Strattera (atomoxetine)

[Grigor]

Yes, very very low dose. A little increased heart rate and warm face was all I noticed. I'm having trouble with potassium deficiency (muscle cramps and extremely low and hard pulse) and I'm a bit worried to take too much of it. I'll try again when my heart seems healthier.

So not too crazy intense?? Have it home now. Curious. Scared lol.

 

[Ninan]

So not too crazy intense?? Have it home now. Curious. Scared lol.

Well, I just took 1/50 of a 10 mg. Start low and you'll be fine.

 

[kangaSue]

Hypofunction of the sympathetic nervous system is an etiological factor for a wide variety of chronic treatment-refractory patholological disorders which all respond to therapy with sympathomometic amines.
http://www.ncbi.nlm.nih.gov/pubmed/21835553

The hypothesis set forth is that the basis for a great many chronic debilitating conditions that involve almost all of the physiologic systems of the body may have as the underlying cause and a common link between them, i.e., hypofunction of the sympathetic nervous system.

 

[Sushi]

I have a question that has nothing to do with the angiotensin-topic but I just came across what you wrote earlier.
I had a total system crash last year when I tried a lot of things which I now know have been really wrong. One thing I did at that time was to stop Venlafaxine (after 5 years of taking it), which is also a norephinephrine reuptake inhibitor.

Is there a possibility that the norephinephrine reuptake inhibitors generally could stabilize POTS? (So one of the reasons I crashed so badly could be that next to the withdrawal I took away the only thing that stabilized my POTS?)

I‘m sorry if this is too far away from the main topic and will delete it if not okay.

I am replying in a Strattera thread to keep the other one on topic. Venlafaxine is both a serotonin and norepinephrine reuptake inhibitor while Strattera is only a norep reuptake inhibitor so the effects will be somewhat different. And yes, when you stop drugs like this you are likely to get some bad withdrawal symptoms if you don't taper them over a long period.

I don't think that norepinephrine reuptake inhibitors would generally stabilize POTS. I have an autonomic signature that is not typical--high vagal tone with the parasympathetic nervous system dominant. That is probably why Strattera worked for me. Most people with POTS have a dominant sympathetic nervous system so a drug like Strattera could make them worse. So, you and your doctor would need to know more about the balance in your autonomic nervous system to make an educated guess about whether a drug like Strattera would be helpful.

Incidently, I just got a script for it again and will give it another try to see if it still works. I had stopped because of cost but it went generic in 2017. I thought that would mean a reasonable price but even the generic is ridiculously expensive. I'll just try it for a short period to see how it works for me now, and if it does, I'll seek a less expensive source.

 

[Malea]

I am replying in a Strattera thread to keep the other one on topic. Venlafaxine is both a serotonin and norepinephrine reuptake inhibitor while Strattera is only a norep reuptake inhibitor so the effects will be somewhat different. And yes, when you stop drugs like this you are likely to get some bad withdrawal symptoms if you don't taper them over a long period.

I don't think that norepinephrine reuptake inhibitors would generally stabilize POTS. I have an autonomic signature that is not typical--high vagal tone with the parasympathetic nervous system dominant. That is probably why Strattera worked for me. Most people with POTS have a dominant sympathetic nervous system so a drug like Strattera could make them worse. So, you and your doctor would need to know more about the balance in your autonomic nervous system to make an educated guess about whether a drug like Strattera would be helpful.

Incidently, I just got a script for it again and will give it another try to see if it still works. I had stopped because of cost but it went generic in 2017. I thought that would mean a reasonable price but even the generic is ridiculously expensive. I'll just try it for a short period to see how it works for me now, and if it does, I'll seek a less expensive source.

Thanks for your answer, @Sushi.
(Should I delete my text in the other thread?)

From my symptoms I would suppose that in me the sympathetic nervous system is dominant, so I can‘t assume that the SNRI made the POTS better.
(So I still don‘t understand the extreme worsening after stopping venlafaxine. Because I stopped it slowly I don’t think that the worsening is only withdrawal symptoms.)
And unfortunately I havn‘t found a doctor yet who knows anything about this.

