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Dr. Bob is Robert Hsiung, MD,
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Posted by comorbid? on May 24, 2003, at 20:24:24
In reply to Atomoxetine (Straterra) - bi polar » comorbid?, posted by paulk on May 23, 2003, at 10:44:29
> I think the bi-polar diagnose is a fad diagnose and unfortunately, ends up removing most of your treatment options. Deciding if a patient is hyperactive or manic is a VERY subjective determination that will get you either a bipolar or a quite different ADD diagnose.
>
> The fix is to go to a new doctor and tell him you want his to diagnose you BEFORE he has access to your old records.
>
> You will most likely get a new diagnose, and if it is non bi-polar you should be able to try stimulants. (In fact I would bet if you go to 5 different doctors, you will get 5 different diagnoses!)
>
> Your best hope to get good treatment is to be very proactive with your doctor.
>
paulk -
Thanks for your input and advice. I must say, my initial self-diagnosis, based on what i ferreted out on the web, was ADHD, inattention subtype, and i wanted stimulant treatment. BUT, i had additional symptoms that were not covered by the ADHD symptom cluster: Depression and hypomania on a seasonal cycle (as well as on shorter cycles), pronounced mood lability of long duration, strong correlation between light exposure and mood, ultra-ultra-rapid (ultradian) mood cycling, and so on. These are all hallmarks of childhood-onset BPD, and after my doc told me he thought i might be bipolar, i looked into it and found that my symptoms were MUCH better characterized by bipolar type 2 than by ADHD.
AN interesting thing: Childhood-onset bipolar disorder is very frequently _misdiagnosed_ as ADHD. I would suggest that any parent who has a child with an "intractable" case of ADHD consider the possiblity of COBPD or "early onset BPD," especially if there is a family history of mood disorders. This is 180 degrees different from your assertion about "fad diagnoses."
To further respond to your suggestions: My current doctor had no medical history to refer to, other than what i told him about my self-diagnosis and my history of winter depression and summer up-mood, with agitation and extreme mood swings in spring and fall (which had been ignored by my previous docs). My case history was unavailable to him, due to difficulties in obtaining the documents and my privacy concerns. This doc has wide experience in dealing with ADHD and numerous other disorders that interfere with studying, because he works in a university mental health setting. He doesn't have any predispostion to one diagnosis or another (which is what i think you're suggesting). And his diagnosis is in complete accord with my symptom cluster, more so than that of any doc i've had previously.
If you look back at my first post, you'll see that my psychometric assessment, which was performed independently by another doctor in the university system (who did not communicate with my current doc) was ADHD _inattention subtype_ with FEATURES of hyperactivity, and that my slight hyperactivity was not my reason for seeking treatment, nor was it the most salient part of my symptom cluster. I have never fit into the hyperactivity model very well; i'm a distracted daydreamer, rather than a disrupter. Always have been, from early childhood.
You may also see from my earlier post that i AM proactive with my doc. We have a very open relationship, and he respects my self-awareness and asks me to consider things rather than telling me what to do (he even suggests that I look up references for various drugs to see what I think about them!). Since i agree with his diagnosis and am doing well with my current treatment (though not finished titrating, and still having some concentration issues that we’re working on), i think it would be ill-advised, even foolish, for me to seek another doctor at this time.
Finally, it bears mentioning that there are NUMEROUS treatment options for both ADHD and bipolar disorder, and a well-informed doc will know about them. My doctor has included the possibilty of stimulants in my case, having decided that my degree of self-awareness and my honesty and openness with him reduce the risk of unwanted complications “snowballing”... Strattera is appealing, because it is not a controlled substance like the amphetamines and appears to be less likely to induce mania. But frankly, i'd rather continue my current course of treatment, because stimulants simply will not address my various problems with long term mood lability (ADHD is often associated with SHORT-TERM mood swings). My doc even suggested the possibility of using stimulants on an occasional basis, for times when i need extra concentration, but i'm not very interested in this option, because i've abused stimulants in the past and am familiar with how they affect my mood when i discontinue them (depression).
