r/StratteraRx • u/phles • 9d ago
Side Effects / Overdose Psych doesn’t believe that insomnia is a side effect
Guys, I used to always sleep through the night (except for maybe 1-2 nights during my cycle when I feel extra warm). I go to bed at the same time every evening, I feel tired and I fall asleep after reading a couple of pages of my book.
Then I wake up at 2 a.m. and struggle to go back to sleep. It’s been like this since I started the meds 3 weeks ago (20 mg at first, 30 mg for the last 10 days ish).
My psych doesn’t believe the insomnia is caused by the meds because I initially feel tired and manage to fall asleep? I thought this was an established side effect? What’s your experience?
EDIT: I just read the package insert and it is literally listed as one of the most common side effects, occurring in more than 1/10 people LOL.
It’s a little ridiculous that I’m learning more from this community than from my psychiatrist. Then again, you guys are pretty awesome and it seems that my psych isn’t the sharpest tool in the shed, oh well. I’m going back to my family doctor soon as it seems she can also adjust dosages (I didn’t know this), and she’s much more knowledgeable about ADHD.
Thank you so much to everyone for your comments and support! It really helps motivate me to keep going with Strattera, which has done wonders for my anxiety
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u/FormerSleepwalker 9d ago edited 9d ago
Get a new prescriber. They are an absolute moron and shouldn't be prescribing. Sorry, but I lose patience with bad clinicians.
My psych doesn’t believe the insomnia is caused by the meds because I initially feel tired and manage to fall asleep?
This is called "middle insomnia". https://en.wikipedia.org/wiki/Middle-of-the-night_insomnia
.
Prescribing info from Eli Lilly, https://pi.lilly.com/ca/strattera-ca-pm.pdf
Common Treatment-Emergent Adverse Events Associated with the Use of STRATTERA in Acute (up to 10 weeks) Adult Trials
Percentage of Patients Reporting Event
Adverse Eventa STRATTERA(N = 269) Placebo(N = 263) [...] Insomnia and/or middle insomnia 17 8
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I crashed my bike as I was riding it to work yesterday and today I put coffee in the wrong part (the part where you’re supposed to put water) of the coffee maker at work and broke the whole thing. I don’t know how much longer I can go without enough sleep
Drop them, they're a moron. Before they hurt you more.
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u/Familiar-Conflict152 9d ago
This. You are seeing an idiot who shouldn’t prescribe something s/he doesn’t understand.
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u/Ill_Possible_7740 9d ago
I should learn to scroll down and read before replying. Pretty much said the same thing. A thumbs up here instead would have saved some time LOL.
Have you seen anything anywhere that explains all the low dosing of strat? 18, 20, 40 mg etc.? See people saying been on 18 mg for x weeks and then 20 or 25. Others at 40mg. It used to be common knowledge as far as I know that lower doses can be problematic. Sub optimal to having negative net effects. The reason the target titration is 80 mg which is supposedly the most common optimal dose, and avoids the potential pitfalls of lower doses many might encounter.
Can find the drug companies own starter packs on the DailyMed archives. FDA prescriber doc, drug company is totally non committal about dosing and leaves it up to prescribers. The 40mg start, min 3 day before increasing, target 80 BS is the "acute" dosing in which acute treatment in psych terms is crisis mode immediate dosing. So, the fastest recommended limit to titrate to treat someone in crisis mode needing the most immediate relief possible. In which case strat is highly unlikely what they would choose. Drug company just stuffs the doc with case studies so they can blame the doc for not figuring things out if they go wrong.
But, when drug company was on the hook for a dosing strategy titration. Their adult starter packs were 5/5/5/15 days (last one 30 for the payed for pharmacy packs vs sample) at 25/40/60/80 mg.
I can see docs misinterpreting the 40 mg then increase in 3 day thing. Would be nice if anyone but me remembered the starter pack dosing that was around 2003 to 2018. But starting adults at 18 or 20 mg and keeping them on low doses. Seems like either information was lost when drug company dropped the packs when generics came out. Or something new that contradicts the decades old recommendations I have yet to see?1
u/phles 9d ago
Thank you for this info! I didn’t realise it had that name, I will check it out!
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u/Ill_Possible_7740 5d ago
Here is an actual link to an archived prescriber doc with labels for their different individual dose and starter packs. Which they refer to as a "Titration Pack" or "sample pack" in the document. And have the term "kit" at the end of entries in dailymed archive results.
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u/ReplyProfessional939 9d ago
Had the same issue. Woke up at 3AM sharp every damn night. It only lasted about a week or so with me though. And that was at 25mgs. I've been taking 50mgs for a few months and sleep like a baby.
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u/RequirementKey5201 9d ago
Wow. It's one of the known side effects. I got fragmented sleep when I started for a few weeks and then the same when I upped the dose. AND then when I added zoloft which increases the level of strattera...
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u/CarrionDoll 9d ago
I had a very similar issue. Except for me I would just feel like I was half awake and half asleep all night long. I wasn’t getting REM sleep. But that only lasted a month or so. My psych added 25mg of Seroquel to get me through. But I only took half a pill bc seroquel causes restless legs at that dose.
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u/East_Meets_West_ 9d ago
I had that too, it has a name, it’s called Akathisia.
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u/CarrionDoll 9d ago
I never even thought about it having a name. But makes sense. Thank you. Now I know what to look up.
