How does Strattera Work?
I have recently started posting to this blog. I have really appreciated the great response to it, and I am watching the comments to find questions which may be worth answering on the blog. As my subscribers know, I have a database of thousands of questions on ADHD, and I will use these as well to draw for content. To become a subscriber, please go to: The ADHD Doctor.
Tim wrote a comment the other day with a question: “I’ve recently started taking Strattera (2 weeks ago). Would you please comment on its effectiveness, how long it may take (should I already be noticing a difference if it is right for me?), why its not prescribed for kids (or is it or when it might be acceptable to use it if it is effective), and what I should be looking for in regards to figuring out whether or not it’s working?”
Let’s answer this one.
Strattera is the first non-stimulant medication which has come out for ADHD. It is FDA (and Health Canada - for us Canadians ;-)) approved for the treatment of ADHD from the age of 6 years old and up. It is approved for Childhood ADHD, Adolescent ADHD as well as Adult ADHD. As a Psychiatrist who deals predominantly with children and teens, I occassionally like to smile at the idea of there being ‘Geriatric ADHD’. While I cannot comment on that at length, I am aware of adults who have started Strattera in their sixties with good effect.
Stratter’s other name is: Atomoxetine.
How does Strattera work?
Strattera selectively blocks the reuptake of norepinephrine (or noradrenaline) in the brain. This, in and of itself, can increase the ability to pay attention and improve hyperactivity. The interesting thing is that Strattera gradually has a downstream effect on the dopamine in the brain, specifically in the frontal lobe. Now, I am throwing around a lot of medical terms very quickly here. Allow me to explain:
The frontal lobe is the ‘command center’ of the brain. This is the area that new brain imaging studies show is most affected in individuals with ADHD. This command center allows people to use their ‘executive functions’, which are the thinking skills which allow for: sustained concentration, impulse control, delayed gratification, etc.
Norepinephrine and Dopamine are called ‘neurotransmitters’. These are little brain chemicals which jump from one nerve cell to the next in the brain to carry a message through the brain.
In individuals with ADHD, research shows that they have ‘underactivity’ of the dopamine and norepinephrine in the frontal lobes.
ADHD medication generally increases the activity of the brain chemicals dopamine and norepinephrine in the frontal lobe, and in so doing, they increase the attention, and decrease hyperactivity and impulsivity (i.e. they increase these ‘executive functions’.
So, coming back to Strattera.
Strattera brought some very unique features to ADHD treatment which were not there prior to its release.
The benefits of strattera include:
- 24 hour symptom control - although it takes the medication about 3-4 weeks to ‘kick in’, when it does, it works 24 hours per day, contrary to the stimulants which work up to 12 hours per day
- No abuse potential at all: because there is no increase of dopamine in the part of the brain called the nucleus accumbens, Strattera cannot be abused to provide any pleasure
- No increase in tics: because Strattera doesn’t increase dopamine in the part of the brain called the striatum, there is no increase in motor or vocal tics with its use. So, for people with ADHD and Tourette’s, this is likely the best ADHD medication
- Good for ADHD + Depression or ADHD + Anxiety: A recent study showed that Strattera helped depression and anxiety (when they were present in combination with ADHD) and the ADHD. This can often mean that someone could take one medication for their condition - i.e. Strattera, instead of needing to take two medications - i.e. one for ADHD and one for the anxiety or depression
- May help for nocturnal enuresis: Strattera causes some ‘urinary retention’. This means that for some children who wet themselves at night, this medicine may lead to more dry nights. This is not a main treatment use for strattera, but it can be a side benefit
- May not cause ‘personality changes’: Some of my teenage patients complain that their stimulant medicine helps their concentration, but may take away their personality, or spontaneity. Strattera is a good option for this, as it does not clinically appear to cause these results
Strattera works for approximately 75% of people who take it. There are some data which suggest that if one takes it after having had treatment with a stimulant, that this may yield a slightly lower response rate. Why is this? It is my clinical impression that this does not relate to the fact that the stimulant has ‘changed the brain’, but rather the fact that as in many conditions in medicine, if something doesn’t respond completely to the first treatment used, it is much less likely to respond to the second treatment - i.e. it is ‘harder to treat’.
How can you tell if strattera is working?
Generally, one should notice an improvement in concentration, and a decrease in hyperactivity and impulsivity. The benefits should generally last for 24 hours -and be more ’steady’ than they are with the stimulant medicines. As mentioned above, it takes about 3-4 weeks for Strattera to start working, so one needs a little patience.
The long acting nature of strattera means that the benefits of the medication last into the evening - meaning that if a teen has homework or a project to be done, they can still have the benefits of the medication to help them late at night.
Also, there are a lot of data that people with ADHD have many more troubles driving - increased tickets, motor vehicle accidents, etc. So, if a teen (or adult) is going to drive home late at night after a party -it is better if their ADHD medication is still working in their system.
The last part of your question, Tim, was why this medicine isn’t prescribed for kids. The answer is (as I am sure that you have gathered by now) that it is used for kids too.
There are some safety issues with Strattera, and these will be addressed in an upcoming blog post.
Thanks for the great question Tim, and I encourage other readers of the blog to comment on this or any other post. Please remember, that I cannot comment on every question, or every post, but I will try.
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Written by Dr. Kenny Handelman - The ADHD Doctor
To find get a FREE special report on ADD/ADHD Medication, visit: Medication Mastery
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August 7th, 2006 at 4:21 pm
i have a 14 year old son who has been on various medications, adderall, concerta, metadate and ritalin and he has either had bad reactions such as headaches and moodiness, or he has not felt any change at all. i’m wondering if straterra is my last choice and do you think it would work any differently for him? he has adhd inattentive type.
help, i’m confused!
thanks for response,
sue
August 7th, 2006 at 6:01 pm
Hi Susan,
The first answer to you question is: speak to your son’s doctor about whether strattera is an option.
