Strattera (atomoxetine)

[Marky90]

I haven't heard of anyone taking it for POTS. But if you aren't getting a narrow pulse pressure, then I'm not sure how much it'll help. And high BP might be a side effect (which is one reason I take it).

Tramadol affects serotonin levels, which is something a lot of us react badly too (though some find it very helpful). Ritalin affects dopamine and norepinephrine, whereas strattera is much more focused on just norepinephrine.

I'm strongly in favor of getting neurotransmitters tested to see where the deficiencies are. Then you have a really good idea of where to start.


I get PEM, and it hasn't changed at all since starting Strattera.

I have some kind of POTS with increased blood pressure when standing, could this help for me?

 

[Valentijn]

I have some kind of POTS with increased blood pressure when standing, could this help for me?

I'm not sure if that would be a good idea - definitely discuss it with your doctor before trying it. Strattera can have the effect of raising pulse pressure or blood pressure further, so that might be pretty nasty if blood pressure is already normal or high.

 

[Hip]

I guess I've been on Strattera about 4 months so far, and it's still working great. The only change I've made is to add an extra dose per day, so now I take 10mg at 7-8am, noon-1pm, and 4:30-5pm. So 3 doses of 10mg per day, each about 5 hours apart. Then I'm up and mentally alert literally all day, which is great.

Valentijn, can I ask: is Strattera still working for you, in terms of mental alertness?

I am thinking of trying this drug to see if it can improve my mental focus and concentration (and improve the bad ADHD symptoms that I developed after being hit with viral meningitis).

Around a year ago, I had an incredibly good experience with Wellbutrin (bupropion), which as you know is a NRI / NDRI drug (though I understand that Wellbutrin is mostly an NRI, as its dopamine reuptake inhibition is very weak).

Wellbutrin worked so well for me that I thought I had found my personal ME/CFS remission treatment. My brain fog was almost entirely banished while taking Wellbutrin (see here).

However, exactly two weeks after I began taking Wellbutrin, it's benefits just completely disappeared. And I have never been able to get this drug to work for me again, even after a long washout period of not taking it. If you look online, some people describe a "Wellbutrin honeymoon", which is where you get two fantastic weeks initially from this drug, followed by a complete loss of efficacy. That is exactly what I had.

Anyway, since Wellbutrin is primarily an NRI drug, I thought I might try some other NRIs to see if these work for me, and was very interested to read your account of the improved mental alertness from the NRI Strattera.

I am just hoping that if Strattera does work for me, it won't suddenly stop working two weeks later like Wellbutrin did.

I did the math on what Strattera is costing per milligram. At the 40mg dose you get 4.53 milligrams per dollar. At the 18mg dose you get 2.25 milligrams per dollar. So the 18mg dose really does cost twice as much

Here Strattera costs less (22 mg per dollar).

My threshold for PEM is still ridiculously low, and it chafes at me more now that I can stand up and think clearly enough. Half the problem is gone, and it annoys me immensely that the other half of the problem is still there and preventing me from fully benefiting from getting the other half solved! I have to focus on the gains I've made in what I can do, rather than what I still can't do.

Have you seen this thread about various supplements which people have found improve / eliminate crashing and PEM. You might consider experimenting with some of these "PEM Busters", if PEM is the major outstanding problem you need to solve in your ME/CFS. Branched chain amino acids and sodium bicarbonate look particularly interesting.

 

[Valentijn]

Valentijn, can I ask: is Strattera still working for you, in terms of mental alertness?

I switched to Yohimbe, since it's so much cheaper. But I have used Strattera intermittently, when running out of Yohimbe and during OI flares, and it still seemed to be working as normal. I didn't notice any diminishing of its effects when I was on it - I think I took it for about a year.

 

[Hip]

I switched to Yohimbe, since it's so much cheaper. But I have used Strattera intermittently, when running out of Yohimbe and during OI flares, and it still seemed to be working as normal. I didn't notice any diminishing of its effects when I was on it - I think I took it for about a year.

