View Full Version : My [new] Medication Journal: Strattera


greenmonkey
01-28-14, 05:56 PM
Hello ADDF!

I haven't been here in a while, likely as a result of my taking time off medication (off and on xanax, actually, after stopping Wellbutrin a couple years ago) and gaining some ground with therapy. I was at the therapy for a bit over a year until my therapist (who I LOVED) moved and I haven't sought a new one.

On the medication front, I was on Wellbutrin for treatment of "ADD-like symptoms" as my pdoc put it, but through some personally traumatic emotional experiences I decided I needed to ground myself again without medication. So I did. I had one last visit with the pdoc and weened myself off the med. I was taking the Wellbutrin from June 2010, through July 2011. An account of much of that experience is in my Wellbutrin journal (http://www.addforums.com/forums/showthread.php?t=85190).

Now a year and a half later, I'm again facing some serious problems focusing on anything at work. I believe much of it is anxiety driven from disliking my job (been there seven years), knowing I need a new one, having thoughts of career change, all the while finally (at 31) becoming truly financially stable, worrying about keeping it up (the financial stability!), and evolving into a new era known as my thirties, etc. However, I have also analyzed some of my past experiences (adolescence) and found I have always had trouble paying attention, and have been told frequently that I'm not meeting my potential. My teachers and employer alike see that when I'm successfully in the zone, I can perform great work. When I'm not, I'm really not, and I just can't keep up. This swing is a natural one, but for me it's more heavily weighted toward a struggling, wandering mind.

Over the past couple years I have taken Xanax off and on, no more than 1/2 mg at a time, and usually no more than 1 mg a day. Taking only a 1/4 mg in the morning and afternoon has often allowed me to get work done, relaxing me just enough to ignore my perceived stresses and actually be able to focus for a bit. A month ago my prescription ran out; I contacted the clinic I've been going to for years to find my primary doctor who was managing the prescription had moved. Once again, I didn't make an appointment with a new doc to fix it. Instead I started drinking more (from a previous average of a drink in the eve to, lately, three drinks between getting off work and bedtime), and failing more at work. I'm inconsistent. Sometimes I go to the office in the morning, get some work done, but come lunchtime I'm so internally agitated, without knowing specifically what about, that I don't feel I can do anything but go home. So I do. I get up and wander out at lunch, and hop on the free way, and drive 45 minutes to get home. Once home I can often get a bit more work done remotely, no longer facing the din of office ramblings, interruptions, fluorescent lights, etc. Ultimately though, my focus still wanders insanely.

Today I went back to see my old pdoc whom I hadn't seen since June 2011. We had a good chat about my current situation and struggles. He has renewed my xanax prescription for a 1/2 mg twice daily, and also recommended Strattera. One thing I wasn't thrilled about with the Wellbutrin, and face again with the Strattera, is the need to take it regularly to build a steady level in my brain. However, I left with some samples and have the following dosage plan:

5 days x 10 mg / day
10 days x 15 mg / day
Reassess with the pdoc whether it's working, needs to be stronger or weaker, or needs to be something else
If the Strattera doesn't work, he said we can try a stimulant next - While I do hope this works for me, my understanding is that stimulants can be used only when needed, without the need to control a steady level. I would prefer this simply so I can be off meds when I don't really need it (such as low stress days in the office, or the weekends), but will press forward with the Strattera for now.


So... on with the journaling...

greenmonkey
01-28-14, 05:59 PM
Day 0

My first dose of Strattera 10mg was about a couple hours ago. My Xanax prescription is being filled.

I need lunch...

greenmonkey
01-29-14, 03:34 PM
Day 1

From what I understand, it can take several days to weeks for a noticeable level of this med to build. It also seems I'm starting at the lowest dose possible with the 10 mg. That said, I had an interesting evening yesterday after my first dose.

Yesterday afternoon, after starting this thread, I had waves of fatigue where I felt I could flop down and fall asleep right away. I resisted this urge and the fatigue would pass to a somewhat mellow blah. I felt more alert through the evening than usual, and more relaxed. I was up past 11 which isn't normal for me (usually in bed 9:30-10), and was awake bright and shiny when my alarm went off before 7.

Whether any/all of my energy swings last night and this morning were due to the single 10 mg dose of Strattera, I really don't know. But my goal here is to track my progression, both for the benefit of others and so I can look back and remember how it's been going. I would like for it to be working already, but if it is it's only affecting my mood and energy (trending up) and not yet helping me to drive my focus.


I took my second 10 mg dose around 8 this morning. Around 9 I had another rush of sleepiness, and a slight nausea which passed. Around 9:30 I took 1/4 mg Alprazolam (Xanax).

