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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by iris2 on October 12, 2004, at 21:39:05
What dose is used to start Strattera and then increase it for depression?
irene
Posted by utopizen on October 12, 2004, at 21:56:43
In reply to Strattera Starting dose?, posted by iris2 on October 12, 2004, at 21:39:05
> What dose is used to start Strattera and then increase it for depression?
>
>
> ireneIt failed in clinical trials for depression. Since Cymbalta affects NE+5-HT at the same time, it would probably be wise to combine Cymbalta and Straterra together (once you get Straterra stabalized).
Unless you experience adverse events, 40mg of Strattera should be well tolerated, and in a few days to a week you can then try the target dose of 80mg, but follow doctor's orders. Some go as high as 120mg I believe.
But recent med articles report strongly urge docs to treat depression before approaching ADD symptoms, since depression can worsen ADD as you well know and often ADD is just disguised depression. Regardless, I wouldn't advise the thinking that Straterra is an antidepressant-- it failed to convince the FDA for this indication, which is why they re-applied and got approval for ADD.
Cymbalta, then Straterra, and then let us know the results. Best of luck!!!
Posted by iris2 on October 12, 2004, at 22:19:36
In reply to Re: Strattera Starting dose?, posted by utopizen on October 12, 2004, at 21:56:43
Thanks.
Actually I did not know that it ws known that "... since depression can worsen ADD as you well know and often ADD is just disguised depression" I have not been sure if my symptoms of "ADD" were just my depression or if I actually had some ADD. I thought that it might not matter what dx I put on it if the Strattera relieved the symptoms. Given what you have written I am definitaly going to rethink my opinion on the topic. I see my pdoc next week perhaps he will be in a mood to share his extensive knowledge. I never know if he is mentally going to be there anymore.
irene
Posted by utopizen on October 12, 2004, at 22:58:06
In reply to Re: Strattera Starting dose? » utopizen, posted by iris2 on October 12, 2004, at 22:19:36
> Thanks.
>
> Actually I did not know that it ws known that "... since depression can worsen ADD as you well know and often ADD is just disguised depression" I have not been sure if my symptoms of "ADD" were just my depression or if I actually had some ADD. >You very well could have both, if you experienced inattentiveness or hyperactivity before the age of 7. Otherwise, I would say depression only. But a lot of times these things happen and worsen one another. I've had ADD since I was 3, very severely-- but was a very happy kid until just two years ago, and then my concentration went from procrastinating and all to flat out not being able to concentrate even with 20mg 3x/day of Adderall and being in the library and all of that. That's why depression needs to be the priority, not the ADD. And Strattera might not even work for you, even if you had ADD. And it takes awhile to work anyhow. You're better off focusing on something like Cymbalta, which can help your energy/drive/focus, and later trying Strattera to add on or perhaps a stimulant if Cymbalta alone doesn't help much. Just try to maxmimize the dose with Cymbalta if you only partially respond-- doses are effective from 60mg-120mg.
Posted by Bill LL on October 13, 2004, at 8:33:09
In reply to Strattera Starting dose?, posted by iris2 on October 12, 2004, at 21:39:05
I really liked Iris2's advice. It seems like many, if not most, people with depression also have ADD. Antidepressants often help alleviate ADD.
If you do not feel depressed, then just try an ADD drug. The dose for drugs like Ritalin and Strattera depend on weight. For Strattera, the average for an adult is around 80 to 100 mg per day.
I personally take 120 mg Strattera each day along with 30 mg Lexapro (an antidepressant). This combo works very well for me.
Posted by iris2 on October 13, 2004, at 9:21:53
In reply to Re: Strattera Starting dose?, posted by utopizen on October 12, 2004, at 22:58:06
Firstly, thank you for such a kind and thoughtful response about the ECT. I did not write anything that I expected a response to especially one so kind.