I looked at yohimbine a while ago, but read that it can simulate ADHD when injected into the prefrontal cortex of monkeys:

Infusion of the alpha-2 antagonist, yohimbine, directly into the prefrontal cortex of the monkey recreates all the cardinal symptoms of ADHD: it markedly weakens impulse control, impairs working memory needed to overcome distractors, and induces a profile of locomotor hyperactivity.

Source: here.

So this made me think that yohimbine might worsen my ADHD. Alpha-2 agonists are sometimes used to treat ADHD, but yohimbine is an alpha-2 antagonist (though this alpha-2 antagonism helps orthostatic hypotension, according to this study).

 

[Valentijn]

So this made me think that yohimbine might worsen my ADHD. Alpha-2 agonists are sometimes used to treat ADHD, but yohimbine is an alpha-2 antagonist (though this alpha-2 antagonism helps orthostatic hypotension, according to this study).

I haven't had any problems with it. But I don't have ADHD, I take a small dose, and I don't inject it into my brain My reason for trying it was due to some research showing ADRA2A to be upregulated in ME patients following exertion, plus the connection between hypotension, ADRA2A, and norepinephrine.

 

[Dufresne]

I switched from Strattera to reboxetine for BP issues as the former was costing me over 5$ a pill, while the latter is a fraction of that when purchased online.

@Hip, the improved focus doesn't really last for any of the NRI's I've tried. You build up a tolerance to them. However if you need to be sharp for an afternoon or whatever, simply double the dose and you get the cognitive boost again. I do this from time to time, or throw some methylphenidate on top.

Unfortunately Strattera and reboxetine can negatively impact one's sexual performance. This is minimal for me at a quarter tablet (1mg) of reboxetine, however I'm considering yohimbine for BP purposes because, as I recall, this actually has the opposite effect on sexual function.

 

[Hip]

@Hip, the improved focus doesn't really last for any of the NRI's I've tried. You build up a tolerance to them. However if you need to be sharp for an afternoon or whatever, simply double the dose and you get the cognitive boost again. I do this from time to time, or throw some methylphenidate on top.

Did you find that the tolerance slowly disappears if you don't take the NRI drugs for some time (say stopping them for weeks or months)?

I had fabulously good effects from Wellbutrin (described above) when I first started this drug, but these effects vanished after just two weeks of being on Wellbutrin. I assumed it was just a tolerance build-up, and so stopped taking Wellbutrin for two months, in order to let my brain receptors reset themselves back to normal, and clear the tolerance.

However, even after this two month washout period, when I restarted Wellbutrin, it had no effect on me at all, providing no benefits or cognitive boost.

This I find very hard to understand, because it seems there is more than just tolerance build-up going on here. Tolerance to drugs tends to be reversible on drug discontinuation. But the tolerance I developed to Wellbutrin seems permanent, because now this drug no longer works for me at all.

So after taking Wellbutrin for a very short time of two weeks, something permanently changed in my brain which made Wellbutrin completely ineffectual thereafter.

I am just hoping this will not happen to me when I take Strattera.

 

[Sushi]

I am just hoping this will not happen to me when I take Strattera.

I never developed tolerance or any loss of the effectiveness of strattera. But then I was taking it for OI.

 

[Dufresne]

Did you find that the tolerance slowly disappears if you don't take the NRI drugs for some time (say stopping them for weeks or months)?

Your experience with Wellbutrin is not so uncommon for psychotropics. I know many people who've gone off their antidepressants only to discover that when they go back on, the drugs don't work the same.

My standard dose of reboxetine is 1mg in the morning and this is strictly for BP issues. If I take an extra mg on top of this I get nicely charged; an extra two or three and I feel like going to a rave. I've not developed any of the weird resistance you describe with it or Strattera. Any tolerance from a larger dose is gone a week or so later.

 

[ebethc]

I never developed tolerance or any loss of the effectiveness of strattera. But then I was taking it for OI.

Hi @Sushi

has Strattera helped w Brain Fog?
how long have you been taking it?

