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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 44. Go back in thread:
Posted by zeugma on June 7, 2004, at 17:57:50
In reply to Re: Would strattera treat depression and ADD?? » Chairman_MAO, posted by zeugma on June 6, 2004, at 19:47:57
whether I am going to stay on strattera for the rest of the summer and whether my pdoc is simply parroting Lilly propanganda (odious thought) are open questions, but I looked thru the clinical trials info on package insert and saw that "fatigue" was more common on qd dosing than on BID. so I took 40 mg at 6 am and took the second 40 around 4 pm. Fatigue was a little better. Hopefully this will carry over tomorrow too, because I have been so fatigued for the past 6 months that I have not wanted to socialize, to talk to anyone, to do anything other than my job and then to collapse... I see a stimulant in my future and I am exercising my brains out and drinking protein shakes to maintain enough weight to tolerate a stimulant, am joining a gym soon and hopefully this plan will work.
Posted by Ktemene on June 7, 2004, at 19:15:25
In reply to BID dosing is a little better, posted by zeugma on June 7, 2004, at 17:57:50
The level of fatigue you have had to deal with while on Strattera is really awful. I was wondering whether you and your pdoc had decided not to do a trial of Provigil? I am sure you have already considered all of this, but it might make sense to try Provigil while you are taking a fairly high dose of Strattera, since many people have found that the two drugs work synergistically together. And trying Provigil would not preclude adding a stimulant as well if Provigil was not enough to eliminate your fatigue (I am currently taking Strattera, Provigil and Adderall to deal with my sleepy-and-tired depression + ADD). By the by, I have also found BID dosing of Strattera to be much better; taking 80 mg at a time just knocked me out. I sometimes wonder whether it would not be better to divide Strattera into four or even eight daily doses instead of two daily doses, especially given Strattera’s extremely short half life. Also, what about Chairman_Mao’s suggestion of adding a little selegiline to your cocktail? Even very low dose selegiline is a very activating augmentation for some people (I mention this because I started taking 2.5 mg selegiline three days ago and I am amazed at how energizing it is) and at least one person on this board found low dose selegiline a great augmentation for social phobia (his name is Rick and his post on selegiline and social phobia is at http://www.dr-bob.org/babble/19991001/msgs/9618.html).
Your suggestion that anergic depression is really a manifestation of severe inattentive ADD is very interesting, and if true would certainly make sense of a lot of things. Do you know of any literature on the subject?
By the way, when your pdoc tells you that Strattera ‘gravitated’ to the PFC more than the TCA’s does your pdoc mention what the evidence is for this claim? Or does your pdoc just expect you to believe whatever your pdoc tells you on your pdoc’s own personal authority? If the latter, it might be worthwhile to look for a new pdoc who is more invested in evidence-based medicine.
Posted by Ktemene on June 7, 2004, at 19:37:08
In reply to Re: Would strattera treat depression and ADD??, posted by CareBear04 on June 3, 2004, at 23:07:40
> speaking of strattera, i've read a lot about strattera dosages and how the recommended adult dosage may be too high. does body size/weight matter in dosing? if i'm about 5'5 and 105lbs, would it be too much to start at 40mgs and work up to 80? how much do you think is a good amount of strattera? i'd be taking it for ADD symptoms.
> thanks, everyone!
>
Hi CareBear,I have seen a number of warnings about starting Strattera at high doses, but the only explanation I have seen is the one that Jarod over at crazymeds.org provides. It is under his article on Strattera and he says his source for it is his pdoc. Jarod feels very strongly that people should start Strattera at 18-25 mg and build slowly from there, and he seems to be a reliable guy. That said, I should mention that my pdoc started me off at 60 mg (I weigh 120lb) and I did not have any more than the usual difficulties when starting a medicine. But, as always, YMMD. Good luck with Strattera. It has certainly helped lots of people, and I hope it turns out to be a good med for you.
