View Full Version : Strattera Replacement


Flarewind
10-04-16, 06:34 PM
So, I'm a Combined type but Inattention is my biggest problem. I'm prescribed Strattera with Adderall because that's the only way that almost all of my symptoms are covered, either of the medications on their own just doesn't cut it. That's the combination I ended up on as a child and after my first year of College when I realized I hadn't outgrown my ADD that's the combination me and my doctor ended up with after some experimentation.

All of the sudden my insurance is refusing to pay for my Strattera until I try all the stimulants. But stimulants aren't what I need, I need something that increases norepinephrine so that the focus I get from the stimulants gets directed towards where it needs too instead of wherever my attention ends up. I ran out of Strattera a week ago and I'm already struggling to meet my obligations. Are there any medications that are almost equivalent to Strattera?

I've tried desipramine but it gave me constipation so I stopped after a few days and Wellbutrin didn't do anything but help me quit smoking. I've been looking at guanfacine but I don't think it would help my problems. Should I try the desipramine again and just deal with the side effects? I'm going to work on the list the insurance company said I had to try before they'd pay for Strattera but they put "etc" at the end so they'll probably tack more on afterwards and I just can't wait that long. (For instance, I had this whole post written out for the past 2 hours and I didn't hit submit.:mad:)

TL;DR Insurance stopped paying for my Strattera. Are there any other norepinephrine increasing drugs that work almost as well?

sarahsweets
10-05-16, 04:34 AM
Have you tried other stimulants alone at all? Stimulants arent like anti-norepinephrine. They work in different ways. Why do you think only the stratterra will work?

bluefoxicy
10-06-16, 09:34 PM
My doctor has encouraged me to use a Canadian pharmacy which accepts U.S. prescriptions (they won't ship without contact with your doctor, and won't ship controlled substances). Atomoxetine in Canada is typically $100-$110 versus $550 at CVS for the same dose and count. The FDA has guidelines that use the word "discretion" a lot; it's like Bob from The Incredibles wrote their public documents (https://youtu.be/_R8GtrKtrZ4?t=53).

Ask your doctor for a way out. They don't want to screw around with random medications until they find something else that maybe-works; they want success. You have success and now your insurer won't hear it--ridiculous. What, do they expect you to go on Desoxyn because it's cheaper? (Not necessarily a bad idea, but why when you have a patently-working combination?)

Standard practice is two stimulants and a non-stimulant before Welbutrin. That means Strattera is a first-line ADHD treatment; Welbutrin is a fourth-line ADHD treatment. Screwing around with your brain in an attempt to replicate success from a carefully-tuned combination of drugs is bad practice, and it is ludicrous that your insurance company would demand you try harder to not use the combination your doctor found after difficult and complex experimentation. If they flatly don't cover it, that's a business decision; if they cover it but they don't think you need it despite the opinion of a medical professional, that's a medical decision.

Strattera doesn't have a generic yet. Your insurance company isn't telling you MAS is cheaper than Adderall and they think it'll work just as well; they're telling you a drug combination with a very particular mechanism of action should be replaced by a different drug combination with a different mechanism of action. The answer to that is to mail your state insurance board a doctor's note.

Really though, appeal it or work around it.

Flarewind
10-07-16, 03:25 PM
So I went to my doctor today and he told me my insurance is refusing to pay for both Adderall and Strattera as they're both for ADHD. He advised me not to drop the Adderall for Strattera because in his experience Strattera doesn't work that well alone and if I did that insurance wouldn't let me back on Adderall if things didn't work out. So I went back on Desipramine but I don't know if it'll work half as well as Strattera or if the side effects will be too much. So for now I'm stuck with Adderall which only helps my hyperactivity which was never my biggest problem to begin with. I've always struggled way more with inattentiveness and getting what I need to done which is only helped by Strattera in my experience.
[/B][/B]Have you tried other stimulants alone at all? Stimulants arent like anti-norepinephrine. They work in different ways. Why do you think only the stratterra will work?
Because Focalin did literally nothing to me. Concerta only made me have to pee even at a really high (100mg+) dose. Vyvanse just felt like weaker Adderall. Adderall makes my train of thought go in a straight line instead of everything from that one song I just can't remember the name of to neurochemicals in class (I'm a business major.) but it doesn't get me to study or do the dishes unless there's an impending deadline (When you naturally get a burst of norepinephrine). The only thing I've found that sufficiently helps my symptoms is Adderall with Strattera.

