Changing from Strattera to Vyvanse for my Adult ADHD - Very Excited!

In the last year, I have been relentless in my quest to ensure I take care of myself and get effective treatment for my ADHD. But as stubborn and determined as I can be, the medical system's wheels turn slowly. Or at least they were from where I was standing.

The non-stimulant SNRI 'Strattera' worked pretty well for a while. I think I had better control over my impulsiveness. My multiple channels of thoughts seemed to quieten down, and I was able to have two or three things going on in my head at a time - that's quiet for me. I could focus much better. I would take a breath before saying something and often times decide not to say something.

I remember just as I was starting medication becoming aware of how I always had four or five trains of thought going at once - and how I thought this was perfectly normal. I would be thinking of the situation at hand, then something perhaps about a previous situation similar to it, and then something completely unrelated, like a task I needed to do, and maybe a thought about some sort of philosophical point, and perhaps something about the etymology of a word that I had just heard in the conversation, and then maybe what I was going to do next, plus maybe something I wanted to excitedly add to the conversation, even though it was not pertinent.

Looking back, that's a lot of stuff happening all at once. No wonder I got distracted easily, and no wonder I spaced out a lot.

Strattera seemed to calm my thinking down and reduce my impulsiveness, as it relates to interrupting conversations, inserting non sequitors, or adding humour at inappropriate times.

But the spacing out, the perseveration, the procrastination, the difficulty I have with attending to priority tasks - was still a big struggle.

And my family doctor is - uhm - well, he isn't really good at customer service. He isn't the guy in the department store who answers "No, I don't know if we have those widgets, but walk with me and I'll introduce you to an associate who knows the department better than I do, and we'll make sure you leave today with either a widget or knowing where to pick one up in this city - we'll call our competitors as needed". No. My doctor is the type of guy who answers "No, haven't heard of 'widgets' - we don't sell them."

He's never - other than asking me if I am having side-effects - asked me in depth about Strattera, and ADHD.

So I started asking around, and phoning around for someone who could give me some answers. After multiple tries, I still wasn't able to get to a doctor who understands Adult ADHD, someone who specializes or at least has some knowledge of it. But the very helpful doctor I went to (who I found through a different channel) suggested that I return to the clinic where I got my assessment done and inquire there.

Well, that worked. I got a call back after half an hour, and a week later attended an appointment with a psychiatrist who is a very senior member of the Canadian psychiatric community, and specializes in Adult ADHD. He is also trained and specializes in psychoanalysis, which is one of my considerable interests. Best of both worlds.

Anyway, my meeting with him lasted for about 45 minutes. It went as smooth as silk. His recommendation was to come off of Strattera. He was genuinely puzzled as to why they recommended a 'second-line' medication for me. He sent a consult recommendation to my family doctor (groan) to put me on Vyvanse, a psycho-stimulant.

I'm very excited about this turn of events. Finally! So - next steps are as follows:

1) Make an appointment with my family doctor (who is out today) so that he will prescribe me the Vyvanse according to the regime that the psychiatrist recommends (i.e. increasing, titrating to effectiveness)

2) Stop taking Strattera. While most accounts say that there are no discontinuation symptoms, I'd rather taper it off, and given the number of capsules I have left, I'll have completely stopped this coming Monday:

Monday, March 28: 80 mg
Tuesday, March 29: 70 mg
Wednesday, March 30: 50 mg
Thursday, March 31: 40 mg
Friday, April 1: 30 mg
Saturday, April 2: 20 mg
Sunday, April 3: 10 mg
Monday, April 2: No more Strattera

I'll keep an eye on symptoms that emerge after coming off Strattera, and just hope that there won't be much of a gap between coming off Strattera and going on Vyvanse.

Cheers,

Mungo

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Please Visit Blogs on the Blogroll

Good morning everyone!

Just wanted to ask y'all to consider visiting the various blogs on my blogroll located at the bottom right of this page. Each and every one of the people who write blogs there put their hearts and souls into their efforts, and I've learned that building a community of like-minded, understanding people is very important.

Thank you in advance, and I hope you encounter new online connections this way.

