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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by fido on February 26, 2015, at 9:58:05
I'm going to try Strattera for ADHD. I will start low with 18mg. I am pretty sure it won't work. Wellbutrin also didn't work. But at least I can say I tried it.
I am thinking about wether it would make sense to add a SSRI cause I also have depression. Wellbutrin + SSRI is a common combo. But I dont know about Strattera + Lexapro.
The thing is I dont want to have to go to my doctor and discuss every little thing with him. I only see him every 8 weeks. Since I still have left over Lexapro at home which I tried in the past and didn't work for depression I could theoretically experiment a bit on my own and try Strattera + Lexapro. But I'm not sure.
But on the other hand it makes no difference if I simply experiment on my own or wether I ask my doc first. I mean if I should get any side effects it's the same situation. It makes no difference is I discussed it with my doc or not.
I could make much faster progress if I started to experiment more on my own instead of always having to wait for the next appointment.
Posted by linkadge on February 27, 2015, at 19:24:20
In reply to Has anyone tried Strattera?, posted by fido on February 26, 2015, at 9:58:05
I tried Straterra. Lower doses seemed to work better for me. It was the cost which was prohibitive for me.
Linkadge
Posted by fido on February 28, 2015, at 12:20:46
In reply to Re: Has anyone tried Strattera?, posted by linkadge on February 27, 2015, at 19:24:20
Did you take it alone or with an AD?
Since I have depression I doubt that it alone would do much. At best it could work for adhd but I also doubt it cause wellbutrin didnt work.
I really dont know if it's even worth trying it out.
I googled if strattera could be combined with a SSRI and found that it's tricky because strattera can prolong QT time and some SSRI can also do this which is dangerous. :/If strattera cant be combined with antidepressants then it's not worth it.
Posted by linkadge on March 1, 2015, at 7:18:15
In reply to Re: Has anyone tried Strattera?, posted by fido on February 28, 2015, at 12:20:46
Hi. I don't think I tried much more than about 10-20mg. If bad depression is your key issue, it may not be the best med to take.
I don't think it worsened my depression much, but it did get an elevated heart rate on it (I get this on all norepinephrine affecting meds).
I think I took it with Effexor / mirtazapine.
I now take Ritalin because it is cheaper. But, I would consider straterra again, if it was affordable.
Linkadge
Posted by linkadge on March 1, 2015, at 7:19:28
In reply to Re: Has anyone tried Strattera?, posted by fido on February 28, 2015, at 12:20:46
The one positive is that it seemed to get me out doing things. For instance, it seemed to enhance my desire to say, go to a movie that I was interested in seeing.
Posted by ed_uk2010 on March 1, 2015, at 14:30:53
In reply to Has anyone tried Strattera?, posted by fido on February 26, 2015, at 9:58:05
> I'm going to try Strattera for ADHD. I will start low with 18mg. I am pretty sure it won't work. Wellbutrin also didn't work.
It doesn't have the same mechanism of action as Wellbutrin. It could still help.
>I am thinking about whether it would make sense to add a SSRI because I also have depression.
Strattera interacts with certain SSRIs, but it should be possible to combine it with sertraline (Zoloft). In spite of some dubious information online, sertraline does not appear to prolong the QT interval.
Posted by fido on March 1, 2015, at 17:59:26
In reply to Re: Has anyone tried Strattera?, posted by ed_uk2010 on March 1, 2015, at 14:30:53
hi, but if wellbutrin 300mg didnt work for me then why should strattera work?
also, what if strattera makes ocd or anxiety worse?
i am pretty scared of it. i also read it can make you suicidal.
i'm really discouraged. my hope in antidepressants has vanished. my whole situation is so bad and hopeless that it's totally unrealistic to think that a drug can fix me.
Posted by 10derheart on March 2, 2015, at 0:15:47
In reply to Re: Has anyone tried Strattera?, posted by fido on March 1, 2015, at 17:59:26
Hi fido,
Sorry you are having such a low and frustrating time, and that I have no amazing suggestions for you.
