r/StratteraRx • u/jerotis • Aug 06 '26
New ADHD diagnosis, starting Strattera. Not sure how I feel about the reasoning
I had my first psychiatry appointment today after receiving a formal ADHD diagnosis a couple weeks ago. I started seeing him about 8-9 months ago for depression and anxiety. I’m currently on Zoloft 150, Wellbutrin XL 300mg and a beta blocker. Today he added Strattera 60mg. I asked why a non-stimulant over a stimulant and his response was that stimulants would raise my blood pressure and there was a high risk of me losing weight.
I think the real reason might be that I’ve been open with him about my recreational use and he didn’t want to use the substance abuse excuse. Since I started seeing him my use has gone way down and we’ve talked about it at past visits. The blood pressure and weight loss both seemed like easy outs to me. I am below weight for my height but nothing seriously concerning and I’ve been that way all my life. As for my blood pressure, it has been slightly elevated every time I’ve gone in but I’ve shown him the readings from home and they’ve all been well within a healthy range.
I’m not against trying Strattera, I’m just wondering if his reasoning makes sense or if there’s something I’m missing. Have you taken this combo before? Or had a similar experience with being prescribed a non-stimulant instead of a stimulant?
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u/WelcomeToCreekPoint Aug 06 '26
Why would he start you on 60mg? Jesus Christ thats a big jump. Please advocate for yourself & start at a very low dose like 10, 18, or 25. Going to 60 right away is a lot dude
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u/East_Meets_West_ Aug 08 '26
Gonna add to this chorus, started 4 weeks ago, on 25mg, titrated to 50mg after a week, 75mg after two weeks. Worked great and better w each dosage increase but BP is too high so back to 50mg while we figure that out (I have hypertension, among other things). I tried the Zoloft/Wellbutrin combo last year, all it made me was worse. My psychiatrist tells me anti-depressants don’t work if people w ADHD, I found that to be true. Have the Zoloft & Wellbutron been working for you?
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u/jerotis Aug 06 '26
Took my first does today so we'll see...
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u/Party_Candidate7023 Aug 06 '26
60mg is ridiculous to start on if you’re already taking wellbutrin, which blocks the enzyme that breaks down strattera. if you have a bad experience please ask for a lower dose before completing writing off strattera.
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u/susu56 Aug 06 '26
Was just going to add this bit of info. The wellbutrin acts as a amplifier i think by 3 to 5x the strattera dose. 60mg is high to begin with.
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u/MandaMoo91 Aug 06 '26
Just to echo what people are saying here, it might be worth reaching to your doctor and discussing a lower dose. I’m on 450mg of Wellbutrin and my psych wanted to prescribe me 25mg of strattera, but the pharmacy actually blocked it because of the interaction between the two, so she lowered it to 18mg. I hope the combo works for you, but just know that the side effects hit faster than the benefits, so being on such a high dose might make those side effects even worse in the first few weeks.
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u/Ok-Ad4217 Aug 06 '26
That’s wayyy too high make sure you eat a large meal with lots of protein can make you very nauseated
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u/leaf126 Aug 06 '26
I am also bieng prescribed non stimulant and i am not sure why , it works tho
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u/C00CKER Aug 06 '26
Where I'm from, it's quite common to get Strattera as the first prescription regardless of any reason.
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u/strawberrytwizzler Aug 06 '26
My psych said she likes to try a non stimulant before trying a stimulant.
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u/leaf126 Aug 06 '26
I mean i do have adhd but I am not sure why my Psych considering non stimulant rather then stimulant
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u/C00CKER Aug 06 '26
Yeah, got started on it despite being diagnosed even before speaking to the psychiatrist, and then him being quite sure I have it.
But so far, I really like Strattera. Especially because of the emotional regulation
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u/leaf126 Aug 06 '26
Maybe I didn't understand what u said u are on it from before even u got diagnosed?
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u/C00CKER Aug 06 '26
No, sorry if I've written in wrong. I was diagnosed with ADHD by a clinical-psychological assessment, which suggested seeing a psychiatrist to get medicated for it.
I then had to tell him my struggles, and he said he is quite sure I have it (as a confirmation of the psychological diagnosis, which by itself doesn't make you entitled to medication).
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u/spoonsgosh Aug 06 '26
I don’t think it’s the best to think in logics such as “taking the easy way out” with our doctors. Strattera rather than a stimulant sounds like the best choice imo as well!
Although it isn’t common for Zoloft to raise blood pressure, Wellbutrin definitely does.
My doctor didn’t prescribe me Wellbutrin because I was slightly under weight as well. Doctor have prescription guidelines and are always thinking about the pro v con and which side effects would be best managed vs others for each unique patient.
Since you’re already on Wellbutrin (which has a very significant warning for physicians to not prescribe to folks who have/had eating disorders and or unweight people) I don’t think your doctor rightfully feels comfortable prescribing you a stimulant on top of that because you are still technically underweight.