Cheers,

Mungo

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Video: Overview on Current Trends and Controversies regarding ADHD

I came across a terrific video about ADHD this weekend. It is very educational, and I highly recommend that you watch it. Dr. Pommer is a Clinical Psychologist, and his primary area of treatment is Attention Deficit Hyperactivity Disorder (ADHD).

In this presentation, Dr. Pommer provides an overview on the current trends and controversies in the diagnosis, misdiagnosis, associated conditions (depression, anxiety, learning disabilities, etc.) and treatment of ADHD.



Cheers,

Mungo

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I'm Forgetful & Freezing Cold

Having forgotten to take my Strattera this morning, I'm finding myself awfully forgetful and - strangely - very cold. I have my winter jacket on, zipped up high. In the office. Could be just a cold coming on.

And the forgetfulness? Well - who knows. I'm not sure what typical effects would be if someone forgets their SNRI for a day. A stimulant, well - the effects of missing a dose is probably quickly evident. But SNRIs are slow to act, and last for 24 hours. Maybe I've still got some in my blood from yesterday. And maybe my nice little orbitofrontal cortex has decided to give me a break and chosen not to completely fall asleep.

Hope everyone is having a nice Friday.

Mungo

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Whoops, Forgot My Medication Today...

For the first time in nearly 10 months since I've been taking Strattera, I forgot to take my tablets this morning. I was in such a rush because I wanted to get to work nice and early. I got to work at 7:20 am. Grabbed a coffee. Wrote my daily work priority list. Reviewed e-mails. Reviewed my schedule.

Then realized I'd forgotten my Strattera.

I wonder if I will notice any significant effects, i.e. worsening of attention or increased impulsivity or hyperactivity? I wonder.

Let's see how the day goes. Pleased that I'm doing my daily priority list and getting in early to get a productive start on the day, though. That's gotta count for something!

Mungo

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Benefit in the Long Term by Delaying Impulses in Adult ADHD

I bought Dr. Russell Barkley's "Taking Charge of Adult A.D.H.D." recently, and I want to recommend it. It is a terrific read - I'm finding it to be extremely practical and helpful. He writes how fundamentally there is a diminished ability to control impulses with ADHD. He presents several principles and practical methods to address ADHD symptoms. One principle is to "Stop the Action". Here, ADHDers should put some delay or obstacle between an impulse and subsequent action or comment, thus allowing the executive region of the brain to fire up and contribute to the thought process, thereby enabling verbal and non-verbal working memory to kick in and help find a socially acceptable way to moderate impulses.

The trouble with ADHD is that planning and reflective thinking ('executive thought processes' which take place in the orbitofrontal cortex) is often bypassed, leading to impulsive actions, as opposed to preplanned, consciously moderated actions. This may be due to neurological structural differences in the orbitofrontal cortex of ADHD brains.

So one method of putting a delay or obstacle between an impulse and subsequent action or comment is to gently bite my tongue or place a finger over my mouth (while looking thoughtful). I reason that it is better for me to be seen as a bit of an odd duck constantly biting my tongue or placing a finger over my mouth during a conversation or meeting, than to be viewed as someone who says something impulsive - albeit possibly true and incisive - but ends up distancing or alienating the person who I am addressing, thereby negatively affecting my relationships.

Another method to help insert executive thought moderation into the 'impulsive path' - which an ADHD brain is highly geared towards - is to quietly talk through the task in which you are currently engaged (like writing a blog post, or planning an appointment or meeting), visualize next steps, and recall previous similar circumstances either earlier performed by oneself, or seen performed by someone else. If you are shy about talking out loud, you could stick one of those blue-tooth headsets on your ear and make it seem like you're on a phone call... or just quietly mutter to yourself. Again, better to be seen as someone who talks to themselves (everyone does it!), than to be regarded as an impulsive, rude or awkward person.

This method of stopping to think and to verbalize your recall and planning not only helps you to establish a repertoire of working memories (in which you are likely deficient, as an ADHD Adult) which will help you in the future to delay impulses, it also helps you to gain access to memories in the moment that will help you perform in a way that will benefit you in the long term.

By using this method, you improve your chances of gaining long term benefits and diminishing the effects of disruption, discomfort, and interpersonal troubles which result from acting upon your impulses.

Cheers,

Mungo

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