Ktemene
Posted by zeugma on June 7, 2004, at 20:24:31
In reply to Re: BID dosing is a little better » zeugma, posted by Ktemene on June 7, 2004, at 19:15:25
Yes, I'm considering Provigil and also more conventional stimulants. I am very confused at the moment. My pdoc came with a high recommendation, he is a specialist in attention deficit disorder, and he stuck with me as I went through a very difficult period titrating up on nortriptyline. Even at that time (more than a year and a half ago), he seemed to have this idea that Strattera and nortriptyline would 'go well together,' despite the fact that they have similar pharmacologies and standard practice is to minimize redundancies. Strattera does feel very different as it hits my brain, it is a drug with a much more rapid absorption and does not have the antihistaminic effect nortriptyline has. I was willing to go along with all this as long as the results were good. The Strattera fatigue did not hit me all at once. At first it was mildly stimulating, then it became neutral, then finally I became so fatigued that I became vulnerable to a relapse of depression. It was only when I become seriously depressed again that I questioned him strongly on the combination (I had asked questions before about the rationale but the situation was less urgent so I accepted half-answers). This differential effect on the PFC as opposed to the other areas of the brain innervated by the NET is something I would need substantiation for, because in the past two months I have been juggling my meds trying to find what was aggravating my already prominent fatigue: I determined that it wasn't the nortrip , then I dropped the buspirone, with little change, and now it can only be the Strattera. Since fatigue is part of inattentive ADD as far as I am concerned, I would only want to keep the Strattera if I had a good reason for doing so, and I am definitely keeping the nortriptyline, even going through the ceremony of another plasma level later in the month to determine whether I'm in the therapeutic window.
He did not produce evidence, but I am going to ask him for evidence at the next session. Even if my fatigue lifts a little as a result of the BID dosing schedule, I am still going to need a stim, and it seems like absurdity to be on two NRI's plus a stimulant (and God knows what that would do to my brain) provided there is no evidence of real difference between the two NRI's and one of them is worsening my anergia. He alluded to Strattera's possible superiority to desipramine and I would *really* like to see ANY evidence of that.
The theory of anergic depression being synonymous with a severe inattentive ADD is simply my own reflection on the course my own symptoms have taken. I had become steadily more disengaged, drained, and anergic over the years and this lack of energy appeared to be related to my inability to carry out any actions on my own due to my increasingly fractured ability to perceive {myself and what was around me). I'm not aware of any literature on the subject, but I can tell you that I consider severe ADD to be a disorder that stikes at the heart of the self and its ability to relate to itself ( a kind of self-disconnection). The anergia may stem from the enormous expenditure in energy it takes to carry out any coherent activity in such conditions.
That's great that selegeline is working for you. I am probably going to try Provigil first, if I stay on Strattera, or some kind of amphetamine if not. Your post has given me a lot to think about.
Posted by zeugma on June 9, 2004, at 0:07:47
In reply to Re: BID dosing is a little better » Ktemene, posted by zeugma on June 7, 2004, at 20:24:31
I am finished with this drug, which has driven my anergia to the breaking point. I took my last 40 mg this afternoon. Even the fog of inattentive ADD would be punctuated by flashes of light, glimmers of energy. I feel completely wiped out on this drug. It is giving me insomnia now to boot. Or it could be the extravagant amounts of coffee I am forced to drink in order to stay focused and awake at work- which means the Strattera is useless for my ADD anyway.I am going to tell my pdoc- whoever he or she turns out to be- that I am suffering from a severe anergic depression, no appetite, severe ADD issues. I have no idea what i'll wind up on.
Posted by Viridis on June 9, 2004, at 6:20:46
In reply to strattera trial ends, posted by zeugma on June 9, 2004, at 0:07:47
Interesting... Strattera seemed to help me at first with focus and depression, but it completely destroyed my appetite. I had no interest whatsoever in food, became extremely dehydrated as well, and (strangely) began slurring my words (suggestive of cerebellum damage). All of these side effects stopped within a few days of discontinuing it (except the speech difficulties, which took a bit longer to subside). I liked it at first, but the benefits quickly diminished while the side effects just got worse.
Scary drug for me, but maybe good for others? My pdoc wanted me off it immediately when I told him this (although he was amenable to a taper schedule if necessary), and I had no trouble at all with sudden discontinuation after about 6 months (max dose 80 mg).
