Any experience with strattera? Or similar?
March 9, 2010 2:07 PM   Subscribe

I've been more-or-less diagnosed with adult ADHD at 33. My psychiatrist said that, if I weren't "too smart," it would be an easy to say I've got ADHD. My psychiatrist wants to medicate and my therapist won't comment.

I'm already on 450mg of generic wellbutrin and 50 mg of generic zoloft for depression and that's working quite well. My diet is good and I get plenty of exercise. What my psychiatrist has told me is that there are pretty much three levels of treating ADHD. 1) Take wellbutrin, it's a mild stimulant that helps sometimes. I'm already doing this. 2) Take strattera, a drug that I've never heard of. or 3) Ritalin, Adderal, or similar. I'm extremely averse to Adderall and other stimulants because, dang, that's a drug I want to take! My situation doesn't, by my reckoning, require a drug of that nature and I'm inclined to form a habit for such drugs. My medical professionals, bless them, are providing me with lots of information to make my own decisions about my health care. What a pain!

So I've got a Dr. willing to write me a prescription for any stimulant as hardcore as Adderall or less who suggests strattera as a starting point and an excellent therapist who (properly) isn't willing to dispense advice about medication but who advises against adderall and similarl as too dang swell of a drug for a marginal case like me.

What I'm hoping for are primarily anecdotal experiences with Strattera and anecdotal experiences with stimulants for the treatment of adult ADHD. I will no way, no how, treat any of this as medical advice, merely as possible avenues of research and questions for my physicians.

Thanks for your help.
posted by anonymous to Health & Fitness (17 answers total) 11 users marked this as a favorite
Adderall is a miracle drug for many. Sttraterra? Not so much.

You need to find a GOOD medical professional that can help you work this out with your symptoms and needs.
posted by k8t at 2:15 PM on March 9, 2010

Have either your psychiatrist or therapist discussed non-pharmaceutical treatment options with you? Is your therapist helping you with anything ADHD-related? Considering you seem to be on the edge of a diagnosis, medication might not be the best solution.

It's good that your psychiatrist is providing you with options and letting you make the call, but a good psych will also present you with options that don't involve a prescription.

Anecdotally, I got a "you could have ADHD, but I can't tell for sure" from my therapist a few years back, and went on Concerta for a few weeks. I was expecting a magic bullet of concentration, but even at the highest dose it did nothing for me.
posted by Metroid Baby at 2:35 PM on March 9, 2010

I think I understand the too smart thing. That's what my doc said too. Since school was easy for me and challenging things didn't truly happen until later in life that the ADD symptoms probably were not apparent or at least not seen as a problem. I was 31 when this was diagnosed after feeling overwhelmed with a big workload, procrastinating, not staying on top of things, and finally feeling like this was a bigger issue than just work.

I was prescribed Dexedrine and also tried Adderall but settled on the Dex because it worked just as well but was cheaper (no drug insurance). I cannot stress enough that I also tried non-drug strategies at the same time such as getting more organized and making sure my environment was conducive to focus.

After about two months of a combined placebo effect and actual drug effect, I was getting more done, but was getting irritated with the constant dry mouth and some difficulty sleeping, not to mention feeling like I was going through a background check every time I got my prescription filled. You may or may not have these side effects. But the dry mouth thing was really annoying. I never drank so much water in my life.

Overall I felt like it had its benefits, but I also felt like I was learning things from the non-drug solutions at the same time. So I kept it up for about a year. At that point I went off the medication because I started competing in a sport where Dexedrine was banned in-competition. However, the non-drug skills have stuck quite a bit.

I'll be honest, the drugs definitely helped, but I'm glad I stopped. The surrendered productivity was a fine trade-off for pursuing competition. But I'm definitely better than before.
posted by thorny at 2:38 PM on March 9, 2010 [1 favorite]

I've got ADD, was diagnosed at 25, and take Adderall. I love it. I can focus and get work done now, it's amazing. I started on a very, very low dose, and my doctor and I adjusted it upwards until it didn't feel like it was wearing off after a week or two anymore. Now, I take it every day in the morning, and on days when I have to work into the evening, I take a second (prescribed) dose.
posted by ocherdraco at 2:48 PM on March 9, 2010

Strattera made it hard for me to pee -- and 7 years after stopping it, it's STILL harder to pee than it was before I ever took it. Might just be me having a psychological block, but definitely a side affect that I would call "highly undesirable" -- plus it didn't work too well at fixing my ADD. Ritalin worked the best for me. I didn't like Adderall. Dexedrine worked OK.

PS: after 14 years of taking ADD meds (age 19 to 33) I decided to just deal with my ADD with behavior mod, exercise, and nutrition 2 years ago. I hated being medicated all the time. I feel much healthier and happier without ADD meds. They felt miraculous at first, but after a while they just feel like chains.
posted by rabbitrabbit at 2:48 PM on March 9, 2010

This recent thread is of related interest.