Thank you for your opinions, but really i think you need to take a closer look at things before making the type of statements you made. Mental illness is complicated, highly variable, and poorly understood; jumping to snap conclusions is not the way to deal with it.
comorbid?
Posted by froggyanna on May 24, 2003, at 20:48:08
In reply to Re: Atomoxetine (Straterra) - bi polar, posted by comorbid? on May 24, 2003, at 20:24:24
> Thank you for your opinions, but really i think you need to take a closer look at things before making the type of statements you made. Mental illness is complicated, highly variable, and poorly understood; jumping to snap conclusions is not the way to deal with it.Yes, I think it's very easy sometimes for people to hear someone else's story and react to one idea in that story and go galumphing about giving unsolicited advice. I'm sure I've done it, too. I'm on a discussion board about thyroid problems, and after posing a question about information that my doctor gave me, I got all kinds of responses along the lines of "Your doctor is stupid, get a new doctor." I find that people have sometimes polarized themselves and set themselves up to automatically disregard doctors, no matter what. It's probably because they HAVE been abused and/or neglected by many doctors in the past. However, in this particular case, I've seen this doctor ONCE, I really liked him, we hit it off, and he spent time with me. So, because he does one thing or says one thing that may not be in line with what some people "know," I'm supposed to run madly away?? No. You can drive yourself crazy finding the one doctor who will tell you what you WANT to hear. Would I switch if I came to the conclusion that he is NOT the doctor for me? Yes, but that will take some time to find out! At least, for this one, it will. There have been other doctors where I knew right away. The fact is: he's NOT stupid and neither am I. If we can work together to find the best solution to my health problems, in a give and take manner, that would be ideal. And that will take a few visits to find out if that's the way it will go. The best way to GET respect is to be sure that you give plenty of it (without giving away your power, of course).
froggyanna
Posted by TenMan on May 26, 2003, at 11:33:56
In reply to Re: Atomoxetine (Straterra) - bi polar » comorbid?, posted by froggyanna on May 24, 2003, at 20:48:08
Anyone have any new updates on strattera? I have a sample bottle of 40mg. sitting in my bathroom and am afraid to take it due to some of the side effects I have been hearing about. I also take 60mgs. of adderall a day. My doc wants me to taper off the adderall and start the strattera. Is it really better to switch or should I stay on the adderall. Thanks!
Posted by froggyanna on May 26, 2003, at 12:45:12
In reply to Re: Atomoxetine (Straterra) - bi polar, posted by TenMan on May 26, 2003, at 11:33:56
Hi TenMan,I've only been on Straterra for four days, so I'm not an expert. But from what I've been able to glean here, each person's experience has been different. It sounds to me, though, that the people who have chosen to "wait out" the side effects are glad that they did. I have been posting a sort of diary about my experience and I'm going to write about my fourth day now in a new thread. My reason for choosing Straterra over one of the stimulants was that I just didn't want to put that kind of substance into my body if I could at all avoid it. I don't know what my final decision will be at this point. It's only my opinion, but I would try not to let fear get in the way of trying something that could potentially be very beneficial for you! I wish you the best!
froggyanna
> Anyone have any new updates on strattera? I have a sample bottle of 40mg. sitting in my bathroom and am afraid to take it due to some of the side effects I have been hearing about. I also take 60mgs. of adderall a day. My doc wants me to taper off the adderall and start the strattera. Is it really better to switch or should I stay on the adderall. Thanks!
Posted by Ritchie on May 26, 2003, at 12:52:26
In reply to Re: Atomoxetine (Straterra) - bi polar, posted by TenMan on May 26, 2003, at 11:33:56
> Anyone have any new updates on strattera? I have a sample bottle of 40mg. sitting in my bathroom and am afraid to take it due to some of the side effects I have been hearing about. I also take 60mgs. of adderall a day. My doc wants me to taper off the adderall and start the strattera. Is it really better to switch or should I stay on the adderall. Thanks!
