![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 671 to 695 of 1242. Go back in thread:
Posted by zeugma on May 31, 2003, at 19:52:26
In reply to Keep the Strattera updates coming! (nm), posted by Hattree on May 30, 2003, at 10:38:47
Halfway through week 3 on Strattera,and very happy with the subtle changes that have taken place. Strattera defintely has a stimulating quality to it (at least as I experience it). I feel like I have to expend less energy *forcing* myself to pay attention to what's in front of me, and in consequence feel that my performance in the workplace is getting much better. Plus I'm less drained by every little task I have to do, and it's such a relief not feeling I have to conserve every ounce of available energy for stayong *on top* of myself. ADHD, for me, has been a disorder of the self that has been absolutely crippling. I was first diagnosed in 1980, when I was twelve, and the subsequent lack of treatment made for a series of ever-worsening disasters, culminating in total academic failure and subsequent hospitalization for severe depression. Now that I feel that the depression is under control, I am hopeful that strattera will help with this core problem.
This is how I'd say Strattera compares with TCA's: no sedative component to Strattera, and possibly a stronger anxiolytic component. Maybe this is because it targets the Executive Function part of the brain more effectively than older drugs. I was very skeptical that Strattera would improve on nortriptyline but it does seem like there is some effect that promotes clarity of thought more than the nortrip. Again, that could just be the lack of sedative effect, but it feels like something more is going on.
Currently I am taking 40 mg in the morning (along with 75 mg nortriptyline at night and 10 mg buspirone tid). I will call my pdoc on Monday to let him know how I am doing on this dose. I am so happy with the results on Strattera that i am thinking about lowering the dosage of nortriptyline while raising that of Strattera. The only thing i would worry about would be a return of insomnia on a lower dose of nortrip. Maybe i could substitute a lower dose of amitriptyline at night for the nortriptyline as it is much more sedative?
Posted by MomofBoys on May 31, 2003, at 23:00:26
In reply to Re: Keep the Strattera updates coming!, posted by zeugma on May 31, 2003, at 19:52:26
I was begun on 40 mg Strattera back in March. I didn't double my dose as I was supposed to after two weeks, thus I stayed on the 40 for six weeks. I was then seen again and did double the dose up to 80 mg.
At 40 mgs, I found morning doses made me extremely tired and nighttime doses kept me awake, however i preferred to use Strattera at nite with xanax or benadryl for sleep. When I went to 80 mgs at bedtime, this did not change and my early morning rising increased but it was a good thing! I was able to get up and work effectively and concentrate better on my work (i work at home on the computer). What a wonderful thing! However, come late morning/early afternoon i was dead tired and could do no more.
I like these effects that Strattera has given me but I will be starting Ritalin during the daytime soon to counteract these effects and be productive the entire day long, not just early morning. I had a trial of the Ritalin and found it to be a wonderful combo so I will take it regularly.
It's been a long time since I've been able to be functional and accomplish so much during my days. I feel human again!
Posted by froggyanna on June 1, 2003, at 15:26:08
In reply to Keep the Strattera updates coming! (nm), posted by Hattree on May 30, 2003, at 10:38:47
I started taking 40mg Straterra on May 22, so that's 10 days. I had a few side effects (slight queasiness, slight dizzyness) but they wore off in a couple of days. I actually got a slight little "high" the first day, but that went away after about two hours. In the afternoons, I experienced severe tiredness. Being unemployed, I could nap through that.
I have also been taking Zoloft, various dosages for several years. Right now I am at 100mg and that seems to keep the tendency to depression very nicely alleviated. And I am taking .2mg Levoxyl for Hashimoto's hypothyroidism for about a year now (Synthroid for many years before that).
Before starting the Straterra, after my first visit with a psychiatrist for the treatment of ADD, I started out with Buspar (buspirone) on April 30, so that's about a month now. The doc has experience with using buspirone to treat snoring and sleep apnea, thus allowing for better sleep and the possible reduction of ADD symptoms due to better-quality sleep. I don't think that it is improving my snoring at all -- I continue to sleep with a CPAP machine (continuous positive airway pressure). And since I have been fairly successfully using CPAP for many years, and supposedly sleeping well because of it, and I still struggle with symtpoms of ADD, I've concluded that sleep apnea (in my case) is NOT the trigger for my ADD.
But I'm still taking the Buspar, because I think it is working well with the Straterra in helping me to get a little more "regulated." That started even before the Straterra. I've noticed a slight increase in my ability to get going in the morning and a greater willingness to just DO the routine little things that one has to do every day that I typically argue with myself about (about whether I really want to do them or not). A lot of that weary emotionality about doing things seems to be fading. And that's a good thing! Oh yes, and I've finished reading two books!! I've almost never finished a book in my LIFE!
But I'm still feeling unwilling to tackle some larger projects and chores that are waiting for me. I still feel procrastination and scatteredness as a major element in my days, and that's what I want to change. At this point, it's crucial, because I need to find a job. We are selling our house (if someone will buy it!) because we want to find something more affordable -- my lack of income has become a crisis. Because of being laid off three times in 5 years, and because ADD has always caused me extreme strain in performing well at work, I think I've got a mild version of post-traumatic stress disorder! I need to find some kind of support, whether it's medical or ADD coaching or both, to get me to focus in on preparing a resume and preparing to go back out into the world. At this moment, I can hardly even begin to think about that.
Because I'm a believer that being hypothyroid can exacerbate ADD symptoms, I have been waiting to add any more Straterra until I can find out from my internist about the results of my latest thyroid tests. I've just recently found out that I may be missing the crucial T3 -- I'm only taking a T4 drug. I will be seeing that doctor June 10 for a complete physical and discussion of my test results. I think that getting my thyroid functioning well will go a long way toward offsetting some of the side effects of the psychoactive drugs (like tiredness).