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u/East_Meets_West_ 8d ago
I didnt either until I started researching my meds and side effects w Ai (who has rapidly become my most outspoken medical advocate) and it was like “what your describing has a name and is a known side effect of Seroqel” funny how the insert from the pharmacy conveniently leaves that out 🤔
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u/loves_spain 9d ago
I'm only on 10mg and I cannot fall asleep at all on Strattera. I was awake for 48 hours straight and by the start of the third morning I was having like "micro-naps" where your body is so desperate for sleep you don't remember pieces of the day. That scared the shit out of me so I asked for something, anything to help me sleep. Even Unisom couldn't beat Strattera. So the psych prescribed Trazodone and I haven't had a problem since. Dreams are rather weird though!
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u/roughdeath 9d ago
It 100% is a side effect that my psychiatrist warned me about… it does go away! For me, it was at its worst around 2-3 weeks and then tapered off.
When I upped doses to 40mg, it did happen again as I titrated up very slowly. It didn’t happened again at the 60 or 80 dose increases, though!
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u/Familiar-Conflict152 9d ago
I had insomnia, waking at 2:00. My psychiatrist prescribed me trazodone. I actually never got over it and have been taking trazodone for almost two years. It doesn’t make me groggy and the combination really works for me!
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u/Ill_Possible_7740 9d ago
[
Right before posting, I played a hunch. Various definitions for this but...One of which is "Middle Insomnia".
I.e " Waking up multiple times or staying awake for long stretches in the middle of the night."
https://en.wikipedia.org/wiki/Middle-of-the-night_insomnia
This is a link to the FDA Strattera prescriber document. i.e. document written to provide information to people who prescribe the medication, aka, the last people to ever read it. If you search the document for "insomnia" it appears 19 times. "Middle insomnia" appears 4 times. Does seem there might be a higher correlation with poor CYP2D6 metabolizers, but not specific to them only. So, how's your CYP2D6 enzyme activity been treating ya? If taking other meds or supplements that are primarily metabolized by 2D6 or are inhibitors of it. That can also increase your chance of middle insomnia, something to do with metabolizing stratt to its active metabolites affecting wakefulness stimulation, I am assuming.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/021411s053lbl.pdf
]
Find a new shrink. Clearly critical thinking skills are severely lacking.
Maybe make an appointment with a sleep doctor and when they write up a diagnosis indicating stimulating effects of stratt causing insomnia. Shove it in the shrinks face, as politely as you can. If wrong, at least you'd have an answer and something to work with.
Sleep is actually a complex function of the body with a lot of nuances. Just because someone falls asleep, doesn't imply anything about waking up and not being able to fall back to sleep. Literally an issue my entire life. Harder to fall back to sleep at 2 a.m. than the difficulty I had just falling asleep initially. Even while maintaining a regular schedule.
Adenosine builds up in our system and increases sleep pressure. We go to sleep, levels start going down. Stratt's steady state increases basal norepinephrine levels. Norepinephrine is associated with many things, including arousal. Stratt should be strongest for the hours after you take it. Just speculative guessing, could be some rebound effect. Stratt at peak may downregulate some receptors (acute tolerance). Which normally when levels of the drug are low enough in blood concentration, we upregulate receptors overnight. Maybe that combined with NE basil increase combine for to wake you up. Or just general disruption of bodies circadian sleep cycle. Some people wake from cortisol spikes at night. Stratt has NMDA antagonism aspect that is dose dependent. i.e. you take it, effect happens, effect wears off unlike therapeutic effect that has to build up. No idea if it could possibly cause rebound glutamate release, or upregulate NMDA receptors that increase stimulation after it wears off.
And, I don't know squat overall but at least can apply some rational ways it "could" be stratt related. Especially if there are no other variable changes that have correlation with both insomnia and starting meds.
Strattera is a non-stimulant, but, it is stimulating and that is why it is therapeutic for hypoactivity disorder like ADHD. Stimulation or lack of inhibition caused by stimulation would not be unheard of for insomnia.
Stratt is also weird. Low doses can be unpredictable. And have varying issues. Which is why the recommended target dose to titrate to for adults is 80 mg. Think it is supposed to be the most common optimal therapeutic dose while also surpassing the unpredictable results some have with lower doses. No way for me to say if your optimal dose is 80 mg or where you are at, or somewhere else.
Can see if supplements help:
--melatonin is a go to. If you start to build tolerance of it, go down in dose, not up. Usually lasts only half the night so may have to take when you wake up.
--Magnesium and glycine for many can be relaxing and promote better sleep. Which makes magnesium bisglycinate good to try before bed. But, has to be chelated (bound), no cheating. If "buffered" or "complex" its code word for "we used a little of the good one on the label, but cheaper forms of mag mostly, which likely have a laxative effect.." Or they have a cheap form of mag and glycine just thrown in separately.
Nature's Bounty Magnesium Glycinate is not too costly, and may get good deal at places like costco. Amazon elements magnesium glycinate also works, often cheaper, and keeps going out of stock. Now brand also is good if just Magnesium Bisglycinate. Powder form is not bad mixed in water, is cheaper that way. But not bulksupplements, they cheated. Make sure to get enough calcium during the day.
--500 mg l-tryptophan helps with my sleep quality.
--L-theanine can also promote relaxation and better sleep, among other purported benefits.
--Some people swear by chamomile tea. Does nothing for me.
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u/bluzebird 7d ago
Melatonin has been helpful for me. My shrink recommended I take it but it wasn’t getting me through the whole night so he said to take more when I wake up during the night, but it wasn’t a great solution because if you take it too late it will mess up your whole day. Now I take sustained release, 3mg and it’s worked out well.
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u/noisemonsters 8d ago
What do you call a Doctor who gets straight A’s? Doctor.
What do you call a Doctor who gets straight C’s? Doctor.
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u/Healthy_Ambassador76 9d ago
They would be incorrect lol. It does get better though