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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Good luck. If you hit a bad medication match, the med roulette game can be frustrating.
ReplyDeleteYour description of the Canadian medical system in this case makes me glad I moved to the US before my diagnosis. :) I've had either my doctor or psychiatrist prescribe ADD meds with no issues.
Thanks for sharing this with us. I've been on Straterra for over a month and while I've had improvement I feel it isn't enough. My psychiatrist seems unaware that it's a second line drug. I'm going to push her on adding a dose of a stimulant.
ReplyDeletePlease keep us posted on your experience with Vyvanse.
The usual reason for prescribing Straterra is that the patient has anxiety or something like a heart condition that makes prescribing stimulants a poor choice. Not only that, since Straterra is a nor-epinephrine re-uptake inhibitor, it can help sooth mild cases of anxiety.
ReplyDeleteI am also on Straterra, though I was prescribed it to boost the results of my Ritalin doses. In order to get the results I would need from Ritalin alone, I would have to take a dosage that triggers my anxiety. So instead I take Straterra as well, because it not only helps treat the ADHD symptoms, it can also help with anxiety.
Also, I am glad that you are getting better results with the medical system than I am. I don't know if it's specifically an Alberta thing, but I am having even less luck than you are. I don't even have a family doctor since my old one retired.
Yes - that might be it. I was tested for heart issues, but passed. But I was also diagnosed with GAD - Generalized Anxiety Disorder. What a super fun party in my head. Anyway, a low dose of SSRI seems to manage the GAD, and hopefully the Vyvanse does the job!
ReplyDeleteThanks for dropping by,
Mungo
On the anxiety thing... I'm in the same boat though not officially diagnosed with anxiety. Ritalin and Concerta raise my HR and BP (to the point of palpitations that sent me to the ER).
ReplyDeleteAfter no luck with alternate ADD meds, my psychiatrist prescribed a beta blocker, Propranalol, which I take with Concerta. It keeps the side effects in check.
I know this is an older post, but this is almost exactly what I went through just a month or two ago. Was first prescribed Strattera for two months, but it didn't work and cause upsetting side effects. However, my psychiatrist just decided to "wait and see" for another *four* months at only 40 mg. Needless to say, I have stopped Strattera and am going med-free for a while, because asking for a low-dose stimulant was met with "I think Strattera is safer." The end.
ReplyDeleteAnyway, it was reassuring to read about your similar experience!
Gen