In the meantime..... I just saw my psychiatrist for the second time on May 29. I told him that I noticed a distinct drop in my appetite after starting the buspirone and continuing with adding the Straterra. He said that because of that, I might want to consider substituting Wellbutrin as my antidepressant instead of Zoloft. He said that it has less of a chance of increasing your appetite than Zoloft does (and I have really struggled with binge eating since taking antidepressants). He said that Wellbutrin will help to reinforce the appetite-reducing qualities of the buspirone and Straterra. Plus, it might keep me from participating in my lifelong habit of ripping my fingernails! He also suggested that I take Straterra at night instead of in the morning to help stave off the afternoon tiredness (apparently studies have shown that it stays in your system for about 25 hours).
So, in summary:
0.2mg Levoxyl in morning;
100mg Zoloft in morning;
60mg buspirone at night;
40mg Straterra at night;
Add and gradually increase Wellbutrin, 100-200mg twice a day over 10 days;
Try eliminating Zoloft after this;
Add T3 thyroid treatment, possibly Cytomel;
Depending on effect of thyroid treatment, increase Straterra to 120mg max.That's my current "recipe," and I feel like I am on the right path. I'm noticing gradual improvement in my functioning and the side effects are not unmanageable. I am looking very favorably right now on Straterra, by itself and in combination with other medications.
GOOD LUCK TO ALL OF YOU!
froggyanna
Posted by LenasGrandkids on June 1, 2003, at 21:41:04
In reply to Re: Keep the Strattera updates coming!, posted by froggyanna on June 1, 2003, at 15:26:08
My wife is in the midst of a severe depression, now on its 7th month. She's bipolar and has tried all of the usual suspects - you all know how long the list is. Now on our 5th doctor, the hope is that a combination of Lamictal (as a stabalizer) and Strattera will break the cycle, bring her out of this depression (which is really, really bad and nasty) and be the combination going forward. The problem, or question, is... how long has it taken, in the experience of anybody with similar history or knowledge, for the Strattera to take effect, or at least before we know if we should give up on it? She's been taking 40mg for 5 days now and is going up to 80 after a week. Any advice would be greatly appreciated. I have gathered a great deal of insight and support from reading the expreiences of the members of this group. I do not suffer from depression, but after seeing what my wife is going through and reading the posts here I have the greatest sympathy and awe for those who have to suffer this incerdibly evil and nasty disease and somehow survive.
Thank you in advance for any help you can give us.
Posted by Hattree on June 2, 2003, at 8:56:27
In reply to Urgent question about Strattera for depression, posted by LenasGrandkids on June 1, 2003, at 21:41:04
Lamictal is a very good choice and kicks in within a couple of weeks (sometimes even days). Strattera seems to involve wading through an unpleasant period of sedation and irritability, but a lot of people here seem to be reporting success on the other side. Best of luck to you.
Posted by tanafofana on June 2, 2003, at 10:29:47
In reply to Re: Urgent question about Strattera for depression, posted by Hattree on June 2, 2003, at 8:56:27
I've been on strattera since May 9th. Started with 40mg and increased to 80mg after a week or so. I really haven't noticed any great effects. In fact, I really haven't gotten anything done around my house in weeks. I have had terrible sleepiness which the doc counteracted somewhat with provigil. I go back to see the doc on Friday which will be four weeks. So far, I'm not very impressed. However, I added strat to wellbutrin which makes me wonder if my norepinephrine was as "uptaken" by wellbutrin as possible and there was nothing left for for the strattera to do. Any comments on that idea?
Posted by teacherkris on June 2, 2003, at 10:41:41
In reply to Re: Urgent question about Strattera for depression, posted by tanafofana on June 2, 2003, at 10:29:47
My only thought would be that the sleepiness is a result of your doctor raising your dose so quickly. From 40 to 80 and even starting at 40 is really quite fast, especially when you're on other medications. Of course I'm not a doctor but from what I experienced the slower the better. As for postive effects, it seems to take up to 6 weeks at the top dose for it to take effect so you might want to give it some time. Also, in the clinical trials most people found the therapeutic dose to be around 110. Just an FYI. Good luck!
Posted by froggyanna on June 2, 2003, at 15:54:12
In reply to Re: Urgent question about Strattera for depression, posted by teacherkris on June 2, 2003, at 10:41:41
Hi teacherkris,
Are you talking about using Straterra for depression, which is what LenasGrandkids asked about, or does the "therapeutic dose" you mention refer to treating symptoms of ADD? I'm confused, because I thought that Straterra was approved specifically for treating ADD. LenasGrandkids, I was touched by your message and impressed by your support for your wife. If she has already tried "all of the usual suspects," I am curious to know what your doctor said about the usefulness of Straterra in treating her depression.
Keep seeking the light, LenasGrandkids. It is a very, very sad thing that you and your wife are going through, but she is very lucky to have you. Believe that the solution is out there.
I have some other questions about Straterra, but I'll start a new subject line....
froggyanna
> My only thought would be that the sleepiness is a result of your doctor raising your dose so quickly. From 40 to 80 and even starting at 40 is really quite fast, especially when you're on other medications. Of course I'm not a doctor but from what I experienced the slower the better. As for postive effects, it seems to take up to 6 weeks at the top dose for it to take effect so you might want to give it some time. Also, in the clinical trials most people found the therapeutic dose to be around 110. Just an FYI. Good luck!