It sounds like he has had bad reactions or limited benefit with multiple stimulant medicines. It is certainly logical - if his symptoms merit medication treatment - to try strattera, as it may work differently for him. As it is from a completely different medication class, it just may work.
Again, talk to his doctor.
August 7th, 2006 at 7:14 pm
Strattera, I have two children currently on Strattera, It is so nice to have one pill to give them a day, there is no up and downs, it works around the clock. with my son, it helped with his moods aswell. In my daugher case, she was on rit first twice a day, then the slow relesase which did no help After she was put Ateral , it also helped with his mood. My daughter, was first on ritalin, the rsperall, then added adderall XR to help with the attention which it did, however this brought back some of the symptoms of her stuckness, the adderall was replaced with strattera, which is not recomemded as the two can “not get along” and affect the liver, however todate, there has not been any. Also the strattera was slowly increase over time. One thing that is not good, is it is very expensive if you do not have a drug planned, and it is difficult to have it covered by the minstry of Health ( Canadian). The other thing that is most important to me, is that you need to take it everyday around the same time, its not one of though drugs that you can take for 5 days then not take on weekend. Other side effect my son had was upset stomack and nausing at times.
One thing also that you dont get with strattera is the “high” or the rush of the others may have. It is a really even medication, no peaks and lows
I hope this help haveing a parent views.
August 8th, 2006 at 12:57 am
What can I say/ Its a fine drug. I have been on it well over a year, We (My Doctor and I) gradually increased dosage until now I am on 105 mg per day taken 80 first thing in morning and 25 at noon. The prev. writer is right, it needs to be taken on a regular schedule for best results. No, one cannot skip a day. The nausea and upset stomach are a side-effect which I found recurs with any change in dosage but disappears in a day or two. Give it time. It also affects appetite which I count a benefit as it has helped me lose needed weight.This, too, levels off after a few days but comes back (for me) if dosage is increased.
Its a great med and I find it produces better results than anything else I have tried. I formerly took it in conjunction wih Alertec.(sp?) (Modifinal) as a stimulant. When ODB stopped my special allotment for it, I was surprised to find that I can function quite well without it, although we did increase the dosage of Strattera. While I don’t think my concentration is quite as sharp as before, it seems adequate for me. I read a lot and mostly rather heavy stuff plus newspapers and periodicals (no novels). Here I should tell you that I am one of those GERIATRIC ADHDers. I was not diagnosed officially until I was 68 or 69, (that is a story in itself) and I started Strattera well over a year ago when I was 78. I turn 80 the day after tomorrow! Oh how I wish I had been diagnosed when I was 6 or 7 and could have been saved a lot of grief and trouble and led a more productive life (though I haven’t done badly in spite of the undiagnosed condition).(another story)
I think Strattera is a fine agent and would not hesitate to recommend it. I have had less side effects and more positive results with it than any other agent.
Along with the previous respondant I am horrified at the expense. We have tried to get “Sect. l allowance for it but without success so far. Dr. Handelman, what have you been able to do to get this drug approved on ODB? It must be made available to all segments of the population at reasonable rates. Parents who have more than one child on it must have a terrible struggle. When there is a parent with ADHD and a child, then it is prohibitive. I hope you are actively pursuing this issue. I would also suggest that all readers of this Blog who face this problem are working through their physician to change Ontario Gov’mnt policy as well as Health Canada.
You may be interested to know that I have a daughter with ADHD and she now has a son with it. My mother had it and I suspect she had a brother with it as well. The genetic factor is very strong with this condition. I have one brother whose Son, now 50, has had it all his life and sufered terribly because no one caught on to it. He diagnosed himself and then sought help and his father still will not acknowledge it. This “young man” cannot hold a steady job and cannot afford the expense of any medications, He lives in the USA without insurance. I have two other brothers whom I suspect are also affected, one is deceased and the other ridicules any mention of the condition, even when he has a grandson who is severely affected. My daughter, mentioned above, is doing a new Masters in Adult Education and as a part of her study is researching familial patterns of ADHD and how affected individuals are parented and how they, themselves, parent their own affected children. She is a 3rd generation and her son is 4th generation. She is a teacher and already has a M.Ed. from OISE. She has written a paper on this subject from her own experience and research and hopes to present it at a major consultation in the coming year. I mention this because parents of children with ADHD are often without resources to help them cope with this issue as well as their need for support groups with others who are in the same situation with one or more of their children.
I trust that this contribution will be of some help.
John B. Duncan, B.Sc., B.D., C.S.W.(retd)
August 8th, 2006 at 1:06 am
Thank you, Nancy and John, for sharing your stories.
John, you have shared a lot of your own experience, as well as that of your family members. Thank you for that, I am sure that it will help other readers of the blog.
I will do a post on the issues of having these new medications covered in Ontario - as it seems that many people commenting are bringing this issue up. There is a process in place, but I will say that it is not too easy.
August 8th, 2006 at 11:11 am
Hi ,
I read all the postings, because my son, 11, has been on 36mg of Concerta for 7 months now, and it has helped him with his concentration in a structured environment. However, in an unstructured environment, he is still very hyper and initiates a lot of chaos with his little brother. It is at these times that I think, is the medication working? Yet, in school and one on one, there has been a significant improvement since being on Concertal. Decrease in appetite concerns us a lot, as he has gotten very very skinny, and it is a fight to get him to eat. In reading about the stratera, there is not much mentioned about appetite, except for the older gentleman, and he said it “bounces back”, what does that mean, that the appetite decrease is only temporary when beginning the medication? I am quite interested in changing my son to Stratera, any comments?
