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Dr. Bob is Robert Hsiung, MD,
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Posted by Magpie on April 7, 2003, at 12:12:10
In reply to Re: Straterra- anyone using as stimulant?, posted by Lexxey on April 4, 2003, at 15:07:29
> I don't see any way this could be a stimulant!!!
>
> It's supposed to effect brain chemistry with norepinephirine and dopamine by suppressing the pump or something like that.
>
> But it does cause the heart rate to increase and can cause the bp to also....maybe that's what he means. It sure doesn't stimulate me. I'm still waiting for the foggy slow motion feeling to fade.
Thank you Lexxy and BlondeGirl for your replies. I didn't really think, from reading the PI, that this was a stimulating drug, and that is what I am seeing here and also on asdm. I will argue this with my docs this week. I think the drug company shrills sold them a line of shit and that my docs didn't even read the PDR on this drug. I know a drug company rep visited them because they have a huge supply of free samples stocked away. Very sad how medicine is being applied nowadays. Thanks again,Magpie
Posted by PuraVida on April 7, 2003, at 15:57:12
In reply to Re: Straterra- anyone using as stimulant? » Lexxey, posted by Magpie on April 7, 2003, at 12:12:10
Thanks to all who answered me. I did take the test at mindfixers.com and came up w/ types 2 and 5 ADD, plus depression. I am hoping fixing the ADD - which I see now but didn't before - will solve the depression. I probably got depressed cuz I couldn't keep up with things with the ADD.
Cybercafe - back in the days when I worked in an office I was diagnosed w/ chronic fatigue, because like you, by noon I felt I needed to sleep. Since then I have held slaes jobs where I have worked from home, but have always struggled with either hyperfocusing or not working at all.
My PD now discounted my question about ADD, so I am looking for another doctor as I type.
I'm so sick of spinning my wheels. I really need to get a job - and also I am having a really hard time with my diet and exercise. In the past I have been able to motivate, but it seems impossible currently.
Thanks again all,
PV
PS Strattera isn't a stim - as you know - it works like Prozac, but targets Dopamine instead of Seretonin. I'm already on Effexor which is also supposed to help, but it seems to have just helped the depression so far.
Posted by paulk on April 7, 2003, at 16:48:06
In reply to Re: Add Meds - thanks, posted by PuraVida on April 7, 2003, at 15:57:12
> PS Strattera isn't a stim - as you know - it works like Prozac, but targets Dopamine instead of Seretonin. I'm already on Effexor which is also supposed to help, but it seems to have just helped the depression so far.
Atomoxetine (Straterra) CAN be thought of as a stimulant. What needs to be understood is that stimulation is the result of neurotransmitters levels in the brain – dopamine and norephranephrine. Amphetamines work by enabling the release of both transmitters with Dexadrine being more selective for dopamine.
Ritalin works by increasing norephranephrine by a nonunderstood process.
Atomoxetine (Straterra), Webutin, and Reboxitine work by blocking the reuptake – that is the reabsorption of the transmitter into the end of the sending nureon. This results in higher brain levels.
To say that Atomoxetine (Straterra) is not a transmitter is more of a political or marketing statement, as the FDA didn’t classify it with the other stimulants allowing it to be prescribed under more relaxed constraints.
Atomoxetine (Straterra) also has a slight seritonin reuptake effect (like the Prozac like drugs).
What seems the most important thing to know about Atomoxetine, is that the dosage can vary quite a lot from one person to the other. Too high a dose seems to cause sleepiness, and for me makes things worse instead of better. If I get the correct dose adjusted it seems to work well. The biggest problem I have is that in the evening, when it is waning in its effects, I get REALY hungry and am gaining weight. I’m going to try splitting the dose to twice a day or slowly increasing the dosage.
BTW I first noticed it's effects on day 2.
Posted by Caleb462 on April 7, 2003, at 17:04:29
In reply to Atomoxetine (Straterra) as a stimulant , posted by paulk on April 7, 2003, at 16:48:06
>
> Ritalin works by increasing norephranephrine by a nonunderstood process.
>Ritalin (methylphenidate) is a dopamine/norepinephrine reuptake inhibitor.
Posted by paulk on April 7, 2003, at 17:40:13
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by Caleb462 on April 7, 2003, at 17:04:29
>
> >
> > Ritalin works by increasing norephranephrine by a nonunderstood process.
