ADHD @lemmy.world procrastinare @discuss.tchncs.de 6mo ago

Doctor recommended trying Strattera, looking for other users experiences

Hi !

Just to go straight to the point, my doctor is thinking of trying Strattera in me, since it was recently made available as a generic and I tend to have prevailing side effects with stimulant medication (ritalin, Rubifen, elvanse).

I have some questions that would like to hear from people that are/were on this medication to share:

I understand this is non-stimulating and seems to work akin to an antidepressant. Therefore, do I have to take it every day? Even on days I do not need ? With stimulant medication I only take it when doing theoretical work, and skip it when on the laboratory or other minor tasks and would never take it in days I'm not working, because I can't just interact with people and gives me a baseline anxiety the whole day.
What benefits did it gave you ?
Any prevailing side effects?
How does it compare with stimulant medication (after taking it for some weeks)?

For a bit of context:

I've been diagnosed for about 6 years now, and started with Ritalin XR. However, I could only keep using it for some months since it gave seriously side effects that persisted 3-5 months after stopping it. I later switched to Ritalin IR, which worked for some time and gave me less side effects. But it started to be ineffective after some months.

Then my doctor tried Elvanse (Vyvanse), it worked on keeping me focused, but the anxiety and the huge time frame of action of the drug led to me only taking it once or twice a week.

I'm now back on Ritalin IR, but always feel the anxiety and aversion to interact with people that I always feel with these 3 stimulants.

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I've been on Straterra for about 18 months.

You do need to take it every day because the drug builds up in your system over about 3 weeks to the correct levels. It adjusts how much of your norepinephrine gets reused and so it takes some time to take full effect. I also was in the habit of only taking stims on work days and this will not work for that, it needs some time.

The biggest side effect I or anyone I know has had is some lightheadedness right before my next dose. I ended up getting split doses 12 hours apart but you can also bump the dose up to avoid this, I've been told.

Compared to stimulants, I prefer the steadyness of Straterra. I don't wake up in a panic state every morning, I think thought a problem first before a knee-jerk reaction sets in, and I can focus on my work without being constantly side-tracked, and I still feel like "myself" and can engage in my creative work day after day in a sustainable way.

Best of luck to you!
- Thanks for sharing! That's very interesting info. I'm a bit curious on how it affects you in your non-work days. Can you still be yourself, what about drug interactions (alcohol, weed), any experience?
  
  The thing with stimulant medication for me is that it turns me into a completely different self, so I'm afraid that with Strattera having to take it everyday this happens permanently
  
  I'm happy to report Straterra leaves me personally totally intact. I get a little more bored on the weekends but otherwise feel fine. I only drink socially but so far Alcohol presents no issues. I'm a full-time stoner and I haven't noticed any differences in my Cannabis effects. I do smoke just a little less because I'm a little more focused during the day but it's not a big difference.
  
  I got off stimulants 20 years ago because I hated feeling like I was 'either on or off' and Straterra has given me a steady middle ground that's supremely pleasant. I was very against meds but after I hit 40 and was working from home over pandemic my symptoms just weren't manageable any more and Straterra helped immensely.
It works great for some but for me it's one of the worst drugs I've ever tried. I made it a few weeks before I gave up on it. The side effects were terrible, I felt like shit until it cleared my system. I didn't notice any benefits from it.
- Yeah, I tried it for a few months before the horrible side effects made me stop. Never saw a noticeable difference in my ADHD.
- I'm sorry for your bad experience. Could you share how long you tried to take it (I assume everyday also?) and what side effects you experienced?
  
  It's been awhile but from what I remember I must have made it more than a month but less than three months. Side effects were I felt bloated, pissed off, sweaty, regularly thought I needed to piss but then didn't/couldn't, had terrible insomnia and nightmares, nausea, erectile dysfunction, and generally felt like I was being poisoned. Of all the drugs my shrink had me try it was the absolute worst.
I’ve been taking it for a few months. Doctor is gradually increasing my dosage and I’m up to 40mg once a day.

I’ve noticed that I can concentrate on complicated problems much better, and my scheduling and time management have greatly improved.

I haven’t noticed any side effects yet, but was a bit nervous about some of them. I had a friend who it did wonders for, and then he had a bad panic attack and his doctor took him off of it.

Fingers crossed that things stay good. I haven’t tried stimulants, so I don’t have much to compare it to.
- Thank you for sharing!
  
  Do you feel the drug effects after taking in a period of like 12h or do you feel them constantly?
  
  Does it affect your sleep? At what time you take it ?
  