Strattera made me have vivid dreams (what felt like) all night long, leaving me feeling unrested in the morning. I didn't notice any useful effect. After just a few days, I gave it up before exhaustion made me crazy.

Methylphenidate (the active ingredient in Ritalin) helps me focus about twenty times better than anything else I ever tried in years of being resistant to the idea of medication and seeking alternatives (though exercise and meditation do help.)

ADHDers are expected to have a so-called atypical reaction to methylphenidate -- it makes us calmer, not hyper. (But if you know it to be the case that you have the typical reaction to stimulants, maybe it'd be better avoided.)
posted by Zed at 2:49 PM on March 9, 2010

Adderall isn't a stimulant for me like it is for many people. For people that "need" it, it allows them to focus but doesn't give you that bug-eyed feeling other stimulants can give you. I was recently re-diagnosed (I'll be 30 in three weeks.) In my case, sometimes I would even forget to take the Adderal until my fiancee reminded me that I was bouncing off the walls and had I taken my meds?

My fiancee's brother was on a non-stimulant ADD med (possibly Strattera IIRC?) and became physically violent with intent to harm...Adderal was a godsend for him, no more violent thoughts and he was able to focus.

Your doctor will not just load you up on adderal and never talk to you again...there will likely be appointments to determine the effectiveness of the current meds.
posted by schyler523 at 2:50 PM on March 9, 2010

There's a lot of smart people in the world with ADHD.

Diagnosed at 31. Put off meds for a while because the thought of taking stimulants scared the crap out of me. I had a bad reaction to Zyban/Wellbutrin many years ago, so I asked for Strattera first and it did nothing for me. Waited another year or so before agreeing to try Adderall.

It's been two months and it has completely changed my life.
posted by elsietheeel at 2:53 PM on March 9, 2010

You should know, first of all, that the DSM notes that you and I, ADD adults, are notoriously bad at self-diagnosis. Most people are terrible at it, but we ADD adults are much, much worse. It took years for me to admit to myself that I was in fact pretty damned bad. So you should at least countenance the possibility that you don't actually have a "marginal case" of ADD but a full-blown, all-out whopper of it. The trick is, you really don't know.

Second, you may see Adderall and Ritalin as "hardcore," but understand that, first of all, you wouldn't be taking massive doses or anything; it's just a bit every day. Avoiding a habit just means seeing a psychiatrist regularly enough that they see and know how the drug is impacting you. Honestly, if you're worried that you're the type to take drugs inappropriately, that's something you need to talk about with her or him, and it would be a problem with the Wellbutrin and Zoloft as well. You'll find, by the way, that any standard, modern amount of Adderall or Ritalin won't be dispensed in such a way that it works so nicely as a recreational drug. A lot of them are slow-release or long-acting, so I suppose you could take them recreationally, but it'd have to be in eight-hour segments.

And, again – if you're worried that you might abuse drugs or form a habit, that's a problem that exists with all medications, and it's something you should talk with your psychiatrist about.

Finally, I have avoided Strattera myself. It's got black triangle status, which doesn't necessarily mean it's evil or anything, but there have been reported side-effects that haven't been fully examined yet. A good psychiatrist should be able to fill you in on this, but Ritalin and Adderall have been quite a bit refined since they were introduced years ago. In short, they're not just speed or anything anymore, despite what some people may say. My personal preference is for Ritalin LA, which I think is one of the better formulations on the market right now (it's completely different from the Ritalin I took growing up, that's for sure) though unfortunately Ritalin LA is not yet available as a generic at all.

I guess the only thing to do is to try something gradually and see how it affects your life – see if it helps your ADD. As I said above, you should remember that you might not be the best judge of how much or little it helps you; you have to continually consult with a psychiatrist (and your therapist) about your life and what's going on in general so that they can get a good picture of how you're doing.
posted by koeselitz at 2:59 PM on March 9, 2010 [1 favorite]

The only thing Strattera did for me was make me sleepy all the time. Not what I was looking for.

I take both Adderall-XR (slow release) and normal fast release tabs, in various combinations depending on the daily situation.

My doc said there was also a patch version.
posted by trinity8-director at 4:45 PM on March 9, 2010

If the doctor is conservative about dosing, you probably won't "like" the amphetamine products. You may not even notice them. Very "clean" or "clear" feeling. Which I think is one of its nicknames.

I had the same fear. When I kicked up dosage on advice of my doctor, I did NOT like it. I felt speedy, red faced and slightly aggressive, like the top of my head was going to shoot off. Maybe some people like that feeling, I didn't. 10mg lower, and I'm just fine.

