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General Medication Discussion This section is to be used for general medication discussion and other medications not broken out in their own respective forums.

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  #1  
Old 08-12-18, 07:18 PM
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Can Strattera and SSRI be started together?

Hi there. I would like some advice in regards to my younger brother. He is 17 years old and diagnosed with PDD-NOS, which is high functioning autism, and ADHD-Combined.

He has trialed Biphentin (similar to Concerta), Adderall and Vyvanse. He responded best to Adderall 30mg which especially helped his mood and self-esteem, but would occasionally feel sedated, anxious and depressed. He has metabolic problems so the biggest problem has been the time it takes for a stimulant to work. Hence unstable mornings.

Since there are 3 weeks left until school begins, we decided that since his greatest problem is consistent coverage, before trying to add an SSRI to Adderall, to trial Strattera. He will take 25mg Strattera for 2 days followed by 40mg for a week and go from there.

He was also given by a prescription for 5mg Lexapro for a month, raising to 10mg for the second month. My question is simply this. Should he trial the Strattera alone first, or is it safe for him to begin both Strattera and Lexapro at the same time? He will most likely need to add the Lexapro after anyways whether he sticks with Strattera or goes back to Adderall.

Thanks!
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Old 08-12-18, 07:31 PM
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Re: Can Strattera and SSRI be started together?

What a nice big brother you are!! We can't give medical advice about starting 2 meds at the same time. Ask the provider who wrote the scripts.

I will say that some people and/or their providers, like to start one med at a time to see which one is doing what.
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Old 08-12-18, 11:13 PM
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Re: Can Strattera and SSRI be started together?

Sounds reasonable that we should see how the Strattera works first. I see that you’re on it yourself actually, do you mind sharing how it’s helped? How long can my brother expect to have a response before the eventual 4-6 weeks buildup. He will probably titrate up to 60mg after 7 days on 40mg if all goes well.

Unfortunately the psychiatrist my brother saw wasn’t as educated on ADHD as I’d like him to be. He prescribed him Lexapro for anxiety though I know that the anxiety went away on Adderall as the generalized anxiety is related to his ADHD. But it will still eventually help him for balancing serotonin and for OCD. The psychiatrist didn’t give us Strattera, he incorrectly believed it is an SNRI and would risk serotonin syndrome with an SSRI. So while we got the Lexapro from him, the family doctor gave us the Strattera to trial.

I am hoping that if the Strattera shows at least some improvement it can be combined with a stimulant, latter helping most of his ADHD symptoms while former provides the 24/7 coverage. Will be tough convincing a doctor to do that though there’s a great study on case trials here. Brown, T. (2004) Atomoxetine and Stimulants in Combination for Treatment of Attention Deficit Hyperactivity Disorder: Four Case Reports. Journal of Child and Adolescent Psychopharmacology 14(1): 129-136. (PDF file)

Last edited by namazu; 08-12-18 at 11:29 PM.. Reason: Added bibliographic information about linked article.
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Old 08-13-18, 01:41 PM
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Re: Can Strattera and SSRI be started together?

I believe one should always try just one new medication at a time.

That way, if it helps, you know which one helps.

If there are side effects, you certainly want to know which med caused them.

And then when you add the second, you'll know if it's improving the first or not.
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Old 08-14-18, 04:46 AM
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Re: Can Strattera and SSRI be started together?

Stratterra was actually meant to be an antidepressant but the company that makes it sort of accidentally found out it had marginal effects on some types of adhd so they jumped on that band wagon and got it approved for adhd. I say that because of how it works. IMO because it works like an antidepressant than taking an antidepressant with it could be dangerous because it targets stuff in your brain like the receptors in the same fashion and antidepressants. Stimulants work differently.
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Old 08-14-18, 05:05 AM
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Re: Can Strattera and SSRI be started together?

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Originally Posted by sarahsweets View Post
IMO because it works like an antidepressant than taking an antidepressant with it could be dangerous because it targets stuff in your brain like the receptors in the same fashion and antidepressants.
Atomoxetine (Strattera) and SSRIs target different neurotransmitter systems (atomoxetine -- norepinephrine reuptake inhibitor; SSRIs -- serotonin reuptake inhibitors). There's no evidence that prescribing atomoxetine with an SSRI is any more dangerous than prescribing stimulants and SSRIs (which happens frequently).

Many of the side effects of Strattera are similar to the side effects of stimulants. (Strattera actually increased my blood pressure more than stimulants ever have, for example.)

That said, if both types of medication are prescribed at the same time, it can be hard to know a) what benefits are coming from which medication (or if it's the combination), and b) which side effects are coming from which medication (or if it's the combination).
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Old 08-14-18, 05:30 AM
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Re: Can Strattera and SSRI be started together?

