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.