Posted by zeugma on June 9, 2004, at 18:34:16
In reply to Re: strattera trial ends » zeugma, posted by Viridis on June 9, 2004, at 6:20:46
> Interesting... Strattera seemed to help me at first with focus and depression, but it completely destroyed my appetite. I had no interest whatsoever in food, became extremely dehydrated as well, and (strangely) began slurring my words (suggestive of cerebellum damage). All of these side effects stopped within a few days of discontinuing it (except the speech difficulties, which took a bit longer to subside). I liked it at first, but the benefits quickly diminished while the side effects just got worse.
>
> Scary drug for me, but maybe good for others? My pdoc wanted me off it immediately when I told him this (although he was amenable to a taper schedule if necessary), and I had no trouble at all with sudden discontinuation after about 6 months (max dose 80 mg).That's the reason you are seeing the same pdoc while I am not. He was not interested in the worsening of my condition, he only advised me to take it at 4 pm and bedtime. I decided on hearing this that he was no longer my pdoc, and I suffered from an episode of insomnia last night (after my 4 pm dose) that gave me the familiar Strattera combination of 'alerting' and fatigue. Luckily I had some buspirone on hand which I took around midnight, and I was able to get a few hours of sleep last night.
The word-slurring is a disturbing effect. This drug is not as well studied as the tried-and-true AD's and ADD meds (TCA's, amphetamine et al.) and the drug reps are pushing it hard. What made up my mind was his seeming willingness to get me off every other drug first to determine what was causing my excess fatigue (as an inattentive ADD'er and probable narcoleptic I have fatigue enough at baseline, thank you) and his eagerness to, for instance, discontinue the tricyclic nortriptyline (which has been off patent for about 2 decades), in contrast to his response to my discovery that, in his words, Strattera was the 'culprit': no dose reduction at all, just change the time of administration! As if my am dose didn't wipe me out for the whole day anyway.
I am glad to hear your side effects abated quickly and hope that mine do so as well. I only needed one cup of coffee to get me through the day, plus some Coke in the afternoon. Hopefully the fatigue will continue to diminish.
Posted by Viridis on June 10, 2004, at 0:26:52
In reply to Re: strattera trial ends » Viridis, posted by zeugma on June 9, 2004, at 18:34:16
Hi Zeugma,
It's disturbing to hear (so often) how much some doctors listen to the drug reps instead of the patients. I'm certainly not trying to "demonize" Strattera, and in fact posted endorsements of it here early on. It could well be a great medication for some people. But I have come across anecdotal reports of reactions similar to mine and yours on the web, and if someone reports a bad reaction a doctor should take it seriously.
I had a situation somewhat like yours, when I reacted very badly to Wellbutrin, and my GP asserted that the new antidepressants do not cause side effects, period. He told me that the anxiety, extreme dizziness, light sensitivity etc. that I experienced must be "my imagination". When I started with my current pdoc shortly afterwards, he said oh yes, he's heard this from other patients and is cautious with this med because everything I described is consistent with his experience (for a minority of patients).
I should add that I'm not usually drug-sensitive or hypochondriacal, but do know when a med is working or not.
I think that in any profession, there are a few really awful practitioners, lots of mediocre ones, and a small proportion of truly skilled individuals. I've seen this with doctors, dentists, plumbers, electricians, auto mechanics, etc. etc. You 're the one paying for the service, and if the pdoc or whatever is unsatisfactory, then it's time to move on (as you have). Many people simply stick with the same doctor because they think that these people have the ultimate authority. But they don't -- you do, even if you're not a medical expert. Patients come to know what works and what doesn't, yet so many stay with the same doctor, regardless of "fit" or competency. Some are just stuck, I guess, and others find it too difficult to change, even when they should.
Anyway, enough ranting -- you know all of this, so I'm just speaking in general terms. As for Strattera, it might be wonderful for some people, but as with all these meds, no one size fits all and especially with the newer ones some caution is warranted.
