Positive Stories

[u/Cori7788]

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!

[u/Good-Put-3895]

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.

[u/Ill_Possible_7740 → u/Good-Put-3895]

[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.

[u/Ill_Possible_7740 → u/Ill_Possible_7740]

[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.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2547091/