> >
>
> Ritalin (methylphenidate) is a dopamine/norepinephrine reuptake inhibitor.From a Monograph:
"Methylphenidate is thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. "
Note the word "thought". It means they don't know.
Anyway, I find Atomoxetine (Straterra) similar to Methylphenidate, but with out as much of a rollar coster.
Posted by RunRedRun on April 7, 2003, at 18:51:59
In reply to Re: ADD meds - » PuraVida, posted by blondegirl47 on April 7, 2003, at 8:51:53
it's actually pretty common for ADD symptoms to become noticable after depression problems are cleared up. that's exactly what happened to me. good luck!!
Posted by Lexxey on April 7, 2003, at 22:10:46
In reply to Atomoxetine (Straterra) as a stimulant , posted by paulk on April 7, 2003, at 16:48:06
I would have said that you were exaggerating to notice effects on day 2 since I have read so many opinions that say we won't notice anything for 2-4 weeks. But I also noticed something early myself....so I would have to be exaggerating, too, and I'm a skeptic!!
I still think it made an improvement in my typing and handwriting. But that's all I've noticed and I'm still waiting for something else to impress me after going into my second week on 80 mg. I'm so unmotivated and blah...can't get anything worthwhile done....just the minimum. And I'm getting hungrier...yipes!!! I didn't bargain for that!!!
Posted by Lexxey on April 7, 2003, at 22:14:12
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by Caleb462 on April 7, 2003, at 17:04:29
About this stimulant description....I think I understand how it might be described as one but I think the benefit of strattera is this drug is not an "abuseable" stimulant...one there would be a market for in the illegal drug trade.
What junkie is gonna score something that takes a month to have an effect???
Posted by PuraVida on April 7, 2003, at 22:47:10
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by Lexxey on April 7, 2003, at 22:14:12
Good info on Straterra. The website says it is the first "non-stimulant medication" that's FDA approved for ADHD...and that it is a norepinephrine reuptake inhibitor (I had said it was dopamine.) I'm aware that norepinephrine is a precursor of dopamine, or vice versa, but I'm not sure I completely understand. Effexor, which I'm taking, is supposed to be a reuptake inhibitor for seretonin and norepinephrine.
I am not depressed any longer, I don't think, but am acutely aware that whatever I start I probably won't be able to follow through on, and this cycle will continue. Rather than get all psyched about doing this and that I am alternately taking small bites or not doing anything at all. But mainly I am trying to get some medical help - wading through doctors and insurance isn't fun, is it?
Question - apparently Mirapex is a dopamine reuptake inhibitor mainly used for Parkinson's, but I have seen on this site some people have used it for depression. Has anyone here tried it? Any info on doses/results is appreciated.
Thanks all -
PV
Posted by Magpie on April 8, 2003, at 2:04:07
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by PuraVida on April 7, 2003, at 22:47:10
> I am not depressed any longer, I don't think, but am acutely aware that whatever I start I probably won't be able to follow through on, and this cycle will continue. Rather than get all psyched about doing this and that I am alternately taking small bites or not doing anything at all. But mainly I am trying to get some medical help - wading through doctors and insurance isn't fun, is it?
>
> Question - apparently Mirapex is a dopamine reuptake inhibitor mainly used for Parkinson's, but I have seen on this site some people have used it for depression. Has anyone here tried it? Any info on doses/results is appreciated.
>
> Thanks all -
>
> PVHi PV,
Man, I know what you mean about just doing things in small bites or not at all, that's the mode I am in, and that's what I was hoping the Strattera would help with. And now I am not very confident about that. Anyway, as to Mirapex, initially I had thought it was helping slightly. I was started on .25 mgs, it was increased to 1 mg but when it was increased I began having difficulty swallowing at night after I took my nightly 3 mgs of Risperdal (I am on one hell of a cocktail, very treatment resistant atypical depression along with other fun things.) So they decreased it back to .25 but I am thinking of dropping that when I see my docs next because of adding the Strattera and trying not to keep adding on more and more drugs. So that is my experience, hope this helps,
Maggie
Actually, now that I think about it, the dosages may be .025 mgs and .1 mgs, I'm not sure exactly, sorry...
