Strattera for ADHD - before I dive in
July 7, 2021 4:19 AM   Subscribe

I've tried Concerta, Ritalin, Vyvanse and Adderall without any relief of symptoms and indeed without even side effects. Finally going to try Strattera even though I've been hesitant due to the need to titrate as opposed to on/off of the stimulants. What do I need to know? When will I know if it's working, what is the "feel"?

Lifelong textbook ADHD, diagnosed about 15 years ago in early thirties. Have developed a habit of working out first thing in the morning in the past few months if that's relevant, will be taking medication together with anxiety medication in the early morning before eating (well half a banana or a small piece of bread) and then working out, protein drink after workout, then go till lunch.
posted by anonymous to Health & Fitness (7 answers total) 10 users marked this as a favorite
I tried stimulants for years and wound up with massive anxiety. While stimulants helped with some of my symptoms I still struggled a lot especially in motivation.

Strattera has been near-miraculous for me! My anxiety is 90% gone and I have much more motivation now. My thoughts are really quiet now & life is so much easier.

I've been on it for about 5 months. At first I could not sleep. I blamed the Strattera but now I think it is from abruptly quitting stimulants. I sorta remedied the problem by forcing myself to stay up late & get up early for a few weeks. I also take a small dose of Trazodone & rarely Ambien.

The first 2 weeks was rough but I knew almost right away it was worth it. Side effects were mostly a weird tingling in my legs & arms, some fatigue in the afternoons, feeling spacey & fitful sleep. I got some odd sweats for the first month or so.

The tingling died down but I still experienced it mildly for about 3 months, just for an hour or so a day. My appetite is effected but not as much as when I was on stimulants.

Now the only side effect is a dry mouth. This occasionally drives me nuts if I think about it too much but is mostly a nuisance.

I can't really feel Straterra like I could Adderall or Ritalin. But Strattera controls my worst symptoms all the time, not just for a few hrs a day. I still struggle with procrastination but I can overcome it much easier now.I no longer feel like life is a never-ending massive effort.

I hope you'll give it a try! Good luck to you :)
posted by i_mean_come_on_now at 5:03 AM on July 7, 2021 [2 favorites]

I was on Straterra for two years. My dr wanted me to try stimulants and I was very reluctant to do so and pushed for non stimulants first. I had a lot of problems with the common side effects (nausea and anxiety) and eventually had to stop them because of that. Literally at night I would have this horrible sense of dread that something terrible was about to happen. If you had asked me if Straterra was working for me in terms of abating adhd symptoms I would have said yes quite a bit. But now that I’m on Adderall I can say stimulants work so much better for me. Adderall has quieted all the ruminating thoughts that I didn’t even realize ruled over me constantly and has squashed all my anxiety. It’s so wonderful. Plus the side effect of appetite suppressant has allowed me to conquer food addiction issues I’ve battled for years and led to 20 pounds of weight loss so far and lower A1C. So Straterra can be very effective for some but the research shows it’s usually less effective for those who have already tried stimulants first. Good luck and I hope you have an amazing story similar to the other replies that said it worked for them where stimulants failed.
posted by TestamentToGrace at 5:32 AM on July 7, 2021 [1 favorite]

If you haven't already done it, consider genetic testing for medication efficacy and side effects. GeneSight is one such provider; there are others.

Full disclosure: I haven't yet been through it myself, but of my admittedly small sample (3 people), they all reported solid results in terms of selection and dosage of medication.

I'm getting assessed for a few conditions (including ADHD) at the end of this week and will be advocating loudly for a genetic test, since I've had mediocre or poor results with psych medication in the pre-genetic testing past. Feel free to DM me and I can report back to you.
posted by Sheydem-tants at 6:02 AM on July 7, 2021

The effects of Strattera felt subtle to me, but present—a vaguely easier time completing tasks or stopping things to go to bed on time, that kind of thing. It does take some time to work but I think of it in a similar way to how I think of SSRIs.

Medicaid covered GeneSight for me but I was very underwhelmed by what it showed me and how that lined up or didn’t line up with my experiences with the host of psych meds I’ve tried over the years. If it’s covered, I’d go for it, but if it’s a hardship to pay for I would not do it. IIRC a psychiatrist I follow on Twitter said she prefers the other major company, not sure if that’s meaningfully better or if we just don’t have enough research to make the genetic testing useful for everyone.
posted by needs more cowbell at 6:19 AM on July 7, 2021 [1 favorite]

My daughter's ADHD was not helped by stimulants -- we tried all the varieties. Strattera does help her. It is not miraculous, but the few times we've missed a dose of Straterra we have definitely noticed that she is much more scattered and distractible.

Straterra can be very effective for some but the research shows it’s usually less effective for those who have already tried stimulants first.

My understanding is different. It was explained to me that stimulants are the first line drug, because they work for most people, and they are highly effective. Straterra is not as effective, but it does help some people who are not helped at all by stimulants.
posted by Winnie the Proust at 7:28 AM on July 7, 2021 [1 favorite]

I am on it now as a complement to my methylphenidate therapy. I am finding it reasonably effective so far. There is a noticeable side effect of appetite suppression, which can last all day, and I tend to get kind of gaggy/retchy/dry-heave-y in the first hour or two after I take it. YMMV.
posted by armeowda at 1:04 PM on July 7, 2021

I started Straterra right before quarantine. While it is no silver bullet, it has been life changing.

I had a terrible time with the side effects of stimulant medications, and not any luck being able to control what I focused on when taking them.

I do need to take it at night so I can sleep through the GI side effects, and I got a lot more regular about taking the melatonin that I use for sleep. (It's possible that the GI effects have gone away with time, but I don't want to mess with a good thing...)

My sleep hygiene has improved, I think in a Pavlovian way.

Other benefits include a strong improvement in my ability to notice that I'm considering an impulsive behavior (and often not do the behavior!), as well as getting myself back on track more easily during a distraction that would have previously claimed an entire day. Shifting gears between tasks has become more manageable as well. Not easy, but a bit less stressful.

My anxiety has decreased by possibly a factor of 10.
posted by bilabial at 3:21 PM on July 7, 2021 [2 favorites]

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