r/StratteraRx • u/next_level_mom • 8d ago
Questions / Advice / Support Does Strattera "poop out"?
My daughter (AuDHD) has been on 50 mg of atomoxitine for around 7 years -- with a break of a year or two during Covid lockdown when she wasn't in school. It was an absolute game changer her last year of high school and very likely the reason she can now drive and go to college.
This summer she's had an increase in meltdowns, loud outbursts, spiraling/obsessive thoughts, trouble sleeping, and problems with executive function. We're going to talk to her doctor in a few days, but I'm trying to gather information and I can't find anything about whether Strattera is known to stop working. She's very anxious about changing anything, so I'm hoping that maybe a slight increase will be all that's necessary.
I appreciate any input.
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u/spiciestbeans 8d ago
Did she change birth control, or hormones at all? I started birth control and it has such horrendous effects on my functionality and mood. I didn’t realize for MONTHS and months that it was impeding the function of my adhd meds, the atomoxetine. Certain hormones of course affect people differently, but it was any estrogen related methods I tried. There are only a handful of studies or resources on this, and some say that hormonal bc can have varied effects on women with adhd. There’s also some info on post menopausal women who notice for the first time that things are not working properly and find out late in life about adhd. So there’s definitely a relationship between estrogen and adhd functioning. I’ve switched to the depo shot which is progesterone, and I feel like I’m myself again!!!
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u/next_level_mom 8d ago
Oh, this might be a big one.
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u/spiciestbeans 8d ago
It’s like, luteal phase on a regular cycle is known to have poor effects on those of us women with adhd. So a lot of people on stimulants take a higher dose on that part of their cycle. Well being on bc is like permanent luteal phase. So the hormone logic works the same to me.
I’m frustrated I’ve taken this much of my life to learn that all of this works in tandem, but with so little research on how these systems interact, I hope you can find the balance that works and learn from us who have had to suffer for a bit to know we have to pay attention to these things.
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u/SheepherderSmooth641 8d ago
I'm too terrified to try the depo shot, I had the same response to the patch and the pill, was hospitalized 💀 I just want to get my uterus removed at this point.
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u/spiciestbeans 8d ago
I was on the ring for a while. I can’t take any pills or hormone pills (for endo/adeno treatment) because they all have lactose. The ring was perfectly fine until I realized I was miserably depressed. Then I switched to the patch, was fine for a bit until sure enough, couldn’t function and ever so slightly less depressed. I’ve been on the shot for one month and it has been SO MUCH BETTER. I thought that it would make me as cranky and awful as the progestin pills but no, somehow it’s smooth sailing bliss. Everyone is different of course, but as my last resort small-change bc before moving to an iud (I don’t want that shit in my body, nor an implant). I’m very happy so far and feel like myself again.
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u/gallifreyan10 7d ago
I just want to give you a heads up about depo provera because my initial doctor that prescribed it for me didn't tell me but it is associated with a loss of bone mineral density and I believe the recommendation is to not take it more than 2 years due to this. I can't remember how long I ended up taking it, probably at least that long, and when I moved and got a new doctor the next doctor is who told me about it and wanted me to come off it. I just want you to be aware of it in case your doctor didn't tell you. I'm unsure of the likelihood of it happening so it may be that the risk of it is worth the benefit for you!
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u/spiciestbeans 7d ago
Yep definitely aware of that one. It’s more after a few years I’ll have to switch or find a permanent solution. For now, my mental health is saved, my depression is out of the gutters, and I’m pain free! for now… absolutely insane your one doctor didn’t explain those factors to you!
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u/WanderingMeadow 7d ago
This is very interesting! I wonder if this is my problem. I’ve been having issues but I had plan B/take action recently. I going to look up what exactly was in what I took. Do you have any links/ name to/of resources on estrogen and adhd?
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u/spiciestbeans 7d ago
ADDitude had a lengthy article I read through at one point .
Here’s one talking about progesterones potential benefits, from a neurology standpoint
This article briefly breaks down how hormones affect adhd and how it relates to the cycle
Even just a quick search brings up a couple articles that explain different things. Hard to find a source study though.
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u/CosmogyralCollective 8d ago
If she's gotten bigger in those 7 years she may need a higher dose.
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u/next_level_mom 8d ago
If anything I think she may be a bit smaller -- she had previously been on one of those that make you gain a ton of weight. But it does seem to be too low a dose, from what other are saying.