All the best,
Viridis
Posted by Ktemene on June 10, 2004, at 0:36:15
In reply to strattera trial ends, posted by zeugma on June 9, 2004, at 0:07:47
The fact that you only needed a single cup of coffee and soft drink to get through the day is a strong indication that you did the right thing in stopping the Strattera. I know what you mean when you say that Strattera gives you a combination of ‘alerting’ and fatigue. When I take Strattera in the daytime I have just that feeling- it is as if I am really very tired but a layer of stimulation is lying just on top of the still clearly perceptible fatigue/somnolence. I have tried taking it at night to take advantage of its sleep-inducing properties, but it tends to disturb my sleep. It is a strange drug. Your experience is tempting me to try dropping Strattera altogether to see how I do on just Provigil and Adderall (and very low dose Selegiline if it continues to work well). I take it you are still using Nortriptyline? And it won’t be too difficult to find another pdoc? With a new pdoc at least you won’t have to worry about countering your former pdoc’s inordinate fondness for Strattera and you won’t have to listen to any unsupported claims that TCA’s work in the brainstem while Strattera works in the frontal lobes etc.
Another positive aspect of the situation is that you have been thinking through a lot of possible alternative meds, and, now that it is summer, you will be able to experiment without endangering your effectiveness in teaching your classes. By the way, I really like your idea about severe inattentive ADD and anergic depression being the same condition. I think you mentioned that one of your areas in philosophy is philosophy of mind. Your idea might make a very interesting and original addition to the philosophical literature. I have always wondered why so few philosophers write about the philosophical implications of depression, especially since so many philosophers suffer from depression.
I hope your withdrawal from Strattera continues to be smooth. Let us know how you are doing.
Posted by zeugma on June 10, 2004, at 20:17:07
In reply to Re: strattera trial ends » zeugma, posted by Ktemene on June 10, 2004, at 0:36:15
Thanks for the responses, Viridis and Ktemene.
I only needed about two and a half cups of coffee today- a fraction of my prior intake, and despite some more insomnia. I made a pot of coffee when i came home, mostly to keep up my focus as I installed my air conditioner. But I found that it made me somewhat nauseous, and that I didn't really need it.
I called my pdoc's office to tell his secretary I was cancelling my next appointment. When she learned I didn't want to reschedule she told me she'd have the dr. call me back. I agreed to this although I was worried he'd convince me to continue with him.
He called back and I told him I'd discontinued the strattera. His first question was whether I had enough meds on hand, especially clonazepam, as that has a serious discontinuation syndrome. He asked me what my plans were to treat my ADD. I told him I planned to try a stimulant, and he advised me to try a short-acting one, as my last stim trial was of a long-acting one (Cylert) and I was forced to discontinue because of weight loss. Ok, this was reasonable, he asked me if I would continue with him and I told him I would get back to him after a week but that I was doubtful. I thanked him for his concern and advice. I could comment more on this, both positively and negatively, but that's all I want to say right now about it.
About the nortriptyline: Yes, I am continuing with it. It has some similarities to strattera in that I recognize an 'alerting' feeling when it hits (much more slowly than Strat) but this is accompanied by, and almost completely muted by, a drowsiness that is clearly antihistaminic. These feelings are faint at 50 mg, unmistakable at 75 mg. By morning there is nothing but usual morning grogginess. It improves the quality of my sleep, especially when combined with buspirone, for some reason.
My plan this summer is to get on a TCA-stimulant combination (plus 1 mg clonazepam, and possibly regular use of 15 mg buspirone at night). It sounds like this pdoc is amenable, and he seemed to acknowledge his mistake. The whole experience is sobering, and as my emotions cool as the Strattera effects subside further I am going to weigh the whole matter carefully.
I have heard a lot about the synergism of Provigil and Strattera, but how much of that is simply provigil's countering the strattera fatigue? That is simply a thought I have had when I considered adding Provigil to strattera myself.
Why don't more philosophers write about the philosophical implications of depression? Maybe because they're too depressed to publish the results of their speculations- or too depressed to write at all.
Posted by zeugma on June 11, 2004, at 15:00:40
In reply to more strattera thoughts, pdoc called, posted by zeugma on June 10, 2004, at 20:17:07
I think I will be starting a stimulant trial as soon as possible.
Posted by Ktemene on June 13, 2004, at 4:26:32
In reply to Re: more strattera thoughts, pdoc called, posted by zeugma on June 11, 2004, at 15:00:40
It's good that your pdoc admitted being wrong about you and Strattera. What stimulant are you thinking of trying? Are you having any problems going off Strattera? I hope you're continuing to do OK.
