http://www.fda.gov/cder/drug/InfoSheets/patient/AtomoxetineP T.htmhtm
Patient Information Sheet
Atomoxetine (marketed as Strattera)...
"...FDA ALERT [09/2005] Suicidal Thinking in Children and Teens...
Strattera may increase thoughts of suicide or suicide attempts in children and teens. Call your child’s healthcare professional right away if your child or teen has: new or increased thoughts of suicide changes in mood or behavior including becoming irritable or anxiousThe label for Strattera is being revised to include the above warnings..."
http://www.fda.gov/cder/drug/infopage/paroxetine/default.htm
"Paroxetine hydrochloride (marketed as Paxil) Information
FDA ALERT [07/2005] – Suicidal Thoughts or Actions in Children and Adults
Patients with depression or other mental illnesses often think about or attempt suicide. Closely watch anyone taking antidepressants, especially early in treatment or when the dose is changed. Patients who become irritable or anxious, or have new or increased thoughts of suicide or other changes in mood or behavior (or their care givers) should contact their healthcare professional right away.
Children
Taking antidepressants may increase suicidal thoughts and actions in about 1 out of 50 people 18 years or younger. Although paroxetine is prescribed for children, FDA has not approved paroxetine for use in children..."
Be careful how you wean him off the Paxil mommady.
http://www.ahrp.org/risks/healy/FDA0204.php
"...5. Given that Paxil/Seroxat shows the greatest number of withdrawal syndrome reports to WHO for any psychotropic drug ever, and given that the full dimensions of this problem remain unknown, with the company changing its estimates as to the frequency and severity of the problem at regular intervals, will FDA outline exactly how a randomized withdrawal design could demonstrate these drugs work for either children or adults?..."
http://www.benzo.org.uk/healy.htm
"PROTOCOL FOR THE WITHDRAWAL
OF SSRI ANTIDEPRESSANTS
by Dr David Healy MD, FRCPsych
North Wales Department of Psychological Medicine,
Bangor, Gwynedd LL57 2PW, Wales, UK
...SSRIs
SSRI stands for selective serotonin reuptake inhibitor. This does not mean these drugs are selective to the serotonin system or that they are in some sense pharmacologically "clean". It means they have little effect on the norepinephrine/noradrenaline system. There are 6 SSRIs on the market:
SSRI US TRADE NAME UK TRADE NAME
Fluoxetine Prozac Prozac
Paroxetine Paxil Seroxat
Sertraline Zoloft Lustral
Citalopram Celexa Cipramil
Fluvoxamine Luvox Faverin
Venlafaxine Effexor Efexor
Note: Venlafaxine in doses up to 150mg is an SSRI, over 150 mg it also inhibits noradrenaline reuptake.
FEATURES OF WITHDRAWAL/WITHDRAWAL SYMPTOMS
The common symptoms on withdrawal from SSRIs break down into two groups(2). The first group may be unlike anything you have had before and include:
Dizziness
Headache
Muscle Spasms
Tremor
Electric Shock-like Sensations
Other Strange Tingling or Painful Sensations
Nausea, Diarrhoea, Flatulence
Dreams, including Vivid Dreams
Agitation
The second group overlaps with general nervousness and may lead to you or your physician to think that all you have are features of your original problem. These symptoms include:
Depression
Lability of Mood
Irritability
Agitation
Confusion
Fatigue/Malaise
Flu-like Feelings
Insomnia or Drowsiness
Mood Swings
Sweating
Feelings of Unreality
Feelings of being Hot or Cold
These symptoms appear in anything between 20% to 50% of patients taking SSRIs, sometimes within hours of the last dose. Paroxetine and Venlafaxine appear the most problematic agents at the moment but similar symptoms are liable to occur with all SSRIs and to a lesser extent with tricyclic antidepressants. In milder cases problems may clear up after a week or two, but in others symptoms may continue weeks or months after the last dose and for some patients it may not be possible to stop treatment. Specialist help may benefit some patients in this latter group, if only to provide suggestions on antidotes to continuing drug induced problems such as loss of libido.