You have to be patient and give it time. The side effects do go away but it takes a couple of months, even the dry mouth is getting better for me. I am at 120mg and I love it. I take it for depression and anxiety not ADD but I am glad I waited it out. I have been trying to find the right med for me for over 6 months and I finally am happy with Strattera.
Jax
Posted by fallsfall on May 26, 2003, at 12:56:05
In reply to Re: Atomoxetine (Straterra) - bi polar, posted by TenMan on May 26, 2003, at 11:33:56
The side effects seem to be less if you start small in increase the dose gradually. I started with 10mg and increased 10mg every 3 days. I did have side effects. I've been on it for 4 months now (80mg). I still have constipation, and maybe dry mouth (or is is one of the other meds I take?), but the benefits vastly outweigh any side effects. Good luck!
Posted by theo on May 26, 2003, at 16:23:26
In reply to Re: Glad To Find This Group -- Starting Straterra, posted by froggyanna on May 24, 2003, at 9:44:01
I am currently taking 10mg Lexapro and thinking about adding Strattera. Any input??
Posted by littie on May 26, 2003, at 16:36:14
In reply to Re: Atomoxetine (Straterra) - bi polar » TenMan, posted by froggyanna on May 26, 2003, at 12:45:12
I'm new to the boards and wondering what positive effects people are noticing on Strattera. I'm on Day 5 and my energy is very low and I'm very quiet and pretty irritable. What's the outcome after the wait, and how long should it be before I experience anything good--like better mood, more motivation--higher spririts?
Posted by paulk on May 27, 2003, at 11:04:47
In reply to Re: Atomoxetine (Straterra) - bi polar, posted by littie on May 26, 2003, at 16:36:14
Straterra worked well for a while but after a few months it just dosen't really make much difference. I tried increasing the dosage, but I ended up sleeping all the time and not getting anything acomplished. Has anyone else taken it for more than 3 months?
Stopping Stratterra left me feeling rather down and very hungrey for a couple of days.
Posted by teacherkris on May 27, 2003, at 11:39:03
In reply to Atomoxetine (Straterra) poop out, posted by paulk on May 27, 2003, at 11:04:47
I've been takign it since about February i think but am still levelling off the dose. I've been at 80 for about two months now but I've just finally gotten my body to accept 80 once a day rather than as a split dose. I was having problems with the once a day but it looks like that was due to Zoloft withdrawl so I went back on 25 mg Zoloft and now it's fine. I've been fairly tired this week but i'm hoping that's just my body getting used to having it once a day. My doc wants me to stabilize on 80 before we consider going up. I still think it's a million times better than any of the stims. The side effects that I never realized I had from the stims such as short tempered and easily irritated by noises etc. are all gone! My motivation is higher and I'm getting things done. I'm more organized and much much more patient! So there's my several months in update!
Posted by fallsfall on May 27, 2003, at 12:23:48
In reply to Atomoxetine (Straterra) poop out, posted by paulk on May 27, 2003, at 11:04:47
I've been taking it for 4 months. I am a little tired, but my life has been hell for the last 2 months, so it is really hard to tell what causes what. When I'm not sleeping I do have more energy than I had before Strattera. So I think it is working for me. I take it for depression.
Posted by cmcdougall on May 27, 2003, at 13:08:03
In reply to Anyone taking Strattera with SSRI's like Lexapro?, posted by theo on May 26, 2003, at 16:23:26
> I am currently taking 10mg Lexapro and thinking about adding Strattera. Any input??
I take 100mg Strattera, 20mg Lexapro, 50mg Trazodone, and 200mg Zonegran each day. I used to take Adderal and am thinking of adding a little back to tweak the Strattera. I LOVE the Strat... I am motivated, able to stay on task, less ruminating, etc, but still not able to wrap my brain around complex problems at work like I was w/ the Adderal. I hope my pdoc w/ let me enjoy the best of both. Will keep you posted.