bluefoxicy
10-07-16, 11:05 PM
If your insurance is okay paying for Strattera but not Adderall, get both but only claim for Strattera (it's expensive). Buy the Adderall out of pocket. It's like $100/month for generic MAS XR at CVS--maybe as low as $70 if you shop around. (MAS is usually similar price for all doses, e.g. $100 for 10mg XR, $115 for 30mg XR.)

I still say you should dispute it with your insurance provider. Adderall is an NDRI, targeting Noradrenaline and Dopamine; it is a Dopamine reversing agent as well, which means MPH blocks dopamine reuptake while AMP additionally reverses the uptake and pumps more dopamine back into your brain. Atomoxetine is an SNRI, which means it blocks Seratonin and Norepinephrine reuptake.

That means you're getting pretty decent Noradrenaline reuptake inhibition from the overlap. That's a highly-customized profile. It's not just an SNDRI; it's an SNNDRI, with ND and SN adjustable as separate knobs.

I want to try Atomoxetine with Adderall, but not right now. I'm titrating and still trying to get the Adderall dose right (20mg drove me out of it; 10mg is okay, but feels normal--and "normal" to me is functional and calm, but anhedonia is still crap). The noradrenaline effect of activating a sense of urgency without the H1 agonism and GABA antiagonism of stress seems like it'd give me that motivational push I need. I keep trying to convince myself I just need willpower and that drugs aren't magically going to fix me; and I keep remembering the economics--the effort required is bigger than the reward, so why should I do all those things I want to do if it's only going to be a bother and not worth my time?

I've been all over the place lately. Between drugs, I'm frequently balanced for a time, before symptoms set back in: I get a week or so where I sleep a solid 8 hours (and it's phenomenal!), where I don't drag through the chore of studying, and where I'm focused and able to work. I get a lot done; and then, just when I've started planning out how much I'm going to achieve and how to approach everything I want to do, I... stop. It all gets hard again.

If I found a drug combination that made me that way permanently and someone tried to take it away from me, there would be hell to pay. I don't feel any sense of reward; at least let me wile away my days in peace instead of struggling to not procrastinate while wondering why it has to be so hard.

You deserve the medically-appropriate treatment, the one that works best without harming you. It is a violation of medical ethic and basic human decency to do any less.

Flarewind
10-08-16, 09:31 PM
If your insurance is okay paying for Strattera but not Adderall, get both but only claim for Strattera (it's expensive). Buy the Adderall out of pocket. It's like $100/month for generic MAS XR at CVS--maybe as low as $70 if you shop around. (MAS is usually similar price for all doses, e.g. $100 for 10mg XR, $115 for 30mg XR.)
That's what I was planning on doing but I called the insurance provider and they said they'd cover both my medications if my doctor did a prior authorization like he was supposed too. But they could just as easily go back on their word if I get the Adderall filled.

Atomoxetine is an SNRI, which means it blocks Seratonin and Norepinephrine reuptake.
Actually the S stands for Selective not Serotonin. Strattera is the only Selective Norepinephrine Reuptake Inhibitor available in the US. It selectively affects the pre-frontal cortex, which is involved in Executive Functioning of the brain, which is one of the most dysfunctional parts of the ADHD brain. But the rest of your information is spot on.

That means you're getting pretty decent Noradrenaline reuptake inhibition from the overlap. That's a highly-customized profile. It's not just an SNDRI; it's an SNNDRI, with ND and SN adjustable as separate knobs.