August 8th, 2006 at 11:49 pm
Hi Debbie:
The first answer is, of course, talk to your child’s doctor about treatment options.
Regarding appetite and Strattera - there is possible appetite suppression, though it tends to be more mild than with the stimulants.
One other concept - it may be that your son is only ‘partially’ treated for his ADHD if he is still symptomatic in group settings. I will put on my list to blog on the topic of achieving complete symptom control.
Thanks for your comment.
August 10th, 2006 at 2:54 am
My son is still symptomatic in unstructured environments, but better when there is structure of a camp setting, school setting, etc. It’s the constant uncooperativeness - not liking what we prepare for meals, always complaining, fighting about why he has to do things, wanting everything done for him. My nephew is here this week, and he and my other son listen to me non stop, I say it’s time to eat, they are in the kitchen within 1 minute, no questions asked, they sit and they eat, when my adhd son comes to the table, last , after several callings, the complaining starts usually before he gets to the table.
I do have an appt. with his doctor/therapist on Friday.
There has got to be more I can do for him to help him, he is angry that he has to take the meds.
August 12th, 2006 at 10:59 pm
Now I regret not giving straterra more of a chance. I am an adult with ADHD exasperated by single parenting(widow) last 7 years of 3 children , now 9,11,15. I tried straterra but with even the slightest increase ( I think 27 mg?) I became so dried mouth and constipated even with my usual daily fruits and veggies that I wanted to try something else. It also seemed to take some of the zest in life out of me…complacent, perhaps more even keel. Maybe that woudl have been better for me.
I started on 5mg adderall per my request so that I would not lose my appetite too much and minimize other side effects since I tended to be skiddish about medication already. By gradually increasing, I made the transition prettysmoothly…But once I reached 20 mg, the dryness was almost as bad as straterra and once the adhd symptoms seemed to come back and my brain seemed fuzzy and more disrganized in its thinking, the doctor thought I shoudl be on a higher dose…I started getting concerned by the constant period of help, plateau and then increase. I decided that at 25 mg, I would not go higher. Same thing happened, plus my emotions gradually seem to be more labile, mostly more agitation at home in evenings, to put it nicely. I asked to be cut back to 20 mg because of the similar side effects of dryness in mouth and eyes, etc. and almost an aching feeling in my head (not quite a headache) if I sat for too long a period (over two hours…I\’d get what I call \”fuzzy brain\” ).
I find I have to stay at least a littel active ( walking , doing chores NOt sitting in frotn of computer or reading too long) or the medication makes me feel kind of sick The lower dose has been a good compromise. But sad to say after about a year now on this dose, I am fruity as a fruit cake, losing memory function, increased problems with concentration and organization, losing things, finding most of them, over stimulated by bombardment of learning and decisions, etc. . I feel like a juggler who keeps getting more and more to juggle and is dropping more of them..and even dropping those thigns once very good at. I swim ( like 100 lengths 3xwk), watch what I eat, read, try to escape for minutes a day for relaxation, etc. I read at bedtime for pleasure..I still dn\’t sleep that well.falling asleep takes longer, staying asleep. I \’m not anxious or depressed when I go tosleep…I most of the time I just let the days troubles be sufficient for that day. I hear it gets worse with age..lovely!
Well, As all can see by my rambling, I\’ve lost my focus on \”medication\” as the topic. So in summary : this won\’t help anyone else, but I think I will stay on medication I am on and ask physician about head scan to make sure my poor little brain isn\’t burning out sooner than it should because it is drenched in \”neurochemicals \” that tell it \”stress alert\” most of the time. If am okay, then I will discuss with doctor possibility of straterra w/ adderal and weanign off adderall as straterra dose is increased…if he agrees…I think I\’ll take being even keel! ALso, will continue to look at how to decrease stress. Did I mention I have a boy with crohn\’s disease, ADHD and receiving allergy shots and another is ADD? Actually, I have nothing to stress about compared to so many….I am rich in many ways and need to only look beyond our US borders to see how spoiled I am…need to chill and take a happy/ chill pill called gratefulness on a more regular basis.
Promise to not do too many of these blogs since I\’m a long winded rambler..there\’s probably a rule about that! Thank you for daring to open this up to the public Dr. Handelman!
August 13th, 2006 at 12:42 am
Hi Brenda,
Thanks for your comments.
No need to worry about ‘rambling’ a little.
If you can’t do it on a blog regarding ADD/ADHD, where can you do it?
I admire you for your strength in taking care of yourself and your kids with ADD/ADHD.
Keep well.
Kenny Handelman
August 15th, 2006 at 10:13 am
Thank you to Brenda! I could easily have authored your entry. It’s nice to know my brain is not the only “fuzzy” one.
My son has ADHD and Aspergers Syndrome, my husband has ADHD. and mommy makes three! (no H in mine though, just ADD). I have found that between the three of us it is nearly impossible to provide a structured environment. Actually, we all seem to perform better in an environment that allows us to “wing it”.
I would really like to see a segment on multigenerational ADHD and parenting strategies when ADHD is a family wide issue.
Thank you for the great info on how Strattera works on the brain. I struggle with the idea of switching form a drug with such a long safety track record to another which works so differently on the brain’s chemistry on such a young and still forming brain.
Thank you for your great Blog!
