![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 464 to 488 of 1242. Go back in thread:
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
Posted by fallsfall on April 9, 2003, at 8:04:34
In reply to stuffed head feeling?, posted by Lexxey on April 7, 2003, at 12:04:35
I have something similar to your "stuffy head" feeling. For me it feels like I have clogged sinuses in the top third of my head - with that tingly feeling. I've been on Strattera for 2 months and this came up about 2 weeks ago. It seems to be going away in the last couple of days - I hope. It is almost like a lightheadedness, it makes me feel unstable. But the good points of Strattera make that a minor inconvenience.
Good luck!
Posted by blondegirl47 on April 9, 2003, at 8:07:53
In reply to Re: stuffed head feeling?, posted by fallsfall on April 9, 2003, at 8:04:34
Hi Fallsfall
Can you tell what good stuff your getting from strattera and what milligram your on?
Thanks
Posted by Lexxey on April 9, 2003, at 8:11:02
In reply to Re: stuffed head feeling?, posted by fallsfall on April 9, 2003, at 8:04:34
thanks for posting I was just wondering...I had the feeling it was the drug since it just happened a while after each dose and I like to make a record of symptoms in case someone else was wondering too.
when a drug is this new we have to work together to kepp info available.
Posted by Stan on April 9, 2003, at 13:52:35
In reply to Re: life after Mirapex » PuraVida, posted by not exactly on April 9, 2003, at 3:40:22
hi bob -- i've read a few of your posts from time to time and am glad to hear that the buspar/klonopin combo is still performing for you -- i'm curious about one thing though -- i recall that when you were taking neurontin, you thought it was making you forgetful and spacey and mentally "slow" in certain situations -- is the klonopin doing any of these things? judging from the tone of your messages, it seems that it's not, and in fact may be having the opposite effect. would you say that there's no cognitive impairment occuring with the K, in your view? i'm curious because benzos make me tired and depressed and i'm considering an anticonvulsant as an alternative.
thanksStan
Posted by fallsfall on April 9, 2003, at 15:07:53
In reply to Re: stuffed head feeling? » fallsfall, posted by blondegirl47 on April 9, 2003, at 8:07:53
I take 80mg in the morning of Strattera. I take it for Depression.
The benefits are for both Strattera and Provigil. Each one alone doesn't help me, but together they are really good.
They give me energy - so much more than I had before. I also am motivated to actually do something with the energy. I think clearer. I can finish things I start. Basically I have been allowed back into the world. It also is doing a really amazing job in controlling suicidal feelings - Situations exist right now where I would expect to be really suicidal, but I'm doing OK.
I looked for over a year to find something that would work for me. I love my Strattera!
P.S. I also take Prozac and Lithium and some other things for side effects.
Posted by PuraVida on April 9, 2003, at 16:05:49
In reply to Re: life after Mirapex - not exactly » not exactly, posted by Stan on April 9, 2003, at 13:52:35
Thanks Bob -
I have an appt w/ a local Dr who works closely with the Amen clinic - so I am looking forward to that - if I can make it till the appt! :)
Just as an aside - I was on Nuerontin for about a year and had persistent headaches over my right eye. When I stopped the Nuerontin, they went away. I'm not really sure if it ever did anything else for me. Then I was on Topamax - only 50 mg, and got fed up with the tingly feeling in my face and lips.
PV
Posted by not exactly on April 9, 2003, at 19:11:36
In reply to Re: life after Mirapex - not exactly » not exactly, posted by Stan on April 9, 2003, at 13:52:35
Stan,
Within days of stopping the Neurontin, I felt my intellect come back. I hadn't realized just how much mental impairment I was suffering until it went away. Thank God it was reversable! Now I can once again do mental arithmetic, picture intricate objects in my mind, remember details, do complex reasoning, think creatively, and instantly come up with witty replies during conversation. My brain works as well as I remember it had back when I was a straight-A grad student, and when I was a software project leader.
Unfortunately, stopping the Neurontin also caused the return of anxiety. Not that I had been totally anxiety-free while on the Neurontin, but it became much worse without it. I was tempted to resume the Neurontin just to help with the anxiety, but I REALLY didn't want to return to that state of impaired intellect. So, since I already had a Rx for Klonopin (p.r.n. for occasional periods of debilitating anxiety), I tried taking small doses (1 mg/day or less) of that instead.