I have been on 80 mg. of Strattera for over 10 years now for ADD, so if there is anything specific you want to know about my experience, please just ask. If you search the PB site using my screen name and "strattera," you will find many old threads by me responding to posters who wanted to know what it was like.
For me, it indirectly helped with depression because my ADD symptoms were severe enough at the time to mess up so many parts of my daily life that IMO, this was the root cause of about 85% of my depression, which eased up simultanously with control of the ADD.
I was never suicidal (related to this med) or more anxious. The side effects were quite mild and disappeared in less than 2 weeks.
Take care. -- 10derheart
Posted by Robert_Burton_1621 on March 2, 2015, at 0:38:48
In reply to Re: Has anyone tried Strattera?, posted by ed_uk2010 on March 1, 2015, at 14:30:53
> >I am thinking about whether it would make sense to add a SSRI because I also have depression.
>
> Strattera interacts with certain SSRIs, but it should be possible to combine it with sertraline (Zoloft). In spite of some dubious information online, sertraline does not appear to prolong the QT interval.
>Good point about sertraline! Another SSRI possibilility would be citalopram: see, Preskhorn (et al), Clin Pharmacol Ther (2006) 79, p 52.; and Gillman, Brit J Pharmacol (2007) 151, at 744-5.
>
Posted by Robert_Burton_1621 on March 2, 2015, at 0:59:14
In reply to Re: Has anyone tried Strattera?, posted by fido on March 1, 2015, at 17:59:26
> hi, but if wellbutrin 300mg didnt work for me then why should strattera work?
As Ed said, they do not have the same mechanisms of action. It would be interesting to know Ed's view about the efficacy of buproprion: it is not prescribed here in Australia except off-label. Gillman opines that buproprion is "is not a clinically significant reuptake inhibitor for either noradrenaline or 5-hydroxytryptamine. It is a weak dopamine reuptake inhibitor; weaker in vitro than sertraline (which is called a selective serotonin reuptake inhibitor). It may possibly have other pro-dopaminergic activity."
See: http://www.psychotropical.com/bupropion
> also, what if strattera makes ocd or anxiety worse?
If that is a possibility, and you notice it, if you are on dual-therapy with an SSRI at the same time, then one option would be to raise the dosage of the SSRI relative to the atomoxetine.
Posted by fido on March 2, 2015, at 16:46:01
In reply to Re: Has anyone tried Strattera? » fido, posted by Robert_Burton_1621 on March 2, 2015, at 0:59:14
Hi,
I really dont know if I should try strattera.
I am off cymbalta since 7 days or so and the past few days I have been VERY depressed. I really dont know if this would even be the "right time" to start strattera cause it even says not to take it when you're depressed.
But I am depressed, duh!What if this stuff makes me suicidal? Seems like a way too huge risk.
What also really irritates me is the warning in the manual that if you open or crack a capsule and the content gets in contact with your skin you must immediately wash it.
Is this a joke or what? If the content is that aggressive then what will it do in my stomach?
Seriously, this is disturbing.Could I not rather try nortriptyline instead of strattera? I would rather try a drug which is old and well-studied than something rather new.
Posted by Robert_Burton_1621 on March 2, 2015, at 21:24:00
In reply to Re: Has anyone tried Strattera?, posted by ed_uk2010 on March 1, 2015, at 14:30:53
> >I am thinking about whether it would make sense to add a SSRI because I also have depression.
>
> Strattera interacts with certain SSRIs, but it should be possible to combine it with sertraline (Zoloft). In spite of some dubious information online, sertraline does not appear to prolong the QT interval.
>Ed and fido, I understand that nearly all studies of straterra state that it has negligible effect on transporters other than NET. However, I've just come across the below 2014 paper which concludes that it occupies SERT, too. I am not competent to understand critically the methods or results of this paper, but might it have a bearing on the question whether a suitable SSRI can be combined with straterra?
