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Re: Strattera and ANGER

Posted by zeugma on February 6, 2004, at 4:56:59

In reply to Re: Strattera and ANGER zeugma, posted by micro on February 5, 2004, at 23:41:26

> > > On Strattera, I felt more aggressive. Normally an easygoing person, I wouldn't let things slide anymore. I liked the new me, but my hubby didn't. I really didn't like getting angry though. I never had a problem managing my anger.
> > >
> > > I'm not taking it anymore.
> >
> > Noradrenergic drugs will make you fight harder. This is good if your depression takes the form of constant self-blame, passivity, and lack of endurance (classic melancholic depression) but is not what is needed if you're closer to 'normal' along these lines. These drugs create imbalances which are either therapeutic (you're lacking in something and the drug functions as a kind of prosthetic device so you function, more or less, or at least keep going) or it pushes you too far in a direction you don't need to go. That's why Strattera gets many complaints about causing mood swings, anger, etc. It increases emotionality, as a general rule.
> >
> >
> Hello, After reading theses few posts, could it be that your dosages were too high? Norepinephrine is the happy chemical in our central nervous system. In excessive amounts symtoms occurring which are similar to those observed with tricyclic antidepressant usage seems reasonable. [carbo-craving, increased appetite, inevitable weight gain,and agitation as well].
> What dosages were you taking and how quick was the titration?
> Were additional Pychotropics involved?
> Are there similar references to this ill-effect at all doses documented elsewhere?
> Inquiry only. Thanks Micro

Hi Micro.

Yes, some people here have complained that the dosage guidelines put out by eli Lilly are wrong and that 40 mg, for example, works better for a lot of people than the official 'standard' adult dose of 80 mg.

I myself take 80 mg, and I don't feel that the med has made me more agitated or anxious. on the other hand, Strattera at any dose has done little for my anxiety. I am taking it for depression, and severe, inattentive ADD. I also take nortriptyline, 75 mg/day, which is similar to Strattera, except that it helps me sleep. They are both primarily noradrenergic meds.

Norepinephrine is activating, but more emotionally than physically stimulating. This is good for me, as my depression/ADD takes the form of a 'deactivated' feeling, resulting in apathy, lethargy, and terrible brain fog. It seems that NE is implicated in the therapy of more severe depressions.

Antidepressant choice to minimise treatment resistance
A. R. Fraser
Mood Disorders Service, Waitemata, Mental Health Services, Takapuna, New Zealand


Malhi & Farmer (1999) comment that in their clinical experience effective therapy for treatment-resistant depression necessitates enhancement of noradrenergic neurotransmission because of the effect this has on the typical symptoms of severe depression, which they speculate is more likely to lead to treatment resistance. It could seem from their letter that they advocate holding noradrenergic antidepressants in reserve for treatment-resistant depression. Such an interpretation would be unfortunate as it is probable that much of what is called treatment resistance results from the use of the wrong antidepressant. Roose et al (1994) showed a substantial superiority for nortriptyline over fluoxetine in patients with melancholia. Melancholia is linked to abnormal response to the dexamethasone suppression test (DST) (Carroll et al, 1981), and some studies have shown a preferential response to noradrenergic antidepressants in patients with an abnormal DST (Fraser, 1983; Kin et al, 1997). The failure of many other studies to replicate that finding is likely to be due to a closer link between DST non-suppression and weight loss or sleep disturbance, than melancholia (Mullen et al, 1986). Nevertheless, no study has shown an advantage for a serotonergic antidepressant over a noradrenergic antidepressant in patients with melancholia, psychosis, or DST non-suppression.

In recent years, psychiatrists have been exhorted to avoid the dangers of the older (especially tricyclic) antidepressants in favour of the safer selective serotonin reuptake inhibitors (SSRIs). Their greater safety arises from an absence of cardiotoxicity, a lack of cognitive slowing, and minimal effect on blood pressure. Preferential prescription of an SSRI is justified on the basis that there is no evidence that any antidepressant is consistently any more effective than any other antidepressant in double-blind controlled trials.

Although it has not been conclusively demonstrated that noradrenergic drugs are better than serotonergic drugs for severe or melancholic major depression, there is a definite possibility that they are. More importantly, there is no evidence that they are worse than serotonergic drugs. Clinicians should preferentially prescribe a noradrenergic antidepressant for melancholic depression. Those who do so are likely to experience a decreased frequency of treatment-resistant depression among their patients, just as I have over the past 18 years.


Carroll, B. J., Feinberg, M., Greden, J. F., et al (1981) A specific laboratory test for the diagnosis of melancholia. Archives of General Psychiatry, 38, 15-22.[Abstract]

Fraser, A. R. (1983) Choice of antidepressant based on the dexamethasone suppression test. American Journal of Psychiatry, 140, 7 86-787.

Kin, N. M., Nair, N. P., Amin, M., et al (1997) The dexamethasone suppression test and treatment outcome in elderly depressed patients participating in a placebo-controlled multicentre trial involving moclobemide and nortriptyline. Biological Psychiatry, 42, 9 25-931.

Malhi, G. S. & Farmer, A. E. (1999) Drug therapy in treatment-resistant depression (letter). British Journal of Psychiatry, 175, 390-391.

Mullen, P. E., Linsell, C. R. & Parker, D. (1986) Influence of sleep disruption and calorie restriction on biological markers for depression. Lancet, ii, 1051-1055.

Roose, S. P., Glassman, A. H., Attia, E., et al (1994) Comparative efficacy of selective serotonin reuptake inhibitors and tricyclics in the treatment of mania. American Journal of Psychiatry, 151, 1735-1739.[Abstract]




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