Everything you wanted to know about Strattera

[TerryB]

I've been search the Strattera studies and I found this one. It seems like many of the Strattera studies are based on short terms sometimes only 3 weeks. Strattera is now known to take much longer to have maximum benefit. This study was longer and studied quality of life rather than just ADHD. The drawback of this study (and most studies is that it is funded by the drug company. there were only 200 participants also. Regardless, it is interesting. Here's the link.

www.adders.org/sunbeam.pdf



Stimulants worked great for my 11 dd with ADD but we had side effects, mostly irritability. I have the impression that Strattera might not give us the ADHD control that stimulants do but perhaps my daughter will be overall a happier child. Time will tell. We've only recently reached target dose.

Terry

[swmom]

Terry -

We found that to be the case. Dd tried the stims and they worked - well! But she was irritable, especially on Adderall -- she was very intense. Lost a ton of weight also.
Strattera didn't make her as focused as the stims but she seemed much happier overall, more compliant, easier to get along with. I know now that with us the Strattera chipped away at her anxiety - which may be why we saw the above. I have also heard that for kids with ocd, Strattera seems to relieve those symptoms, too. That may be why they seem easier going, because they are better able to "let go" of those obsessive thoughts. Does that make sense?

What Strattera didn't help much with was the impulsivity. We really needed extra help with that. That's where the Clonidine came in. It was enormously helpful.

Also, they have found that kids do best at the higher end of their range with the Strattera or even beyond it. We have found that to be the case.

Good luck!

[swmom]

Help. The Strattera is not working - AGAIN. We just increased it by 10 mg. about 3 weeks ago. It helped, she was back to 'normal' and then, it stopped working - AGAIN. We've been through this SO MANY TIMES NOW. She was congested at the time it stopped working but that's gone now and the med still is not working. I am so tired of this. I'm really ready I think to try something else. She seems to metabolize the Strattera so quickly it requires constant management. Does anyone know of a med or a combination of meds that would replace the Strattera? We did not do well on stims.

[Mayleng]

How about a combo of stims and strattera?

[swmom]

I guess I can inquire about that. Adderall was bad. Concerta worked but she lost tons of weight. She is still very thin, and her appetite is fine on the Strattera. She is just a tall, thin girl. Anything that affects her appetite just won't do. She can't afford the weight loss. Any of the stims that don't affect the appetite?

[Mayleng]

Give Metadate CD a try. Doesn't seem to affect the appetite for my son, whiles Adderall Xr and Concerta and ritalin la all affected his appetite.

[swmom]

I just read an interesting piece on abcnews.com re: new interest in ocd and the connection to strep. I wonder now if the connection we see with dd's congestion and the med stopping to work is actually a resurgence of strep. Hmmm.

[TerryB]

Hi everyone! I've been seeing a consistent improvement in dd's ADD symptoms starting at 5 weeks at target dose. I thought I'd make a note of this here to give others hope. We also had to split the dose into an am and pm dose because dd was tired and that took away from the benefits of the med. Perhaps we can go to single dosing as dd is on this longer.

dd is definitely more organized, more confident, less easily frustrated, less forgetful, more patient with her younger sister, less distracted in the morning and best of all she is smiling that big huge smile that I had missed. She's not smiling constantly but acting more like a typical preteen. Has ups and downs during the day rather than constant downs. She's only touching, not picking, one particular scab right now. I'm really enjoying her company now. We worked together in the kitchen making fruit salad and brownies for 40 people and she stuck with the boring tasks with good humor. She's seeing herself as the older, more mature, sibling now rather than a peer. It is really nice that she understands that I expect more from her than her younger sister in regards to responsibility. This cuts down on the rivalry a bit.

I know that school will be the real challenge to this medication but I'm really seeing a wonderful change here at home. The attention is not perfect but it is good enough for ordinary situations.

Terry

[swmom]

That is WONDERFUL news!!!! I am soooo glad.

[Mayleng]

That is good news, the thing with strattera is the attention is never as good as stimulants.

[VaMom]

swmom,

my ds was like your dd, we tried Ritalin, Concerta, Metadate, everything made him anxious and irritable. This was the case with Metadate even with the Strattera in place. Then in April 2006 we tried Focalin XR and it has been the only one he has been able to tolerate. It is a refined version of the med. in Ritalin and for us has eliminated many side effects. He eats just fine and generally sleeps well. On the very rare occasion he has trouble getting to sleep, half of a 1mg. melatonin has taken care of it. If you want to try a combo I would try the Focalin XR with the Strattera.