Clinical doses of atomoxetine significantly occupy both norepinephrine and serotonin transports: Implications on treatment of depression and ADHD.
Authors
Ding YS1, Naganawa M2, Gallezot JD2, Nabulsi N2, Lin SF2, Ropchan J2, Weinzimmer D2, McCarthy TJ3, Carson RE2, Huang Y2, Laruelle M4.
Author information
Journal
Neuroimage. 2014 Feb 1;86:164-71. doi: 10.1016/j.neuroimage.2013.08.001. Epub 2013 Aug 9.
Abstract
BACKGROUND: Atomoxetine (ATX), a drug for treatment of depression and ADHD, has a high affinity for the norepinephrine transporter (NET); however, our previous study showed it had a blocking effect similar to fluoxetine on binding of [(11)C]DASB, a selective serotonin transporter (SERT) ligand. Whether the therapeutic effects of ATX are due to inhibition of either or both transporters is not known. Here we report our comparative PET imaging studies with [(11)C]MRB (a NET ligand) and [(11)C]AFM (a SERT ligand) to evaluate in vivo IC50 values of ATX in monkeys.METHODS: Rhesus monkeys were scanned up to four times with each tracer with up to four doses of ATX. ATX or saline (placebo) infusion began 2h before each PET scan, lasting until the end of the 2-h scan. The final infusion rates were 0.01-0.12mg/kg/h and 0.045-1.054mg/kg/h for the NET and SERT studies, respectively. ATX plasma levels and metabolite-corrected arterial input functions were measured. Distribution volumes (VT) and IC50 values were estimated.
RESULTS: ATX displayed dose-dependent occupancy on both NET and SERT, with a higher occupancy on NET: IC50 of 31±10 and 99±21ng/mL plasma for NET and SERT, respectively. At a clinically relevant dose (1.0-1.8mg/kg, approx. 300-600ng/mL plasma), ATX would occupy >90% of NET and >85% of SERT. This extrapolation assumes comparable free fraction of ATX in humans and non-human primates.
CONCLUSION: Our data suggests that ATX at clinically relevant doses greatly occupies both NET and SERT. Thus, therapeutic modes of ATX action for treatment of depression and ADHD may be more complex than selective blockade of NET.
© 2013.
PMID 23933039 [PubMed - indexed for MEDLINE]
Elsevier Science: Full text
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Related citationsEvaluation of [(11)C]MRB for assessment of occupancy of norepinephrine transporters: Studies with atomoxetine in non-human primates.
Neuroimage. 2011.
Atomoxetine occupies the norepinephrine transporter in a dose-dependent fashion: a PET study in nonhuman primate brain using (S,S)-[18F]FMeNER-D2.
Psychopharmacology (Berl). 2006.
Imaging the norepinephrine transporter in humans with (S,S)-[11C]O-methyl reboxetine and PET: problems and progress.
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Posted by fido on March 3, 2015, at 20:53:51
In reply to Re: Strattera and serotonin? » ed_uk2010, posted by Robert_Burton_1621 on March 2, 2015, at 21:24:00
This sounds problematic. If this is true then mixing it with a SSRI could be dangerous. That's not good. :/
Posted by linkadge on March 4, 2015, at 17:12:03
In reply to Re: Strattera and serotonin?, posted by fido on March 3, 2015, at 20:53:51
Its not too difficult a situation. Start with a low dose, and keep track of your mood. If you feel worse, stop taking it. If anything, the effects on mood are subtle.
I felt that it actually improved my mood.
Linkadge
Posted by fido on March 6, 2015, at 18:05:25
In reply to Re: Strattera and serotonin?, posted by linkadge on March 4, 2015, at 17:12:03
Hi,
today I took 36mg. Didn't feel more focused.
But this stuff makes me sleepy during the day.
This is not good. If this doesn't go away then it's definitely not for me.
I plan to increase gradually to maybe 70mg if it doesn't do anything by then then I'll get off it.
This is the end of the thread.
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