Is there a way to find out if the parasympathetic nervous system or the sympathetic nervous system is dominant? (A special examination?)

Good luck for your new try with Strattera

 

[Sushi]

(Should I delete my text in the other thread?)

Not necessary.

From my symptoms I would suppose that in me the sympathetic nervous system is dominant, so I can‘t assume that the SNRI made the POTS better.

True, I don't think you can assume that...or really anything about a response to a drug like that which will have multi-faceted effects. It is a complex drug so it is possible that it helped you in unanticipated ways.

(So I still don‘t understand the extreme worsening after stopping venlafaxine. Because I stopped it slowly I don’t think that the worsening is only withdrawal symptoms.)

How slowly did you stop? I think I did it over about 3 months of tapering.

Is there a way to find out if the parasympathetic nervous system or the sympathetic nervous system is dominant? (A special examination?)

Yes, there are such tests but not many specialists who understand how to administer and interpret them. I had a tilt table test that also included about 6 other autonomic tests. It is difficult for patients with POTS to find in-depth testing.

 

[Peyt]

Hi,
I read the whole thread and it's very interesting.
My question: Has anyone tried Copper to increase norepinephrine naturally?
From what I understand, some people have plenty of Dopamine but are low in NE. There is an enzyme called dopamine beta-hydroxylase which is responsible to convert Dopamine to NE which is low on some individuals, Copper helps with the conversion.
Anyone tried it?

 

[Wayne]

low in NE

What's NE? -- Thanks...​

 

[Sushi]

What's NE? -- Thanks..

norepinephrine

 

[Pyrrhus]

Strattera/atomoxetine (10mg) also worked absolute wonders for me for about 8 hours, although it then led to a month-long crash.

For most people, atomoxetine has a blood half-life of about 5 hours. However, some people are genetically poor metabolizers, and their blood half-life is more like 22 hours, which would interfere with sleep.

 

[mitoMAN]

I have taken Strattera 60-120mg for ADD. No benefits on POTS or CFS Symptoms at all

 

[Shanti1]

About 4 weeks ago I thought I would be able to tolerate a slow bike ride on level ground . I felt deceptively fine while on the bike and road for 9 miles in the glorious outdoor air and sun . I was pretty exhausted in the afternoon and evening, but figured I would recover in a few days since I have been relatively well. The next day I developed orthostatic intolerance, which I had never had before despite BP that runs about 85/55.

Suddenly I found that sitting or standing caused loss of visual acuity, numbness of my face, inability to think, and a feeling that I could pass out. Lying down would alleviate the symptoms. I also developed mild neuropathy. This was my second bout of neuropathy, I had a more severe bout Dec.

The last four weeks I have been desperately trying to find a way to get upright. Full length compression stockings and abdominal binders allowed me to sit in a semi reclined position for limited periods. I tried midodrine, fludrocortisone, salt/fluid loading, IV saline (helped for one day), mestinon, phenylephrine, butchers broom, and pseudoepinephrine. None of the meds helped, some made me feel worse.

I also tried various peptides (GDF11, secretagogues, BPC157 and ARA290). The GDF11 and secretagogues helped to some degree, but I also got side effects that caused me to discontinue them.

I started trialing Strattera/atomoxetine two days ago (today is my third day) and so far it is working amazingly. I am pairing it with full length compression stockings, but I am able to sit up and walk around with out any feeling of orthostatic intolerance. I am also finding an improvement in my mental energy and focus. My fingers are crossed that it continues to work for me and doesn't bring on a crash. I am very sensitive to meds so am currently taking 5mg spread throughout the day (I was able to get it as a 10mg tablet).

I tend to be parasympathetically dominant and whole-body urinary neurotransmitter testing showed very low catecholamines, so I am not surprised I feel better with a little more norepinephrine in my synapses.

