Tags
ADD, dopamine, epinephrine, medications, meds, norepinephrine, science, side effects, strattera, Wellbutrin
I’m trying to give Strattera a chance. Really, I am. I realize that it might take up to 6 weeks to actually do anything for me, which is completely unacceptable given the immediate efficacy of stimulants. But I’m trying. Now I know why a lot of people don’t wait out that 2 months to get to effectiveness on Strattera. It’s the side effects, and the fact that it does nothing for the ADD in the meantime while it makes you feel awful. Supposedly the side effects fade away after awhile, but we’ll see…
To better figure out why the side effects I’m noticing are so nasty for this drug compared to Adderall, I’ve been digging around to try to understand more about the related neurochemistry. So here’s an inexpert synthesis of what I can find online that’s comprehensible to me. Warning: it gets a bit thick and complicated, but this is what I can make of the information I could understand.
Strattera is a selective norepinephrine reuptake inhibitor, and I already take a norepinephrine-dopamine reuptake inhibitor (NDRI – Wellbutrin/bupropion). Dopamine, epinephrine (adrenaline), and norepinephrine (noradrenalin) are all adrenergic receptors (a class called catecholamines), but dopamine acts on different receptors than the other two.
Epinephrine is naturally produced from norepinephrine. I don’t react to epinephrine very well, which I know because I can’t tolerate dental anesthetics (lidocaine) that include epinephrine to reduce bleeding. They give me an instant panic attack. Why? Both epinephrine and norepinephrine are fight-or-flight hormones, and basically stress responses. I just seem to be extra sensitive to the adrenaline and sometimes have a strong shock response even from relatively mild stressors.
Both epinephrine and norepinephrine have similar physiological effects, such as raising heart rate – so it’s also a good thing I have normal-to-low blood pressure. Norepinephrine is the psychoactive chemical of these two. Generally speaking, the neurological response to increased norepinephrine levels are supposed to include greater attention and focus, which is an important part of fight-or-flight, and obviously the part that would improve ADD.
Some people are hypersensitive to norepinephrine, and experience high blood pressure, anxiety and fear, panic attacks, sensitivity to light and sound, and feelings of unreality. Hypersecretion of epinephrine and norepinephrine can lead to hypertension, hyperglycemia, nervousness, sweating, and eventually to complete adrenal exhaustion, which I’ve experienced previously due to prolonged high stress.
Of the adrenergic receptors, two are influenced by norepinephrine, which acts as an agonist in both cases: Alpha-1 and Beta-1, but the latter primarily affects the non-neural systems (blood pressure and and glucose release). Antagonists to Alpha-1 include several antidepressants, the old-school MAOIs. Logically, that would suggest that an Alpha-1 agonist might have a negative effects on monoamine oxidase levels, which could have a depressant effect. This could be why there’s a suicide risk warning for kids with Strattera – just a guess, though.
The effects of Alpha-1 agonists are: loss of appetite, increased sweat production, increased blood pressure, iris dilation (light sensitivity), the contraction of the ureter, urethral sphincter, and seminal muscles (difficulty with peeing and ejaculation), and also relaxation of the erectile tissue blood vessels (sexual dysfunction in both sexes.) These are all known side effects of Strattera. They are listed as uncommon, but they are the responses that your body would have if the norepinephrine levels are too high.
Since I started Strattera, the main side effects that I’ve noticed are headaches and excessive sweating, just like with Wellbutrin dosage increases. So I’m betting that’s where some of the side effects from Wellbutrin come from – it must be the norepinephrine, because I’ve never noticed any side effects from amphetamines, which affect dopamine levels more than norepinephrine. I’ve been excessively tired, even after a good night’s sleep. That’s a pretty common side effect (reported at 20%) and my sleep has been “disturbed” too. I’m conscious of waking up a lot more often but not necessarily moving around, so it doesn’t show up in any of my sleep tracking tools. Freakier yet, I’ve been experiencing intermittent vertigo that feels like being mildly drunk, which makes me a little concerned about driving.
My mood also took a precipitous drop right after starting Strattera, which hasn’t really improved much. It was a little better yesterday, but that mood shift was at the introductory dose of 25mg; I start 40mg today and am supposed to go up to 80mg over the next few weeks. The gradual increase is meant to reduce side effects, but if this is how I feel at a low dose, I’m a little terrified of what a higher dose will do to me.
Stress definitely triggers mood swings, typically depression for me, and this drug triggers a stress response, which is worrisome. There’s no indication that the Strattera precipitates mood swings by itself, but if it induces a strong enough stress response, that might do it. The side effects themselves and the lack of effective ADD management are also distressing, making this all worse. I don’t have much choice but to wait and see, but I’m not at all happy with the way Strattera is affecting me so far. I’m not sure at what point to pull the plug on this experiment due to side effects, but I guess I’ll know it when I get there.
I’m sorry you are having such a hard time with Straterra. I tried it once (even though I haven’t been diagnosed ADD) and it helped me, but probably at the time I need an anti-depressant instead. Thanks for all the great info. Good luck with it. I hope it works, or that you can find a doctor who will prescribe the stimulants for you.
I’m doing a bit better so far on the stepped-up dose, so I’m hopeful that it may improve and potentially prove helpful. But I’m not holding my breath – the stimulants were so effective that it’s hard to believe that this will come anywhere close!
Pingback: A Good Session « Disorderly Chickadee
I have to tell you I had an awful experience with stratera. I am diagnosed ADD and am also bipolar with other things too. I ws told to stick it out as well and that the side effects would go away. For me they never did. I had completely lost my personality, I went from 130lbs to 107lbs in the short time I was on it. All of my co workers thought I was using drugs. At this time I was not even being treated for bipolar. Unfortunately I also have bad anxiety and panic attacks so I can not take adderall. I really hope you have a better experience than I did. I say stick with what works. The doctor should have no reason to deny you this. Good Luck, please dont let it go to far. If you feel your personality changing, just get off of them.
There’s a post going up today about how Strattera has (not) worked out! No personality changes or weight loss, but about 10 other side effects that got unbearable.
Pingback: Screw Strattera « Disorderly Chickadee
Thanks for writing about your experience. My psychiatrist put me on Straterra for adult ADD, and while it did help (more focused, less indecisive), the side effects were just too much. Nausea, muscle weakness, dizziness, headache, and a pounding in the back of my neck EVERY with even the SMALLEST of stressors: hearing a siren or being 90 seconds late to a meeting, or, you get the idea. I hung in there for two weeks and then called my psych and said I was discontinuing. I’ve had brain zaps for the past four days, ugh, I hope they stop soon, but it’s far better than the side effects of the medication itself. I do feel less focused, but the brief glimpse of what is “normal” behavior for most people gives me something to work for. I’ll just do try to get there without medication.
Pingback: A Pictorial History of My Bipolar Meds « A Canvas Of The Minds
Pingback: Search Query Fun Times « Disorderly Chickadee