  It seems to be fairly constant for me. I take them when I first get up, and haven’t noticed it affecting my sleep much. I travel frequently for work though, so my internal clock is always a little messed up. 😂
You take it every day. It's a neural reuptake inhibitor, so it needs to build up in your system.

For me, it's not a fast fix like a stimulant would be. It just takes the edge off of my symptoms, make them easier to manage, and makes it easier to do stuff. In fact, the biggest thing I've noticed is the effect it has on executive dysfunction.

Atomoxetine (straterra) is a slow burn. It takes at least a few weeks to start noticing any effects. I haven't noticed any side effects, other than some trouble sleeping the first week when I first started taking it; but that was because my insurance wouldn't approve me for a lower dosage to have a more graceful "ramp up" period.
take it every day

more executive function overall. I wasn't exhausted after a day's work.

sexual side effects, anxiety, high blood pressure, blurry vision

once onboarding was over, it worked better for me than simulants because there was no ramp up in the morning and no crash in the afternoon or evening.

I stopped taking it because once the starting side effects (nightmares, even worse anxiety, even worse sexual side effects) started to wear off, so did the efficacy.
- Interesting. I'm sorry about your side effects.
  
  After you stopped medicating did they go away completely? If your conformable sharing, did the sexual side effects include ED and/or reduced sexual appetite?
  
  Yep, they seem to have gone away. Currently trying Wellbutrin. Too early to tell if it's working, though.
  
  Sexual side effects included some ED but the main one I noticed was separation of orgasm and ejaculation. Ejaculation came first then orgasm maybe 20 or 30 seconds more of stimulation after. And that was a problem for penetrative sex because part of me wanted to be in a refractory period and the other part wanted to continue to have an orgasm.
I'm not suggesting this will happen to you but for me strattera made me throw up every time I stood up for about 4 weeks after quitting it. The reason I quit was a massive surge in my blood pressure. It was so extreme that my doctor probably weened me off too quickly. There was nothing in the official side effects about this kind of reaction. After a few weeks of scouring the internet I found a message board where someone described the exact same symptoms as I had. There was one other person who had commented about it happening to them. Both described when they started to get better and both felt they nearly died. at the four week mark I finally could stand without immediately throwing up. By week five I had a appetite for the first time in a month. I went from 240 to 175 pounds in that time.

I'm only sharing this to let you know that if you start having massive blood pressure induced migraines and you can't get your blood pressure to drop you need to go to your doctor immediately. I waited a week like the others and think it may have not been as bad if I had started reducing my dosage sooner. My reaction was extreme and not at all common but I will never forget the spring of 2012 because of it. I really feel like I could have died.
- I'm sorry for your experience! Will keep an eye for my BP, thanks for the heads up
One of my kids (1 of 2 with adhd) is on Strattera. He first tried ritalin, but that was really bad for him. Physically it was fine, but he ended up with a constant dark mood and dark thoughts that a 10 year old should not have.

He then tried Elvanse, and while it worked for his adhd, he seemed emotionally numbed. Unmedicated he was bouncing between the walls, but at least he was happy. On Elvanse he was just... numbed.

Now he's on Strattera, and he's not that bouncy anymore, and a much happier kid. And his parents aren't exhausted all the time either, which is a bonus. The only ill effects is that he sometimes gets a bit queazy for a short while after taking it, but it doesn't take long to pass. This could be a result of his aversion to pills, but bribing him with a glass of chocolate milk makes him take it without hesitation.

EDIT: For reference, his older brother had very good effect feom ritalin pretty much right away, so he's on concerta with reduced appetite as the only side effect. He eats like a T-rex in the eveneing to compensate, so it evens out with no issues.
Yes, its daily. It took a few days to notice a difference for me, but it definitely helps me with executive function. I'm up to the max dosage after 18 months, but it's still working.

Side effects for me are nausea for maybe an hour after I take it, and major "shrinkage". Sex is a real challenge for around 8h after taking it, and it looks like I've been swimming in the Arctic sea for about that long. This isn't a major problem because I take it in the morning, but it has been occasionally frustrating. That effect wears off by evening, though, so my spouse is ok with me taking it. 🙂

I have never taken stimulants, so I can't offer a comparison there.
- Thanks for sharing! Do you notice any other effects related to shrinkage ? Similar to vasoconstriction?
  
  When I take stimulant meds this is very common, plus the obvious repulsion to any thoughts of sex.
  
  Does it affect your sexual appetite during and/or after the 8h window of taking ?
  
