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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Peter on May 16, 2003, at 19:09:24
Hi everyone:
I'm in one of those transitional periods where I'm taking a ridiculous number of pills multiple times a day, because I'm reducing some and increasing others, etc.
My current regime is as follows: 10mg strattera (started it a week ago); 10mg prozac; 50mg lamictal; 35mg adderall divided bid(15+20); 2mg klonopin; 15mg temazepam; 5mg ambien; 25mg trazadone. I think that's it-I might have missed something.
Anyway, I've been on and off adderall for a few years. I also go on and off of SSRI's, changing brands each time. I was taking zoloft 100mg with adderall XR 20mg and depakote 750mg, then replaced the depakote with lamictal. I went up to 100mg of lamictal over a few months, but it started having a wierd synergy w/ the zoloft, so I weaned of the zoloft (that was a terrible withdrawel-doc had me do it all in a week). Then the lamictal started cavering me w/ a 'wet blanket' that negated the adderall effects, so he had me cut the lamictal in 1/2 and I've been on 50mg ever since.
I had a major depressive episode, so we decided that I'd start Prozac (the only SSRI I hadn't yet tried) at a low dose (10mg). I've been on that combo, with everything else, for many months now.
But my mood began to destabilize throughout each day, and my doc decided that the adderall was sort of raising my dopamine temporarily and then my DP would drop to sub-normal levels. I'd get cranky, my SP would increase, etc.
So, he's having me gradually replace the adderall w/strattera. He's also having me reduce the klonopin significantly, since I was up to 3mg at bedtime WITH temaepam and ambien. The ambien 10mg started degradating my sleep quality, so we cut it in half and added 25mg trazadone with the goal of replace some of the sedatives w/ the trazadone. So far, I've reduced from 2.75mg klonopin to 2mg daily. Ambien is at 5mg, temaz. at 15mg, and traz. at 25mg.
Within the 1st few days of starting the 10mg strattera, the effects were similar to when I began Prozac-My sleep/wake cycle improved drastically and I started getting more consistent energy levels and motivation. In fact, it seemed to make me a bit manicky at the start-pressured speech, etc. I also decreased adderall from 40mg to 35mg within that first week.
Then, out of nowhere, my mood got worse; my sleep cycle was better, but my SP got worse- I started getting ultra self-conscious and paranoid around crowds, and began to isolate in my apartment again.
Pdoc said it might be a synergy between the prozac and strattera that got me too wound up and now it's causing anxiety. But at the same time, my drive/motivation has plummeted, and I dip into depressive episodes. Also, my short-term memory got terrible, and I'd forget things mid-sentence.
I suggested that perhaps I should revisit adderall XR, since I remember it's action to be smoother; it seems that my lethargy, SP, and inner restlesness really comes about during that period in between adderall doses. While the Adderall is working, I get calm and focused; so, I thought, maybe if I had a more long-acting, smoother stim, it would help my general state.
But we decided against it because he said it really isn't worth it - wouldn't affect anything.
He said I should continue reducing the adderall by another 5 mg, and if, within a few days, my symptoms don't subsude, we'll try dropping the prozac for a few days(he said since it's so long-acting, I can drop the whole 10mg and the blood-level will gradually go down over a few days) to see if it's synergy with the strat. is in fact the problem.
Sorry for all this; I'm just trying to get everything clear in my head. It continues to be a long journey of guessing-games.
Can anyone verify if this seems like a good plan? Could there really be a negative prozac/strattera synergy like this? What about stratettera in general-anyone find that it is as good as adderall or other stims, in terms of focus, calm, and motivation? Anyone taking similar meds? Thanks-just want to vent and interact.
Peter
Posted by fallsfall on May 16, 2003, at 23:12:37
In reply to more med shuffling-adderall and strattera..., posted by Peter on May 16, 2003, at 19:09:24
Prozac and Strattera do interact, though at the doses that you are taking, I wouldn't think there would be a problem. Basically, if you take both Prozac and Strattera you need much less of the Strattera (1/2?) to get the same result.
I take 60mg Prozac and 80mg Strattera (that is a LOT of Strattera with Prozac, as I understand it). I take it for depression rather than ADHD. It is very helpful for me.
Good luck!
Posted by Peter on May 17, 2003, at 0:27:16
In reply to Re: more med shuffling-adderall and strattera... » Peter, posted by fallsfall on May 16, 2003, at 23:12:37
> Prozac and Strattera do interact, though at the doses that you are taking, I wouldn't think there would be a problem. Basically, if you take both Prozac and Strattera you need much less of the Strattera (1/2?) to get the same result.
>
> I take 60mg Prozac and 80mg Strattera (that is a LOT of Strattera with Prozac, as I understand it). I take it for depression rather than ADHD. It is very helpful for me.
>
> Good luck!
