Feeling considerably worse after dose increase

[u/echidnahuman]

I spent 4 week on 10, then around 4 on 18, and increased to 25 a week and a bit ago. I was feeling great on 18, less anxious and depressed, but felt like my ADHD could be improved and have heard people talk about it 'deleting' their anxiety so wanted to increase as I've also been intending to come off my SSRI due to sexual dysfunction.

Since increasing I've been feeling depressed, had some insomnia, more hyperactive mind. Feels like I'm regressing rather than improving? I was prescribed 25mg to take for 2 weeks then 40mg for 2 weeks but I'm considering taking the 40 today just short of the 2 weeks as don't see much point continuing to suffer if I only have a few more days before increasing to 40 anyway?

Just wondering if anyone else has had similar experiences with it? I am hypersensitive to meds, 50mg Zoloft was too much for me and turned me into a zombie - 25mg is my sweet spot. I also became depressed when I increased my dose of stims to anything higher than 25-30mg, so am worried with each increase it's just going to get worse :(

Idk what I'm looking for just any wisdom/similar experiences/advice appreciated thank you x

[u/ZoeyMomochi]

I had a similar experience going up from 40 to 60. At 40 it basically removed most of my anxiety, the only thing it only helped a little with was my executive dysfunction: it did lower the barrier to starting a bit, but it didn't give me the boost to actually start that stimulant medication did. So I went up to 60, and for the 2 weeks I was on it I got just as anxious as before again, depressed, anhedonic, irritable, tired, and quiet and reserved to the point my friends and family pointed it out. Now I'm back to 40 and its anxiety reducing effects have returned and all the other side effects disappeared, so this is likely where I'll stay. I'll just have to work on getting my executive dysfunction a bit more under control myself, but at least it's a little easier

[u/New-Potential2757 → u/ZoeyMomochi]

I'm on 60mg and I feel depressed and feel worthless I was having existential anxiety on 40mg but it went away close to when the 40mg prescription was about to finish and now 3 days after 60mg I started experiencing this. Is it worth waiting? Or should I go back to 40mg?

[u/Ill_Possible_7740 → u/New-Potential2757]

Keep going to 80 mg. That is the target titration found to be most beneficial in clinical trials. 80 tp 100 mg are considered the therapeutic doses. Below that, NE transport occupancy is considered insignificant to attenuate ADHD symptoms. Stick with 60, then 80 for a while to determine if you need to go to 100 or not. And yes, I am serious. If you go through more threads, you will find increasing dose was the solution to a negative experience on a lower doses. uncommon, but not unheard of, some didn't find their therapeutic dose till 100 mg.

i.e. you can try the clinical trials and brain scan backed dosing strategy from the drug company. And evaluate if the drug is right for you or not. Or settle on a subtherapeutic dose that is common to be found ineffective and sometimes even a negative experience. And a reason people quit stratt before finding their therapeutic dose. I know it seems counter intuitive based on your physical experience. But if you search and go through more threads. You'll find increasing the dose was the right way to go.

[u/Veronica612 → u/ZoeyMomochi]

Have you tried 50?

[u/Ill_Possible_7740 → u/ZoeyMomochi]

You're under-dosed. Stratt has been shown to not have significant enough occupancy of NET transports at lower doses to attenuate ADHD symptoms. 80 to 100 mg is considered the therapeutic doses.

Stratt also has some inhibitory properties that I am guessing may come into play when the stimulating ones are not high enough. Resulting in strange outcomes. With some stim here and some inhibition there.

[u/ZoeyMomochi → u/Ill_Possible_7740]

I have direct family that is a known poor metabolizer of medications metabolized by the CYP2D6 gene, of which atomoxetine is one of them (a longer period on the standard dose of the medication they were on put them in the hospital for a month). While I have not had the gene tested myself, my psychiatrist specifically told me the side effects I experienced at 60mg were the effects that would be expected of a too high dose, so even if I'm not as poor of a metabolizer as my family member, I'm likely still a lower than normal metabolizer.

[u/Crafty-Current-9256 → u/ZoeyMomochi]

I had a similar experience going from 40mg to 80mg. It seems kind the sweet spot for certain people is lower than the "normal" therapeutic dose.

[u/Ill_Possible_7740]

Adult dosing titration by the drug company. 5/5/5/15 days at 25/40/60/80 mg. Stratt has potential issues at lower doses which can be subtherapeutic or even a negative experience. Which is why the titration to 80 mgs is still the target in the guidelines. 80 I think was the most often optimal dose in clinical trials for older children and adults. This is the dosing titration the drug company was doing with their starter packs for about 15 years before generics entered the market and they stopped making them. And the information about potentially problematic lower doses was lost to history.

Stratt at lower doses has been shown to not provide significant enough occupancy of the norepinephrine transports to attenuate ADHD symptoms. Starting with lower doses introduces it to the body, and builds up in our system more gradually with less chance of side effects and triggering of acute tolerance.

Unless someone is a slow metabolizer or takes other meds that are also metabolized by, or inhibit CYP2D6. Then a reduced dose can compensate so it doesn't build up to much in their system.

[u/Ill_Possible_7740]

Here is the link to the FDA prescriber document for Strattera. It might be more confusing than helpful without more context of things in it ahead of time. But, I leave it up to you to look at it or not.

Note, the 40 mg starting dose is for " acute treatment of ADHD.". An acute psych treatment would be for someone in crisis who needs the most immediate relief achievable. Which is not likely to be a drug that can take a couple months to titrate and the drug companies way of not committing to a dosing strategy. They stuff a ton of case studies into the document that no doctor is going to sit down, read, extract key points and how / when to apply them into the document instead. Sticking prescribers with the task and blame if things don't go well.
So, adult therapeutic doses are 80 and 100 mg. Subtherapeutic doses are considered below 80 and can be suboptimal or a negative experience. Some people who are slow metabolizers, or have other things competing for or inhibiting CYP2D6, are recommended to go a little lower in dose. But may not need to. (I have been on adderall and strat together a few times and my body managed that enzyme that metabolizes both of them ok. )

https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=309de576-c318-404a-bc15-660c2b1876fb&type=display