IS THIS WITHDRAWAL?
There are three ways to distinguish withdrawal from SSRIs from the nervous problems that the SSRI might have been used to treat in the first instance.
First if the problem begins immediately on reducing or halting a dose or begins within hours or days or perhaps even weeks of so doing then it is more likely to be a withdrawal problem. If the original problem has been treated and you are doing well, then on discontinuing treatment no new problems should show up for several months.
Second if the nervousness or other odd feelings that appear on reducing or halting the SSRI (sometimes after just missing a dose) clear up when you are put back on the SSRI or the dose is put back up, then this also points towards a withdrawal problem rather than a return of the original illness. When original illnesses return, they take a long time to respond to treatment. The relatively immediate response of symptoms on discontinuation to the reinstitution of treatment points towards a withdrawal problem.
Third the features of withdrawal may overlap with features of the nervous problem for which you were first treated - both may contain elements of anxiety and of depression. However withdrawal will also often contain new features not in the original state such as pins and needles, tingling sensations, electric shock sensations, pain and a general flu-like feeling.
Before starting to withdraw, it should be noted that many people will have no problems. Some will have minimal problems, which may peak after a few days before diminishing. Symptoms can remain for some weeks or months. Others will have greater problems but these can be helped by the management plan outlined below.
Finally however there will be a small group of people who are simply unable to stop. It is important to recognise this latter possibility in order to avoid punishing yourself. Specialist help may make a difference for some people in this latter group, if only to provide possible antidotes to attenuate the problems of ongoing SSRIs such as loss of libido.
MANAGEMENT OF WITHDRAWAL
Withdrawal from SSRIs is something to be done in consultation with your physician. You may wish to show this to your GP. Over-rapid withdrawal may even be medically hazardous, particularly in older persons.
1) Convert the dose of SSRI you are on to an equivalent dose of Prozac liquid.
Seroxat/Paxil 20mg,
Efexor 75mg,
Cipramil/Celexa 20mg,
Lustrat/Zoloft 50mgs,
ARE EQUIVALENT TO 20mg OF PROZAC LIQUID.
The rationale for this is that Prozac has a very long half-life, which helps to minimise withdrawal problems. The liquid form permits the dose to be reduced more slowly than can be done with pills.
2) Stabilise on the Prozac for a week, then halve the dose.
3) If there has been no problem with step 2, the dose can be further halved. Alternatively if there has been a problem from this point on the dose can be reduced even more slowly in weekly increments.
4) From a dose of Prozac 10mgs liquid, consider reducing by 1mg every few days over the course of several weeks - or months if need be. With Prozac liquid this can be done by dilution.
5) If there are difficulties at any particular stage the answer is to wait at that stage for a longer period of time before reducing further.
6) Withdrawal and dependence are physical phenomena. But some people can get understandably phobic about withdrawal particularly if the experience is literally shocking. If you think you may have become phobic, a clinical psychologist may be able to help manage the phobic problem.
7) Self-help support groups can be invaluable. Join one. If there are none nearby, consider setting one up. There will be lots of other people with a similar problem.
There is anecdotal evidence and some theoretical grounds to believe that another option is to substitute St John's Wort for the SSRI. If a dose of 3 tablets of St John's Wort is tolerated instead of the SSRI, this can then be reduced slowly - by one pill per fortnight or even per month.
Some people for understandable reasons may prefer this approach. But it needs to be noted that St John's Wort has its own set of interactions with other pills and its own problems and you may wish to consult your physician if this is the option you choose.
FOLLOW-UP
The problems posed by withdrawal may stabilise to the point where you can get on with life. But in either this case or in cases where it is not possible to withdraw, it is important to note ongoing problems and to get your physician or someone to report them if possible.
There are clear effects on the heart from SSRIs. The list above does not include cardiac problems occurring during the post-withdrawal period. Such problems if they occur may however be related to withdrawal and should be noted and recorded.
SSRIs are well-known to impair sexual functioning. The conventional view has been that once the drug is stopped, functioning comes back to normal There are indicators however that this may not be true for everyone. If sexual functioning remains abnormal, this should be brought to the attention of your physician, who will hopefully report it.