Posted by PuraVida on April 8, 2003, at 2:32:49
In reply to Mirapex » PuraVida, posted by Magpie on April 8, 2003, at 2:04:07
Thanks Maggie -
I was asking because I have grown quite close to my neighbor, who has Parkinson's, and some Mirapex. I know its a dopamine thing, and so is this apathy/inattentive ADD. I tried a .125 mg one day around noon - I was so depressed, and it seemed to boost me - but for her it puts her to sleep. Probably psychosomatic, though. But that night I took .375 and could NOT sleep! But my brain was positive - creative -hopefull! I actually exercised the next morning - like my old self! I have been rather afraid to take anymore, I don't want some doctor to refuse me for being self-medicating - which could be a good thing now days, since some doctors know less than we do - but I digress. So I'm kind of existing - and I'm trying to get an appt w/ a good adult ADD Dr. in San Diego. I am very hopefull - I have known on a certain level, I think, that depression is NOT what it so all about. I do have depression - maybe because of the ADD, maybe in addition to, but I'm NOT bipolar and, the main reason I'm depressed is because I KNOW that I'm smart enough to handle things, but somehow, I can't/don't - make sense?
PV
Posted by Magpie on April 8, 2003, at 2:48:59
In reply to Re: Mirapex » Magpie, posted by PuraVida on April 8, 2003, at 2:32:49
> Thanks Maggie -
>
> I was asking because I have grown quite close to my neighbor, who has Parkinson's, and some Mirapex. I know its a dopamine thing, and so is this apathy/inattentive ADD. I tried a .125 mg one day around noon - I was so depressed, and it seemed to boost me - but for her it puts her to sleep. Probably psychosomatic, though. But that night I took .375 and could NOT sleep! But my brain was positive - creative -hopefull! I actually exercised the next morning - like my old self! I have been rather afraid to take anymore, I don't want some doctor to refuse me for being self-medicating - which could be a good thing now days, since some doctors know less than we do - but I digress. So I'm kind of existing - and I'm trying to get an appt w/ a good adult ADD Dr. in San Diego. I am very hopefull - I have known on a certain level, I think, that depression is NOT what it so all about. I do have depression - maybe because of the ADD, maybe in addition to, but I'm NOT bipolar and, the main reason I'm depressed is because I KNOW that I'm smart enough to handle things, but somehow, I can't/don't - make sense?
>
> PVHey PV,
Wow, that is great, how you responded to it. It does make me sleepy as well, though. I do take it in the morning none-the-less, in order to space it far out from the Risperdal which I take at night, as to prevent the swallowing problems. (I really want to get off of that Risperdal and maybe try Abilify.) I wish I could tolerate a higher dose and maybe then I would get the great results you got at the higher doses. Maybe when you try a different doctor don't mention that you self-medicated but say you know a friend who takes it with good results or you researched it and want to try it or something along those lines. I would be afraid, myself, to admit to self-medicating, these doctors are so paranoid nowadays. I only know about ADD/ADHD in children, I'm really not familiar with how it manifests in adults, I assume it is different? I guess maybe I should look into that angle myself, although I don't really feel I have attention problems. And I am definitely depressed, but no bipolar either (sometimes I wish I could have some mania, well not really...) Well anyway, I wish you good luck and that you do find the solution to your problems, whatever they may be.
~Magpie
Posted by not exactly on April 8, 2003, at 3:04:29
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by PuraVida on April 7, 2003, at 22:47:10
> Question - apparently Mirapex is a dopamine reuptake inhibitor mainly used for Parkinson's, but I have seen on this site some people have used it for depression. Has anyone here tried it? Any info on doses/results is appreciated.
Mirapex (pramipexole) is a dopamine (primarily D3) agonist (NOT a reuptake inhibitor). Its only FDA-approved use is for treating Parkinson's Disease. It was tested for effectiveness as an antidepressant (I was a volunteer in one of the early trials) but it failed to win FDA approval for that use.
In the trial, participants were randomly (double-blind) assigned to one of four groups: 7mg/day, 3mg/day, 1mg/day, or placebo. The drug was administered orally b.i.d. I was in the 1mg/day (0.5mg/dose) group (I didn't know my dose during the trial; they were able to tell me years later).