Posted by zeugma on June 13, 2004, at 10:57:38
In reply to Re: more strattera thoughts, pdoc called » zeugma, posted by Ktemene on June 13, 2004, at 4:26:32
> It's good that your pdoc admitted being wrong about you and Strattera. What stimulant are you thinking of trying? Are you having any problems going off Strattera? I hope you're continuing to do OK.>
Thank you for the concern. My pdoc (yes, still the same one, I will see how much he can help me now that the strattera is not an issue) suggested a short-acting one: am I correct in supposing that plain old Ritalin is the shortest-acting one? What about d-amphetamine? Does Adderall come in an immediate release as well as XR version? I need something that will help with physical energy as well as mental focus, but that will wear off quickly enough so i can sleep (still experiencing some insomnia). I would appreciate any suggestions.
I am continuing to do OK. I was able to do my laundry this week and to go to the supermarket this weekend, which shows that I am getting some energy back.
I still feel disillusioned over medications. Strattera was supposed to be a wonder drug, and it seemed to be for me at first. I remember wondering at the time if Strattera would make the TCA's obsolescent. The stims have been around forever, they are not miracles, but if they can treat aspects of my disorder, that is all i am looking for. I may start on a stimulant as early as tomorrow. Any advice would be greatly appreciated.
Posted by Viridis on June 14, 2004, at 1:44:41
In reply to stimulants » Ktemene, posted by zeugma on June 13, 2004, at 10:57:38
I do well with Adderall (for ADD, but it also acts as an antidepressant). I take a pretty low dose (5-15 mg/day) and haven't had any problems with it. I've been taking it for a few years and can still skip it for a day or two without any withdrawal etc. I take the immediate-release generic made by Barr Labs, and haven't tried the XR version. For me at least, there's no "crash" of the kind that people describe for some stimulants, and it doesn't interfere with my sleep.
Good luck!
Posted by Ktemene on June 14, 2004, at 4:24:20
In reply to Re: more strattera thoughts, pdoc called, posted by zeugma on June 11, 2004, at 15:00:40
I agree with Viridis about Adderall; I had very much the same experience. I also take immediate release Adderall. My pdoc prescribes 20mg per day, but I often take only 10 mg. I have never experienced any sort of crash as the Adderall wears off, and I have never experienced any sort of euphoria when I first take it, although the energizing effect does feel like an antidepressant effect to me since my depression is of the extremely sleepy sort. Also, I have never had the impulse to take more than the prescribed dose. In fact, after I first started taking Adderall I asked my pdoc why Adderall was considered to have so much potential for addiction, since it struck me as having about as much addictive appeal as aspirin. And my pdoc told me that my response to Adderall was typical of people with ADD, for whom the medication's main effect was a distinctly noneuphoric calm-but-alert feeling. The energizing effect kicks in within a half an hour or so, and lasts several hours. (Although I should say that I always take my morning dose of Adderall with 200 mg Provigil and 200 mg caffeine, so I am not really sure which kicks in first.)
The other prescription stimulant I have been taking for some time is Provigil. As you know, Provigil really is a medication for narcolepsy, although it is widely used off-label for depression and ADD. This might be a point in its favor for someone like you who has a lot of narcolepsy symptoms. The best aspect of Provigil for me is that I can take it late at night and still get to sleep when I want to. Provigil takes away the need to sleep without taking away the ability to sleep. Provigil helped me a lot, but not quite enough, which is why my pdoc added Adderall to my cocktail.
It is a shame that Strattera was such a disappointment in your case after it appeared to be so promising. Strattera was not as disastrously soporific for me as it was for you, but it has certainly not been what I hoped for. Reboxetine might have worked better, but I gather that it will be a long while before Americans will be able to try it.
Good luck in finding the right stim!
Posted by zeugma on June 14, 2004, at 18:04:09
In reply to Re: more strattera thoughts, pdoc called » zeugma, posted by Ktemene on June 14, 2004, at 4:24:20
I got a prescription for provigil and am starting at a low dose tomorrow. As you say i have a lot of narcolepsy symptoms and I think that was a deciding factor in my pdoc's decision to to try that first.