  Last question would be, could you put an alarm 2h before waking up and take it so that instead of 8h of side effects you would only get 6h (waking) ? Or does the drug has any stimulant or other noticle effect that would prevent you from falling asleep
  
  I don't notice anything else related to vasoconstriction. My BP hasn't changed since I started on it, for instance. It doesn't really affect my appetite for sex, just my ability. This has lessened over time, but it's still present. (And after ~8h, everything is fine.)
  
  You can take it before bed if you like. Some people find it sleep-inducing at first. I find it simulating an hour or two later.
  
  From what I have read, there are several different experiences from it. You'll likely have to try it and see how it works for you, and what accommodations you'll need to make. Hopefully the comments in this thread give you an idea of what to look out for.
1 - yes 2 - more internal filter, better able to start tasks and focus 3 - slightly less hungry maybe 4 - much less effective then stems, but consistent throughout the day.
Never tried not-stimulants but I have read some studies that suggests that a combination works best for some people.

Out of curiosity, what side effects are you experiencing with stimulants?
I've been taking this (Atomoxetine) for at least 15 years. The biggest side effects for me are: Intense, but quick nausea about 3 hours after ingestion. It helps to take it with food. Lowered sex drive. Drowsiness.

I take it daily and its been the best drug for me, despite the side effects.
- Does the drowsiness and lowered sex drive persist during the whole day ?
  
  The drowsiness lasts a few hours (2-4?), but the decreased sex drive doesn't usually last as long (1-2) hours.
  As long as I've been taking them regularly, both of these symptoms are more manageable. I've never felt it was unsafe to drive my car or anything, but your mileage may vary.
Yes, as said - you have to take it every day. For me personally, there are no any side effects. But, there are also no benefits.
- This was my experience too. No side effects, no benefit.
Straterra didn't do anything for me. Had no effect on my ADHD. Didn't have many side effects other than no dreams, which I only noticed after I stopped taking it.

I'm currently taking Vyvanse and it's starting to lose its efficacy. At first it gave me anxiety and other side effects but they all leveled out.
- Yeah the Vyvanse side effects wore off for me too, but so did it's efficacy over time even though I rarely take it every day. I did take it daily for a couple months recently though.
  
  I've heard of people not taking it on weekends to keep that from happening. I haven't tried that.
  
  You could also take L-Tyrosine on days off to replenish your dopamine levels
I comboed vyvanse and guanfacine for this and it worked. Another option. Don't get, it takes a while. I too had a long journey.
I tried Strattera to avoid side effects from Adderall, but Strattera made me throw up whenever my heart rate got too high. I had to give it up, not to mention it didn't really feel like it was helping me focus. I now take very small doses of stimulant medication, 5 XR and 5 IR each day.
It gave me the big sad so I gave it up
I went through a month's supply of strattera before switching to adderall. I also only took it on "need to be productive" days, which may have been the wrong approach. I was reluctant to take it otherwise because of the side effects. I felt like it did help me focus on tasks, but the benefit was essentially offset by the drowsiness it caused making it something of a wash for my productivity. I work at home so I would end up needing to take a nap most days I took it. Sleeping became very refreshing though, which was a silver lining.

Other symptoms were a pounding head, a decrease in appetite, and an increase in anxious thoughts. None of the symptoms were intense except drowsiness, and all of them mellowed out after a few weeks.

Adderall works a lot better for me now and has fewer side effects. But I've seen others in the community really appreciate what straterra has done for them, so it seems to vary a lot from person to person. Despite my disappointment with it, it may be worth trying if stimulants aren't working well for you. My doctor recommended it initially because it was working well for some of her other patients.
- Accountability time: No "maybe" about it.. You didn't follow the instructions and then you say it didn't work for you. Well of course not. You never gave it a chance.
  
  This is like buying a nailgun and then ignoring all safety warnings, you use it like a hammer and accidentally shoot your kneecap with it. So you call it defective and return it to the store, telling everyone hammers work better for you. Okay, maybe that's a strained analogy.
  
  I was using it almost daily from the start and felt worse for it, so I started dreading taking it and quickly preferred no medication. I eventually finished it off and instead of getting a refill, I switched to something that worked great from the start and was cheaper.
  
  I'm not saying it's not a good medication, I even recommend it, but if it requires a strict schedule and that much of a miserable buildup just to still be worse than an alternative it's simply not the right one for me.
Have you ever tried the namebrand of any of them? I personally take namebrand Concerta. The generics are laughably bad and are constantly being pulled from the market for not being bio identical. Generics have a pretty wide margin for what is considered equivalent to the name brand. It's also pretty common to be allergic to inactive ingredients in Generics, which can cause adverse effects.

You can find all sorts of articles on these subjects here: https://adhdrollercoaster.org/?s=Generic

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