>
Posted by froggyanna on June 2, 2003, at 16:52:39
In reply to Keep the Strattera updates coming! (nm), posted by Hattree on May 30, 2003, at 10:38:47
Hi All,
I posted in another message:
> So, in summary:
> 0.2mg Levoxyl in morning;
> 100mg Zoloft in morning;
> 60mg buspirone at night;
> 40mg Straterra at night;
> Add and gradually increase Wellbutrin, 100-200mg twice a day over 10 days;
> Try eliminating Zoloft after this;
> Add T3 thyroid treatment, possibly Cytomel;
> Depending on effect of thyroid treatment, increase Straterra to 120mg max.
>
> That's my current "recipe," and I feel like I am on the right path.
> I'm noticing gradual improvement in my functioning and the
> side effects are not unmanageable. I am looking very favorably
> right now on Straterra, by itself and in combination with other medications.I have to kind of amend that statement. I'm on my 11th day today and over the past two days, I began to notice an increase in irritability. It's been years since I've had a problem with that. Yesterday (Sunday), it was so bad that I found myself being very sarcastic to my husband in a very rare, emotional kind of argument. We made up OK, but I hated it. The irritability is definitely being caused by something I'm taking. Along with the irritability, I'm feeling increased agitation. I kind of always used to shake my leg a bit when sitting, but that has gotten even worse.
As I also said in that message, my pdoc suggested I take Straterra at night to forestall the daytime sleepiness. That seems to work a bit, but yesterday, because of the argument, and because I just want to get my act together NOW, I decided to take an additional 40mg daytime dose after the one I took at bedtime the night before. MISTAKE. The tiredness hit me like a brick and I was out for three hours. Woke up even more agitated and only slightly less irritable.
I had been told by the doc to start with 40, go up to 80, and then 120. But now I'm really beginning to BELIEVE the people who are saying to take it in 10mg increases. And teacherkris mentioned a study saying 110mg was found to be the "therapeutic dose."
So my questions are:
1. Has anyone else been advised to take Straterra at night? If so, is that decreasing your daytime sleepiness?
2. If you increased your dosage slowly, did you avoid the tiredness? The agitation? The irritability?
3. Would there be any benefit to taking part of the dose before bed and part in the morning?
4. How many days did you go before increasing?
5. Was it a month or more before you started experiencing any real effect on your ADD symptoms? Are you MAINTAINING those effects?
Those are only some of my questions, actually. I'm just so eager to get my head straightened out that I'm feeling impatient, even though I KNOW that I have to give it time. I suppose that if someone had actually stabilized on Straterra they might not still be hanging around this discussion forum. But I sure would like to hear some real success stories. I am "afraid" to start taking the stimulants... at least not until I've done all I can without them.
Thank you VERY much for any and all advice you can offer!
froggyanna
Posted by Ritchie on June 2, 2003, at 17:50:52
In reply to Urgent question about Strattera for depression, posted by LenasGrandkids on June 1, 2003, at 21:41:04
> My wife is in the midst of a severe depression, now on its 7th month. She's bipolar and has tried all of the usual suspects - you all know how long the list is. Now on our 5th doctor, the hope is that a combination of Lamictal (as a stabalizer) and Strattera will break the cycle, bring her out of this depression (which is really, really bad and nasty) and be the combination going forward. The problem, or question, is... how long has it taken, in the experience of anybody with similar history or knowledge, for the Strattera to take effect, or at least before we know if we should give up on it? She's been taking 40mg for 5 days now and is going up to 80 after a week. Any advice would be greatly appreciated. I have gathered a great deal of insight and support from reading the expreiences of the members of this group. I do not suffer from depression, but after seeing what my wife is going through and reading the posts here I have the greatest sympathy and awe for those who have to suffer this incerdibly evil and nasty disease and somehow survive.
> Thank you in advance for any help you can give us.I have taken the Stattera specifically for depression and it took a couple of months and I am at 120 mg which has been working. The depression is better and suicidal thoughts are gone. I know the FDA has only approved 100 mg but Strattera is specifically for ADD, my doctor just ran out of choices for me and we thought we would try it and it is working, it is nice to be out of the hell I was in for so long. I am not taking anything else cause I have horrible side effects. The worse effect I have on Strattera is dry mouth. Hope this helps.
Posted by fallsfall on June 2, 2003, at 20:56:11
In reply to Straterra at night ? Other questions....., posted by froggyanna on June 2, 2003, at 16:52:39
> So my questions are:
I take Strattera for Depression
>
> 1. Has anyone else been advised to take Straterra at night? If so, is that decreasing your daytime sleepiness?When I was increasing my dose I took some in the morning and some at night to decrease the side effects. Strattera wakes me up, so I now take it all in the morning.
>
> 2. If you increased your dosage slowly, did you avoid the tiredness? The agitation? The irritability?I started at 10mg and increased 10mg every 3 days. I did not have tiredness, agitation or irritability (but, again, I don't have ADD).
>
> 3. Would there be any benefit to taking part of the dose before bed and part in the morning?For me it reduced side effects.
>
> 4. How many days did you go before increasing?3
>
> 5. Was it a month or more before you started experiencing any real effect on your ADD symptoms? Are you MAINTAINING those effects?I felt a difference right away. But I have to be taking both Strattera and Provigil. Just Strattera didn't do it for me. The effects I have are increased initiative, energy and vastly reduced suicidality. My world has been turned upside down since I started the Strattera, so I don't know how good it will get, but I can tell despite my turmoil that it is helping significantly.
>I know things are a little different between depressed people and ADD people and Strattera. So our results may vary. The most important thing for me was going up slowly. I still had some side effects, but they were managable.
Be patient. Good Luck.