It was a miracle drug for me. Completely cured my depression and ADD almost immediately! But after the trial, my depression & ADD returned just as quickly. Unfortunately, since pramipexole was not yet approved, they couldn't prescribe it to me. So I went for years trying many other antidepressants, but none worked anywhere near as well (most made me feel worse).
When Mirapex was finally approved (for Parkinson's only, but at least it could be prescribed), I tried it again. Alas, it didn't work as well as it had years before, and finally "pooped out" completely after several months. Bummer.
My theory is that, because it's an agonist, the brain down-regulates the dopamine receptors to compensate, so eventually the benefit wears off.
- Bob
Posted by blondegirl47 on April 8, 2003, at 7:59:32
In reply to Atomoxetine (Straterra) as a stimulant , posted by paulk on April 7, 2003, at 16:48:06
paulk...Thanks so much for the info, very interesting reading. I start 60 mg tonight, it seems when I go up is when I have the most side effects. Like dizzy and wanting to eat everything.
Posted by teacherkris on April 8, 2003, at 10:15:13
In reply to Re: Mirapex » Magpie, posted by PuraVida on April 8, 2003, at 2:32:49
Hi there, I'm not sure if this is appropriate to post or not but I'm in San Diego and have a great psychiatrist that I've worked with for years. He's located in Hillcrest and his name is Randy Hicks. He's very cautious with meds and as you'll see in my earlier posts that frustrated me at first, however, it's paid off. Just to clarify cautious in a good way. I've always brought new meds to his attention and he's more than willing to have me try them he just likes to change one thing at a time and makes sure he has all the info. For example, he wouldn't start me on Strattera until he sat down with a rep from Lily to get all the information. Anyway, hope that helps.
Posted by paulk on April 8, 2003, at 10:44:51
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by Lexxey on April 7, 2003, at 22:14:12
> About this stimulant description....I think I understand how it might be described as one but I think the benefit of strattera is this drug is not an "abuseable" stimulant...one there would be a market for in the illegal drug trade.
>
> What junkie is gonna score something that takes a month to have an effect???IMHO non of the stimulants are abusable if prescribed in the amounts needed to treat ADD.
Posted by Lexxey on April 8, 2003, at 10:57:59
In reply to Atomoxetine (Straterra) as a stimulant , posted by paulk on April 8, 2003, at 10:44:51
By "abusable" I meant that it was something that could be sold to another for whom it was not prescribed and taken in higher amounts that would cause a over stimulated experience. As when students sell ritalin or dex to others who want to stay up and study. I don't think there would be a market for Strattera as there is for the others.
Posted by paulk on April 8, 2003, at 11:20:44
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by Lexxey on April 8, 2003, at 10:57:59
Such abuse is overrated. More politics than fact. They are even giving our pilots in Iraq Dexadrine.
The result of the politics is that people that suffer from ADD have a hard time getting what they need.
Posted by Magpie on April 8, 2003, at 15:03:38
In reply to Re: Mirapex, posted by teacherkris on April 8, 2003, at 10:15:13
> Hi there, I'm not sure if this is appropriate to post or not but I'm in San Diego and have a great psychiatrist that I've worked with for years. He's located in Hillcrest and his name is Randy Hicks. He's very cautious with meds and as you'll see in my earlier posts that frustrated me at first, however, it's paid off. Just to clarify cautious in a good way. I've always brought new meds to his attention and he's more than willing to have me try them he just likes to change one thing at a time and makes sure he has all the info. For example, he wouldn't start me on Strattera until he sat down with a rep from Lily to get all the information. Anyway, hope that helps.
Hi PV,
Sure, this is appropriate, and I truly appreciate it. But I am East Coast, LOL, in New Yawk, so it is a bit far. :-) But thanks anyway,
Magpie
Posted by BrettMan on April 8, 2003, at 17:36:37
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
Incase any one is interested in detailed information that your doctor has access to about Straterra, you can download(*.pdf format) the information here- http://pi.lilly.com/us/strattera-pi.pdf
I'm on my first week and so far so good. Its kinda nice to be off the stimulant because I no longer feel that there arent enough hours in each day to get everything done! The only problem I noticed was that it tends to wear off in the evening. Currently I'm working nights and its not a good thing. I'm considering splitting the morning dosage in two.
