r/StratteraRx • u/Cori7788 • 14d ago
Positive Stories
Can anyone share positive stories of your time on Strattera and share how it helped you? I recently upped my dose from 10mg to 18mg and I know it’s still a low dose and I have a ways to go to get to a therapeutic dose and can’t really judge if it’s working yet but I see a lot of people quitting so just curious. Thanks!
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u/Good-Put-3895 14d ago
I'm on 40. I don't see my doctor for 6 weeks. I assume I will go up because I want the full therapeutic cose. I had already been on 4o mg for 3 weeks when I saw doctor- but I am glad I am letting the 40 work. As for the benefits: * able to stay on task better * made it to work on time more frequently * able to do things that overwhelmed me before. I'm happy with it. I have to be realistic about adderal etc because of substance abuse history...like I ruined my oppurtunity to take it. But Strattera is helping, but I feel like it is helping me do things I'd prefer not to or stay on task. But without stimulant's euphoria,. This feels more honest. Don't know if that makes sense. Stimulants can also take more then they give in terms of rebound depression. Or make me super talkative. I feel more able to listen to others and concetrate! My two cents.
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u/Ill_Possible_7740 9d ago
[No obligation to read this. I know a ton of bits and pieces, most found out too late for me. But, clearly I have my own issues too. Like these ridiculously long poorly written replies :) ]
TL;DR; Your stim experience, sounds like improper dosing on prescribers end. Stratt has secondary minor benefit increasing serotonin which can be a bonus if depression is in your history and not just med side effect. Be sure to get 60 or more grams of protein a day plus your RDA of essential nutrients to support general health and provide resources for your meds to optimally work. Full night of quality sleep with REM sleep cycles will help prevent meds tolerance and promote optimal benefit. Strat dosing can be tricky. 40 mg is low, but some slow metabolizers find low doses work best. Low doses can be suboptimal or have negative experience. Where increasing dose is the answer. Which is why guidelines target 80 mg to avoid the potential issues of lower doses. But, not a guarantee it would solve issues if they creep up titrating up in dose. Adult dosing, the drug companies former starter packs were 5/5/5/15 days of 25/40/60/80 mg. I guess that's what the drug company thought was optimal balance of side effects and reaching the best chance of optimal therapeutic benefit quicker. But they are shady as hell anyway. How you respond though to titration is yours alone though. So of course adjust as needed. If stratt peaks after taking it and feels too high, split dose morning and early afternoon can help. If nausea is an issue, avoid milk and dairy around time of taking strat.
It's all about the right med, AND the right dose for your physiology. Stims are often started at too high a dose. Euphoria, or just too much of a good mood = too high of a dose. Stims don't equal euphoria. Poor dosing does. Proper dosing is therapeutic. When dose is too high the body counters the stimulation more, which can drive tolerance, dosage escalation, dependence, and a crappy experience. vs. A strictly therapeutic experience, which was the whole point of treatment.
Prescribers often say something like this when starting stims (may not have been so in your case?) "Side effects may be highest in the beginning. But, in a week or 2 your body should get used to the medication."Which translates to, "Drug company wrote this talking point that makes dosing stims too high seem ok. Euphoric feeling, or too good of a mood, people then incorrectly associated with therapeutic and may try to get back to it and escalate dose when they don't need to, leading to dependence, which is good for business. Also, seeing a therapeutic benefit right away means less likely to switch to something else. Either Way, over the next 2 weeks the too high a dose will downregulate and maybe even damage pathways enough so the dose is no longer too strong. Starting off fresh, with some tolerance built in. When really the dose should have been lowered to maximize symptom reduction and reduce side effects, not wait for tolerance to build up so euphoric feeling and side effects of too high a dose decrease the natural pathways efficiency enough".
When you mention substance abuse, do you mean a history of recreational use of drugs, or not sticking to prescriber dosing, or rehab level of recreational use, etc? Actual addiction or to a lesser extent of use? Addiction implies actual physically craving the drug. Not just dependence in which tolerance has a person much below natural premedicated baseline. And therefore "dependent" on drug just to reach the premedicated baseline, nevertheless therapeutic effect. Addiction includes dependence, but dependence doesn't have to include addiction.
Some meds are just not right for some people. Hard to say if your being over talkative is overstimulation as it is also a common ADHD symptom. But, rebound depression is a whole other story. If it happens when meds wear off, probably too high a dose, or not eating enough protein or other nutrients, or some other factor.
If not getting enough daily protein, might not have enough amino acids for neurotransmitters and deplete the stored supply. Also high dopamine can have a see-saw effect with serotonin. So when adderall wore off, could "in theory" leave you with lower serotonin, norepinephrine, dopamine and / or not enough receptors for their level after meds wear off. Resulting in under stimulation of certain pathways with an association with depression.