[TerryB]

VaMom,
I'll keep Focalin XR in mind for an add-on stimulant if dd doesn't get enough attention with the Strattera when school starts. From what I understand, Focalin has not been studied extensively in regards to side effects and that the reduction in side effects is still a theoretical expectation. Your experience certainly supports the theory and helps me to consider it as an option. I'd certainly like to see the picking stop all together before even considering a stimulant again. The picking is a real negative socially, a real friend-repellent.

[swmom]

TerryB -

What do you mean by "picking"? Is that an ADHD behavior? My dd picks at things like mosquito bites and her psych said that's a common behavior in OCDers. Oh how I wish we could get her to stop. Her lower legs are covered in scars where mosquito bites have been and picked them to death. I fear the day she starts to shave because nothing will be hiding those.

[TerryB]

When on stimulants, she picks scabs to the point of bleeding and infection. It is an OCD symptom but my dd so far does not have an official diagnosis. We are looking for other symptoms before pinning that diagnosis on her. OCD is in the family and she also has had an irrational fear of sharks in her bath-water so it is very likely that OCD is just under the surface. Stimulants tend to aggravate OCD symptoms.

[swmom]

Interesting, TerryB. Dd for the longest time has a had a fear of "the deep end" in a pool. Finally, finally after a swim coach MADE her swim across a deep end in June did she begin to realize that maybe it wasn't so bad after all. She also kayaked across Charleston Harbor this summer which is the ultimate "deep end." I think she was afraid to object because she was in a kayak camp and other kids were around. She didn't want to appear "uncool."

At dd's psych appt. last week, the psych suggested that we begin to try and replace some of dd's compulsions with appropriate substitutions, i.e. putting on hand lotion instead of licking her hands, squeezing a squeezy ball anytime she gets the urge to lick or wring her hands.
I'm hoping that this will give dd more of a sense of control over these urges and thoughts.

[TerryB]

As usual, our dd's have a lot in common!!! It is good to challenge the compulsion, so going in the deep end was just what she needed to do. This is cognitive behavioral therapy. We recently got over the bath water fear after swimming in lake water while camping. There were fish in the water. We put on life preservers and swam out deep. DD had to be right with me, in contact actually, but now a bath seems easy.

The best way to stop picking is to put a bandaid on every single finger nail. Unfortunately, you have to plan on being home for several days for it to work. This treatment dd came up with on her own. Other things that we have done include clipping the nails short, covering each bug bite with one of those spot band aids, covering scabs with cream or hydrocortizone so that their isn't an itch and naturally me nagging her. When dd was on stimulants she said that it was just too difficult to conquer so we only had limited success.

Dh had a great idea for picking but dd refused to try it. He thought that she needed a bead necklace that she could fondle. Why dd wouldn't cooperate is beyond me.

I do like the hand lotion idea that your psych. suggested for the licking. This is obviously not socially acceptable and a germy habit. Any little wins that she has against the licking need to be expanded until she stops all together. You could get a timer and have her practice delaying the urge to lick. The period of delay can be expanded slowly as she gets "stronger" fighting the compulsion.

I'm practically an expert on OCD because my younger daughter was diagnosed with it at age 4 and we were fortunate enough to to get referred to a psychologist that specializes in OCD and anxiety. Cognitive behavioral therapy is the best treatment. I have a really good book on CBT for OCD. If you are interested, I will try to find it and post the title and author.

[swmom]

Yes, I'd love to know the name of that book. Guess we need to start an OCD thread...

[TerryB]

swmom,
Look under the Comormid section for the OCD book info.

[Mayleng]

For Codyjr.

"Another quick question...IF he would be on 60mg for 4-6 weeks and their is no difference, the next dose would be 80mg (1.8) ....would you then have to try that for 4-6 weeks too before you made your judgement???Or should the "effects" occur quicker? maybe I should start another thread......"

No, the next dose is not 80mgs, the next dose would be 65mgs (you will need different multiple dosage pills ie one 40mg pill and one 25mg pill). I would not raise the dosage by 20mgs. Play within the minimum and maximum range ie. for his weight of 105 lbs, the minimum is 57mgs and maximum is 85mgs. So you increase by 5mgs at a time within his range. You don't go from minimum immediately to maximum. Also it will probably take a week on a new dosage to see if it is effective (after being on target for 4 to 6 weeks).

[codyjr]

Okay,thanks Mayleng. Obviously we will just wait out our 4-6 weeks. I am pleasantly suprised at the "no side effects" part. Hope that continues. He says he feels "calmer" on it, but he may just be thinking since thats what the pill is supposed to do,it must be doing it. The doctor said if the 60 doesn't work,we would then try the 80mg so I will have to talk to the dr about that if it comes up.....hoping the 60 will do trick. I also spoke to the dr that does the capd testing. He said that the accoms that you(and others)suggested would be what he suggested so I can wait and see if I want to actually get the capd testing done. I think I will wait and see if the new accoms and strattera make a good difference for him. I'm hoping the social anxiousness/goofiness will be better once this med kicks in.
As for strattera.....how does norephinephrine help since that article mentioned dopamine? Can you clue me in on that. I realize my son probably doesn't have adhd,but the inattention he gets as a result of the possible capd...couldn't the strat help with that? I don't know.....