Love and luck,
Carly
Posted by Hattree on May 28, 2003, at 9:23:59
In reply to Re: Anyone taking Strattera with SSRI's like Lexapro? » theo, posted by cmcdougall on May 27, 2003, at 13:08:03
Some people complain about Strattera wearing off in the afternoon or evening, which seems like a curious feature of a drug that takes weeks or months to reach its full effect. Wondering if those initial short-lived boosts might be side-effects in themselves.
Anyway, for those of you who have been taking Strattera practically since it came on the market, are you experiencing the late-day dips?
Posted by paulk on May 28, 2003, at 12:10:05
In reply to ? for the strattera veterans, posted by Hattree on May 28, 2003, at 9:23:59
What I experienced was a good effect in the morning after taking the medicine, with lots of hunger in late afternoon. I also found that after a while it did less and less and taking more did not do anything except make me more tired. When I stopped taking it I go a lot of energy.
It seems to me like something builds up over time that stops it from working. If I stop for a few days it will work again. It doesn’t seem like tolerance because taking more makes it worse. What is so interesting is that after a couple of days off of it (and feeling a bit down), I start to feel energetic; just like I started taking it again and have lots of energy – even though I didn’t take anything! I’m wondering if it would be best to take it for a few days and then stop – when symptoms return take it again for a while – stop (repeat)
My guess is that a side effect appears as some metabolite builds up negating the good effects.
Posted by Ritchie on May 28, 2003, at 15:42:46
In reply to ? for the strattera veterans, posted by Hattree on May 28, 2003, at 9:23:59
> Some people complain about Strattera wearing off in the afternoon or evening, which seems like a curious feature of a drug that takes weeks or months to reach its full effect. Wondering if those initial short-lived boosts might be side-effects in themselves.
>
> Anyway, for those of you who have been taking Strattera practically since it came on the market, are you experiencing the late-day dips?---------
Yes I have the afternoon dips also, I just started to try 400 mg of Green tea. It seems to help somewhat but not the best. I don't do caffiene. I get a lot of yawning in the afternoon also. But other than that I like it.
Posted by Susannah on May 28, 2003, at 16:11:27
In reply to Glad To Find This Group -- Starting Straterra, posted by froggyanna on May 22, 2003, at 4:32:32
Does anyone have anything positive to say about treating ADHD children with Strattera? My 9 year old daughter has been taking Adderall XR 10mg/day for about a year now and I have not seen any improvement. Before Adderall XR she took regular Adderall (15mg/day bid) for about 2 years and that worked much better; however our doc insisted that we switch to a once a day formula. She took Ritalin once, very briefly, but had an increased heart rate from med and was promptly taken off. She is already very small and thin for her age, she is only 50lbs. She has trouble falling asleep at night ans is subsequently tired and irritable in the mornings.
Her therapist thinks she will do better on Strattera because he claims she is "sad" as well and this med should treat both ADHD and her sadness. I'm taking her to the psychiatrist on Monday and I am going to ask him to switch her meds. I have read boards similiar to this and only see bad things. Does anyone have anything good to say or has anyone or their child had a positive experience with Strattera?
My daughter has a relatively mild cause of ADHD, more inattentive than hyperactive although her symptoms can change in response to social situations, school, ect.
Any information would be greatly appreciated.
Posted by Hattree on May 29, 2003, at 8:16:19
In reply to Re: ? for the strattera veterans, posted by Ritchie on May 28, 2003, at 15:42:46
Posted by Hattree on May 30, 2003, at 10:38:47
In reply to Anything Good to Say about Strattera?, posted by Susannah on May 28, 2003, at 16:11:27
Posted by gouda on May 30, 2003, at 11:25:43
In reply to Anyone taking Strattera with SSRI's like Lexapro?, posted by theo on May 26, 2003, at 16:23:26
> I am currently taking 10mg Lexapro and thinking about adding Strattera. Any input??
I am taking 20 mg Celexa (which is the "older precursor version" to Lexapro - the newer and revamped version of Celexa)
Just started Strattera, yesterday @ 18 mg, I'll keep you posted .... so far:
SLEEPY! TIRED! but pdoc said this is normal! I am hopeful!