Posted by paulk on June 2, 2003, at 21:42:08
In reply to Re: Straterra at night ? Other questions..... » froggyanna, posted by fallsfall on June 2, 2003, at 20:56:11
I tried taking it at night - didn't work out too well. My sleep was disturbed too much.I think there is something going on with interactions between dopamine and norepinephrine levels in the brain.
I find that a reduced dosage helps with the sleepyness.
Has anyone found a successful way to overcome Straterra induced sleep disturbances?
Posted by zeugma on June 2, 2003, at 22:03:41
In reply to Straterra at night ? Other questions....., posted by froggyanna on June 2, 2003, at 16:52:39
>
my questions are:
>
> 1. Has anyone else been advised to take Straterra at night? If so, is that decreasing your daytime sleepiness?
>
I was advised to take Strattera in the morning. I have found it energizing so far.> 2. If you increased your dosage slowly, did you avoid the tiredness? The agitation? The irritability?
>
I increased the dosage from 18 to 25 mg after four days, with some increase in energy. After about ten days on 25 I went up to 40 mg. No tiredness, agitation or irritability. But I DID feel irritable when I started on nortriptyline last summer. Noradrenergic meds have a tendency to cause irritability.
> 3
>
> 4. How many days did you go before increasing?
>
I have been on 40 mg since last Wednesday. I spoke to my dr. this morning, and he wants me to stay on 40 for at least another week.> 5. Was it a month or more before you started experiencing any real effect on your ADD symptoms? Are you MAINTAINING those effects?
I noticed ADHD benefits soon after beginning. The drug seemed (and continues to seem) ALERTING to me (unlike the experience of a lot of other posters, who became tired and sleepy on it. I have also been ravenously hungry since beginning this med. In my case that is quite good since i am underweight and weight loss was always the reason i've had to steer clear of stimulants.)
My ADHD symptoms are quite severe: disorganization, inability to get started, inability to perceive detail, hatred of following a set routine, etc. I believe Strattera, in conjunction with the nortriptyline, has helped these symptoms but I'm not sure how much of this is the Strattera and how much is attributable to the raised dosage of nortriptyline that kicked in soon before starting Strattera. The Strattera, though, feels very different from the nortriptyline, in a way that specifically helps with alertness.
>
> Those are only some of my questions, actually. I'm just so eager to get my head straightened out that I'm feeling impatient, even though I KNOW that I have to give it time. I suppose that if someone had actually stabilized on Straterra they might not still be hanging around this discussion forum. But I sure would like to hear some real success stories. I am "afraid" to start taking the stimulants... at least not until I've done all I can without them.
>
> Thank you VERY much for any and all advice you can offer!
>
> froggyanna
>
Posted by gouda on June 3, 2003, at 6:20:45
In reply to Re: Keep the Strattera updates coming!, posted by froggyanna on June 1, 2003, at 15:26:08
Hi Froggyanna and all,
I just read your 5/31/03 post! :)
First, I just wanted to say thanks for your lengthy post! Gave me lots of reassurance since I am also taking depression meds w/ Strattera and good laughs with the ripping nails (which I am doing as I take breaks writing this post).
Second, my question: I like how you ruled out sleep apnea ... which got me thinking about sleeping problems. But I am new to this ADD stuff, what advice do you have to give about getting testing done on sleep disorders? How do you snore exactly? Do all ADDers have sleep problems?
Third, another question: what is CPAP? I gather it is a some kind of device you wear when you sleep?
Fourth, your new addition of Wellbutrin: my experience with Wellbutrin ... PRO: it will definitely help with your reducing your appetite (I lost 5 lbs in 2 weeks), help you stay calm and focused, less distracted by conciously tuning out distractions (for me I stopped noticing what other people did in lecture & stopped obsessing about my to-do list during study time) CON: lots of those tingly sensations in brain, ringing ears, hyper alertness (you will notice a lot more sounds like A/C blowing, but the meds will force you ignore it), extreme calm --> I hated the CONS that I experienced. Pdoc thinks I am very sensitive to meds, so I am now on CELEXA. Great, I like Celexa so far and am on 20 mg!
Fifth, Strattera at night: I am kinda behind you, only on my 5th day, but I had same problem of shutting down in the afternoon into "coma sleep, 2-3 hours after taking Straterra" ... I've been taking it 2-3 hours before my bedtime, and it's been great to help me "fall asleep"
Sixth, Strattera and irritability: Same problem as you, if not worse. I get pissed off at least once a day, and I take it out on whoever is pissing me off by rattling my mouth. IT's like I have less control over my emotions. Usually I'm right *he he* but I do seem to be more harsh and straightforward. I dunno, I hope this goes away, or doesn't get worse.
Posted by Mike Oxsbig on June 3, 2003, at 12:23:41
In reply to Re: Anyone taking Strattera with SSRI's like Lexapro?, posted by gouda on May 30, 2003, at 11:25:43
> > 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!I also just started strattera today @ 40 mg and have been on 10mg of Lexapro since late October. Have just gone off of Concerta which I miss already, but I will give that Strattera a chance.
Posted by glaciergirl on June 3, 2003, at 13:53:30
In reply to Re: Anyone taking Strattera with SSRI's like Lexap, posted by Mike Oxsbig on June 3, 2003, at 12:23:41
Mike,
Could you tell me a little bit about your experience with Concerta? I am beginning my 3rd week on it. I haven't noticed a big increase in motivation to do things, though. (Taking for ADHD) I tried Strattera first and didn't like it! On Concerta, I've been doing better at work getting things done, but as far as everyday chores (cleaning kitchen, paying bills, etc.) I'm still feeling lazy about doing them...will it take a while for me to get motivated..or should I already be wanting to get things done?