So, where does this all leave me this morning? I'm working from home today (remote IT work) and feeling about my normal level of focus/attention/motivation -- Nil. Maybe a bit better than nil, but not great. I do feel less anxious than my average angst over the past several months. I don't feel terribly stressed. But I do feel like I really want to be able to dive into some work tasks and actually be able to focus on completing them, like I know I'm capable of.



Self Reminder: Don't get frustrated with yourself for getting off track all the time. Your mind is wandering something fierce, but you're trying to fix that. Gently try to bring yourself back to the task at hand without self-reprimand.

I guess I should try to focus on my work some more :umm1:

greenmonkey
01-31-14, 02:02 PM
Day 2

I'm happier. I'm more relaxed. My anxious fog which has been consuming my brain for a while is clearing. I feel better.

I still can't concentrate. :confused:

I came home from work a bit early, got another hour or so of work done, then flopped on my couch for an hour nap before dinner. After dinner spent the evening watching some TV and researching some stuff online. Pretty mellow.


Day 3

Went to bed last night around 9:30 and was awake multiple times between 3:30 - 6:30. Even with 1/2 mg Xanax before bed. Well, it's Friday now and I've got a pretty mellow day. I'll be working (not from the office) until early this afternoon, then off for a relaxing weekend out of town! I'll keep up with my 10 mg/day dosage of Strattera, and try not to use the Xanax unless I really need it. The Xanax is most helpful to me at work as it actually allows me to focus slightly more than normal. Slightly. And good for getting me to sleep if I'm too wound up.

*shrug* Feeling good about the weekend. Hopefully this med routine will give me some amount of regularity to my focus next week. At least I'm no longer feeling panicky every day!

greenmonkey
02-04-14, 03:03 PM
Day 7

I started on the 18 mg dosage a few days ago. I don't think I've noticed a difference from the 10 mg, but I do continue to be surprised by my clearer, calmer, happier mind.

I still find myself feeling more normal, as a person, more grounded in my own body and mind, since starting Strattera... It hasn't been very long, but my flow of feelings are much more consistent than usual. I still find myself dashing between thoughts and tasks too chaotically to focus and get any efficient work done; however, I'm less stressed about my situation, so don't have all the angst I've been struggling with for... a while. I'm less stressed about my lack of focus, but still lacking focus.

The only downside, and it isn't very bad (yet, and hopefully won't be), my sex drive is altered. I've read about the most common side effects, and it sounds like many men experience issues getting it up and/or keeping it up. I find myself most aroused in the mornings (when it has been about 24 hours since my last dose), but morning arousal is nothing new to me... I'm less sexually inclined during the day than I usually am, whether by myself or with my love. If anyone wants to chat more on that topic feel free to message. I hear the sexual side effects often go away with time.

Oops, late for my next conference call...

greenmonkey
02-18-14, 01:36 PM
Day 20

I've been taking 25mg daily (up from the previous 18mg) for six days now. I'm scheduled to be on 25 mg for another ten days or so, then step up to 40mg for four days before seeing the pdoc again in two weeks. The thing is, this really isn't working for me. The Strattera itself is fine, and has had many positive effects on my mood, reduced some depression I'd been ignoring for a while, and made me feel generally more comfortable in my skin and more confident to be myself -- I still can't get a damned thing done in an organized manner, am having tremendous trouble at work, and am again getting very frustrated by my lack of proper executive control. I called and made another appointment for
[...]


Day 21

What was I saying?

Oy.

My pdoc is available next in a week. It's probably best that I have another week on the 25mg to better judge for myself how I'm doing on it. At first I was actually excited, because Strattera had an immediate uplift for me. Now though, I'm feeling it's been a useful transition for my personal mood/energy, but my concentration, focus, clear lines of thought, and even sometimes my ability to make myself GO on something, small or large, is still dreadful...

It's frustrating and frightening. I've exhibited similar symptoms as long as I can recall, but had no childhood therapy/psychiatry/medicine/etc. I think it's better that I didn't medicate as a child, but now I'm not able to function normally and get through my work day in any kind of organized manner. Some days I get no work done, simply because I can't direct my mind to the task at hand, whatever it may be. I understand that these medications can take a while sometimes, but I'm fairly convinced at this point that norepinephrine, while apparently beneficial for my mood (now with Strattera and a couple years ago with Wellbutrin), it does frack-all for my cognitive (st)ability.

*sigh* :umm1:

Can I go back to my pdoc, explain all this to him, remind him that he managed my Wellbutrin for a year with similar results, and then actually ask for a stimulant to try? I wouldn't mind staying on the Strattera, but I'm feeling desperate for a chance to function normally. I can feel the normal function just out of reach. I can feel the possibility of a personally gratifying day of successful work. I just... I want to feel it for real. I understand the naturalness of spacing out or losing focus, but I also have a deep understanding of my own inability to grasp a proper focus in the first place. A deep understanding that I often am not able to put into words.