> Thanks for ther input. Does this possibly mean that the adderall (not the prozac) might be conflicting with the low-dose strattera? I find the adderall very difficult to reduce. After a while of taking it, your brain gets used to a certain dopamine level, and when I reduce it, I become noticeably more scattered and restless, as well as depressed. However, perhaps my replacing the adderall with the strattera would be advantagous, as I've heard that Strattera, while mainly a SNRI, also raises overall dopamine levels over time - in a gradual, smoother way, rather than in the temporary ways of the stimulants, which might cause spikes and dips in mood. This is what I am hoping for; hopefully, reducing the adderall (though difficult) and eventually titrating the strattera would help my symptoms in a more overarching, consistent manner. What's your opinion on this?
Thanks,
Peter
p.s- do you recall how long it took for you to experience the positive effects of the strattera after having begun treatment? It's been 1 week for me, and aside from the initial energy surge, I don't really know what to be looking for, as I'm still on a moderate adderall dose. Have I been taking it long enough to experience the full activity of the 10mg dose, or does it act more like an SSRI, with 2-3 weeks until full benefits are reached?
Posted by fallsfall on May 17, 2003, at 15:50:56
In reply to Re: more med shuffling-adderall and strattera... » fallsfall, posted by Peter on May 17, 2003, at 0:27:16
I'm not sure about the adderall connection. I got most of my information from the Strattera web site: http://www.strattera.com/index.jsp the "Information for Healthcare Professionals" gives you the text of the insert that is in really tiny type. That tells about the Prozac/Strattera connection.
I am taking it for Depression, not ADHD. I'm assuming that is what you use it for? So I'm probably looking for something different than what you are looking for. I noticed a change (energy) right a way, but that is pretty much all that I am looking for. The energy does increase over time (I've been on it for 3 1/2 months). There have been other threads where more ADHD people have talked about it, it seems that it does take some number of weeks to really kick in. You might want to find those other threads.
10 mg is a very low dose. The "normal" dose (as far as I know) is 80mg. My pdoc was shooting for 40mg since I am on Prozac at the same time. That wasn't enough, so we brought it up to 80mg which seems pretty good. It is worth it to raise the dose slowly (I increased by 10 mg every 3 days, but others have increased once a week) - otherwise the side effects will kill you.
Posted by Ritch on May 18, 2003, at 10:01:18
In reply to more med shuffling-adderall and strattera..., posted by Peter on May 16, 2003, at 19:09:24
.....> My current regime is as follows: 10mg strattera (started it a week ago); 10mg prozac; 50mg lamictal; 35mg adderall divided bid(15+20); 2mg klonopin; 15mg temazepam; 5mg ambien; 25mg trazadone. I think that's it-I might have missed something.
......> Can anyone verify if this seems like a good plan? Could there really be a negative prozac/strattera synergy like this? What about stratettera in general-anyone find that it is as good as adderall or other stims, in terms of focus, calm, and motivation? Anyone taking similar meds? Thanks-just want to vent and interact.
> PeterPeter, I think your pdoc's idea of backing off the Prozac some might be a good idea. You are already on the lowest dose of Straterra (10mg), and you're med sensitive. I found it impossible to tolerate the anxiety from Prozac at 10mg a day for very long. When I started Prozac the first time (20mg/day), I could tolerate that for about ten days and then I couldn't sleep at all and my pupils were dilated, etc.... So, I cut it in half and could handle that no more than about another week, then I cut it in half again (to 5mg) and I could manage that for a few more weeks, but finally settled on a range of 2.5mg-4mg/day. That stuff accumulates a lot and very slowly, it is like you are increasing the dose just by maintaining a dose-I think it takes about a month to stop accumulating given the same dosage.
Posted by Peter on May 18, 2003, at 11:33:05
In reply to Re: more med shuffling-adderall and strattera... » Peter, posted by Ritch on May 18, 2003, at 10:01:18
> Peter, I think your pdoc's idea of backing off the Prozac some might be a good idea. You are already on the lowest dose of Straterra (10mg), and you're med sensitive. I found it impossible to tolerate the anxiety from Prozac at 10mg a day for very long. When I started Prozac the first time (20mg/day), I could tolerate that for about ten days and then I couldn't sleep at all and my pupils were dilated, etc.... So, I cut it in half and could handle that no more than about another week, then I cut it in half again (to 5mg) and I could manage that for a few more weeks, but finally settled on a range of 2.5mg-4mg/day. That stuff accumulates a lot and very slowly, it is like you are increasing the dose just by maintaining a dose-I think it takes about a month to stop accumulating given the same dosage.>
< Hi Mitch! How are you? Haven't spoken to you in a long time.
I see what you mean about the prozac and my drug sensitivity. In fact, my pdoc told me that when Prozac was first released, the lowest dose was 20mg. Dr. Donald Klein actually had to petition the company to offer lower doses, because his patients were having panic attacks! They agreed to reduce it to 10mg which could be halved for 5mg. But still, my pdoc told me a lot of people take even less, and that Prozac is now offered in liquid form for that very reason.
I see the reasoning behind dropping it and letting its levels lower in my blood.