First of all, the Klonopin helped with the anxiety in a much more effective way than the Neurontin ever had. No more introverting social anxiety, no more terrifying acrophobia (an unexpected and wonderful benefit, since mountaineering is one of my favorite hobbies!), no more paralyzing non-specific background anxiety. It did cause some sedation/drowsiness/hypersomnia for the first few days, but once I got used to it, these side effects completely disappeared. Now it almost feels like a stimulant, because I feel I'm no longer inhibited by my nameless fears. But I'm not taking so much that it's supressing reasonable caution and respect for real danger - I'm still a safe driver and don't act rashly. In short, I'm now confident and functional.
Secondly, the Klonopin did NOT have the inellect-dulling effects that the Neurontin did. I did not do enough careful testing with & without to be able to claim that there is ZERO impairment, but if there's any dulling at all, it's not really noticable. And the ability to think and act without the constant nagging anxiety more than makes up for any minimal dulling. I would say that I'm noticing absolutely NO side effects at this point.
I'm not worried about becoming a benzo addict. This is a very low dosage, I have no desire to escalate the dosage, and I certainly don't intend to discontinue it abruptly. The half-life is long enough so I don't have to worry about falling apart if I accidentallty miss a dose. Since it appears to be effectively solving a significant chronic problem, I wouldn't really mind if I had to take it for the rest of my life. Does a diabetic worry that he's "addicted" to insulin? Klonopin is cheap and benign insurance.
As always, the YMMV disclaimer applies. I'm sure there are folks who think that Klonopin causes cognitive impairment, and Neurontin doesn't.
- Bob
Posted by Stan on April 9, 2003, at 22:08:11
In reply to Re: Klonopin vs. Neurontin » Stan, posted by not exactly on April 9, 2003, at 19:11:36
Posted by Viridis on April 10, 2003, at 0:43:21
In reply to Re: Klonopin vs. Neurontin » Stan, posted by not exactly on April 9, 2003, at 19:11:36
I also find that Klonopin (1 mg/day) helps me think more clearly. Before using it, anxiety interfered tremendously with my cognitive processes and sleep, and induced severe depression on a regular basis. When I started it, I had a week or two of mild sedation etc., then the side effects totally of K disappeared and only the benefits have remained.
I take Neurontin as well (1200 mg/day) and really don't think it does much at all (for me -- YMMV etc.). The first couple of times I took it I experienced a pleasant, "floaty" high, and since then I've felt nothing. My pdoc suggests I stay on it because it may add "background" stability, but honestly, I don't think it has any effect any more, good or bad. Klonopin is definitely the driving force, and for me is a excellent med, with no negatives after almost 2 yrs of use at the same dose.
Posted by Hattree on April 10, 2003, at 13:51:40
In reply to Re: Klonopin vs. Neurontin » not exactly, posted by Viridis on April 10, 2003, at 0:43:21
Posted by blondegirl47 on April 10, 2003, at 14:09:05
In reply to Please keep the Strattera updates coming! (nm), posted by Hattree on April 10, 2003, at 13:51:40
Posted by Lexxey on April 10, 2003, at 15:26:10
In reply to Re: Please keep the Strattera updates coming! (nm), posted by blondegirl47 on April 10, 2003, at 14:09:05
OK...I have an update, of sorts....
I'm in my 11th day at 80mg [40 at 8am, 40 at 4[pm]and this was after 2 weeks on 40mg and all I notice is that I'm sleeping better and still having fun, vivid dreams.
I don't feel any ADHD relief. I haven't been getting much done and I have been all **too hungry**, and I have been as uncoordinated as ever. I was hoping this would help the physical coordination as Ritalin did for the 19 years I took it. I know what it feels like to have my brain work right and this isn't it yet!!!
I just can't get into gear and do some jobs I need to do, and actually, usually enjoy...I just put them off apathetically...[if that's a word]...I mean with apathy....blah-ness. Don't give ahoot!!!
I want some kind of revelation or motivation or something to let me know this is kicking in and I'm not wasting my time.
I have a question....
The doc gave me some 60mg pills in case I wanted to take one of those in the am instead of 40mg. I weigh 150#. Do yall think I should up my am dose to 60mg? I'm putting it to a vote!!! See how bored I am!
I just sat here for 4 hours and read everything I could on this drug and how dopamine affects ADHD and I'm not sure much has sunk in.
Posted by blondegirl47 on April 10, 2003, at 15:32:45
In reply to Strattera update/Impatient!, posted by Lexxey on April 10, 2003, at 15:26:10
Hi Lexy
Here is a link to dosage.
http://www.johnswank.com/strattera_dosing_chart.htm
Wish this was going better for the both of us. If I didn't have my adderall xr, I'd really be in trouble.
Posted by Lexxey on April 10, 2003, at 15:51:28
In reply to Re: Strattera update/Impatient! » Lexxey, posted by blondegirl47 on April 10, 2003, at 15:32:45
that chart answers my question without having to figure how much I weigh in kg.