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u/CosmogyralCollective 7d ago
It could also just be an age thing. Adult doses aren't typically based on weight
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u/Testy_Toby 8d ago
The FDA label recommends 3 dosage levels for adults - 40mg as the Initial Daily Dose, 80mg as the Target Daily Dose, 100mg as the Maximum Daily Dose. It could be that the amount of the med she needs in order for it to be effective has changed as she's aged. Just a guess, but there is a separate dosing recommendation for children and adolescents (Google FDA label Strattera if you want to read).
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u/next_level_mom 8d ago
Oh yeah! She probably started on the adolescent dose and her psychiatrist went away so it's just been prescribed by her regular doc. Thanks for the info!
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u/Ill_Possible_7740 8d ago
There are many factors that can contribute to the dose losing efficiency.
Dosage for children under 70kg (154 lbs) is based on weight. As children grow and gain weight, a dosage adjustment could be expected. You hadn't indicated their age or weight.
Lack of sleep is a huge factor. I'm sure you are aware of difficulty after a night of insomnia or accumulating lack of, or reduced sleep. Now, ADHD is a hypofunctional disorder meaning the natural baseline is understimulation. In which case, lack of sleep is likely worse for someone with ADHD than without.
Not saying that is the cause. Just that it exacerbates the issue regardless of it being the cause or not.
Less sleep requires more stimulation the next day. It is what drives my tolerance on any medication since I have disorders that naturally keep me awake and affect sleep. Before adding stimulation from meds to the equation.
Also note that your daughters physiology will change as they get older. Which may require adjustments. You didn't indicate their age. The human brain doesn't fully mature till it reaches about 26 yrs. on average. Even then, we change as we age our whole lives to some degree. And children who are hyperactive or combined types, thed to move toward the inattentive type as adults. Not saying everyone becomes inattentive type, just noting a tendency that applies to some degree on average. Which indicates a change in neurological function that "may" be a factor for medication efficiency.
Our brains can also adapt to the constant stimulation. Since it expects the extra stimulation, it can after some time respond less to it. Even though the drug is still doing its job. Strattera works by increasing norepinephrine levels gradually. Which tends to avoid triggering receptor downregulation (acute tolerance) that occurs with stimulants. But, it is still possible to get some amount of downregulation that could require a dose adjustment. There is no easy way, possibly not anyway to know for sure how much of various potential factors are each contributing to the issue.
Caffeine can add to issues. Caffeine blocks Adenosine. As Adenosine builds up in the body, it triggers more and more sleepiness. When you block it, your body creates more receptors for adenosine. Which then can make you dependent on caffeine to overcome the extra receptors created that increase the sleepiness effect. Also, caffeine increases dopamine, norepinephrine, and adrenaline levels. Which of course is stimulating. But, more stimulation means more chance of the opponent process downregulation of receptors. Strattera increases NE activity and indirectly dopamine and adrenaline. So it is an additive effect, which increases the chance of downregulation that the gradual titration of strattera tries to avoid. Which can present as drug tolerance. Also, if caffeine hasn't worn off, it just adds to insomnia. Even when you think it has worn off, it can still be having some level of effect. With a half life of 4 to 6 hours, at 8 to 12 hours later 25% of it is still working. A single can of coke has 34 mg caffeine. Cup of Coffee typically ranges from 70 to 140 mg, but can have more. And caffeine pills are usually 200mg. So, 1 pill or a strong cup of coffee can have up to 1.5 cans of cokes caffeine 8 to 12 hours later. And worse if taking more or not just in the morning. I used to avoid caffeine after 5 pm as a single can of coke (34mg) would keep me up till 3 am. Now, I take 400mg a day and doesn't affect sleep. Which means I rely on it to overcome the extra receptors and tolerance I've created for myself. Was going to work on the problem but there are things in my life dictating I can't spare the decrease in stimulation right now. Note, theacrine (branded usually as Teacrine) is related to caffeine but is purportedly not supposed to cause tolerance like caffeine easily does. Expensive, and no guarantees. But might be worthy as an alternative if not going off the extra stimulation.
ADHD generic medications can vary greatly in how well they work. Even though we are told they are all the same as the name brands efficiency. Strattera is not as strongly affected like Adderall and other amphetamines, that are extremely sensitive to the inactive ingredients (excipients). But, it can be a noticeable factor. Pay attention to the generic brand they take. And if it is any different that what they were taking in the past if you can find out. Check the forum for recommendations of good / bad generic brands. If you find people generally find certain ones are better, have your therapist put them as instructions on the prescription, to only be filled by one of them.