:scratch:

greenmonkey
02-27-14, 07:47 PM
Day 29

Potentially promising changes!

I saw my pdoc yesterday. I explained the benefits I've had from Strattera, and the complete lack of benefit where I need it - the ability to focus on, and complete, a chosen task. I also expressed a moderate feeling of extra drain at the end of the day (without more-than-my-norm physical or mental activity) and not really wanting to increase to 40 mg.

I spent the hour discussing, sobbing, reading a couple of my journalings aloud, explaining the way I think and how it doesn't work at work... He told me I need to figure out where my anxiety stems from, presumably to determine if we should focus on my anxiety as a cause of my inattention, or otherwise. At that point I pulled this up to recite to him, which I wrote last weekend during an intense day of self-analysis:
"My anxiety is not about the task at hand.
Despite the fact that the task at hand,
regardless of the task,
often triggers my anxiety,
it is the abundance of thoughts,
and lack of time to produce them all,
or to even produce those I want to,
which drives my anxiety."

I described my weekend during which, while my girlfriend was out of town, I thoroughly cleaned most of the apartment and it looks amazing! He seemed at first to see this as a sign that maybe I can concentrate and get stuff done and just need to tap into that. However, I can draw a very clear line between my own ability to perform physical tasks in a chaotic way (and boy was my cleaning chaotic, working on cleaning every room at the same time), and my ability to produce desired results from concentrated mental tasks. At home it doesn't matter that I process my tasks in chaotic parallel. It doesn't even take focused attention to do. I had everything pulled off the living room shelves, the contents of my desk also being cleaned and reorganized, piles on tables and chairs from everywhere, dishes getting washed, bathroom scrubbed, plants watered, trash, recycling, make the bed... All day I was amazed at how sporadic I am (I seem amazed every time I truly watch myself), bouncing from task to task, forgetting what I'm doing while doing it, remembering five times I want to wipe down the kitchen table before I actually get around to it and then not remembering whether I've done it yet, but eventually getting it all done. It works. When I'm sitting at a desk, have scheduled meetings, deadlines, five systems to manage/configure/support, four vendors to work with for those systems, involvement in a couple large projects, many groups at work to coordinate with, etc... this is when my chaos is a huge deficit and I need the ability to follow controlled linear thoughts.

My doc said we needed to try adding a stimulant medication. As of this morning, I'm taking 25mg Strattera (no plan to increase, but staying on) combined with 18mg Concerta. Though he said it can take a few days to get the full benefit of the Concerta, I definitely feel it in my system, and also feel it's already helping some. From what I've read the tablet has a 12 hour release, and should be around its peak release 5 to 6 hours after taking it (nowish).

---

I've been working at the same company (non-IT-centric), with various roles in IT, for the past seven years. I've gotten by. A few weeks ago my management placed me on a formal HR-documented "performance plan" which I must follow to a T and form weekly reports on for my manager. I'm a few weeks in (lasts two months). I'm doing OK with most of the plan deliverables, but have yet to put together my weekly reports. I need to. I know this could be a major problem if someone asks him to see my current status reports. I talked with him on this a couple days ago. Still no status reports. I could do them right now, this moment, but then I'd neglect other things which I need to be doing now. So when can I write up sensible reports on what I've been doing with my time?

I'm not consciously/insubordinately resistant to doing my work. I don't choose not to get things done when they need to be, I just don't seem to be able to. I'm unable to choose what work I focus on when. Fingers crossed this recent change will show continued improvement for me.


Strattera wrap-up
Although my experience with Strattera has only been for a month, and I'm continuing to use it, I don't see a lot of value in maintaining my Strattera-focused journal thread with the Concerta now added. I previously spent a year taking Wellbutrin. While I appreciate the once-a-day nature of my Strattera (I was taking 2x100mg IR Wellbutrin, twice daily for four pills total), the psychological response I have (a positive one) has been very similar to that of Wellbutrin.

This medication has improved my mood, evened out my energy flow, made me feel more comfortably me again which I haven't fully felt in a while. This has all reduced my ongoing anxiety a bit. It doesn't make me feel amazing, nor am I looking for any medication to make me feel amazing. Strattera does a good job at what it does for me. That said, neither Norepi-RI medication has done much for my ability to direct my focus and attention, clear my ways of thinking, and allow me to be linearly productive.

My past, Wellbutrin, Jun 2010 - Jul 2011: http://www.addforums.com/forums/showthread.php?t=85190
Going forward, Concerta, Now - Who Knows: http://www.addforums.com/forums/showthread.php?p=1621992