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Originally Posted by namazu View Post
Atomoxetine (Strattera) and SSRIs target different neurotransmitter systems (atomoxetine -- norepinephrine reuptake inhibitor; SSRIs -- serotonin reuptake inhibitors). There's no evidence that prescribing atomoxetine with an SSRI is any more dangerous than prescribing stimulants and SSRIs (which happens frequently).

Many of the side effects of Strattera are similar to the side effects of stimulants. (Strattera actually increased my blood pressure more than stimulants ever have, for example.)

That said, if both types of medication are prescribed at the same time, it can be hard to know a) what benefits are coming from which medication (or if it's the combination), and b) which side effects are coming from which medication (or if it's the combination).
Quote:
Interactions between your drugs
Major
fluoxetine ↔ atomoxetine

Applies to:fluoxetine/olanzapine and Strattera (atomoxetine)

FLUoxetine may significantly increase the blood levels of atomoxetine. This can increase side effects such as dizziness, dry mouth, loss of appetite, sleep disturbances, and heart palpitations. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Quote:
Interactions between your drugs
Major
escitalopram atomoxetine

Applies to: Lexapro (escitalopram), Strattera (atomoxetine)

Using escitalopram together with atomoxetine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Quote:
Interactions between your drugs
Moderate
atomoxetine duloxetine

Applies to: Strattera (atomoxetine), Cymbalta (duloxetine)

DULoxetine may increase the blood levels and effects of atomoxetine. This can increase side effects such as dizziness, dry mouth, loss of appetite, sleep disturbances, and heart palpitations. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Quote:
Interactions between your drugs
Moderate
bupropion atomoxetine

Applies to: Wellbutrin (bupropion), Strattera (atomoxetine)

BuPROPion may increase the blood levels and effects of atomoxetine. This can increase side effects such as dizziness, dry mouth, loss of appetite, sleep disturbances, and heart palpitations. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
I think what I did was skim the beginnings of these interactions and then made my own assumption that it was more about receptors and less about absorption and the heart stuff. My apologies. I guess because I know the company was first trying to get approval as an antidepressant,then jumped on the adhd band-wagon and then HEAVILY marketed the medication to families with children my judgement gets clouded and my feathers are immediately ruffled. I swear Namzu is the Confucious of this forum.
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Old 08-14-18, 05:55 AM
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Re: Can Strattera and SSRI be started together?

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Originally Posted by sarahsweets View Post
I think what I did was skim the beginnings of these interactions and then made my own assumption that it was more about receptors and less about absorption and the heart stuff.
Thanks for pointing out the potential metabolism and heart-related issues. I should correct my statement above about the potential for side effects when combined -- though I know for a fact that doctors sometimes prescribe them together, since I took them together myself.

You're right, there can be some interactions metabolism-wise between antidepressants and atomoxetine (if the medications both are processed through the CYP2D6 pathway). That's unrelated to the neurotransmitters the drugs target, and also unrelated to the fact that atomoxetine was investigated as an antidepressant first.

There are a bunch of drugs of all different types of classes that are metabolized in this way, and a portion of the population may be either rapid or very slow metabolizers. The very slow metabolizers are the ones who tend to have special problems with these medications, especially if they are combined.

It may be worth asking the doctor about the heart thing and/or seeing if they want to do an EKG prior to prescribing atomoxetine with Lexapro.

Last edited by namazu; 08-14-18 at 06:19 AM..
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Old 08-16-18, 07:25 AM
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Re: Can Strattera and SSRI be started together?

This thread - relevant to my interests.

I am on Strattera 80 mg, and Mianserin, 60 mg.

I am trying to add an SSRI/SNRI to this.

I tried Effexor - and in accordance with a search on this forum, experiences of this combination (effexor+strattera), light headedness, floating away, slightly nauseous, and then, depression.

I don't know what my diagnosis or ailment is but - as to the use of strattera - which is by far the most effect drug for me when used with a sufficiently dosed autoreceptor blocker (mianserin) - this forum seems to have the most experience with this drug.


One dude above - uses strattera with wellbutrin??

I understood that would have a strong interaction via wellbutrin CYP2D6 inhibition??
Especially since you're at the full dose of strattera - 100 mg?

I can only tolerate up to 80 mg of strattera.


I also tried lexapro but - didn't like this drug.

And sertraline - which went excellent initially but - then efficacy reduced to the point I had to come off it.

So - Duloxetine is next on my list.


Given the interaction checker comment listed above - ???

I think it's often difficult to predict actual interactions.
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