Posted by noa on April 8, 2003, at 19:05:21
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by Caleb462 on April 7, 2003, at 17:04:29
This is my understanding of this, but I am not as well versed in the biology/chemistry of these things as many here are:
When I see the word "stimulant" I understand it to mean a "central nervous system stimulant", which implies a "dirty" (non-selective)medication, not a selective one. I did not think stimulants, like Ritalin, are reuptake inhibitors but I might very well be wrong on that.
My *understanding* is that atomoxatine is not a central nervous system stimulant, that it is a selective norepinephrine reuptake inhibitor (SNRI), and that in fact it is supposed to be a highly selective one--targetting specific receptors in a way that CNS stimulants do not.
Posted by PuraVida on April 8, 2003, at 19:05:29
In reply to Re: Mirapex, posted by teacherkris on April 8, 2003, at 10:15:13
Thanks Kris - I've been on the phone all afternoon trying to get an appt somewhere. Left a mssg for my current Dr again (she's an RN) reminding her she promised to get me in for an evaluation...but as I said, she doesn't seem to beleive in Adult ADD.
BTW, there is a program at UCSD that does intensive nueropsychiatric testing and follow up for ADD and all potential comorbid or other disorders. Apparently it costs $1250, which insurance doesn't pay for. Still, if I have the funds I'd be tempted - what price a healthy brain, you know? I am sick of this treadmill!
Thanks again,
PV
BTW, do you know of any groups for ADD in SD? There is a website for an organization, but it looks pretty defunct.
> Hi there, I'm not sure if this is appropriate to post or not but I'm in San Diego and have a great psychiatrist that I've worked with for years. He's located in Hillcrest and his name is Randy Hicks. He's very cautious with meds and as you'll see in my earlier posts that frustrated me at first, however, it's paid off. Just to clarify cautious in a good way. I've always brought new meds to his attention and he's more than willing to have me try them he just likes to change one thing at a time and makes sure he has all the info. For example, he wouldn't start me on Strattera until he sat down with a rep from Lily to get all the information. Anyway, hope that helps.
Posted by paulk on April 8, 2003, at 19:10:08
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by noa on April 8, 2003, at 19:05:21
If you look at the effects of a CNS you will find them listed as side effects in the monograph. The issue is pointless - except that it is much more difficult get perscriptions of the other, politicaly/government determined classification.
I see it as a lobbying win by Libby on the FDA.
Posted by PuraVida on April 8, 2003, at 19:19:25
In reply to Re: Mirapex » PuraVida, posted by not exactly on April 8, 2003, at 3:04:29
Thanks Bob - I guess I'd better figure out the difference. I did read your posts about your trial, and that whole thread, before I tried it...
>
> Mirapex (pramipexole) is a dopamine (primarily D3) agonist (NOT a reuptake inhibitor).I have heard this, too - but what do you do then?
> My theory is that, because it's an agonist, the brain down-regulates the dopamine receptors to compensate, so eventually the benefit wears off.
>
> - Bob
>
Posted by not exactly on April 9, 2003, at 3:40:22
In reply to Re: Mirapex » not exactly, posted by PuraVida on April 8, 2003, at 19:19:25
> > My theory is that, because it's an agonist, the brain down-regulates the dopamine receptors to compensate, so eventually the benefit wears off.
> I have heard this, too - but what do you do then?
Unfortunately, you give up on the pooped-out med (discontinue, wash out, endure the depression-intensifying rebound) and then look for something else to try. I tried lots of other meds & combinations before I finally found something that provided a significant and sustained benefit.
I've already posted (to another thread) my current successful med combo [http://www.dr-bob.org/babble/20030310/msgs/208344.html] and why I think it's working for me [http://www.dr-bob.org/babble/20030310/msgs/208906.html]. BTW, this combo is also helping with my ADD - I'm feeling less distractable and more focused. It's now easy for me to make decisions, get motivated, and follow projects to completion. It's been working fine for a couple of months now, and I sure hope it doesn't poop out.
I'm not necessarily recommending this combo to anyone else - my brain chemistry seems to be quite different from most people's. But if your ADD is accompanied by atypical depression, anxiety, and social phobia, you might want to give it a try. The meds are cheap (both are available as generics) and have relatively benign s/e profiles.
- Bob
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