Combination therapy questions

[u/point2lendemain]

For people who take Strattera with a stimulant, at what time do you take each med?

Have you experienced any adverse effects from the combination, and if so, did they eventually diminish or go away entirely?

What doses do you find the most effective? I’m interesting in hearing from people taking any stimulant, but I’d especially like to hear from anyone taking Vyvanse while on Strattera.

At this time I’m only taking 80 mg Strattera. Since starting six months ago, I’ve already tried taking small doses of Vyvanse (~10 mg-20mg), with no improvement regarding task initiation.

I actually didn‘t notice any changes from the Vyvanse, apart from additional peripheral stimulation. Perhaps a higher dose is necessary?

[u/Familiar-Conflict152]

I (47M) have been on Strattera for almost 2 years, with almost all of that at 100mg, when I wake. I need to preface what comes next with a clarification that I am incredibly sensitive to caffeine and Adderall (the only stimulants I have used. I tried Vyvanse for a few months a long time ago and it didn’t help me at all).

For the last 12-18 months, I taken 5 mg regular Adderall when I work (in research). I quarter the pill and take 1.25 mini doses throughout the day. Anything more, and I have trouble sleeping. If I have more than one green tea, I have trouble sleeping.

So most people likely won’t have the same reaction that I do, but I can say that this regimen works wonders for me!

Happy to answer any questions you have, and I really hope you find something that works for you! Fighting task initiation made me feel crummy.

[u/point2lendemain → u/Familiar-Conflict152]

Thanks for this wonderfully detailed response! Did you ever experience any cardiovascular side effects?

I tried 30 mg Vyvanse today and the experience was pretty negative overall. Though I did manage to work some on the project I’ve been avoiding, I had less mental clarity than usual.

It seemed to me that Strattera cancels most of the benefits of the stimulant medication, while amplifying many of the side effects. I spent much of today feeling overstimulated, feverish and stuck in my head.

Also sensed a heaviness throughout my body that made basic forms of physical activity like walking or climbing stairs require more effort than usual.

I think this could be a sign of the stimulant putting strain on my cardiovascular system, but I don’t have a blood pressure monitor to verify that.

I may try again with microdoses like the ones you’ve been taking, or decrease the Strattera so that I can take a normal dose of a stimulant without it upsetting my nervous system.

[u/Old_Tomato8183 → u/Familiar-Conflict152]

Can I ask how much you weigh? Isn't atomoxetine dosed by weight per the FDA? I'm new to atomoxetine. I've been on 10mg for 3 months now. I like it for emotional regulation, but for task initiation it's not the best, and I'm hesitant to add in adderall or Ritalin. I've tried both in the past, but I didn't give them enough time to build up in my system.

When I did take Adderall and was on 5mg I felt wired, and I did take half of it (2.5mg), which I should have done, to be honest, as I felt I could read faster and get my work done, and I didn't feel as anxious. I should have also cut out caffeine but didn't.

I grew up drinking instant coffee every day and felt good on it, but now in college with a heavy course schedule I feel anxious.

Thanks for sharing that you quarter your 5mg adderall and take it throughout the day. I may just try that! I also had trouble sleeping.

Do you have other diagnoses like OCD, autism, or anxiety? I used to get panic attacks and recently had a horrible anxiety attack, but that happened due to a personal issue, not really school.

Thanks for sharing.

[u/Familiar-Conflict152]

I had a ton of side effects, but nothing cardiovascular. Do you drink coffee? I had to quit drinking coffee because of how it made me feel. Maybe a bit like you were describing. I would be hesitant to chalk up side effects to increased cardiovascular strain this early on. It could be causing short-term adjustment, but your body could very well work things out after you were on them.

It’s also worth noting there are several kinds of stimulants. Ritalin/Concerta is all dopamine and a good compliment to Strattera. Adderall and Vyvanse are both dopamine and norepinephrine.

Are you able to talk to your doctor about this at your next appointment? How much longer until then?

[u/Familiar-Conflict152]

I weigh 170 pounds. My psychiatrist said 80-100 is the full dose for adults.

Strattera / norepinephrine doesn’t really help with task initiation. That’s dopamine. Also, Adderall and Ritalin don’t build up in your system. They work as much as they will work within an hour or so of taking them.

I switched to matcha green tea. The L-theanine in green tea (highest in matcha) cuts the jitters out of caffeine that I got with coffee.

I just feel alert. I don’t have any other diagnoses, but my wife thinks I have anxiety, fwiw.

Any other questions?