View Full Version : Can you take Strattera with an SSRI?


Batman55
08-14-17, 12:31 AM
Up until I read the nightmare stories posted here, I was under the impression that Strattera is a non-stimulant and possibly the mildest of all the ADHD drugs available. These posts give me some pause.

Straterra may be my last hope in terms of the meds for ADD; I understand it recently became generic, which would be good news per affordability (in the USA.)

To stay on point, I still take an SSRI for social anxiety/depressive tendencies. However, I also know that Strattera is a kind of antidepressant and according to some sources, using Strattera with another antidepressant may be unwise, as it raises the risk of serotonin syndrome.

My psychiatrist said there shouldn't be any problem with the combination; he is entirely unconcerned. He even gave me samples for the "kiddie size" doses and said I could start extremely small.

I'm profoundly inattentive ADD and cannot even function at the level of a 15 year old at this point, despite being more than twice that age. I can't tolerate any other drug, not even Wellbutrin, not even half a Nuvigil (both caused caused anxiety/panic symptoms.)

TL;DR How has Strattera worked for others here? Do you take it with an SSRI; if so, how does that work for you? What do you think about the safety profile?

Arei
08-14-17, 10:17 PM
I take like, 5 daily meds for bipolar and strattera is my ADD drug. I'm on 2 antidepressants and strattera and I'm far from blissed out lol.

There IS a rare side effect that taking strattera and SSRIs (though it might mainly be fluoxetine) can decrease your heart rate. I think the Rexulti amps up my heart rate so it's too high to begin with, I'm not noticing a lowering effect.

Everyone is different, and I'd trust the doctor's judgement. I personally like Strattera the best out of anything I've taken for ADD, it works without any pesky side effects.

You sound like stimulants are too much of an upper for you to handle, so Strattera might bring some welcome relief.

Batman55
08-15-17, 01:16 AM
I take like, 5 daily meds for bipolar and strattera is my ADD drug. I'm on 2 antidepressants and strattera and I'm far from blissed out lol.

There IS a rare side effect that taking strattera and SSRIs (though it might mainly be fluoxetine) can decrease your heart rate. I think the Rexulti amps up my heart rate so it's too high to begin with, I'm not noticing a lowering effect.

Everyone is different, and I'd trust the doctor's judgement. I personally like Strattera the best out of anything I've taken for ADD, it works without any pesky side effects.

You sound like stimulants are too much of an upper for you to handle, so Strattera might bring some welcome relief.

Thanks for your reply! For what it's worth, I'm a "hypersensitive" with all drugs so that's what makes it so hard to find anything. I just can't tolerate anything.

Do you think you have hyposensitivity with meds? For it sounds like you take a lot of different medications there. Out of curiosity, are you able to handle any amount of caffeine given the increased potential for synergy?

sarahsweets
08-16-17, 04:24 AM
I found this:
Three cases are presented in which patients diagnosed with depressive disorders responding to treatment with SSRIs achieved remission with the addition of atomoxetine, a norepinephrine reuptake inhibitor. All of the patients presented for treatment in 2003. The patients' areas of nonresponse were ongoing fatigue, low energy, and poor concentration. These patients were unable to tolerate dual-action antidepressants currently available on the market or had experienced side effects that were intolerable. Atomoxetine is approved for the treatment of attention-deficit/ hyperactivity disorder,4 and its use in depression is outside the scope of this U.S. Food and Drug Administration indication. A recent PubMed search on atomoxetine in the treatment of depression using the keywords atomoxetine, depression, and treatment, with no limitations on language or date of publication, revealed no reports.

And this:
Adding Atomoxetine to an SSRI: A Negative Study

August 2007

What to do for a patient who responds only partially to an initial antidepressant is a question that has troubled clinicians for the past 50 years. As we have noted in recent summaries of the STAR*D trials, common approaches are to augment the first medication with a second or to switch to a different agent (BTP 2007;30:27-28, 2006;29:33-35). There is no one clear and obvious answer.

The usual first-line agents for depression today are the selective serotonin reuptake inhibitors (SSRIs). Venlafaxine (Effexor and others) and duloxetine (Cymbalta) inhibit the uptake of both norepinephrine and serotonin and are often used as second-line treatments. Tricyclic antidepressants as well inhibit the uptake of both norepinephrine and serotonin.