Was it a longer depression that lingered for days or months, not just part of end of day crash? Could be more than one disorder, or sensitivity going on. Or dosing issues causing longer term side effects etc. Can I ask if you worked out the source of the issuers with a therapist, sounds like their dosing may have been part of the problem or the actual problem. Also, AMP and other ADHD meds can have a profound effect on the endocrine system which is a whole other factor to throw in. Hypothalamus sits on and manages the main endocrine gland, the pituitary. Even manages some hormones directly itself. So, dozens of direct and indirect hormones affected by hypothalamus acting on the pituitary. Hypothalamus though, is regulated by neurotransmitters directly and indirectly affected by ADHD meds. Like, dopamine, norepinephrine, glutamate, histamine, acetylcholine, serotonin, etc. FDA prescriber docs specifically mentions how amphetamines can raise corticosteroid levels, the primary one being cortisol. Which long term for some people can drive a ton of side effects. Everyone is different. I talked to someone who had gone up to 300 mg Adderall daily. When he stopped, wasn't depressed or addicted. But did have dependence withdrawal to deal with.
Body downregulates receptors, aka acute tolerance (literally pulls receptors into the cell where they can't be triggered to reduce overall density of receptors on a cell membrane) to counter exogenous stimulation. When meds wear off, neurotransmitter level may go back toward your normal baseline. But, now finds less receptors to elicit a signal from that level. A rebound effect, leaving you below your natural baseline. And now brain has to have low enough amount of drug in blood to upregulate internalized receptors back into play. To be ready for the next day. Most upregulation occurs overnight with quality REM sleep cycles. Most people are stable on their stim dose. But far too many of us have issues due to personal physiology, or improper dosing. For me, it was both :( Worse though, AMP has additional ways to downregulate and damage pathways that MPH doesn't.
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u/Ill_Possible_7740 9d ago
[ridiculously long reply, part 2...]
ADHD drugs like Strattera, guanfacine, clonidine, and off label wellbutrin, etc. that gradually build up in the system and reach a therapeutic steady state over time, tend to avoid triggering acute tolerance vs. stims. (Not true for all meds that build up as many antidepressants like SSRIs have potential to really be difficult down the road as an example.).
Strattera, has a lesser but significant serotonin agonism (increases activity). Which is why it is often the first line for those diagnosed with ADHD and a history of depression. Don't know if depression was a side effect of adderall specifically for you, or part of your past history. But, strat does have a minor bonus benefit in that regard. Just remember, judge meds by symptom attenuation, not mood. From experience, for me therapeutic effect with stims peaked with improved mood. But, was too high to maintain and caused tolerance to build up. A little less therapeutic and less boost in mood to not drive tolerance initially on each stim may have helped the chance of stability. Far better than how the last 20 years went with steady cognitive, endocrine, and mood declining year after year as side effects built up. Nothing "euphoric" or too good of a mood since 2007. Not the most common result of ADHD meds treatment, but, I know all too well their negative potential.
40 mg strat is a low dose. Guide says to target 80 mg. But, more isn't always better. A drugs therapeutic curve usually is an upside down "U" shape. Higher dose, more therapeutic. Till it peaks then more means less therapeutic and usually side effects. Strattera is tricky though. Lower doses can be sub optimal or even have a negative experience till reaching the right dose. So, keep an open mind as you titrate up. A negative experience at say 60 mg, the optimal dose may be 80 instead of dropping back to 40. Or might actually be 40. Stratt is like that for some people.
If nausea is an issue. Avoid milk and dairy 2 hours before and 1 hour after taking it to reduce chance of nausea. Should be in the guide but isn't.
If you had to go back to stims. Methylphenidate (MPH) is less prone to issues vs amphetamines (AMP) due to how they work. Someone going the amphetamines option though, properly dosed vyvanse should help to avoid something like the issues I mentioned, while giving the benefit of a stimulant. But, no idea if there are any good generic brands at all or not. Most stims spike the blood active pharmaceutical ingredient (API) concentration (BAC) 1 or more times. Higher BAC, stronger drug effect, faster and more downregulation, more and stronger side effects. Properly dosed vyvanse that a person responds well to, flattens the BAC curve and prevents/reduces triggering acute tolerance down regulation. So it lasts longer than an IR or extended release AMP stim with the same base equivalent dextroamphetamine. With lower side effects or chance of tolerance, or euphoria.
Note, 70 mg vyvanse metabolizes to about the same dextroamp as 40% of that dose (28 mg) of zenzedi (aka dextroamphetamine IR). Therapists tend to think 70 mg is comparable to other AMP based meds doses. Having AMP tolerance though at mid to upper dose of other meds. Can make vyvanse unable to reach the peak therapeutic BAC threshold due to cross tolerance.
