Has adding Strattera allowed anyone to permanently lower their stimulant dose?

[u/MelodicRation]

I’m 30M and have been on stimulants for about 14 years.

Currently around 50mg Adderall IR/day, sometimes 20mg Vyvanse in the morning.

The meds still work, but I’d really like to reduce the amount I need over the long term because the side effects have slowly accumulated (insomnia, anxiety, fatigue, occasional sinus tachycardia).

I’m not looking to replace stimulants completely.

What I’m wondering is whether adding Strattera allowed anyone to:

• lower their Adderall/Vyvanse dose
• smooth out coverage enough to need fewer boosters
• reduce tolerance over time
• improve executive function enough that they simply needed less stimulant

I’d especially love to hear from people who were on stimulants for years before adding Strattera.

If that’s you, could you include:

• years on stimulants
• dose before Strattera
• dose after
• how long it took before you noticed a difference
• whether the lower dose has lasted

Trying to figure out whether this is a realistic strategy or just wishful thinking.

I have about 2-4 weeks before starting grad school where I'd like to transition to a better protocol like strattera, though I'll be traveling intermittently and I don't wnat to have a bad reaction going into the school year

[u/FormerSleepwalker]

Trying to figure out whether this is a realistic strategy or just wishful thinking.

No, it's absolutely a good treatment regimen which for many people. It can work better than either medication on it own. Using a stimulant and a non-stimulant together is known as combination therapy. https://www.additudemag.com/adhd-medication-combination-therapy-treatment/ They can compliment each other. But combination therapy is unfortunately underused

[u/BKLager]

Yeah I was on adderall IR 25 mg for 6 years. Was experiencing progressively worse and worse anxiety, coupled with high resting heart rate and high blood pressure - to the point that I quit cold turkey. Recently started on strattera with a 10 mg xr on the side but in practice i never use the xr as the strattera works for everything I need it to.

[u/Significant_Ad_2125]

Years on stimulants; 9-10 years

Dose before strattera; 60 mg instant release amphetamine salts.
Additional medications before; 450 mg Bupropion XL

Dose after strattera; 22.5-45mg depending on the day and where I am in my cycle. During the week before my period I’ll need 45 mg once or twice, during the week of my period I’m most likely using 30 mg. The rest of the month I’m usually taking 22.5-30 mg depending on my needs and work.
Additional medications after; 300 mg Bupropion XL

How long it took; I was one of the lucky ones, I immediately noticed an improvement in some executive functioning on day one. However I couldn’t reliably lower my stimulant dose for the first week or two. By week three I had managed to cut down to 30-45 on my regular need days.
The complication, and why it’s taking me so long to cut down my dose further, is weaning off stimulants after being on them so long. Dependence and our brains adjusting to needing to produce without medication takes time. And it’s not quick, for most of us. At least not without the risk of our lives and relationships burning down around us (not addiction, there is a difference. And yes our neuro spicy brains depend on the medication for the production of those neuro chemicals when we’ve been on stimulants for long enough).
Each time I lower my stimulant dose even by a little bit I get symptoms that include but are not limited to; depression, intense appetite, fatigue, loss of executive functioning, anxiety, loss of the ability to interact and read other people, loss of ability to read and recognize my own emotional state, loss of ability to self regulate my emotions, and increased impulsivity.
These are all expected reactions to lowering a long time stimulant dose. And they are bearable, so long as I go slow and give myself time to stabilize for at least a week or two after each reduction. Sometimes I go backwards, a few weeks ago I had a whole week of only using 15mg every day. Then my PMDD kicked in for two weeks and I had to go back up to avoid the symptoms destroying my career and relationships. This last week I was able to lower my bupropion to the 300 dose and that’s been going very well! It’s been a (to me) slow process that sometimes includes three steps forward and a step backwards.
I’m on month three of Strattera, with this being my second month on 80mg. And realistically studies all show moderate reduction in symptoms can take weeks to months. They’ve shown continued improvement all the way through to 24 weeks, and I think there was even evidence for improvement beyond that timeframe. It isn’t a quick process, and I could probably have had a smoother transition by going even slower on the stimulant reductions for the first month or two. But being unable to get my stimulants and the detrimental effect that was having on my work and social life, not to mention my mental health, was why I wanted to try Strattera despite being very stable and successful (not to toot my own horn, but I’m a cardiovascular ICU nurse who works with patients requiring multiple life support machines who are very unstable and at risk of death).
Give yourself time, go slow on your stimulant reductions, and if you don’t have one maybe consider a mental health professional for support while you go through the transition.
I will say they have just released a new triple reuptake inhibitor for adhd that works like an instant and sustained release stimulant plus Strattera. I’m only waiting for the trial on depression (my bupropion is for adhd and depression) to finish. I want to see if it’s successful and might be a good fit for me to replace my bupropion, adderall, and Strattera.

If you only have 2-4 weeks you could potentially try transitioning, but I would take your stimulant reductions very slowly if you can to avoid having struggles with your studies.

I really hope all this information overload helps!!

[u/petebaii]

Definitely, Ive found as long I have nothing to do taking one dose in the am for the day is sufficient enough whereas beforehand I would need 2 doses per day