[Mayleng]

The strattera may help with the anxiety if he does not have adhd, but it really does not help capd. ADHD is a chemical imbalance, capd is a learning disability in terms of his ability to process what he hears. His hearing is ok, it is how it processes what he hears that is the issue IF he has capd. You are comparing apples and oranges here.

As to the how Strattera works, this is what it says in their leaflet.

Pharmacodynamics and Mechanism of Action

The precise mechanism by which atomoxetine produces its therapeutic effects in ADHD is unknown, but is thought to be related to selective inhibition of the pre-synaptic norepinephrine transporter, as determined in ex vivo uptake and neurotransmitter depletion studies.

Norepinephine is one of the brain's neurotransmitters involved in the formation and function of dopamine and serotonin.

[codyjr]

Quick question, the last three days my son has complained of a heavy type of feeling in his chest...if he burps a lot,it finally goes away.Its occured every day at least once. Would this be related at all to strattera? Is it possibly indigestion? Anyone else experience this? Also,I noticed on the side effects for adults on strattera there can be urinary problems. Has anyone seen this in a child or is it strictly adult problems...my son is almost 14. My son doesn't have any urinary symptoms,just something I was wondering about.
Thanks.

[Mayleng]

It could be indigestion. My then 9yr son (when he took strattera) had problems peeing for a few weeks while on strattera.

[codyjr]

If it IS from the strattera, is there something to do to combat this? Maybe it will just go away on its own though too since we've just started....

[Mayleng]

It is probably the initial side effects. You really need to be on 4 to 6 weeks on target to see if all the side effects goes away. My son would get nauseous and throw up once a month, even after being on target dose. This happened the entire 9 months he was on it. One of the reason why I choose to stop strattera.

[Mayleng]

Here's the link:

Reduced-dose atomoxetine may be effective as maintenance in ADHD

www.nelm.nhs.uk/Record%20Viewing/vR.aspx?id=574301

[swmom]

For crescent and those who are just starting out on Strattera, here's an example of how sensitive that med is. For the past few days, we've noticed the return of some of those ADHD-like symptoms, ie. irritability, limited self control, etc. She was particularly bad at dinner last night. Anyway, this morning I had her get on the scale. Sure enough, she'd gained 3 pounds and we most likely need to adjust the dose again.

[swmom]

For crescent and those who are just starting out on Strattera, here's an example of how sensitive that med is. For the past few days, we've noticed the return of some of those ADHD-like symptoms, ie. irritability, limited self control, etc. She was particularly bad at dinner last night. Anyway, this morning I had her get on the scale. Sure enough, she'd gained 3 pounds and we most likely need to adjust the dose again.

[brenden]

My Son Brenden is 9 he weighs 65lbs and has been taking strattera 60mg in the morning with breakfast for about 1 1/2 years. Brenden has been on stimulants and they did now work for him. Strattera has made a great improvement in Brenden. He does great in school and at home in all areas. He also takes clonidine at bedtime to help him sleep and to help control his tics. He would occationally have an upset stomach from the strattera even if he took it with food but it was only one or two times in a two week period. He recently began having an upset stomach every morning and now vomits almost every morning. Brenden also has asthma and allergies that he takes meds for, I have noticed when his asthma acts up his strattera seems to not work and lately I believe its not working because he keeps vomiting it up. Brenden also recently began having headachs daily. I took him to a Neurologist and Psychologist which diognosed him with migraines. So now I don't know if the vomiting is from the migraines or the strattera. I'm so confused about everything! Does anyone have any advice?

[Mayleng]

My older non ADD son also suffers from migraines, and when he does have his migraines he does vomit. His migraines are controlled by Periactin (one every nite) for the last 4 years and he has been doing great. He has only 2 or 3 migraines in a year and he can normally feel it coming on before it becomes full blown.

Now to Strattera, some of our members have mentioned that strattera does not seem to work well when allergies start.

My ADDer who took strattera for 9 months, used to throw up at least twice a month. When your son started throwing up every morning, did he have a headache or did he just have the nausea? Did he feel better after he threw up?

Did the doctor give any meds to help control the migraines?

Has the doctor suggested you stop the strattera to see if it was causing the vomitting and headaches?

I am sorry I have more questions than answer.

If it were me, since the strattera is not working now anyway, I would stop it, and see if the headaches and vomitting goes away. I would want to make sure it is not strattera causing it.
But you should discuss this with the doctor.