Thanks,
Brooke
Posted by froggyanna on June 3, 2003, at 14:19:30
In reply to Q A to Froggyanna: CPAP and sleep apnea?, posted by gouda on June 3, 2003, at 6:20:45
Hi gouda (do you come with crackers?) heh heh,
> First, I just wanted to say thanks for your lengthy post!
You're welcome! I just gotta get it outta my system. Get ready for an even LENGTHIER post!!> Gave me lots of reassurance since I am also taking depression meds
> w/ Strattera and good laughs with the ripping nails (which I am
> doing as I take breaks writing this post).
Has anything helped you with that? I've done it for as far back as I can remember, and I have never found anything that would help me stop. Nails, skin, stray hairs, anything "protruding" gets an unreasonable amount of attention, and I go into paroxysms of desperate attempts to remove the offending "object." It's only just this past week that I came to the startling understanding that this could be related to my ADD, or perhaps even be OCD. I've always been embarrassed by it. I tend to be a perfectionist on top of the procrastination. In computer terms, that would mean having an outrageous urge to put every single pixel in line (which I have done quite a bit as a sometimes graphic designer). Of course, that's only when I'm not ripping at my fingernails! But it's funny.... you'd think I'd want to have perfect manicures every day, but no, I rip my fingers to shreds. It's got something to do with the feeling of it, and getting rid of those extra bits of skin, a release of tension, perhaps. Anyone else have any insight into this? Also, right now my knee is bouncing up and down like crazy, and I really wish this agitation would go away.
> Second, my question: I like how you ruled out sleep apnea ... which got me
> thinking about sleeping problems. But I am new to this ADD stuff, what advice
> do you have to give about getting testing done on sleep disorders?
> How do you snore exactly? Do all ADDers have sleep problems?
Hey, that's three questions. But OK. First, though, I "ruled out sleep apnea" as the cause of my ADD. Is that what you meant? Cuz I can't rule it out of my life! I've definitely got it!I'm new to this ADD stuff, too. I haven't heard that all ADDers necessarily have sleep disorders. But my psychiatrist told me that many people in his practice who don't have SERIOUS APNEA have sometimes been able to rid themselves of ADD-like behavior through the reduction of snoring. Because even mild snoring means that you are not sleeping optimally. And if you are not sleeping optimally, then you are more prone to going through your days fuzzy, distracted, etc. So that's why he initially prescribed buspirone for me -- to see if it relieves my snoring/apnea and thus relieves my ADD-like behavior (assuming I DON'T have ADD). I was skeptical, though (but excited that it might be that simple!). Alas, it has not really done anything to stop my apnea, or even the snoring. So dang it, I must have ADD!
About six years ago, I was evaluated for surgery for apnea. I decided not to do it, because the success rate is not very good, and it's a truly gruesome proposition. We're talking about major trauma to the throat and soft palate, cutting away lots of tissue, "pulling" the tongue forward by cutting it and repositioning it to allow more room around the airway, and even breaking and repositioning the jaw. I talked to three people who had it done: an older fellow in his late 50s-early 60s, and two women in their 30s. Only the older man felt that it was worth the pain. His apnea was significantly reduced if not outright cured (I can't recall). The women found no relief at all and had very difficult recoveries. Yeesh. The surgeon took pictures of my airway with one of those little cameras on a wire (had to take it down the nose) and showed me right there as I was sitting that my airway is significantly narrower than normal. He showed me pictures of "normal." I could see that my poor little passageway was MUCH smaller than most people's. I'm just built that way. I asked him if this is from being overweight, and he said, "NO, this would be the case even if you were very thin." Lucky me.
And I WAS very thin as a 14-year-old summer camp student and the other girls in my tent threatened to throw me out of the tent at night or put rocks in my bed so I wouldn't lie on my back snoring. I already had social phobia to begin with, so this was quite traumatic. I don't recall how the problem was resolved. I think I've blocked it. Somehow, through my first marriage, it never was a problem to my ex-husband. Nor was it a problem to the various men that I dated after divorcing. But once when I was vacationing with my mother and two daughters, and my mother and I were sleeping in one of the beds together, we woke up the next morning and my mother said, "You made sounds that I've never even heard before!" She said at one point that she wanted to put my pillow over my head. Thanks, Mom.
Apnea is when your airway gets loose and closes completely down, which is why they call it Obstructive Sleep Apnea. And when that happens, your mind wakes up to deal with it. You choke, you gasp, the airway opens, and you go back to "sleep." You usually don't even know you're doing it. But your roommates do!!! And you never go down to the deep third and fourth levels of sleep because you're always waking up. Snoring is caused by the airway not completely closing -- all the soft tissue is loose and rattling around, but air still gets through. Apnea sounds like snoring until the obstruction happens -- then there's silence for about 10 seconds followed by a loud snort as your mind "fixes" the problem and the air rushes in.
To get a sleep study, you usually need to go to a dedicated clinic or hospital department. Most big cities have a "Sleep Disorders" clinic of some kind. Another doctor generally refers you but there's no reason you couldn't suggest it to your doctor first. It's an overnight stay and they really wire you up. They measure your breathing, your heart, your brainwaves, and your leg muscles. That's what I know about, at least -- there could be other things. Some people have Restless Legs Syndrome, where your limbs jerk around, so they want to include that in the picture. And they videotape the whole night in all your glory! Usually, if you've given them enough data to go on during the first half of the night, they wake you up and put you on a CPAP mask. Then they titrate the air pressure for the rest of the night to find just the right pressure that keeps your airway open without causing other kinds of discomfort.
> Third, another question: what is CPAP? I gather it is some kind
> of device you wear when you sleep?