I do not think I had ADD as a kid so my problems with concentration and such must be due to my depression. I already take 40mg of Ritalin sr and used to take 100mg a day. I was obnoxious because it motivates my speech intensely. So I quit taking it but could not get out of bed. That is probably also why this post is so long as I took it about half an hour ago:) Sorry. It helps a lot, not too much with concentration though. I have not been able to take other stimulants that my pdoc thought had better potential to lift my mood and not activate my speech so because of the bladder disease I have, interstitial cystitis or I.C. This is the entire reason I thought about taking Strattera. I thought it might work better than the Ritalin in lifting my mood and also helping me concentrate and focus and am unable to take other stimulants. I also have difficulty taking almost all meds so I might not be able to take any of the ones I am asking about but I am aware that stimulants are out.
I have thought about Cymbalta and have been waiting for it to be approved forever. I cannot remember why but I first went on Amisulpride, about two months ago, which helps with mood a lot, I do better on 75-100mg of it and am just able to tolerate 50mg again because of the I.C. It does not help with adhedonia unfortunately. I then tried Milnacipran instead of the Cymbalta (again I do not remember why I made this decision) and could not take it at all because of the I.C.
Now I am looking at Mirapex and Strattera. I am a little wary of the Cymbalta because I have read now that it is causing people urinary hesitation. I thought it was going to be great because it is also used bladder problems but now I think this might very well work against me. Again though every medicine has the potential to aggravate the I.C.
I hope you do not mind my writing to you so much but you seem to know a lot and I am still undecided about what to do next. My pdoc is generally not helping me make these decisions so I need input from those that understand and know more than I to make the most informed decision I can.
Recently someone suggested Lamictal. I had not even considered this as an option. I tried to read up on it a little and I still think it is not the best option for me right now. My dx is atypical depression, bulimia and sometimes borderline personality disorder. Do not know the short version for depression DP and personal… PD?
I am interested in your opinion about what you think I should try next. I am to see my pdoc this coming Monday and was going to have him write several prescriptions at that time so that even though I am undecided I would have the prescriptions at hand for whatever I decide to take. I had not intended for him to write a script for Lamictal but perhaps I should?
Thanks for your interest and help,
irene
Posted by iris2 on October 13, 2004, at 9:28:23
In reply to Re: Strattera Starting dose?, posted by utopizen on October 12, 2004, at 22:58:06
My concentration being what it is I reread your post and see that you would definitely suggest Cymbalta first and then adding perhaps the Strattera.
I also wanted to tell you that I hope that you are doing well. Keep me posted and let me know if there is anything I can contribute to help.
irene
Posted by iris2 on October 13, 2004, at 9:42:17
In reply to Re: Strattera Starting dose?, posted by Bill LL on October 13, 2004, at 8:33:09
I don't think I was trying to give advice but trying to elicit it.
Thank you for your input as to what has helped you and why you think it helps. I am trying to make decitions as to what to try next.
irene
Posted by iris2 on October 13, 2004, at 9:44:52
In reply to Re: Strattera Starting dose?, posted by Bill LL on October 13, 2004, at 8:33:09
Bill LL,
How do you take the Strattera? Once a day? Also how long do you think it might take to feel any effect?
irene
Posted by Bill LL on October 14, 2004, at 10:07:15
In reply to Re: Strattera Starting dose? » Bill LL, posted by iris2 on October 13, 2004, at 9:44:52
I take the 120 mg all at once in the morning when I wake up. It started working after a few days. The first few days on it made me feel a little out of it. At that point I took 60 mg. After a few weeks, I went up to 120 mg. It makes me feel more calm and also helps with concentration.
The side effects for me are urinary hesitation and tiredness. The hesitation is not too bad and has diminished to some extent over time. The tiredness is caused by both the Strattera and Lexapro. I take caffeine pills most mornings which work well. Each pill has 200 mg caffeine and I usually take 2 pills, sometimes 3.
> Bill LL,
>
> How do you take the Strattera? Once a day? Also how long do you think it might take to feel any effect?
>
> irene
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