For a depressed patient who responds only partially to an SSRI, an alternative would be to add an agent that selectively inhibits the uptake of norepinephrine, such as reboxetine, which is available in many countries but not in the United States. Atomoxetine (Strattera), another selective norepinephrine reuptake inhibitor, is available in the United States but labeled only for attention deficit hyperactivity disorder (ADHD). Funded by atomoxetine's manufacturer, Michelson and others used it to augment sertraline (Zoloft and others) in patients who did not achieve remission on treatment with the SSRI alone.1

All patients were treated initially for 8 weeks with open-label sertraline, up to 200 mg daily. One hundred forty-six subjects remained symptomatic and were randomly assigned under double-blind conditions to receive 8 more weeks of treatment with either atomoxetine, 40 to 120 mg daily, or placebo, in addition to sertraline. The results were negative. Patients assigned to atomoxetine augmentation showed no greater improvement in depression than those who received placebo. Significantly more patients in the atomoxetine group reported dry mouth, insomnia, and constipation.

Theories about antidepressant mechanisms of action and how we might take advantage of them have been extant for decades. The STAR*D trial and most research over the years have failed to find empirical justification for preferring one type of antidepressant over another. This trial similarly came up empty-handed in an attempt to exploit a very reasonable theory that adding a norepinephrine reuptake inhibitor to an SSRI would help more depressed patients achieve remission.

1Michelson D, Adler LA, Amsterdam JD, Dunner DL, Nierenberg AA, Reimherr FW, Schatzberg AF, Kelsey DK, Williams DW: Addition of atomoxetine for depression incompletely responsive to sertraline: A randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2007;68:582-587.

There were other examples but it seemed like a toss up as to whether it helped or hurt in the treatment of depression.

Arei
09-26-17, 02:55 PM
Thanks for your reply! For what it's worth, I'm a "hypersensitive" with all drugs so that's what makes it so hard to find anything. I just can't tolerate anything.

Do you think you have hyposensitivity with meds? For it sounds like you take a lot of different medications there. Out of curiosity, are you able to handle any amount of caffeine given the increased potential for synergy?

Super late responding here :lol: I think I'm hyposensitive to a lot of things (pain included). There are medications out there I cannot tolerate whatsoever, but not as many as the ones that I'm fine with. And I seem to have no problem taking a decent combination of stuff. Bipolar was running my life for many many years, and treating it helped to get a handle on the migraines and ADHD. Apparently I needed a cocktail.

And I've never had a sensitivity to caffeine, in fact I usually take a 30oz bottle of coffee to work everyday. The only thing I can't do is drink that much coffee and an energy drink in the same day... that's *too* much *heart beats out of chest* But otherwise no, I can generally tolerate as much caffeine as I want.

Batman55
09-27-17, 12:56 AM
Super late responding here :lol: I think I'm hyposensitive to a lot of things (pain included). There are medications out there I cannot tolerate whatsoever, but not as many as the ones that I'm fine with. And I seem to have no problem taking a decent combination of stuff. Bipolar was running my life for many many years, and treating it helped to get a handle on the migraines and ADHD. Apparently I needed a cocktail.

And I've never had a sensitivity to caffeine, in fact I usually take a 30oz bottle of coffee to work everyday. The only thing I can't do is drink that much coffee and an energy drink in the same day... that's *too* much *heart beats out of chest* But otherwise no, I can generally tolerate as much caffeine as I want.

I think I'll give the Strattera a shot... starting with the 10mg "kid's dose." :lol:

I wonder if I'll even be able to handle that.

As an aside, since you mention migraines. I don't get classic migraines but I suffer from chronic daily headache.. more specifically, NDPH is what the neurologist thinks. It's a sensation of "constant head pressure" feels dull, no pain, but it's incredibly annoying. Have had it for 10+ years every day. I'm wondering about Gabapentin, for that.

Apparently some of these kinds of drugs can also help ADD, by calming the mind. Now that's something I could use.. for sure!

CharlesH
09-29-17, 12:48 AM
I don't have personal experience with this, but since your psychiatrist thinks it's fine, I would just trust him. Strattera was actually originally developed as a potential depression treatment. It failed the clinical trials for it, but then they discovered by accident that it seemed to be helping with ADHD! An SNRI can be used for depression, so maybe an NRI (Strattera) + SSRI ~ SNRI? This is my very non-scientific guess!