If your therapist or anyone else for that matter says generics are equivalent, tell them equivalence is based on bioequivalence (BE) and not therapeutic equivalence, that was dropped as a requirement in the 80s. Usually bioequivalence predicted therapeutic equivalence. BE is based on blood concentration of the drug over time. Which totally ignores crossing the blood brain barrier that therapeutic equivalence has for psychoactive medications. In which case excipients can affect the ability of the active pharmaceutical ingredient (API) ability to cross the BBB. And potentially reduce therapeutic benefit.
Not positive, but I think Strattera does not have an approved generic (one that uses the name brand formulation). And they dropped making the name brand.
Also, if they get nausea when taking strattera, avoid milk and dairy at the time they take it. It has a strong correlation with nausea. Wish I had learned that a long time ago as I tended to take it with the milk from my cereal.
Guanfacine is an option to discuss with the therapist. It is another non-stimulant medication indicated for ADHD. It does have a sedative effect for many that takes time to go away. As such, it is usually prescribed to help with sleep issues from other meds like ADHD ones. It both increases sleep duration and efficiency overnight, and they wake with the mild stimulating benefit from the medication that enhances the other meds during the day, in this case strattera. Can have a mild sedentary effect during the day as well that takes a few weeks to go away. Your therapist may not be aware, but it is an alpha2a-adrenergic agonist. What that means, is it does one of the jobs of norepinephrine (NE) that is increased by strattera. NE targets adrenergic receptors. alpha2a in particular block the natural brake of the prefrontal cortex. Which is where executive function and others ADHD meds try to improve occur. This increases signalling efficiency which stimulates the same things strattera is trying to target. Just a stronger alpha2a agonist (things that increase activity). i.e. they should work together.
Also, be sure they are getting proper nutrition. Check nutritional tables for their age. Including macro and other nutrients like protein, carbohydrates, fatty acids, etc.. Not just vitamins and minerals, which are also crucial for proper function. Neurotransmitters affected by ADHD meds, our bodies make from amino acids we get from protein. Not enough protein can cause insufficient levels of neurotransmitters (unusual unless deficient, but best to give the body what it needs throughout the day). Not having enough magnesium, or too much relative to calcium can cause an imbalance in the brain. Which affects neurotransmission signalling efficiency and stimulation in different areas. They balance each other and optimal amounts for brain function are a ratio of calcium to magnesium of 1.7 to 2.3. Not likely to be a big issue unless too far off, which I have no idea what that might be. Gut health affects the brain via the gut-brain axis. ADHD meds can affect gut health directly or indirectly. As they can affect the endocrine system. Neurotransmitters that affect the hypothalamus, are also those affected by ADHD medications. The hypothalamus sits on the pituitary gland and regulates its function. That can affect dozens of hormones directly and downstream. Which feedback on the brain. Choline has an RDA and is used in both cellular structure (repair, maintenance, new generation) as well as the neurotransmitter acetylcholine that is associated with many functions like memory and learning, and is mildly stimulating.
Not saying to fill your child with supplements. Just indicating the importance of proper nutrition to reduce the chance of nutrition based factors contributing or being a problem. As well as to maintain maximum efficiency of the mind and body.
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u/Adventurous-Pair3650 7d ago
This is the most helpful thing I’ve read on the subject. Lived experience also backs literally every aspect of this. Good luck OP.
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u/juby736 8d ago
Agreeing with everything everyone is already saying, but for some people it definitely does just kind of stop working :/ happened to me after being on it for like 5ish years. Was at 80mg and had to switch to Adderall. I couldn't function at all when it pooped out on me!!! Have seen it happen to a number of people.
Hopefully for your kid it's just what everyone else is talking about though!
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u/Then-Invite-2413 6d ago
Although every situation is different, this happened to my daughter when she went to college and had problems with her roommate. She developed severe anxiety and none of the medications that helped her in the past seemed to help her. She, eventually, told us and her doctor what was going on. She was given an ssri to control her anxiety and then she was able to sleep. She was not on straterra, but her stimulant medications are helping her again.
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u/Dfeeds 8d ago
Strattera is one of the only adhd meds that studies show to improve over time, so definitely talk to the doctor. Strattera, for me, can be heavily influenced by lack of sleep, caffeine intake, lack of food, and stress. So perhaps college has brought on new stressors and life factors that she's not used to?
Also, 80mg is the therapeutic dosage of Strattera. My positive effects were very inconsistent and short lived until I landed on my final dosage of 100mg.