August 16th, 2006 at 11:25 pm
I come from a family rich in ADHD history. It comes from my mother’s side of the family and there are so many of the grandchildren and their children that have it. My mother is ADHD and she is just now accepting it. Depression also runs along with it and most often in the females. I come from a family of two children and we both are ADHD. I have two children and they too have it. My brother’s son and my son both have learning disabilities and are very hyper.
My son has to be in motion all the time and is gifted mechanically. At 17 he can completely put together motors of all kinds, weld and on and on. He has the hardest time reading, writing and his soft skills are very week.
I have had to learn much on my own about ADHD but was finally glad to learn why I was the way I am. My daughter said she would like to be normal for one week and see what life is like without being ADHD. I never understood as a child why I was so gifted in many ways but sometimes could not keep all the balls up in the air. Now I know.
I have opted to take medication where my brother will not. His one son like mine has been on Ritalin since they were in grade school. I have taken Ritalin and had to take an anti-depressant with it. I did not find the combination good. I was thrilled to hear about Strattera. I had mixed results with Ritalin, I use to use it when I wanted to read and do paperwork. My depression seemed to be worse when I was taking it though. I have taken the Strattera twice now. I did notice an improvement but had mixed results and now I know because I was not taking it correctly to be honest. I would not take it on weekends and it effectiveness was reduced. My worst side effect with Strattera is the bitter aftertaste. I have just recently started taking it again and I do strive to take it on a schedule. I have really noticed it helps so much in my compulsiveness.
My daughter is also ADHD and she is so unorganized that it really affects her success at school. She does work she neglects to turn in. She hated the side effects of stimulants and I think she would benefit from the Strattera. She runs Cross Country and plays soccer so I am unsure how that will affect her as an athlete. I am excited about my use with Strattera this time around now having more information at hand to understand the importance of timing and how the drug works. I now know it has long lasting results if taken correctly. I appreciate the insight.
Melody
August 16th, 2006 at 11:41 pm
Melody,
Thanks for the great comments.
As you well know, ADHD is very genetic. A post will be coming soon on this one.
I just wanted to say that regarding the bitter taste of strattera - I have had my patients teach me that when there is a side effect that affects the GI system (nausea, upset stomach, etc.) it may improve by changing the timing of the strattera with food. You can try taking it just before food, just after food, or by ’sandwiching it’ in the middle of a meal. By eating some food, then taking the strattera, and then eating some more, you may be able to avoid the bitter taste that has been bothering.
Regarding how the medication affects athletic ability - I have seen mixed results in my practice. We may need to do a survey of the readers of this blog! It may take me some time to get it done, but I will soon.
May 4th, 2007 at 6:27 pm
HI, ITS NICE TO HEAR SOME OTHER PEOPLES STORYS ABOUT ADULT ADHD, I LIVE IN A LITTLE PLACE CALLED TASSIE,AND ALTHOUGH THERE ARE LOTS OF CASES OF CHILDHOOD ADHD THE INCIDENCE OF DIAGNOSED ADULT ADHD IS UNMNETIONABLE, AFTER YEARS AND YEARS OF STRUGGLING WITH ALL THE THINGS I THOUGHT I SHOULD BE ABLE TO DO, I AM GOING TO FIND SOME HELP SO I CAN BE ALL I CAN BE (I ALWAYS FELT AS THOUGH I WAS MISSING SOMETHING FROM MY LIFE), TO BE HONEST WITH YOU I AM RELIEVED I WAS STARTING TO THINK THAT I WOULD HAVE TO FLY TO THE USA AND HAVE A LONG MEETING WITH YOUR DR PHIL. SO THANKS AGAIN
August 18th, 2007 at 12:11 am
Hello Dr. Handelman:
I just wanted to tell you how incredibly informative I have found your blog site. We have a son that we are trying to establish on ADHD medications. Concerta is not working for him properly, It is just hitting all the symptoms, He is not hyper any more but his focus and attention have not improved. Neither has his impulsiveness. We are thinking of trying Straterra. Now we just need to know the medical concerns. I am looking forward to your blog about this. School is coming close now and we will need this info.
Once again thank you for starting this blog.
September 19th, 2007 at 6:03 am
Thanks for the good information here doc. I am 24 years old and just started taking Strattera. I was diagnosed with ADHD early in my childhood and given Ritalin to help the symptoms. At the highest dosage I was taking 25mg Sustained Release along with a 10mg tablet in the morning and another 10mg tablet at lunch. Sometime in junior high I refused to take the medication anymore. I was tired of how I always felt ‘medicated’ and ‘in slow motion’. I tried to tell my mother this and also my doctor. However, the more I complained the more they wanted to up the dosage. So I just quite taking any medication whatsoever and decided that I was just going to ‘muscle through it’ and carry on with my life. In public school this wasn’t really too hard. Just coming to school and getting through the day without getting into too much trouble is all thats required to pass.
Jumping ahead to the present, Now i’m attending my third college working on my fourth major and I have been in college now since 2001 with not a single degree to show for it. This semester I finally decided that maybe my academic troubles along with my relationship troubles might have something to do with the ADHD I was diagnosed with so long ago. I asked around campus until I figured out where our clinic was. Asked them about what kind of treatment was available and they didn’t have any idea. So I started searching the internet and found a place to call. The following friday I had an appointment and after talking to the nurse practitioner for about an hour or so he decided that I should give Strattera a try.
He gave me alot of samples and instructed me to start off taking a weeks worth of the 18mg, then a weeks worth of the 25mg, then the 40mg, then 60, and finally taking an 80mg dose once per day on the 5th week. The 80mg dose is my target dosage from what I’m told. Tomorrow I will complete the last of the 18mg tablets. Obviously, I haven’t really noticed anything yet. I am however aware that it will take some time before I get any benifit from the medication. Of course, I really don’t know what to expect — Don’t really know what it will be like when it does start working.
