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All new menu! SSRI + Strattera (+ stim?)


nyota

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Hi smarties,

It's a long story, but recently I was NOT so smart and discontinued all AD & ADD meds. It's been almost 3 months and I'm still standing, but it's very clear to me that I do better with meds - what's not so clear is which medications. I know you folks can understand that one...

So, I had an appt with a new pdoc who wants to put me on an SSRI and either Strattera OR a stim. I'm fine giving that a try, but it sounds like many people do better on Strattera in combination with a stimulant, and since I've had OK results with stims in the past I would like her to keep that open as an option. I know the combo can work, but that idea doesn't seem to be on her radar. I want a little more info as to why the 2 together might be better than either one alone. I'll probably go with just Strattera + an SSRI (maybe Lexapro?) for now, but what can I tell my pdoc to strengthen my case for adding in a stim at some point. I'm concerned that just Strattera won't be enough of a kick in the pants for my special brand of sluggishness.

(From past experience, SSRIs tend to make me sleepy and lethargic. Wellbutrin kept me awake and feeling OK, but anxiety became a problem and it didn't do wonders for my depression, and almost nothing for ADD. Stims were sort of helpful for keeping me on track, but even they aren't especially activating, and I was still a scattered mess.

To complicate things, I am hoping to get pregnant at some point in the nearish future. The idea is to take an AD that I could continue on if I got pregnant, but to discontinue whatever else I'm taking at that point.)

Anyway, I think I'm rambling. I know there are plenty of you out there with impressive understanding of how all these chemicals try to interact. What are your thoughts on the advantages of Strattera plus a stimulant, and why?

I have another appointment with pdoc tomorrow and I'd like to go in with a clearer idea about what I want to do.

This is short notice, but I'd love any advice.

thanks!

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(From past experience, SSRIs tend to make me sleepy and lethargic. Wellbutrin kept me awake and feeling OK, but anxiety became a problem and it didn't do wonders for my depression, and almost nothing for ADD. Stims were sort of helpful for keeping me on track, but even they aren't especially activating, and I was still a scattered mess.

To complicate things, I am hoping to get pregnant at some point in the nearish future. The idea is to take an AD that I could continue on if I got pregnant, but to discontinue whatever else I'm taking at that point.)

Anyway, I think I'm rambling. I know there are plenty of you out there with impressive understanding of how all these chemicals try to interact. What are your thoughts on the advantages of Strattera plus a stimulant, and why?

Strattera, like Wellbutrin, is primarily a noradrenaline (NA) reuptake inhibitor. Once NA is released, either one can keep it in action longer than what for you would be normal. In addition, Wellbutrin inhibits dopamine reuptake to a limited degree, which takes some of the edge off of the NARI effects. Neither works very well if your nerves don't make or don't release much noradrenaline.

Enter the stimulants, which are very good at getting noradrenaline and dopamine released. Some increase serotonin release as well. Keeping the transmitters from reuptake is something they do not do so well, not counting the fact they are usually much shorter-lived medications.

The combination of an NARI + stimulant is almost always synergistic. On one end of the tub you're opening the faucet, we don't know how wide-open the drain (monoamine oxidase A) is, and you've punched a big hole in the bucket you bail with. The overflow could be messy.

One of the big deals with noradrenaline is that it's a major "fight or flight" neurotransmitter. That's ... not so great for anxiety levels. Or insomnia. But, it's also good for waking an ADDer's frontal lobes back up (which can promptly fire off a "go to sleep already" message)

On the depression front, if you respond to serotonin reuptake inhibiting meds and not to a NARI like Wellbutrin, Strattera is unlikely to help you. It can act as an antidepressant (for people who need higher NA levels to feel better) but that doesn't mean it does jack for serotonin.

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