Yep, the Continuous Positive Air Pressure machine, our friend Mr. CPAP. It's just a little portable "box" that blows air through a flexible tube. It is adjusted to your precise pressure. At the end of the tube is either a mask that fits over your entire nose or "nasal pillows" that get inserted into your nostrils. The mask has an elastic band that holds it in place, and the "pillows" are attached to headgear that fits around your entire head. They both have their advantages and disadvantages and everyone responds to them differently. They definitely take getting used to, which is why a lot of people are noncompliant and consider surgery. People keep trying to come up with variations on these two themes, to increase the comfort and the likelihood that more people will be compliant. I'm waiting for the device that hangs from the ceiling! (My fantasy.) The tube comes down at night with a remote button that you push, you place the mask or the pillows over your nose and somehow "lock" them in place, and the tube just follows your movements as you toss and turn in happy oblivion. You don't have the flexible tube hanging and dragging all over your pillow and behind your head, you don't have the sadistic-looking mask over your head, and at the touch of a button, the tube zips back up into the ceiling in the morning! Just like Star Trek! :-)> Fourth, your new addition of Wellbutrin: my experience with Wellbutrin...
SOMEthing has definitely reduced my appetite, but I noticed that even with the buspirone and Straterra. I'm just glad that this is happening, because I have been binge eating for years on Prozac and Zoloft. I now need to lose about 150 pounds. As for staying calm and focused, what dose are you taking? I've just finished 5 days at 100mg 2x/day and tomorrow I start on 5 days at 150mg 2x/day. I will then go to 200mg 2x/day if I'm "not impressed," as the pdoc says. Did you gradually increase like this? I haven't had any of the "tingley" things you mention -- I hope I can avoid that by going slow. But I also haven't noticed any improvement yet in my agitation or the urge to rip flesh. I can't stop shaking my leg or picking. And did you say that "extreme calm" was one of your CONS? How so?> Fifth, Strattera at night: ... I've been taking it 2-3 hours before
> my bedtime, and it's been great to help me "fall asleep"
Maybe I'll try that. Maybe I could take it with my second dose of Wellbutrin for the day. I like to make these things as easy to remember as possible! But it would be hard to do that if I were to get a normal 8-5 job -- the hours wouldn't work. Right now I'm still not sleeping regular hours. My go-to-bed and wake-up times are all over the map. I hope that these meds can help me to regulate that some.
> Sixth, Strattera and irritability: Same problem as you, if not worse.
Rats. OK, that's two of us then who are hoping that this will wear off. Anyone else got some encouraging reports? Did any of you have irritability initially but it eventually went away? ADDled minds want to know!! :-)If you've bothered to read this far, thank you -- I appreciate the space to write like this. I don't mean to be a blowhard, but there is so much about all of this that is fascinating to me, and writing helps me to understand it better.
Cheers,
froggyanna
Posted by bookgurl99 on June 3, 2003, at 17:43:13
In reply to Atomoxetine (Straterra) veterans » Hattree, posted by paulk on May 28, 2003, at 12:10:05
> 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)I've heard this referred to as 'pulsing' a dose. You take it for a few days on, a few off, etc., etc. This might work.
Posted by Mike Oxsbig on June 5, 2003, at 8:04:37
In reply to Re: Anyone taking Strattera with SSRI's like Lexap » Mike Oxsbig, posted by glaciergirl on June 3, 2003, at 13:53:30
Brooke
To make a long story even longer- I am inattentive with a tendency to over focus. My biggest problem is procrastination on the mundane. I will find something that I prefer to do and do it all day long in order to avoid doing those mundane things. I was hoping that Concerta would help me do the mundane. In actuality it made things worse. I have been off of concerta for a week after starting it on Dec 5th at 36 mg then going to 54 after the first month. Over the last month I went back to 35mg.
There were some great effects from the Concerta. My verbal skills were much improved. I could find the words and had confidence in making presentation infront of large groups of people. I have always been prone to low blood sugar problems which went away on concerta. I did not have that mid afternoon let down that many get. I was not tired when I got home from work. I have done so much around the house in the last 5 months you wouldn't believe it. My wife and I have gotten along incredibly well over the last few months. Family have commented on what a dedicated father I am. I was happy as hell.
All of the old symptoms have come back. Tired, low blood sugar, wife and I argued a bit last night, sat on the couch after I put the kids to bed, got into bed at 9:45.
On the other hand, I have been more productive at work over the last week than I have for the last 3 months. On concerta I wouldn't plan out my days. I avoided the mundane, but didn't care. I was working but not doing anything that was making me money. I was unorganized and inefficient on concerta, but had confidence and energy. I could think things through clearly such as strategies, ideas and plans, but I would not implement. I had more thoughts going through my head than ever.
I would like to see if a small dose of concerta with the strattera would work. I have read and heard of people continuing a stimulant until the strattera kicks in.
A couple of other things, since I started taking concerta I quit drinking alcohol. I would usually only drink on weekends, but usually put away a good amount on either Fri or Sat night. I think the positive side of the concerta allowed me to give up alcohol. I also became a caffeine addict on concerta, but now even a cup of coffee is giving me a bout of hypoglycemia. A week and a half ago I was drinking my morning coffee out of a 32oz. cup.
I will post an update. Remember everyone is different.
> Mike,
> Could you tell me a little bit about your experience with Concerta? I am beginning my 3rd week on it. I haven't noticed a big increase in motivation to do things, though. (Taking for ADHD) I tried Strattera first and didn't like it! On Concerta, I've been doing better at work getting things done, but as far as everyday chores (cleaning kitchen, paying bills, etc.) I'm still feeling lazy about doing them...will it take a while for me to get motivated..or should I already be wanting to get things done?