I don’t guess I really have any specific questions for you. Just thought I would throw out my story in a nutshell and see if it sounds familiar to anyone. Perhaps see if anyone else is taking the medication in the stairstep fashion that I am taking it. I was happy to hear that a medication for ADHD existed that wasn’t a stimulant - however I am somewhat sceptical about its efficiency at treating the symptoms. I do hope it works though. It will be a month and a half before I can get an appointment with someone who can prescribe a stimulant if thats what it comes down to. (although I really hope it doesn’t - I hate stuff like that.)
Sorry for the long post
and thanks for listening,
Justin
September 19th, 2007 at 8:57 am
Hi Justin,
Thank you for sharing your experiences.
Your comments will be particularly helpful to some of the parents here who struggle with their kids or teens not wanting to take the medicine. Your insights will help!
Regarding strattera, most of the time it is prescribed in a ’step wise’ fashion.
However, I dare say that you have a lot of steps!
Generally, for an adult - the dosage would start at 40 mg for a week, then 60 mg for a week, and then 80 mg per week.
This is done to minimize side effects, and get to the ‘therapeutic’ dose in a timely fashion.
It will still take up to 4 weeks for strattera to work (maybe a bit longer with the dose escalation you have).
I am not telling you to change the timing of your dose changes - buy maybe talk to the nurse practitioner and ask about this…
Please come back and let us know how it goes.
And good luck with school!
Dr. Kenny
September 19th, 2007 at 1:36 pm
Thank you, I will do my best keep you guys updated on what happens as I continue to take Strattera
September 21st, 2007 at 1:46 pm
Well, this is just an update. I’ve finished week 1 with the 18mg dosage and today have taken my first 25mg capsule. Obviously no signs of the medication taking effect yet. I’ll update again next week.
Until then,
Justin
September 29th, 2007 at 2:08 am
Week 2 with the 25mg dosage has completed. Today I started my first dose of 40mg. i’ve noticed little in the way of side effects thus far. I haven’t really felt any differant either. I guess it’ll take a couple more weeks before it kicks in.
Justin
October 10th, 2007 at 11:43 am
My son, 8, has been diagnosed about 2 months ago with a mild case of inattentive ADHD. He started on Strattera about 1 1/2 months ago and we saw an immediate improvement. In fact it surprised his doctor how well it has worked for him. In the last 2 weeks however it doesn’t seem like the medication is working. In fact his teachers just called recently and said that he is in ‘la la land’ during many facets of the day. His doctor thinks that maybe it is a placebo effect wearing off and the medication never did work - I have a hard time believing that one. Of note…this 2 week ‘regression’ seems to have coincided with his breaking his arm playing sports. I don’t see any corrleation but noted it for information. Any help appreciated as we are to see his doctor for possible change in medication but are apprehensive on going to stimulants…..
January 12th, 2008 at 11:03 pm
I have a question regarding developing a tolerance to Strattera. I began taking Strattera about four years ago. After a little calibration with the dose, 80mg daily taken in the morning, the benefits seemed tremendous. However, about two years ago the benefits seemed to wane.
I’d like to get back to a place where I experienced that level of benefit, but I have not been successful.
Is there any research in this specific area that would shed some light on why the benefits diminished?
Does anyone have/know of any similar experiences? Are there any regiments in terms of different dose levels, different times of day and any meds that helped boost the positive Strattera effect for ADHD?
I’d appreciate any suggestions or information.
Many thanks
February 7th, 2008 at 1:33 am
I know alot about neurotransmitters, but please tell me how strattera can help with ODD. What other drugs can help with ODD?
February 7th, 2008 at 1:24 pm
Generally speaking, any medication which helps with ADHD helps with ODD.
There are studies for the methylphenidate medicines (i.e Ritalin, Concerta, Metadate CD, etc), the amphetamine medicines (i.e. Adderall, Vyvanse, Dexedrine), as well as the non-stimulant, Strattera.
Of course, behavioral treatments are very important as well for ODD.
To learn more about ODD, visit here:
http://www.addadhdblog.com/oppositional-defiant-disorder-odd-and-adhd/
All the best,
Dr. Kenny
February 10th, 2008 at 10:11 pm
Dr. Kenny,
This blog has been so helpful. I have a question. My teenage son was diagnosed with ADHD last summer via psychoeducational testing. He tried Concerta and Ritalin which he said helped with his focus and concentration. I didn’t notice any improvement with executive function at all - which is our biggest concern. He liked the Ritalin a lot and said it made him feel high and that he felt it could be “addictive”. As soon as I heard that I insisted that he discontinue the Ritalin and we went back to our doctor. Since he wants to avoid stimulants, the doctor prescribed Wellbutrin to try to help with ADHD and depression. He has been on Wellbutrin for over 4 weeks and doesn’t feel it has helped with his concentration at all. The next plan is to try Strattera. My question is this: if my son felt high when he took Ritalin, is it possible he was misdiagnosed with ADHD? Everything I’ve read leaves me with the impression that only people who DON’T have ADHD respond to stimulant medication in this manner …
I would so appreciate your opinion on this.
February 11th, 2008 at 3:12 pm
Hi,
Some people can feel ‘happy’ with their ritalin.
1) The longer acting forms of this medicine - i.e. concerta and others are not really abusable, so they are pretty darn safe.
2) Yes, you can have ADHD and still get a happy or high feeling from Ritalin. Not very common, but possible.
3) Straterra is a good option - and has a higher chance of working than wellbutrin.