A week off Strattera and my mind is noticeably 'looser,' freer, which is both good and bad obviously. I don't feel on edge constantly like I did with Strattera, noticing every little thing while feeling that awful fatigue, but I am now conscious of the fact that I'm poorer at perceiving detail. My pdoc said that provigil was relatively similar in effect to Cylert, which didn't have the alerting properties of Strattera, but which gave me a little more energy and I think I functioned better for the brief period i was on it. The Cylert was monotherapy while I am taking nortriptyine now which should moderate any weight loss from Provigil. Plus, notriptyline does have some pro-attentional effect, so the Provigil will have some 'help'so to speak.
At least the combination of nortriptyline and Provigil makes more sense to me. In case provigil doesn't work my pdoc indicated that Ritalin will be the next course of action. I hope to find the right treatment soon, since I need to have a productive summer (as well as a life), and I hate taking meds only to feel like the life is being drained out of me. Thanks for all the support.
Posted by Cairo on June 15, 2004, at 7:43:42
In reply to Re: strattera trial ends » zeugma, posted by Viridis on June 9, 2004, at 6:20:46
An 8 week trial of Strattera for ADHD induced melancholic symptoms in our teenage daughter which abated upon withdrawal of it. What could possible be the mechanism for this? She has dysthymia, ADHD, anxiety/social phobia, and Fibromyalgia with atypical features. Thoughts/conjectures?
Cairo
Posted by TJO on June 16, 2004, at 16:47:03
In reply to Re: Mechanism for Strattera CAUSING depression?, posted by Cairo on June 15, 2004, at 7:43:42
> An 8 week trial of Strattera for ADHD induced melancholic symptoms in our teenage daughter which abated upon withdrawal of it. What could possible be the mechanism for this? She has dysthymia, ADHD, anxiety/social phobia, and Fibromyalgia with atypical features. Thoughts/conjectures?
Hi.Reboxetine, also a NE reuptake inhibitor, made my depression dramatically worse and produced anxiety. As far as trying to explain why this happened, I haven't got a clue. I'm not sure there are many neuroscientists who would. The brain is still a black box to a great degree, and it is difficult to derive the causes and effects for many psychotropic phenomena with certainty without a fuller understanding of the physiology of the brain and the properties of the drugs used to alter its function. Our scientists have much work yet to do. (I wish they would hurry up!)
Out of curiosity, how would you use the information were it available?
Wellbutrin (perhaps combined with Effexor) might be a good drug strategy to look into for treating the conditions you describe. Parnate might be another option.
Good luck.
- Scott
Posted by SLS on June 16, 2004, at 17:06:45
In reply to Re: Mechanism for Strattera CAUSING depression?, posted by TJO on June 16, 2004, at 16:47:03
I'm sorry. The previous post was from me. I sometimes use the computer of TJO, and I forget to change the posting name.
- Scott (SLS)
Posted by zeugma on June 16, 2004, at 20:07:21
In reply to Re: Mechanism for Strattera CAUSING depression?, posted by TJO on June 16, 2004, at 16:47:03
One of the few clues we had was that NE reuptake inhibitors were THERAPEUTIC for melancholic depression, so it's ironic that while non-selective NE reuptake inhibitors (TCA's) have real efficacy for this disorder, selective ones like reboxetine and Strattera can worsen or induce such symptoms. Not only is it a black box, it's a black box whose output hardly seems to be amenable to conjecture yet.
I doubt scientists are going to make any real progress with psychotropics except by accident. I mean that for the foreseeable future (the next hundred years or so).
Posted by zeugma on June 16, 2004, at 20:19:52
In reply to Provigil, posted by zeugma on June 14, 2004, at 18:04:09
two days on Provigil, and it seems vaguely similar to the other stimulants I've taken in the past, i.e. slightly calming, no real energizing effect yet, but I've minimized my caffeine intake to an absolute low. I am not pinning all my hopes on this med. 50 mg is too low a dose and I have no idea how long it takes Provigil to exert its therapeutic effect. From all my research it seems scientists have no clue how this drug works. I can only hope, then, that they stumbled on something valuable. Where Strattera immediately made me alert, even at 18 mg, this one is calming. So maybe I am having the classic ADD response to a stimulant. My pdoc seems to want to give this one about two weeks, then it's on to Ritalin, so I gather it's not like an AD in its delayed therapeutic effect. I'll probably have a clearer picture after I go to 100 mg on Monday.