 

[Sushi]

Hi @Sushi
has Strattera helped w Brain Fog?
how long have you been taking it?

I stopped taking it years ago because my OI improved so much and I don't like to take extra medications, particularly expensive ones! I don't remember the effect on brain fog as is was so long ago.

Sushi

 

[Ninan]

I have adrenal fatigue and problems with OI. Yohimbe works but just partly, and I'm thinking of trying Strattera.

But I wonder: Are they bad for adrenal fatigue? I read Strattera inhibits the reuptake of norepinephrine in the brain, not that it makes the adrenals produce more. But some sites claim Strattera is bad and worsens adrenal burnout. Anyone here who knows?

 

[Valentijn]

Are they bad for adrenal fatigue? I read Strattera inhibits the reuptake of norepinephrine in the brain, not that it makes the adrenals produce more. But some sites claim Strattera is bad and worsens adrenal burnout.

As far as I know, as an NRI it just uses/reuses existing norepinephrine more effectively. It shouldn't increase production, so "adrenal burnout" seems unlikely. What's the source for burnout claims?

Also, I had no problems while I was on it. Not sure how long, but I think it was over a year.

 

[Ninan]

As far as I know, as an NRI it just uses/reuses existing norepinephrine more effectively. It shouldn't increase production, so "adrenal burnout" seems unlikely. What's the source for burnout claims?

Also, I had no problems while I was on it. Not sure how long, but I think it was over a year.

Thanks Valentijn. My source is a not very knowledgable friend and reading Google headlines quickly. Pretty crashed... So you're probably right. Good!

 

[Ninan]

As far as I know, as an NRI it just uses/reuses existing norepinephrine more effectively. It shouldn't increase production, so "adrenal burnout" seems unlikely. What's the source for burnout claims?

Also, I had no problems while I was on it. Not sure how long, but I think it was over a year.

Is Yohimbe the same? Or does it stimulate production?

 

[Valentijn]

Is Yohimbe the same? Or does it stimulate production?

In small doses it's an antagonist (blocker) of the adrenergic alpha 2 receptors. But it "facilitates the release" of norepinephrine, which helps with vasoconstriction.

The alpha 2 receptors usually inhibit the release of norepinephrine, and there's been a couple studies by the Lights showing increased expression of alpha 2 receptors after exertion in ME patients. It sounds like those receptors bind the norephinphrine, so Alpha 2 antagonist prevents it from hoarding the norepinephrine, and allows it to be used more elsewhere?

I've been on it for 2-3 years with no problems. It still helps at exactly the same dose that I found helpful at the start.

 

[adreno]

It sounds like those receptors bind the norephinphrine, so Alpha 2 antagonist prevents it from hoarding the norepinephrine, and allows it to be used more elsewhere?

Presynaptic alpha-2 are auto-receptors, which turn down NE release when activated. Blocking them removes the brakes on NE. Since postsynaptic alpha-2 are also blocked, it's mainly alpha-1 that will get activated when more NE is released. Interestingly, alpha-1 agonists are often prescribed for OI.

 

[Ninan]

In small doses it's an antagonist (blocker) of the adrenergic alpha 2 receptors. But it "facilitates the release" of norepinephrine, which helps with vasoconstriction.

The alpha 2 receptors usually inhibit the release of norepinephrine, and there's been a couple studies by the Lights showing increased expression of alpha 2 receptors after exertion in ME patients. It sounds like those receptors bind the norephinphrine, so Alpha 2 antagonist prevents it from hoarding the norepinephrine, and allows it to be used more elsewhere?

I've been on it for 2-3 years with no problems. It still helps at exactly the same dose that I found helpful at the start.

What dose of yohimbe do you use? Once ore twice a day?

 

[Ninan]

I read at the Swedish Wikipedia that norepenephrine stimulates the adrenals, among other organs, to produce hormones that regulate blood pressure. So it doesn't do that on it's own? Guess that could be a strain on the adrenals after all.