The only time I have felt the slightest twinge of "wanting" the drug is if I forget to take it, need to concentrate on something, and it's too late to take it or I won't be able to sleep. And possibly sometimes if I take it way too early in the morning and it runs out in the evening. And that's really just an eating binge.

Another tip is to cut back on the caffeine. (For me) they work synergistically for side-effects (jitters, blood pressure, etc.), but against each other for the desired effects. Too much caffeine and I get to feeling bouncy and "pressured". And not on an empty stomach.

But yeah, it's a godsend if you need it.
posted by gjc at 6:31 PM on March 9, 2010

Chiming in to say that I, too, remained undiagnosed with ADHD for many years because I was a "high-performing individual." Your "intelligence"/more efficient processing compensates for your inattentiveness. Simple. This doesn't mean that you do not suffer from ADHD-related stressors or symptoms, and this doesn't mean that you are performing to the fullest of your potential.

Now, medication: Strattera is an SNRI, similar to SSRIs (one of which you are currently taking). My previous experience with SSRIs made Strattera a non-option, although I have heard many criticisms of it anyway. You say your case is "marginal"; if this is true, you can have very effective results with a very low dose of stimulants. I take 18mg Concerta (started on 5mg Ritalin twice daily, but Concerta is extended-release and is a 'smoother ride' for many adults) and it has made a remarkable difference. I have increased motivation and efficiency and feel more competent and on top of things since I've started taking it.

The amount of medication you are taking, while chemically similar to street stimulants, is nowhere near the dosage level to take such drugs for recreation. I went through a period of adjustment when I started taking the meds, and again when I upped my dose, during which I felt my pulse and breathing were faster than normal, I had hot flashes, and my libido increased--all side effects that can occur when one takes recreational amphetamines--but this quickly faded as my body adjusted to the meds.

I do not want to take my pills for fun. I take one in the morning, & continue about my day with the ability to read and retain information, pay attention in conversations, and not startle people with my apparent non-sequiturs. Plus, the manner in which the medication is dispensed makes it very hard to abuse your medication while also experiencing its helpful benefits.
posted by opossumnus at 6:42 PM on March 9, 2010 [2 favorites]

Strattera is an SNRI, similar to SSRIs (one of which you are currently taking). My previous experience with SSRIs made Strattera a non-option

Could you explain? why did having a bad response to a serotonin reuptake inhibitor make you think you'd have a bad response to a norepinephrine reuptake inhibitor? thanks
posted by DMelanogaster at 4:52 AM on March 10, 2010

I was diagnosed at 29 and prescribed Strattera. Why? My Psych didn't really believe me that I had ADHD and wanted to try something less serious (in management) that Adderall.

It was horrible. I had all the side affects. Dry mouth, pee problems, and couldn't sleep. It only marginally helped my ADHD. What it did to was leave me a zombie. Meaning I didn't have strong emotions either way. Every day was a big pile of "meh".

Except for hate/anger. I'm not an angry person. On those meds though, if something triggered that response it was white-hot. There were a couple arguments as a result and a few really bad days at work that I had to leave the office to cool down.

All this lasted from beginning to end and peaked after I reached my full dose. I took myself off them over a two-week dosage reducing regiment.

Currently, I am unmedicated and unemployed. I very much look forward to the day that I have insurance again and am able to try Addreall. From all the anecdotal evidence, it works wonders for the inattentive subset of ADHD that I have.

Good luck.
posted by damionbroadaway at 9:21 AM on March 10, 2010

Interesting thread. I'm self-diagnosed w/ ADD, and coffee helps a lot. Based on the above comment about self-diagnosis, I'll look into it further.
posted by theora55 at 9:21 AM on March 10, 2010

Don't be reluctant to try stimulants just because some people abuse them. Stimulant use is contextual. The same drugs (e.g. amphetamines) have completely different effects depending on who is taking them and why. It's not like you take your first Adderall dose and then three months later find yourself on a Faces of Meth poster. Certainly, stimulants can be very destructive and addictive when used in a certain way - in excess, to get high. But that's not how or why you'd be using them. You'd be using them as medicine, to correct a neurochemical imbalance. You'd be using them because decades of research have shown them to be the most effective treatment for the disorder you've been diagnosed with.

Ironically, it's when I'm off my meds that people think I'm on drugs.
posted by granted at 8:04 PM on March 10, 2010 [1 favorite]

Just adding yet another bit of anecdata: 33, diagnosed with ADD less than a year ago; being treated with stimulants has CHANGED MY LIFE for the better, it's almost unbelievable. It's not a panacea, but it's helped me focus enough to work on other areas of my life, and the creative process is a bit less blood-from-a-stone than before.
posted by jtron at 12:35 AM on March 11, 2010

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