4) 4 weeks is when the wellbutrin should just be starting to work. Talk to your doctor about considering more time.
Of course - talk to your doctor about any treatment decisions. My goal is to educate and support you.
To learn about the most comprehensive course on medication for ADD/ADHD, visit: http://www.medicationmastery.com
All the best,
Dr. Kenny
February 13th, 2008 at 5:36 pm
Dr. Handelman,
I’d be very interested in your insights and observations on Strattera used in conjunction with moderate to heavy levels of exercise. I am a distance runner and triathlete and have noticed some interesting effects when doing long workouts. While I do feel less energetic and lethargic, I seem to have a better capacity to go greater distances without becoming fatigued. I’m just wondering if there are any potential heart-related concerns with taking Strattera and exercising.
February 29th, 2008 at 12:48 pm
Hi Dr. Handelman,
I was on Strattera for about 6mos a couple summers ago. It made an amazing difference in my ability to focus on and complete tasks, but some of the side effects were a little unsettling.
During the adjustment period, my heart raced and i felt generally off. This lasted for about 3 weeks, and then subsided for the most part. A new and very strange sexual side effect arose after that, decoupling of orgasm and ejaculation. I always seems to get the rare side effects
My question is, i would like to start taking Strattera again but i’m worried about the seriousness of that side effect. Why does Strattera cause that side effect? is it doing any damage?
I’m also interested in Mark’s concerns. I also do endurance exercises and noticed the same effect. Any comment?
Thanks!
February 29th, 2008 at 2:24 pm
Adam,
Regarding sexual side effects and Strattera - my understanding is that a percentage of men have some issues with erectile dysfunction, and some have trouble with orgasm. The percentages that come to mind are approx 10%. These side effects should resolve when the medicine is stopped.
Regarding long exercise - I just don’t know. Best to talk to your doctor about any cardiac concerns - as this medicine will increase the heart rate and blood pressure slightly.
Dr. Kenny
March 14th, 2008 at 5:41 pm
We just started my 7 year old on Straterra. We had a lot of testing done by his school counselor and a district occupational therapist. His doctor agreed with all the testing (especially after my son ran circles around the doctor’s office).
I’m having some difficulties finding positive children experiences on the internet. But, I have seen quite a few long term concerns - two concerns being a child’s growth (specifically height) and liver damage. Are these things I should be really concerned about? Or is it more of a few cases being very vocal.
March 28th, 2008 at 12:01 pm
My 18-year old son started taking Strattera one month ago. He started with 40 mg for two weeks and then 60 mg for two weeks. His family doctor prescribed 80 mg for him yesterday. He hasn’t noticed any benefits thus far and nor have I. He weights 165 lbs and is 6′2″ so hopefully the 80 mg will be the right dose for him. He has had a few side effects - the biggest being stomach pain. This does seem to be avoided if he takes it with a meal (not just a snack). He takes it at dinner because taking it in the morning seemed to cause sleeplessness issues which don’t occur if he takes it later in the day. My fingers are crossed because executive functioning is a very big problem …
April 13th, 2008 at 9:17 pm
My son is on week 7 with Strattera but only on week 3 of what is probably is correct dose. Neither he nor I have noticed any benefit whatsoever. What he does seem to notice is flu-like symptoms after vigorous exercise. Any suggestions anyone?
April 13th, 2008 at 10:09 pm
My son was on Strattera for about a month - 2 weeks on his top dosage. He didn’t show any signs of improvement. In fact, his aggression and frustration only got worse. He actually to a knife to our bathroom door because his brother locked it to get a little privacy. He then through a book at me when I tried to get him to do his homework.
We called his counselor and the doctor. We took him off the pills and he immediately was happy that day. He was still a ball of unbridled energy, but not angry. We have put him on a low dose of Concerta - he’s been on it for three days now, and it appears to have taken the edge of. Here’s hopin’!!!
April 15th, 2008 at 4:03 am
I think that Hitler used this stuff to get the Jewish people to just walk in the showers,like they didn’t know what the heck was going on!My child is now either a zombie or at other times,he’s an SS officer.I don’t know when I can speak to him or not.10 years old and I feel so sorry for him.In my opinion,this stuff will be off the market within a year!
April 18th, 2008 at 11:15 am
Son number 2 was just diagnosed, and prescribed 18mg daily of Strattera. Number 1 is on a 40 MG a day dosage with excellent results. We had previously tried Concerta but it made him super emotional and moody, not good.
The trick with Strattera is to take it with food and never miss a dose. We had trouble with this at first and he started hiding it and not taking his meds because tehy were making him nauseous. But regularity and food are the keys. Even missing one dose can cause upset with the next. That has been our experience so far.
But as far as effectiveness, we are thrilled. He is 100 percent more successfull at school which means his self esteem has risen significantly which in turn has it’s own benefits. We are in our second year of treatment.
I”m starting son number 2’s meds tomorrow. I am nervous, and worried. He’s only six, which looks like the youngest allowable age fot this drug.
A lot of guilt I find comes with treating your kids with these meds, even when you have tried all the behaviour mods out there. but that is another issue for another thread I’m sure.
So here’s hoping strattera continue to work for our family.
April 20th, 2008 at 3:11 pm
Is there any literature regarding steps for overcoming Strattera tolerance? Strattera worked great for approximately 2 years, but fizzled out after that. Either discontinuing for a period of time or increasing the dose?
April 21st, 2008 at 12:25 am
The concerta has shown us amazing progress. Tyson can actually sit and do his homework. He is still moody, but no where near what he was on the Strattera. I understand that Strattera works kind of like Wellbutrin. I took that and it made me almost jump out of my skin. Tyson hasn’t lost any of his personality, but can focus when he needs to.