I want to try Atomoxetine with Adderall, but not right now. I'm titrating and still trying to get the Adderall dose right (20mg drove me out of it; 10mg is okay, but feels normal--and "normal" to me is functional and calm, but anhedonia is still crap). The noradrenaline effect of activating a sense of urgency without the H1 agonism and GABA antiagonism of stress seems like it'd give me that motivational push I need. I keep trying to convince myself I just need willpower and that drugs aren't magically going to fix me; and I keep remembering the economics--the effort required is bigger than the reward, so why should I do all those things I want to do if it's only going to be a bother and not worth my time?
I can't say for sure but it sound's like you're a Combined Type with more Inattentive qualities than Hyperactive like me.You should really try it, Adderall alone just makes my thoughts go in a straight line and I can concentrate on tasks, I just can't force my self to focus on the things I need done. I used to feel just like you about willpower and that I was just weak or lazy but once I started Strattera with my Adderall I've been cleaning the house more, doing my homework earlier, keeping the kitchen stocked more. Strattera is an absolute god send for those moments where you're sitting on the couch thinking about some boring task that you need to do and it feels like there's a rock weighing you down whenever you try to start a task and it lasts 24 hours. The extra noradrenaline (as you Brits call it) gives me the kick in the pants I need to be productive instead of just spend every day procrastinating.

I've been all over the place lately. Between drugs, I'm frequently balanced for a time, before symptoms set back in: I get a week or so where I sleep a solid 8 hours (and it's phenomenal!), where I don't drag through the chore of studying, and where I'm focused and able to work. I get a lot done; and then, just when I've started planning out how much I'm going to achieve and how to approach everything I want to do, I... stop. It all gets hard again.
That happens to me alot, I'll think of all these things I'm gonna clean, and how I'm gonna get ahead on my paper, and then I'm gonna go to the gym. And none of it ever gets done because it's a legitimately Herculean effort to get myself to do even one of those things when I know for a fact a normal person wouldn't have had 1/4 as hard of a time as me starting those menial tasks.


You deserve the medically-appropriate treatment, the one that works best without harming you. It is a violation of medical ethic and basic human decency to do any less.
I completely agree, they dropped this on me in the middle of the semester when I'm taking 6 courses and was makings A's quite easily. To barely turning in a paper that was only 80% done ever though I spent 6+ hours on it because my focus kept getting side tracked again and again. Even a deadline couldn't force me to work diligently because without Strattera my Inattentiveness is in full bloom and Adderall didn't do a damn thing to help.

bluefoxicy
10-09-16, 04:56 PM
Actually the S stands for Selective not Serotonin. Strattera is the only Selective Norepinephrine Reuptake Inhibitor available in the US.



That's interesting. I'm not sure now, as it's listed as an NRI, but I've seen otherwise (https://www.ncbi.nlm.nih.gov/pubmed/23933039). >90% NET and >85% SERT, selective in where it achieves this activity.

I'm not a psychiatrist; I'm a giant nerd. Apparently there's debate about this. I claim nothing.


once I started Strattera with my Adderall I've been cleaning the house more, doing my homework earlier, keeping the kitchen stocked more. Strattera is an absolute god send for those moments where you're sitting on the couch thinking about some boring task that you need to do and it feels like there's a rock weighing you down whenever you try to start a task and it lasts 24 hours. The extra noradrenaline (as you Brits call it) gives me the kick in the pants I need to be productive instead of just spend every day procrastinating.


That's why I want to try both. I'm pulling a pharmacogenetic test (comprehensive panel, $400) just to be safe; but I've heard the norepinephrine thing a few times, and the clinical "it makes me motivated" thing, and I want that. I've had that when coming down between drugs, and I want that as a permanent steady state.

It's not something I can do right now. I need maybe a month or two to settle on the Adderall before I add another drug. I don't even want to add in melatonin (I feel tired all day, then suddenly feel myself waking up at 10-11pm?!) or alcohol, because I don't want to mess up the data. I need some solid information on how I respond to these drugs. If my psychiatrist doesn't have good information to work with, how is he going to know wtf is going on while we change things around at random?

That's not a problem. I can work with this for now.