Now...I just wondered if some well informed folks here would know if the kava kava I have been taking at night to help me sleep...[only for 7 days now]....could it be interferring with the Strattera?
They both work on dopamine somehow but since I don't know what the word "reuptake" means I can't understand what it does to the dopamine.
I have a bunch of ritalin I could be taking but I don't want it to interfere with the effects of the Strattera just incase it starts working....besides I don't want it to affect my blood pressure any more either.
Posted by blondegirl47 on April 10, 2003, at 16:01:47
In reply to Re: thanks/new comment, posted by Lexxey on April 10, 2003, at 15:51:28
I just did a cut and paste from strattera site.
Strattera is a norepinephrine reuptake inhibitor
I am not sure either, the site is www.strattera.com
I don't think I would take kava, kava with the sterrata, you could be over amping your receptors in your brain. For example too much serotonin can actually burn out the serotonin receptors in your brain, which can lead to you being quite sad. I haven't read up on kava kava in a long time, but they both do setative things.
Posted by PuraVida on April 10, 2003, at 17:24:38
In reply to Re: thanks/new comment, posted by Lexxey on April 10, 2003, at 15:51:28
Lexxy -
I wouldn'take tha Kava Kava - have heard negative things about it esp w/ taking pych drugs. Have you called your docter? And, remind me why you are trying Straterra?
PV
> Now...I just wondered if some well informed folks here would know if the kava kava I have been taking at night to help me sleep...[only for 7 days now]....could it be interferring with the Strattera?
>
> They both work on dopamine somehow but since I don't know what the word "reuptake" means I can't understand what it does to the dopamine.
>
> I have a bunch of ritalin I could be taking but I don't want it to interfere with the effects of the Strattera just incase it starts working....besides I don't want it to affect my blood pressure any more either.
Posted by oops...trythatbutton on April 10, 2003, at 17:33:28
In reply to Re: Strattera update/Impatient! » Lexxey, posted by blondegirl47 on April 10, 2003, at 15:32:45
hmmm, but they do sell the 80mg dose...I tried the 40mg for 2 weeks...the first few days were interesting....next few days were very good but after 6 days or so I did feel right. I was just loosing interest in things in general...just didn't care type additude...which is way not me... the 40 was too much for me (or bad side affects?) and I was dropped down to 18....18 felt fine but by late afternoon I was somewhat my old self...I am now at 25 but...not sure...
How about going to a lower dose, Lexxey
Posted by oops...trythatbutton on April 11, 2003, at 1:57:30
In reply to Please keep the Strattera updates coming! (nm), posted by Hattree on April 10, 2003, at 13:51:40
First, I hope I didn't stop the Straterra posting traffic. Being my first posting, I was the last posting of the day at 5:30 on this topic. It felt like I said something wrong. I have been reading only, sort of like " outside, looking in" ...actually, re-reading the posting, I realized that I was not making much sense.
My Straterra History:
I started taking 40mg of Straterra in the second week of February for my ADHD. The first 2 days I was a bit out of it....loss of appetite(like nothing), dry mouth, lighthead-ness. The next several days were excellent, I was completing tasks/projects at home and work. I finished things that I started instead of getting sidetrack and off doing something-else. I stopped daydreaming in the middle of normal conversation. I was losing weight...yea!! Then about the 8th/9th day, I noticed that I had stop doing any of my million hobbies, clothes weren't washed ...things were starting to get neglected. I felt...I really didn't feel, I just didn't care and I stopped losing weight. My "something's wrong" control in my head kicked in (about day 13). Called my doc. I was told to stopped the 40mg. With determination, we restarted me with 18mg, thinking that 40mg starting was too much for me. Took the 18mg for about 2 and a half weeks. Everything was going good (still had the dry mouth) but it felt like it was wearing off by afternoon. I started on 25mg after that. I have been on 25mg for almost a month now. I take 25mg of Straterra at 6am when I wake up.Presently:
Like clockwork, I wake up about this time (about 12:30 to 1). Boom, wide awake. This started happening this pass week. I hope it goes away. I do notice that it last towards the evening (but not quite...my impulse shopping/spending kicks in among other things). With a stressful day at work, the Starterra feels like it last maybe to a bit after noon then I notice some of my "habits" creeping back. I am thinking about asking for two 10mg a day, one in the morning and one for mid afternoon. I notice I get grumpy when my blood sugar gets low, different from my past "really hostile crankness" when this happens. Also occasionally, I just get the munchie and just want to eat.Hope everyone is doing well on their Starterra.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.