> Thanks,
> Brooke
Posted by glaciergirl on June 5, 2003, at 8:47:18
In reply to Re: Anyone taking Strattera with SSRI's like Lexap, posted by Mike Oxsbig on June 5, 2003, at 8:04:37
Mike,
Thanks for your reply! I am doing exactly what you have done, I feel great and I have the energy to think about doing the things that I don't really care to do, but like you, I will find something I enjoy doing in order to keep from doing what I know I should be doing! At work, I surf the net way too much...putting off my work, I just can't make myself do my work unless I know my boss is watching..same thing at home (i finally payed my bills that were late...during work time)!! It definitly does not give me motivation.
I am getting along very well with my husband, he was getting a bit irritated with my personality, which was due to changing meds every month...but I have evened out now and as he says "am back to the woman he married" (We've been married 7 months)
I have a months supply of Wellbutrin SR from 2 years ago that I started taking yesterday (Wednesday) with my concerta, I am going to see if that helps to motivate me some!
FYI: When I was taking Strattera, i was very irritable! I seemed to not want to get along with anyone, the smallest things would bug me and I always felt very defensive. I had to have an excuse for everything I did and if my husband would so much as make a comment to me about doing something, I snapped back with my excuse. He kept telling me I didn't have to explain to him why I was doing what I was doing (we're talking making coffee, going to the store, what I was watching on tv, what I was eating for supper, etc)...but I was on the defense. Don't know if this is what you are experiencing with your wife or not, but I thought I would share!
Posted by MomofBoys on June 5, 2003, at 9:47:19
In reply to Straterra at night ? Other questions....., posted by froggyanna on June 2, 2003, at 16:52:39
So my questions are:
>
> 1. Has anyone else been advised to take Straterra at night? If so, is that decreasing your daytime sleepiness?YES! It has decreased my daytime sleepiness for a limited time. I wake up just a raring to go, get lots of work done (i work at home) and then by noonish I do have the sleepiness, for which my doc is thinking of adding Ritalin and I will find out today. The Strattera has been incredibly helpful to me so I would like to continue on this but the sleepiness does hold me back a bit.
>
> 2. If you increased your dosage slowly, did you avoid the tiredness? The agitation? The irritability?I started at 40 and went to 80 where I am today. Tired YES. Agitated NO. Irritable NO. But if something sparks my temper, yes I am agitated and irritable. Is it me or the Strattera? Don't know.
>
> 3. Would there be any benefit to taking part of the dose before bed and part in the morning?I am going to ask this myself today when I go to the doc about splitting my dose to day/night instead of just one dose at night.
>
> 4. How many days did you go before increasing?40 for six weeks or so then 80.
>
> 5. Was it a month or more before you started experiencing any real effect on your ADD symptoms? Are you MAINTAINING those effects?My effects on ADD were almost immediate. I could organize, get things done. It was amazing to me.
>Hope that I could be of help with my experience. But I will find out more from my doc today.
MomofBoys
Posted by gouda on June 5, 2003, at 12:39:45
In reply to Re: Q A to Froggyanna: CPAP and sleep apnea?, posted by froggyanna on June 3, 2003, at 14:19:30
Sorry for the delay in reply, Strattera @ the new dosage of 25 mg (originally on 18 mg) is just knocking me out!
I sleep well since I take 25 mg 2-3 hours b4 bedtime.
In the morning, I feel more motivated, getting things done, and thinking up more to-do things for my to-do list.
However, I have to take another 5 hour nap in the afternoon! This totally sucks!
So I am currently on my "awake" window, so I thought I'd better reply to you before I conk out again.
> Has anything helped you with that? I've done it for as far back as I can remember, and I have never found anything that would help me stop. Nails, skin, stray hairs, anything "protruding" gets an unreasonable amount of attention, and I go into paroxysms of desperate attempts to remove the offending "object." It's only just this past week that I came to the startling understanding that this could be related to my ADD, or perhaps even be OCD. I've always been embarrassed by it. I tend to be a perfectionist on top of the procrastination. In computer terms, that would mean having an outrageous urge to put every single pixel in line (which I have done quite a bit as a sometimes graphic designer). Of course, that's only when I'm not ripping at my fingernails! But it's funny.... you'd think I'd want to have perfect manicures every day, but no, I rip my fingers to shreds. It's got something to do with the feeling of it, and getting rid of those extra bits of skin, a release of tension, perhaps. Anyone else have any insight into this?
I have no insight, but I can totally relate to your tendencies! I too love ripping and shaving my fingernails, totally disguisting, but I just can't help it. When I am tense, working on a deadline, I also feel this incessant need to find any imperfection in my hair, scratching my scalp, pulling out stray hairs that are sticking out, pulling out the one wavy hair in my sea of straight hair. Totally neurotic and counter productive! It totally drives me crazy! I have been diagnosed with "obsessive compulsive traits", and my pdoc wants to increase my SSRI (Celexa) from 20 mg - 40 mg "to counteract my OCD". So maybe you might wanna check that out for yourself and take a OCD "Yale-Brown Obsessive Compulsive Test". Don't worry, you're norm for an OCD person ... hehe.
Also, right now my knee is bouncing up and down like crazy, and I really wish this agitation would go away.
>I've got a different tick, when I am awaken during sleep, I will kick my leg in frustration, even though I am still partially sleeply. Weird!
I don't have the jittery knee though like you.
> Hey, that's three questions. But OK. First, though, I "ruled out sleep apnea" as the cause of my ADD. Is that what you meant? Cuz I can't rule it out of my life! I've definitely got it!
>Yep, sorry, yup that is what I meant to ask. I too want to find out the cause of my ADD.