 

[Pyrrhus]

From another thread:

That is a very good point. It reminded me of a study I had seen recently in a presentation a Dr. Raj who specializes in dysautonomias. The atomoxetine made the POTs worse because it was increasing epinephrine on top of an epinephrine surge when subjects stood up (see slides below).

I think it is helpful for be because I don't get any tachycardia when I stand, my heart seems to care less that all my blood is rushing to my feet and I'm becoming cognitively impaired. I just don't seem to have any sympathetic tone or response to poor venous cardiac return.

 

[xebex]

I tend to be parasympathetically dominant and whole-body urinary neurotransmitter testing showed very low catecholamines, so I am not surprised I feel better with a little more norepinephrine in my synapses.

How do you know you are parasympathetically dominant? I think i am too but would like to know your expereince of this - i have had positive effects with ritalin and pseuoephedrine but theyu seem to swing me too much the other way, so it'll be 1 good day for 1-2 bad days (but not necesarily causing me to crash) so i stopped using them. Am intriged by strattea though and would like to know how it's going for you now a couple of months later.

 

[Shanti1]

How do you know you are parasympathetically dominant?

I feel better with stimulants and, unlike many people with ME/CFS, I don't tend to have anxiety, but tend more toward apathy and hypersomnia. I react well to stimulants like modafinil and amantadine (but I don't take them every day) and calming meds or supplements such as a benzo, melatonin, or even magnesium make me feel worse. My chronically low blood pressure and now orthostatic intolerance are another clue.

I did have whole body neurotransmitter testing done twice, these are some of the values from my 2018 test showing the the more stimulatory and catecholamine neurotransmitters low and GABA elevated. My 2016 test looked the same.

I don't think someone needs to get tested to know though, and whole body neurotransmitter readings have to be taken with a grain of salt since, in reality, neurotransmitter production is compartmentalized in various areas of the body (For example, CNS, PNS, and gut) and may be high in one place and low in another, having differing effects depending on where they are being produced. And, of course, its not always about a neurotransmitter level, but also about receptor sensitivity and other factors.

In my case, I really do feel parasympathetically dominate almost across the board, but I think many people may have a mix of parasympathetic and sympathetic dysautonomias and altered brain signaling.

 

[Shanti1]

i have had positive effects with ritalin and pseuoephedrine but theyu seem to swing me too much the other way, so it'll be 1 good day for 1-2 bad days (but not necesarily causing me to crash) so i stopped using them.

This happens to me too. Usually, the first day or days using a med is good, and then it turns on me. I have taken to only using meds like modafinil or amantadine once every one to two weeks when I have something that I need some extra "help" for. I am also a lightweight, so I take only a fraction of a tablet and then add more if needed.

Am intriged by strattea though and would like to know how it's going for you now a couple of months later.

Amazingly, Strattera hasn't turned on me yet, but my body has adapted to it a bit and I now take about 20mg spread throughout the day instead of 5mg. It isn't enough by itself to maintain my blood pressure, I have to combine it with compression, but it has been a lifeline for me.

 

[xebex]

@Shanti1 ah thanks so much for your reply and description - very helpful - now i've read your description it seems that I likely have wild swings between the two states - i never really used to be anxious and that's proabably when the stimulants worked better - over time i have become a lot more anxious - but i still get the parasympatehtic hypersomnia (though can't actually sleep) - weirdly in crashes i often feel stoned and couchlocked like i took too much cannabis - no actual cannabis involved. I seem to very quickly fall into a parasympathetic response - i did 10 seconds on a tens machine for vagal stimualtion and i was sleepy for a week!!! maybe i need stimulants on sleepy days and vagus nerve stimulation on anxious days - kind of scary to experiment with that though.

so you don't take straterra daily? just on an as needed basis? ritalin was helpful for me for about 2 years until the down days overruled the good days and yes i could also really only take it once a week.

 

[Shanti1]

so you don't take straterra daily? just on an as needed basis?

I accidently wrote atomoxetine instead of amantadine above, I just corrected it. I do take Strattera daily, thankfully, it has been helpful for me on a daily basis. I rotate other meds ie amantadine, modafinil and a couple of others.