Heck, I probably fit all the parameters for ADD in the DSM-IV :-)
> You say you're not depressed. But depression takes many forms. Just because you don't feel sad and hopeless every day doesn't mean that all forms of depression can be ruled out. You may have a touch of atypical or bipolar depression.This is always a possibility. I never had a "major depressive event", but I did have panic attacks in high school and, for all I know, I may have a touch of GAD as well.
> BTW, I'm no doctor, and I apologize if my conjectures are making you uncomfortable. I'm just thinking out loud, and mostly trying to be supportive.
Not to worry...I always appreciate a new opinion...it's good to have feedback from outside myself and it helps me to look at things in a different light than I might have otherwise.
> How long has it been since you took Ritalin or Concerta? If you discontinued a stimulant recently, that can produce "spacey" feelings for a while.
I stopped the stims months ago. I've been unmedicated for that time and I'm probably the worse for it.
> Another possibility is that it's an "adjustment" phenomenon. Strattera may have changed your perceptions of reality just enough to make the world seem a bit "unfamiliar". If so, this feeling will disappear once you get used to it.
Could be...hope so.
> Again, congratulations on discovering the "magic bullet" so quickly. This sort of success usually takes a lot more trial & error.
Thanks again...I'm trying to keep my euphoria in check...two days is a REALLY short time to evaluate an NSRI, or any new drug for that matter, but SOMETHING is happening and I am hopeful that I may have found an answer for me. I'll update periodically.
Cheers,
Bill
Posted by HADD Enough on February 2, 2003, at 17:54:36
In reply to Re: Started Strattera Yesterday To: not enough, posted by HADD Enough on February 2, 2003, at 17:50:53
Posted by HADD Enough on February 2, 2003, at 18:02:19
In reply to Re: Started Strattera Yesterday Woo-Hoo! » HADD Enough, posted by SLynn on February 2, 2003, at 12:35:18
> Hello...
>
> I am so glad that the Strattera is working for you! I am thrilled so far with this new ADD medication myself.
>
> My son (he is 9) started it yesterday. He weighs 65 pounds and they started him on 18 mg...he is to take it for 4 days then increase to 25mg. He was pretty tired all day, but he was not near as "figity". He seemed pretty alert, but the tiredness really got to him. However, he had "tics" on the stimulants and they are now stopping! I am so relieved. Also, he did not get sick...which from what I have read, is a sign of an allergic reaction. They say that the Strattera takes time, so if you are feeling this much better already, just think how you will feel after the next 7 days or so. Also, the "spaciness" that you are feeling seems to be pretty normal the first few days (from everything that I have read...my son is doing the same thing). How did you sleep while on the Strattera compared to the stimulants? My son fell asleep on the floor at 8:30 last night and I had to get him up at 9:45 this morning. I could not believe it! Usually, I cannot get him to go to sleep or sleep peacefully all night. He had the best sleep last night than he has had in years! Please keep us all posted on your progress...this medication is so new that is nice to read about what others are going through. I am so glad to get my son off of stimulants (he has been on them for 3 years)...they have really messed him up. I am praying this new drug will work for everyone out there who is sensitive to the stimulant medications. Congratulations and keep us informed!!!
>
> SLynn
>Thanks for your kind words. I am really happy for you and your son and I hope he continues to do well!
I fell asleep easily last night at about midnight, but I woke up at around 5 AM...early for me, but I didn't feel as though I didn't get enough sleep. I'll see how this goes as I progress.
Cheers,
Bill
Posted by SLynn on February 2, 2003, at 20:30:55
In reply to Re: Started Strattera Yesterday Woo-Hoo! » SLynn, posted by not exactly on February 2, 2003, at 13:34:49
> How recently did your son discontinue stimulant medication? The tiredness may be due to stimulant withdrawal rather than a Strattera s/e.
>
> - Bob
>
Hi Bob...He just went off of the stimulant yesterday, so I know that the tiredness is due to the stimulant withdrawal. So far so good with Strattera side effects...have not seen any!
SLynn
Posted by dancingdp on February 5, 2003, at 18:48:24
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
Is this site working now? TEST
Posted by fairnymph on February 5, 2003, at 22:15:10
In reply to Re: is strattera the same thing as reboxetine?? » not exactly, posted by Phil on February 2, 2003, at 16:25:35
I found reboxetine very effective for depression, stimulating, and free of side effects. It didn't help with my anxiety/OCD, but it was a fantastic med otherwise, one of the best I've tried (and I've tried half a dozen).
> I should hope so, Reboxetine was a big flop with, I think, everyone on this site who tried it.
Posted by Cindylou on February 7, 2003, at 7:13:57
In reply to Re: Started Strattera Yesterday Woo-Hoo! » not exactly, posted by SLynn on February 2, 2003, at 20:30:55
I posted earlier about severe sedation I experienced my first day on Straterra (I took 25 mg.) The sedation set in about 5 hours after taking it. My pdoc wants me to try it at night, but I haven't tried it since that first day.
I'm very curious to know if anyone else has experienced this effect, and/or has any insights or suggestions. I greatly appreciate any responses!
Thanks,
Cindy
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