Posted by gouda on May 30, 2003, at 11:44:56
In reply to Atomoxetine (Straterra) poop out, posted by paulk on May 27, 2003, at 11:04:47
Hello all! Enjoyed reading posts!
I just started @ 18 mg, am kinda afraid about initial experience!
Got very sleepy! Knocked out for 20 hours! Dreams were short, which was kinda nice!
Starting to feel moody! I ranted over the phone to my boyfriend for 2 hours about all his flaws ... felt kinda strange and guilty about it.
Can anyone tell me what I should expect in the coming weeks?
What is ato-moxe-tine stand for anyway? All I know is that this is NOT an amphetamine, which is a good thing.
Posted by bookgurl99 on May 30, 2003, at 12:05:48
In reply to I am a Newbie on Strattera: need support!, posted by gouda on May 30, 2003, at 11:44:56
were short, which was kinda nice!
>
> Starting to feel moody! I ranted over the phone to my boyfriend for 2 hours about all his flaws ... felt kinda strange and guilty about it.My pdoc said this is due to _too much_ dopamine. Maybe you want to lower your dose?
Posted by littie on May 30, 2003, at 12:30:20
In reply to Keep the Strattera updates coming! (nm), posted by Hattree on May 30, 2003, at 10:38:47
Let's just say, I feel okay. Not great, but not depressed. I was really beginning to have trouble getting to sleep and staying asleep but my doctor gave me some trazadone and I slept for eight straight hours last night. As far as staying on task goes, I think I'm better--much better. I don't have that I-can't-deal-with-the-laundry feeling anymore. I was hoping to feel more "up" from this drug, but I've only been on it a couple of weeks so time will tell. Just started 80 mg a week ago. I have ADD but can't take any stimulants because of a long-ago substance abuse problem. Pity. Stimulants used to be my drug of choice, because they solved all the problems I have being a citizen of the world.
Posted by gouda on May 30, 2003, at 12:52:58
In reply to Re: I am a Newbie on Strattera: need support!, posted by bookgurl99 on May 30, 2003, at 12:05:48
> were short, which was kinda nice!
> >
> > Starting to feel moody! I ranted over the phone to my boyfriend for 2 hours about all his flaws ... felt kinda strange and guilty about it.
>
> My pdoc said this is due to _too much_ dopamine. Maybe you want to lower your dose?
>
>Thank you for your post, I will make sure to sure to ask about "too much dopamine" to my pdoc next visit! ...
I thought Strattera is only supposed to affect "nonepinephrine"? How does dopamine come into play as well?
Posted by teacherkris on May 30, 2003, at 13:02:15
In reply to Re: I am a Newbie on Strattera: need support!, posted by gouda on May 30, 2003, at 12:52:58
I know I'm repeating myself but just in case you haven't read the old posts I say hang in there with the side effects and go up as slowly as possible. I started at 10 mg for a week and added 10 mg each week until I got to 80. I am now doing great with 80 1x a day. The first few weeks were rough. My students, i teach middle school, definitely had to suffer through my extreme irritability and tiredness. The first few days the tiredness was the worst and I slept a lot! I was worried and ready to give up many times during the whole process but in retrospect I'm glad he made me go up so slowly. I seemed to get the side effects back for one or two days each time they raised the dose but now it's fine. I currently take 80 mg once a day along with 25 mg of Zoloft.
Posted by gouda on May 30, 2003, at 13:16:34
In reply to Re: I am a Newbie on Strattera: need support!, posted by teacherkris on May 30, 2003, at 13:02:15
Thanks teacherkris for your reply! ... (its so hard to go through every past thread, not very organized, so I must not have read your past post)
Wow, my pdoc started me on "18 mg - 1st four days, then 25 mg - 2 week" Starter PACK ! You started on 10 mg (which I now wish I had) ... I am very sensitive to medicine, so I don't understand why he started me on 18 mg.
I am glad you told me about your irritability and sleepiness. Poor students!
I'm still very tired after 20 hours of sleep. I totally want to conk out! This is kinda a scary experience for me b/c it feels like I'm am having the flu without the high temperature.
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