April 21st, 2008 at 8:09 pm
I’m afraid my son (18 years old) hasn’t had any luck with Strattera after almost 7 weeks. There weren’t any benefits at all. I feel like we’ve given everything a try: Concerta, Ritalin (both long and short-acting), Wellbutrin and Strattera. He had a real problem with mood swings from Concerta and the short-acting Ritalin was almost addictive for him. I don’t know what to do. He needs help. Our very supportive family physician feels somewhat out of his league since he’s not an expert on ADHD and I respect that he doesn’t want to prescribe stimulants again without my son seeing a psychiatrist. This process takes so long. He starts college in the Fall and I really fear for him. I’m wondering about Adderall.
April 22nd, 2008 at 4:09 am
My child went back to the Dr. an O.D. not an M.D.He doubled his dose.The child is a complete animal,he hates his little sister and screams at everyone.My mother was his favorite person in the world,and he refuses to go to her house.I think this DR.over-stepped his boundries and should have sent him to a mental health place.Stay away from Columbiana Family Practice in Columbiana,Ohio.DR.Gerald Maxwell.O.D.Go to a real doctor and find out whats really in your childs head.This guy thinks you can take a pill for anything.
May 20th, 2008 at 2:36 pm
Hi - there is a lot of very helpful information here but I have a couple of questions I can’t seem to find answers for.
I have a 6 year old son with Fragile X who started taking Strattera 2 weeks ago and is currently at about 60% of his optimum dose for his weight. He is in a mainstream class/school and has been keeping up academically with the help of a shadow who accompanies him at school all day ( for motivation-focusing attention and behavioral problems). Since starting Strattera both his teacher and shadow have said there is no point in sending him to school. His normal enthusiastic (albeit nutty) personality is gone and for the days I’ve sent him all he’s done is put his head on his desk from the time he arrives and ask ” Is it time to go home yet?” He’s very well behaved and sedate since starting the medication but all the academic gains he’s made in the past 5 months have disappeared (he no longer wants to write, read, add, substract, do Phys ed - not even free play time.) He’s dopey and tired despite my efforts to go very slowly on increases (more conservative even than his psychiatrist recommended). I’ve seen that fatigue is a potential side affect but what I haven’t been able to find out is whether this is temporary ( while adjusting to the dose) or a permanent side-effect. If it’s permanent this can’t be the right medication for him. Has anyone had any experience with this?
The other concern I have is that I’m not sure if his fatigue is related to the fact that so far I’ve had to break the strattera capsule and mix it into diluted honey to get him to swallow it. I’ve read and tried everything out there (m&ms tic tacs, put it food, big rewards etc.) to try to get him to swallow a capsule - with no joy yet but he is trying and we might still get there some day. I tasted the stuff - and he has my full sympathy and respect for continuing with this. I’m wondering if the fact that he’s getting the contents into his stomach without a capsule to potentially slow down the metabolism could have something to do with his drowsiness. I spoke to a pharmacist who admitted he knew nothing about strattera but said that breaking the capsule would result in the capsule being broken down prematurely in the stomach instead or the intestine. This makes no sense to me but I haven’t been able to find any more information to confirm or dispute this idea. Plus I live in the United Arab Emirates where sensible informed support is in short supply. So I really would appreciate if anyone on this blog or you Dr Kenny has any advice.
May 22nd, 2008 at 5:08 pm
Dear BB,
Some quick thoughts to help you along - and talk to your doctor for more specific info for your son.
Regarding sedation - sometimes it is short lived, and sometimes it is ongoing while taking the Strattera. You will have to wait and see.
Sometimes, you can switch the medication to nighttime dosing, and this may help the sedation, or alternatively move to twice daily dosing. Ask your doctor about these ideas.
Regarding opening the capsule - the biggest issue here is how awful the medicine tastes. It is an irritant. when the strattera is opened, usually it causes more stomach aches/nausea, but I don’t believe that fatigue is increased because of it.
I hope these thoughts help.
Dr. Kenny
May 28th, 2008 at 2:30 pm
Thanks so much for getting back to me Dr. Kenny. I just wanted to let you know that since switching to evening administration, things have improved dramatically. My son is no longer drowsy and the past four days have been his best days ever in school. He’s doing things (participating in an entire phys - ed and music class ) that he’s never done before. He’s also independently noticing things he’s never paid attention to before (that the size and spacing of written letters is important too, and that you can find help for your math work on the teachers display boards). His shadow reports that he’s back to his own self but a lot calmer and hasn’t had any behaviour issues for the past 4 days either. I was worried about sleep disturbance and have to admit that since changing to evening administration he’s been waking about once a night which he doesn’t normally do. But it hasn’t been a huge hassle as he’s quite happy to be tucked in again and goes right back to sleep. The other wonderful thing is that today he swallowed a capsule for the first time. It has taken almost three weeks but my nanny has been working on helping him swallow (m &ms, tic tacks, and even empty capsules that I saved after giving him the contents with honey) and he did it for the first time today. Luckily he’s had a good attitude towards the whole thing and we haven’t had any huge battles over it. We’re thrilled with the results so far. He’s now on 25 mg which is 5 mg less than the optimum dose for his weight (at a ratio of 1.2 mg /kilo) but his doctor ( who finally returned my call today - after over two weeks ) says that I should stick with 25 mg if it’s working. So far it seems to be so we’re thrilled.
Thanks so much for your help and hope this is helpful for someone else. Practising with m&ms and tic tacs really helped. Also practising with empty capsules coated in olive oil (so they don’t stick to his throat and because he likes olive oil) also helped to get over the psychological barrier he had against swallowing.