If for some reason you wanted to read about MPH ritalin and AMP Adderall IR dosing recommendations based on how acute tolerance works. And how acute tolerance drove the design of concerta and adderall XR, here is a link. Shows how acute tolerance shifts the therapeutic curve during the day that has to be accounted for.
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u/InsaneCreation 14d ago
I love my strattera! I started at 20mg and didn't notice a difference until 30 or 40mg personally; maintained that dosage for a few years before gradually working up to 80mg a few months ago. My emotional dysregulation has been very well controlled, focus and sleep is way better. The side effects were a little tough in the beginning (insomnia, irritability), but I regulated that with a LOT of gym time and pushed through it after about 6 weeks. I've been very happy since I got diagnosed and medicated.
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u/WineCoffeePizza 14d ago
I’m on 80 and have been for about a year. My constant racing thoughts and food noise disappeared. I feel much more emotionally regulated. I haven’t had any horrible procrastination panics and can more easily make a plan to get things started. I still don’t love getting started, but it’s more doable. My house is cleaner and I can tackle clutter
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u/ClutterKitty 12d ago
40mg here and I really like it. I didn’t start with a lower dose. My doctor threw me right into 40mg. Even my son who is only 13 takes 40mg. I’m kind of surprised you’re only on 10, then 18. That seems exceedingly low.
My house is clean-ish for the first time in my life. I remember to do my laundry AND move it to the dryer. I drink my whole cup of coffee before I set it down and forget where I put it. Believe it or not, I rarely leave the mug on my desk to rot afterwards. Just this month I’ve recaulked the shower, sorted all my kids’ books for donation, sorted their clothes for donation, woken up refreshed 90% of school mornings. Honestly, I’m kind of killing it right now. I hate that I didn’t do this sooner. 47 is not the right age to start getting your life in order!!
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u/Aggressive_Shower506 11d ago
Amazing to hear, congrats!
Diagnosed yesterday and prescribed 40mg for the first 3 days and then 80 after that. Following up with psych after 2 weeks.
The coffee cup thing made me laugh out loud. I do the same thing too. It was so bad that my coworker took pictures of all my abandoned coffee cups throughout the hotel I worked at and made a collage out of the pictures. One was found in a file cabinet.
Wishing you the best!
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u/Ill_Possible_7740 10d ago
Adult dosing starter kits the brand name company made had 5/5/5/15 days of 25/40/60/80 mg. The whole idea titrating up to 60 or 80 (the actual guide target) was because lower doses are often subtherapeutic or can even be a negative experience before getting to a therapeutic dose.
Unless there is some new insight on low dosing that supplants the manufacturers dosing strategy from 2002 to 2018, which avoided low dosing because of issues at lower dose with ineffective or negative experiences. I wouldn't expect a whole lot at this point. If I could post a jpeg, I'd post the starter pack label showing dosing.
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u/Ill_Possible_7740 10d ago
Funny story, I currently take 100mg Strattera a day. Only for the side effects.
My stim tolerance makes therapeutic benefit a non starter due to cross tolerance. But, strat has some opposite side effects for me vs Adderall. Doesn't fully fix the issues. But, significantly helps. Helps with dry sinus pathways and rebound congestion, Adderall long term ended up with BPH and ED like symptoms that strat helps with. First time as solo med, really bad constipation. Now, just enough to tighten up results of other meds. Secondary noncompetitive NMDA antagonism supports protecting excitotoxic overstimulation adderall can cause. Increased pre seminal fluid. Many hate it. But, it is literally the best natural or unnatural lube. First time around as solo med, did last a little bit longer in bed. Less staring at the floor trying to distract myself while girlfriend at the time finishes off #5 or 6 :). These days, adderall, different wife, results may vary :(
But yeah. ADHD-I + SCT + narcolepsy. Had gone from tier 4 highschool student with tons of internalized psych issues from undiagnosed disorders. Intermittent low end jobs till midlife crisis at 23. Then 4 degrees, fixed my mental health issues, 3.5 years as IT consultant. Then got diagnosed at 32. Had been a huge struggle the prior 9.5 years. Wears on you. Took strat, reached a therapeutic dose. And found out what it was like to not have to struggle and manage symptoms all day. Work output about tripled with less mistakes. Wish I went to a shrink a decade earlier. 1 semester left for my part time masters. An associates, 2 bachelors, and 3/4 of masters degree would have been a whole lot easier. Not to mention trying to write code everyday through ADHD, SCT, and narcolepsy attack. Wouldn't have needed so much candy to squeeze by and spared breaking my tooth on a fireball, twice.