But there's also the issue of the adderall; I've been on 40mg for so long, that it seems very difficult to reduce it 5mg at a time, as my doc is instructing me to do each week. I've only reduced the first time so far, so I'm down to 35mg. Since I take it bid, there's a few hours in the early afternoon (in-between doses), when I get irritable, restless, unable to begin or continue a task, etc. As soon as I take my p.m adderall dose, these feelings are alleviated.
In fact, After cutting down my 20mg a.m dose to 15mg for a week, I began one night to reduce the p.m 20 mg to 15mg also. But I found that the 15mg didn't make me calm and focused like the 20mg; so I took that extra 5mg to get back to 20mg. I told my doc, and he said I should try further reducing the a.m dose. But man! I wake up like a zombie! 10mg adderall would have no effect on me whatsoever.
Since I'm gonna have to bite the bullet either way, I'm thinking of just forcing myselfd to stick with the original plan and begin to try to taper the p.m. dose down by 5mg (so I'll be taking 15mga.m+15mgp.m). That's why I wonder if strattera will be a sufficient replacement for the adderall for me. The reason he's changing it in the first place is because he finds that the adderall causes me more mood lability than necessary. But do you know if strattera helps for calm, focus, and motivation/drive like the adderall?
He's not even having me titrate the strattera from 10mg to compensate for my adderall decrease.
thanks,
Peter
Posted by Ritch on May 18, 2003, at 15:03:34
In reply to Re: more med shuffling-adderall and strattera... » Ritch, posted by Peter on May 18, 2003, at 11:33:05
> > Peter, I think your pdoc's idea of backing off the Prozac some might be a good idea. You are already on the lowest dose of Straterra (10mg), and you're med sensitive. I found it impossible to tolerate the anxiety from Prozac at 10mg a day for very long. When I started Prozac the first time (20mg/day), I could tolerate that for about ten days and then I couldn't sleep at all and my pupils were dilated, etc.... So, I cut it in half and could handle that no more than about another week, then I cut it in half again (to 5mg) and I could manage that for a few more weeks, but finally settled on a range of 2.5mg-4mg/day. That stuff accumulates a lot and very slowly, it is like you are increasing the dose just by maintaining a dose-I think it takes about a month to stop accumulating given the same dosage.>
> < Hi Mitch! How are you? Haven't spoken to you in a long time.
> I see what you mean about the prozac and my drug sensitivity. In fact, my pdoc told me that when Prozac was first released, the lowest dose was 20mg. Dr. Donald Klein actually had to petition the company to offer lower doses, because his patients were having panic attacks! They agreed to reduce it to 10mg which could be halved for 5mg. But still, my pdoc told me a lot of people take even less, and that Prozac is now offered in liquid form for that very reason.
> I see the reasoning behind dropping it and letting its levels lower in my blood.
> But there's also the issue of the adderall; I've been on 40mg for so long, that it seems very difficult to reduce it 5mg at a time, as my doc is instructing me to do each week. I've only reduced the first time so far, so I'm down to 35mg. Since I take it bid, there's a few hours in the early afternoon (in-between doses), when I get irritable, restless, unable to begin or continue a task, etc. As soon as I take my p.m adderall dose, these feelings are alleviated.
> In fact, After cutting down my 20mg a.m dose to 15mg for a week, I began one night to reduce the p.m 20 mg to 15mg also. But I found that the 15mg didn't make me calm and focused like the 20mg; so I took that extra 5mg to get back to 20mg. I told my doc, and he said I should try further reducing the a.m dose. But man! I wake up like a zombie! 10mg adderall would have no effect on me whatsoever.
> Since I'm gonna have to bite the bullet either way, I'm thinking of just forcing myselfd to stick with the original plan and begin to try to taper the p.m. dose down by 5mg (so I'll be taking 15mga.m+15mgp.m). That's why I wonder if strattera will be a sufficient replacement for the adderall for me. The reason he's changing it in the first place is because he finds that the adderall causes me more mood lability than necessary. But do you know if strattera helps for calm, focus, and motivation/drive like the adderall?
> He's not even having me titrate the strattera from 10mg to compensate for my adderall decrease.
> thanks,
> Peter
Peter, he probably doesn't want to boost the Straterra any until you get your Adderall dosage down somewhat or maybe not until you are off of it entirely. It definitely sounds like you have become very tolerant of the stimulant! He also might not want to boost the Straterra (change it), until you find a tolerable Prozac dose as well. Hey, don't be surprised if you wind up on 5mg of Prozac every other day or something. So do you think the Lamictal definitely helps you? Can you elaborate on the things it appears to help with? I know it is tough to figure out what med is doing what good when you have to take so many different ones... :) I'm still on 250mg of Depakote + .5mg of Klonopin and 1-2G of EPA (fishoil) every day. I still take a tiny bit of Effexor (aprox 4 mg or so), and 25mg of WB for the lowspots and for anxiety. We added Zonegran (not much either!), and I got super irritable and couldn't hardly sleep it was really awful. Then we added Keppra for a couple of weeks. I slept better, lost some weight, BUT I felt depressed and listless, unmotivated. SOOOO, just wondering what your personal experience with the Lamictal is. I noticed you dropped it down-have you noticed a big difference by doing that? ----Mitch
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