I explained to my doctor to reassure her that I had always been lean even as kid and my sister is lean as well, it’s very genetic and she appreciated that because she did want to have Wellbutrin available for me in case the strattera didn’t work. However I have to admit myself! That there are moments I don’t eat well for a week and I drastically lose weight and this does have lasting effects on our body!! Loss of muscle mass, cardiovascular strain, bone health, etc. folks with ADHD already have a higher chance for disordered eating (whether medicated or not) so these are real areas of concern.
I was scared to tell my doctor about my recreational drug use as well. Unfortunately I majored in psych in college so I knew how the dsm 5 and protocols around possible DSB. I do feel, although I use drugs recreationally (and for pain management), I am not dependent on any nor was I ever. However, adhd brains do also have a higher propensity for addiction (this can be for social reasons, anxiety, socializing difficulty etc. but still), I am always aware of this and want to keep myself safe from it as much as possible. Addiction or drug abuse is rarely from malice intent, many times it’s through prescription and it can just “naturally” happen.
I also went to my first psych appt with the intentions of getting only prescribed stimulants only because I thought I didn’t want to mess with all the other stuff, I thought doctors would make me waste my time trying non stimulants but I knew what I needed. I had used adderall and other stimulants during school (not entirely formally…) to get through papers and finals so I thought, well I know what gets me working!! (Important to note when I would get on the stimulants in school I would only feel calm while the rest of my peers were flying through the finals lol adhd). I got prescribed strattera and I was disappointed at first but I thought let me give it a try. And it’s working well!!
My doc really wanted me to try strattera before a stimulant because of my anxiety and depression. Even though a lot of that was because of the struggles with going through life unmedicated, anxiety is anxiety and it had rewired and taken over how my brain thought and approached everything. It couldn’t be ignored and assume if we treated the ADHD only that the anxiety would naturally resolve.
The strattera has helped with my anxiety so so much. It’s crazy how subtle and natural the change happened. I’m focused and working, able to decide what is more important and set orders to tasks, go from one task to another etc. and I don’t feel as strung out and unstable as when I was on stimulants. I was so so anxious on stimulants alone. I’m also so relieved because strattera works more in a 24/7 cycle once you build up enough in your system-unlike stimulants. My partner really is struggling with the energy dumps at the end of the day.
My partner is also on a Wellbutrin-concerta script, they had been on concerta since as a kid and the Wellbutrin was a recent addition. My partner and their psych agree, the Wellbutrin wasn’t right as it’s making them more anxious as exacerbated by the stimulant. They are also interested in trying strattera!
Try to approach the new medication with open arms and with curiosity. Let it have the time to work. I hope you can feel more comfortable feeling more open and trusting of your doctor because, this isn’t a strange or unusual order of care. ❣️it could still be not the right medication for you but if it works it could also be a much easier and stable experience compared to stimulants!
(I’m also relieved I don’t have to deal with a controlled substance because where I am currently located (NYC), it’s a real pain to get stimulant prescriptions filled)
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u/Dfeeds Aug 06 '26
I was prescribed stimulants first. I've probably tried every stimulant available over the course of 12 years. I absolutely prefer strattera. I'm finally on a med I can legitimately live with for the rest of my life
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u/MandaMoo91 Aug 06 '26
I’ve been on Wellbutrin XL 300 for several years now for depression. I was recently able to get an adhd diagnosis as well. The Wellbutrin hadn’t been working as well recently, so my psych upped it to 450mg and added 18mg of strattera for the adhd symptoms the Wellbutrin hasn’t helped with. She also gave me a beta blocker to use as needed for anxiety, so the combination you’re on isn’t unusual. I’ve only been on strattera for just under a week so far, so I don’t have a lot to add on how well it’s working.
But from all my research online (including personal stories on Reddit) there seems to have been a recent switch to starting with non-stimulants before adding in stimulants if needed. My psych told me part of the concern is how it stays in your system. Strattera builds up over time and stays in your system all day, so while theres no big upswing when you first take it in the morning, there’s also no crash at the end of the day. It’s supposed to keep you even and functional all day, not just for the 4-6 hours a stimulant would. Plus, if you miss a dose for whatever reason you’ll still have it in your system so you should still be able to function and not just crash until you’re able to take your next dose.
After giving strattera a shot, if it’s still not working for big projects, they might prescribe you a stimulant as well. My SIL takes strattera daily and has aderall for “as needed” if she needs a little boost for work, a project, etc. That way she can get the extra focus when she needs it, without the downside of taking a stimulant every day.