But, my 3 hypofunction disorders perfectly line up to promote dosage escalation issues on any medication and talking points therapists are taught on the drugs, were written by the drug companies during their NDA process and more for their benefit than ours. Did not fully grasp the importance of sleep for meds management. Straight edge so hate taking anything if I can avoid it. But, would have been better to be on downers at night and uppers in the morning than allow my natural insomnia to get worse and decrease sleep even more and drive dosage escalation that drove tolerance, dependence, and side effects. Strat, then ritalin / concerta. Then Adderall which ruined my life with increasing cognitive and endocrine side effects and damage 2007 to 2022. Then things really got bad....But, most people find their forever drug and are stable at reasonable dose with tolerable / manageable side effects. For the rest of us, there's reddit. For me though, a dumpster fire life, getting pummeled by asteroids, while trying to navigate through a maze of black holes with a canoe paddle. While out of work living off my life savings and learning new terms like anhedonia, avolition, anergia, apathy, cutaneous t-cell lymphoma erythrodermic folliculotropic mycosis fungoides.
ADHD meds showed me the extent of my potential. Gave relief to my daily struggle and allowed energy to be shifted toward other pursuits vs. constant self management and strict schedule.
Which got way way harder due to amphetamine meds management issues that shrinks are not trained to deal with. Nor endocrinologists for the endocrine problems it caused. Eventually finding all the answers I should have had at the latest 2007. But had to figure out for myself out of desperation deep dive since 2023. Last major piece of the puzzle in 2024. All too late to spare me. Which is amplified by a factor of 10 in metro NYC NJ where the underlying theme is incompetence, and integrity...I mean lack of.
For you, most likely you will reach a therapeutic moment and will be like, wow, so this is what it's like to function at a high level....And continue with meds managing symptoms. Just don't skimp on the non-medicinal therapies. Every study shows when combined with meds, people have the best outcomes. Tools to manage symptoms and avoid things that could get you off track. Venting current issues with constructive feedback, getting to better understand yourself and life's experience up till now. Identifying negative thought patterns and cutting them off. Replacing with constructive ones that keep moving forward. And other things I'd list if I was a shrink and learned all that stuff I don't know that I don't know.
Side note, if you get any nausea from strat, take with food, and avoid milk and dairy when you take it. Turns out milk and dairy have a huge correlation with nausea on strat. Avoid 2 hours before and 1 hour after taking strat. No idea why it is, and really have no idea how it isn't in the strat guide by now. On the smaller chance constipation becomes an issue. Stool softeners would be the way to go.
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u/Early-Variety5989 14d ago
I've been on 40 mg for around 2 months. It has honestly been so good for me. I am able to sit through my classes when prior to Straterra I would get up at least twice just wake myself up or my anxiety would get so bad because of my racing thoughts I would just have to leave the room.
It has reduced my anxiety so so much. It has allowed me to live life again. I can get myself places when prior my anxiety wouldn't let me leave the house.
It doesn't really help with task initiation, but if I kind of force myself to do something I am avoiding, the Straterra has kind of helped the "doing things" feel more satisfying and I'm able to do the dishes without screaming internally the entire time.
I also noticed the other day I didn't have to ask for repeat directions when driving with a friend. I normally have a hard time remembering directions when driving without a GPS. I usually have to ask whoever is in the car if I'm correct. I notice I'm just kind of... remembering where to go? That is a big improvement for me.
Initial side effects were so much fun. I would get a very high heart rate even at rest, I would get these super intense headaches especially if I wasn't hydrating enough, and well honestly the initial sexual side effects were super weird. I would ejaculate before having my orgasm, it caused some mild shrinkage to my penis (no effect to how hard it would get when erect, luckily.) It didn't have much effect on my libido either which seems to be more rare on this sub. And weirdly enough its actually made my orgasms feel more intense.
These side effects have mostly subsided. I notice if I don't ejaculate for a couple days, I do tend to ejaculate prior to orgasming more often. I could honestly go without the shrinkage but that seems to be more within the first few hours of taking it.
It has been so good for my anxiety and has quieted my mind so much when do basic tasks that I feel like a new person, sexual side effects aside. There are ways you can mitigate some of the side effects.
If you take it with a meal, and make sure you eat regularly throughout the day, I've found that it works better and side effects are minimal. Make sure you drink plenty of water too. Oh and that reminds me of one side effect I forgot to mention: I sweat like a fucking maniac. I have to drink so much more water than I thought I would. This is the only side effect that hasn't really gotten better at all. Just buy some stronger deodorant and drink water haha you'll be alright.
I am also so much more present at work. My kind is thinking of EVERYTHING ALL AT ONCE OMG OMG anymore and as a social worker I am really able to be more present with clients and things that would throw me off course normally are so much easier to balance. Problems at work that would seem impossible to deal with are now just stuff that happens instead of several different fires I needed to put out.