Thanks again
BB
May 28th, 2008 at 2:44 pm
BB,
I’m glad to hear that things are progressing well for your son with Strattera.
I hope that your comments help other parents as well.
Regarding swallowing - one other idea that I’ve started suggesting recently is taking a ‘gummy worm’ and cutting it into a small piece to start practicing swallowing. Then, if it feels like it is getting stuck - at least it tastes good. This makes it easier for kids to practice.
All the best,
Dr. Kenny
June 17th, 2008 at 12:23 am
My son is 10 and has been taking Geodon for mood disorder for approx 2 years with some benefit. He also takes Clonodine for a sleep disorder. He has auditory processing disorder and ADHA. The psychiatrist added Strattera about 4 weeks ago starting with 20 mg then 40 mg and now to 60mg. So far we are seeing wonderful improvements in his anxiety and depression and some with focus and attention. My question is - He has been taking 60 for one week and I see improvements but we do not seem to be there yet. How long does it take before you really know if it is going to be effective at this dose. Has anyone changed from taking it at night to morning? My son takes other sleep medications and he is sleeping but since taking this at night he seems very restless. Has anyone gone to Wellbutrin from Strattera for anxiety, depression and ADD. I currently take Wellbutrin successfully and wonder if Strattera is not strong enough if Wellbutrin would be the next logical choice. Any input would be appreciated
June 18th, 2008 at 12:20 pm
Hi Dr. Handelman,
My daughter is 20 years old and has OCD. She has been prescribed all the SSRIs at one time or another over the years and has run out of options. Her new psychiatrist just prescribed Strattera to treat her OCD.
Do you have any information or experience regarding whether Strattera is useful for this condition?
Thank you for your help,
Sue
June 18th, 2008 at 1:36 pm
Hi Sue,
Speak to your own doctor to ask specific questions regarding your daughter.
I am not aware of any research which shows that Strattera helps OCD.
There are studies which show that Strattera helps Generalized Anxiety Disorder, and Social Anxiety when it is co-existing with ADHD. As a treatment for these disorders without ADHD, there are no data.
One other medicine that you haven’t mentioned is: chlomipramine. This is an older tricyclic antidepressant which works well for OCD.
As I say, ask your doctor about specific treatment issues for your doctor.
All the best,
Dr. Kenny
July 7th, 2008 at 6:12 am
I am a 28 yr old mother and wife. I am bi polar and was recently prescribed Strattera along with Lamictal and Abilify. I have never been on an ADHD med before and wasnt sure of the effects on a bi polar person who tends to have rapid cycling manic episodes.
He started me out on 18mg and Im now on the 25 mg for a week then I will be taking the 40 mg a week. Is that not a very low dose for somebody of my age and size? Also are there any risk that Strattera will help encourage a manic episode? I have also noticed that I am not hungry as much as I used to be. Is this a known side effect of Strattera? Its a much welcomed one if so because due to being on many other meds throughout the years Ive gained a considerable amount of weight. Any thoughts would be welcome!
Kim
July 10th, 2008 at 1:26 am
Hi….My 9 year old son Jayde will be starting Straterra tomorrow…I am very concerned…as I have read good things…..as well….many bad things…he is currently on ritalin and stopped working. However..the issues I’ve been hearing with no appetite goes for alot of medications these days. for my son…he has the drink boost…that really helps with not losing so much weight!
August 6th, 2008 at 9:25 pm
Hi..my daughter is 8. She has been on Focalin and Vyvanse. Vyvanse was better than Focalin. The Focalin made her sensitive and irritable. The Vyvanse cut those two symptoms out and gave her stomach aches and headaches. Now we are on our third day with the Strattera. Her doctor started her first 3 days with 20 mg daily, then she was to finish the month with 40mg daily. The first night on the medicine was scary. She was nausea, sweating, tired, her head heart…she just didnt feel right. Now, she is 60 pounds. Was that dose too high? I gave her just the 10mg the second day and she only had a stomach ache that lasted about 45 min. We are still waiting for the dose tonight to kick in. If tonight goes well I am going to ask her doctor to finish the month on the 20mg per day and see how that goes.
Now my questions are the dose and the stomach aches. Will a 10 mg start and 20 mg for the remainder be effective? If I need to increase too much I am afraid she will have the bad reaction again. Does the stomach aches go away as the body gets use to the medication? I hate seeing her with an upset stomach. I wont put her through that.
August 14th, 2008 at 6:05 pm
I know for sure I have had ADD all my life. I’m 46 now and because my job changed from high intensity to administrative I nearly died. I started Strattera this week and within two days started to notice a big difference. I am amazed! My only concern is my liver.
I don’t drink but take tylenol every day for pain related to my high intensity job. I also take vytorin for cholesterol. With the three medications hitting my liver I’m a little concerned.
August 21st, 2008 at 12:38 pm
Is 40mg of strattera too high of a dosage for my 60 lb 4 yr old diagnosed with ADHD?
September 6th, 2008 at 11:28 pm
I’m 64 and have been cursed with this problem (ADD) all my life.
(1) Are there varying degrees of ADD, and does the condition vary over time?
(2) Is it hereditary.
Thanks for this site.
September 7th, 2008 at 11:51 am
Hi,
Regarding the heredity - please see this article on the genetics of ADHD:
http://www.addadhdblog.com/genetics-of-adhd/
Yes, there are degrees of ADHD. It can be mild, moderate or severe. And yes, depending on external factors, situations and coping strategies, it can vary over time.
Thanks for joining the conversation,
Dr. Kenny
p.s. you can join a new community of people with ADHD at: http://www.adhdworld.com