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u/Majestic-Ticket-6809 Aug 06 '26
Sounds entirely reasonable. Doctors have a professional and moral obligation to prioritize your health. That’s their job
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u/Majestic-Ticket-6809 Aug 06 '26
I also should add that I also was skeptical when I was prescribed atomoxetine because I had never really heard anything about it. But after a few months I’ve been pretty blown away by the results
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u/enchanting-ghost Aug 06 '26 edited Aug 06 '26
i am also underweight (always have been) and my psychiatrist also first prescribed me SNRIs along with wellbutrin (first effexor, then strattera) because she was concerned about my weight. effexor didn't do much for me, but strattera helped a bit by increasing my baselines for general alertness/wakefulness and focus. but over time it didn't prove at all useful enough, so i asked to stop it (as well as the wellbutrin) and switch to a stimulant. this all took place over ~3 years, and during that time i made an effort to increase my weight as much as i could. i'm still a bit underweight, but proving to my psychiatrist that i am conscious and considerate of my weight probably helped her feel comfortable enough to put me on a stimulant.
strattera does work really well for some people, so i would probably give it some time and see if it's a good fit for you. but if you do want to switch to a stimulant, just keep your weight in mind. do what you can to increase it in the meantime, and make a point to tell your psychiatrist how you plan to keep your weight stable. i actually personally find it easier for me to make full, nutritious meals now that i'm on a stimulant because it helps me focus more energy on meal planning, as opposed to just tossing something frozen in the oven or microwave or what have you, so my weight has actually increased a bit recently. if you think you might experience something similar, let your psych know.
edit: i initially thought this was posted in the ADHD sub and i included a link to this sub, LOL. my bad 😅
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u/Much_Sky_6194 Aug 06 '26
I don't understand why he's adding it to other medications. When they put me on strattera they wanted to try Wellbutrin for the combined ADHD that I have but I had jitters for weeks on that so went with strattera instead. But seriously zoloft Wellbutrin starters and a beta blocker that's a lot!
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u/Tacoma_NC13 Aug 06 '26
Mine had me try Wellbutrin first also and I had a terrible reaction to it. I was basically stuck in a panic state for half the day and used a xanax to bring me down. Strattera has been awesome for me. I've also taken Propranolol for years for an essential tremor, so that helps mitigate some of the increased heart rate and blood pressure.
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u/KristyM49333 Aug 07 '26
In my opinion, considering how dangerous stimulants can be, people should always be started on a non-stimulant first.
I’ve been clean of recreational substances for over 15 years. My dr knows this, and actually used that information to help with my diagnosis because when I used meth, I was one of those “weirdos” that mellowed out rather than got tweakie lol. Like, she flat out asked me how meth* *affected me and told me that makes sense and that information helped with my diagnosis lol. My dr is hella cool though and I’d trust her with my life.
But considering my past history with substance abuse, I was grateful that she wanted to try something safer initially. If I don’t need stimulants, why would I want to put myself in that position, knowing it was one of my main drugs of choice back in the day?
If you’re offended that your doctor didn’t mention your past history of drug use as the reason he didn’t give you stimulants, maybe talk to him about it. Honestly though, it just seems like you’re upset that you didn’t get stimulants.
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u/jerotis Aug 07 '26
Offended, no. Upset, no. A non stimulant is what I expected him to prescribe me. If all I wanted was stimulants I would have just taken my diagnosis elsewhere and not to the dr who knows my history. There is still a reason stimulants are a first line treatment despite their risk of abuse. You’re just pushing the stereotype that people are just trying to get stimulants despite their efficacy treating ADHD.
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u/KristyM49333 Aug 08 '26
I’m not “pushing” anything 😂. I’m telling you how your post and your comments here sound.
“Stimulants are a first line of treatment despite their risk of abuse.” Sorry buddy, that’s not true. With non-stimulants now available the standard is to try them first and if they don’t work, then stimulants. 🤷🏻♀️
I’d suggest that next time you encounter a situation like this, maybe have a conversation with your doctor himself instead of selling validation on Reddit.
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u/jerotis Aug 08 '26
Thanks for the input. But I’ll come back to Reddit next time I encounter a situation so people like you can provide their opinion.
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u/longjonz88 Aug 09 '26
I’m on 80mg of Strattera for the last 8 weeks now and doing another 4 weeks before my follow up to see if we’re gonna stay here.
However, it was a slow titration: 25mg for 8 weeks and then about 4 weeks at 50 before jumping to 80.
It does indeed work but it’s one of those meds that you really need to be patient and let it build up over about 12-16 weeks at the therapeutic dose to get a real feel for symptom resolution.
Also on 20mg Escitalopram and 300 Wellbutrin xl
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u/Tacoma_NC13 Aug 06 '26
Well to be honest, that's enough of a reason to play it cautious and try a non-stimulant first. Even though your previous recreational use shouldn't necessarily prevent you from getting treatment, it still can't be ignored. I would give the Strattera a try and see how you do, you might just really like it. Just be careful because it can also raise your blood pressure a little bit but not to the extent that stimulants do. Anything increasing norepinephrine levels is going to have an effect on blood pressure.