Personally, I think my ADD is cause by (a) sleep disorder (b) genetics (c) head injuries as a toddler who was very accident prone.
> I'm new to this ADD stuff, too. I haven't heard that all ADDers necessarily have sleep disorders. But my psychiatrist told me that many people in his practice who don't have SERIOUS APNEA have sometimes been able to rid themselves of ADD-like behavior through the reduction of snoring. Because even mild snoring means that you are not sleeping optimally. And if you are not sleeping optimally, then you are more prone to going through your days fuzzy, distracted, etc. So that's why he initially prescribed buspirone for me -- to see if it relieves my snoring/apnea and thus relieves my ADD-like behavior (assuming I DON'T have ADD). I was skeptical, though (but excited that it might be that simple!). Alas, it has not really done anything to stop my apnea, or even the snoring. So dang it, I must have ADD!
>Thanks for your extensive description of your sleep apnea. Your snoring sounds just like my dad and grandmother! And they definitely might have ADD, although never diagnosed.
> To get a sleep study, you usually need to go to a dedicated clinic or hospital department. Most big cities have a "Sleep Disorders" clinic of some kind. Another doctor generally refers you but there's no reason you couldn't suggest it to your doctor first. It's an overnight stay and they really wire you up. They measure your breathing, your heart, your brainwaves, and your leg muscles. That's what I know about, at least -- there could be other things. Some people have Restless Legs Syndrome, where your limbs jerk around, so they want to include that in the picture. And they videotape the whole night in all your glory! Usually, if you've given them enough data to go on during the first half of the night, they wake you up and put you on a CPAP mask. Then they titrate the air pressure for the rest of the night to find just the right pressure that keeps your airway open without causing other kinds of discomfort.
>Wow, I think I would like to consider this ... I just mentioned earlier that I've been doing the leg whapping thing at night. Hmm, what is the cost of taking part in a sleep disorder treatment? I would need to budget for this.
CPAP! Dang, that was funny! Wow, it sounds so complicated!
> SOMEthing has definitely reduced my appetite, but I noticed that even with the buspirone and Straterra. I'm just glad that this is happening, because I have been binge eating for years on Prozac and Zoloft. I now need to lose about 150 pounds. As for staying calm and focused, what dose are you taking? I've just finished 5 days at 100mg 2x/day and tomorrow I start on 5 days at 150mg 2x/day. I will then go to 200mg 2x/day if I'm "not impressed," as the pdoc says. Did you gradually increase like this?Yes, I started on 100 mg 1x/day for about a month, then increased to 150 mg 1x/day for another month ... I never got to 200 mg, b/c I really disliked the experience (but this should not dissuade you; most people have good experiences with Wellbutrin)
I haven't had any of the "tingley" things you mention -- I hope I can avoid that by going slow. But I also haven't noticed any improvement yet in my agitation or the urge to rip flesh. I can't stop shaking my leg or picking. And did you say that "extreme calm" was one of your CONS? How so?
>Yes, you should be patient with Wellbutrin, I didn't have any benefits until 3 weeks.
Extreme calm meaning I kinda felt unnerved about how calm I was when tackling whatever I was doing. It was almost like I had no emotional component whatsoever. "A Just Do It" w/o the kick-butt attitude. Very weird!
> > Fifth, Strattera at night: ... I've been taking it 2-3 hours before
> > my bedtime, and it's been great to help me "fall asleep"
> Maybe I'll try that. Maybe I could take it with my second dose of Wellbutrin for the day. I like to make these things as easy to remember as possible! But it would be hard to do that if I were to get a normal 8-5 job -- the hours wouldn't work. Right now I'm still not sleeping regular hours. My go-to-bed and wake-up times are all over the map. I hope that these meds can help me to regulate that some.
>I hope so for you too! Sounds like you're on lots of meds, so it will require a good pdoc to sort all your symptoms out.
> > Sixth, Strattera and irritability: Same problem as you, if not worse.
> Rats. OK, that's two of us then who are hoping that this will wear off. Anyone else got some encouraging reports? Did any of you have irritability initially but it eventually went away? ADDled minds want to know!! :-)
>
> If you've bothered to read this far, thank you -- I appreciate the space to write like this. I don't mean to be a blowhard, but there is so much about all of this that is fascinating to me, and writing helps me to understand it better.
>
> Cheers,
> froggyanna
>Glad to hear from you! Yes, I'm just trying to deal with meds too without a job, so I think our discussions are the best form of therapy. Look forward to hearing from you again, and hang in there!
Posted by paulk on June 5, 2003, at 15:44:40
In reply to Re: Straterra at night ? Other questions..... » froggyanna, posted by MomofBoys on June 5, 2003, at 9:47:19
Sure sounds like they should come out with an exteded release version of Strattera
Posted by bookgurl99 on June 5, 2003, at 16:34:45
In reply to Atomoxetine (Straterra) veterans » MomofBoys, posted by paulk on June 5, 2003, at 15:44:40
Isn't Straterra basically an ER drug? It's not supposed to be a stim.
Posted by MomofBoys on June 6, 2003, at 9:03:10
In reply to Re: Anyone taking Strattera with SSRI's like Lexap, posted by Mike Oxsbig on June 3, 2003, at 12:23:41
When I went to the doc yesterday, she started me on Lexapro 10 mg to add to my Strattera of which I take 80 mg at bedtime. She also added 20 mg of Strattera in the morning. I feel like I've lost the initial energy I felt when I started taking Strattera at night...I would have restless sleep but wake up and just go-go-go! If I took the Strattera in the morning i was dead tired to the world.
I hope this change helps some. If not, stimulants are in my future, or so she says. We will see.....
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