Posted by rod on June 17, 2004, at 5:29:10
In reply to Re: Mechanism for Strattera CAUSING depression?, posted by Cairo on June 15, 2004, at 7:43:42
I definetly dont know, but one thing comes into my mind.
There are receptors called hetero-receptors which are noradrenergic receptors located on serotonergic nerve firbres (they also exist for other neurotransmitters), without noradrenergic nerve ending present. They seem to rely on the NE floating through our brain. When they get activated by NE, they "turn off" the serotonin nerve.
So, if a drug produces more NE to float around the brain, it "slows down" our Serotonin system. But this does not really explain why some NE reuptake inhibitors cause melancholia and some work against it. But I think this can be one possible explanation. And I am sure other, yet unkown pathways and/or even undiscovered neurotransmitters play a role in this.Roland
Posted by SLS on June 17, 2004, at 6:02:34
In reply to Re: Mechanism for Strattera CAUSING depression?, posted by rod on June 17, 2004, at 5:29:10
> I definetly dont know, but one thing comes into my mind.
> There are receptors called hetero-receptors which are noradrenergic receptors located on serotonergic nerve firbres (they also exist for other neurotransmitters), without noradrenergic nerve ending present. They seem to rely on the NE floating through our brain. When they get activated by NE, they "turn off" the serotonin nerve.
> So, if a drug produces more NE to float around the brain, it "slows down" our Serotonin system. But this does not really explain why some NE reuptake inhibitors cause melancholia and some work against it. But I think this can be one possible explanation. And I am sure other, yet unkown pathways and/or even undiscovered neurotransmitters play a role in this.Smart!
:-)
Good work, Roland.
- Scott
Posted by Dave001 on June 20, 2004, at 21:11:00
In reply to Re: Mechanism for Strattera CAUSING depression?, posted by TJO on June 16, 2004, at 16:47:03
> > An 8 week trial of Strattera for ADHD induced melancholic symptoms in our teenage daughter which abated upon withdrawal of it. What could possible be the mechanism for this? She has dysthymia, ADHD, anxiety/social phobia, and Fibromyalgia with atypical features. Thoughts/conjectures?
>
>
> Hi.
>
> Reboxetine, also a NE reuptake inhibitor, made my depression dramatically worse and produced anxiety. As far as trying to explain why this happened, I haven't got a clue. I'm not sure there are many neuroscientists who would. The brain is still a black box to a great degree, and it is difficult to derive the causes and effects for many psychotropic phenomena with certainty without a fuller understanding of the physiology of the brain and the properties of the drugs used to alter its function. Our scientists have much work yet to do. (I wish they would hurry up!)
>I agree with this response.
Dave
> - Scott
Posted by WAKI on July 24, 2004, at 6:49:34
In reply to Re: Mechanism for Strattera CAUSING depression?, posted by SLS on June 17, 2004, at 6:02:34
Hi,
I am involved with a Federal Grant for a university. The grant compares solving depression with meds symtomatically then to figure a way to ween you off meds and solve the problem another natural method.
Welbutrin has been the only drug that has solved my depression fatigue.
I have been on Strattera 40 mg for 2 weeks and 80 mg for 4 weeks to work on ADHD.
The Welbutrin gives me adrenlene and hypes me up. Concerta or Welbutrin does not help my ADHD, it makes it worse.
I notice all side effects of Strattera have subsided. I also notice i am not as much hyped up. I sleep (much much mucho much!)better at night when I take the Strattera.
I wonder if they are balancing each other out?
I also wonder if the Strattera is not helping the ADHD because the Welbutrin is antognizing it?
I'm thinking of tapering off the Welbutrin to see if the Strattera is helping the ADHD....
I'm also wondering if I will be tired and fatigued on Strattera. If I recall Welbutrin and Strattera reuptakes norepinephrine.
Wellbutrin reuptakes norepinephrine and dopamine.
I guess my point is what does norepinephrine do alone and what does dopamine do alone? If I recall my p-doctor said norepinephrine generates adrenelene or simulates it.
On Welbutrin I am able to get my heart rate much higher when I excercise which means I am not as fatigued.
My p-doctor is going to lower Welbutrin and assess the effect. Raise my Strattera which will be interesting.
I hope this corrects fo my ADHD.
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