Withdrawal may reveal other continuing problems, similar to the ongoing sexual dysfunction problem. It is important to report these. The best way to find a remedy is to bring the problem to the attention of as many people as possible.
Healy D (2001). Psychiatric Drugs Explained. Churchill Livingstone, Edinburgh; Healy D (2001). The Creation of Psychopharmacology. Harvard University Press, Cambridge Mass.
Rosenbaum JF, Fava M, Hoog SL, Ashcroft RC, Krebs W (1998). Selective serotonin reuptake inhibitor discontinuation syndrome: a randomised clinical study. Biological Psychiatry 44, 77-87"
[QUOTE=BALANCED]
and the Canada Health warning on PAXIL includes....
"MAY CAUSE PERIODS OF SEVERE AGITATION RESULTING IN SELF HARM OR HARM TO OTHERS "
... or harm to others ... means that Paxil can kill you even if you're not taking it. Remember Nicole Simpson and Ron Goldman... 2 victims of O.J. Simpson's Paxil rage ?
[/QUOTE]
*Sigh*
You keep bringing this one up - so I have to reply to it.
There is NO connection in the Simpson case to SSRIs!! He was an enraged, self-indulgent ex-star who had taken anabolic steroids and other meds during his sports career. He was jealous of his ex-wife's getting on with life - and we assume he did it.
This is like trying to assume that if we found out the green river killer was on meds that that caused him to kill. COME ON. Do you ever read proper information - i.e. not in the weekly world news?
Glen,
Perhaps you should have read the Edmonton Journal shortly after the O.J. Simpson trial.
He gave an interview to a British reporter and told her that during the time of the killings and slow motion car chase..." They just put me on a new antidepressant and you know how weird those make you feel". (Paxil)
Paxil has been responsible for thousands of deaths... not only suicides.
Donald Schell took Paxil for ...2 days... then murdered his wife, his daughter and granddaughter before commitng suicide. The jury awarded the surviving son in law.... ,000,000. from GSK.
GSK did not appeal and just paid up.
Straterra and anxiety - My poor 10 year old experienced the same thing! She has anxiety and motor tics, so we wanted her off the stimulants and we tried Straterra. Her anxiety went through the roof!!! She hung in there for almost two weeks, because I kept reassuring her that it just took time to work. Finally one morning I went to give her the meds, and she was lying on her bed sobbing. She said she felt so scared and awful that she had to throw the pills out the window! I felt terrible, thanked her for giving it such a brave try and told her that we were done trying that medicine and that I would never put her on it again.
I decided to give her a little break from her meds since it had been such an awful two weeks for her. Well - that decision lasted about two hours! Her good old impulsive, ADHD self was soon back, and I quickly remembered why she is on meds!
So now we continue with Concerta, celexa and clonidine for sleep, and I keep waiting for a different non-stimulant drug to come along. I must say, life is never boring!
Sarah mama to a fab 10 year old with Tourette's, ADHD, anxiety, etc - who keeps me on my toes and brightens my life beyond belief!
Is paxil something prescribed for ADHD? Is this an ADHD forum? For me, and it changes with each individual, Strattera is working very well so far. Perhaps when a child is depressed the parent should be an active participant in his recovery. If drugs are prescribes observe your child. The drug may not be the one for him. Parents who lack thought and observation and want a band-ade remedy for their children may notice the bad effects when it is a little to late. Perhaps this should also be considered????I can't speak for kids but I am on my fourth day of strattera. So far no negative side effects. My anxiety is actually down but I'm not sure it that is must my mind. I feel a little calmer and not as reved up but again, I'm not sure if it is just my mind. I have been extremely busy so that may be another reason....?
I also started omega 3...4000 mg a day when I started strattera. My dose on strattera goes up tomorrow.
Wodka? Vat iz wodka? Yo quiero guaro...and the Canada Health warning on PAXIL includes....
"MAY CAUSE PERIODS OF SEVERE AGITATION RESULTING IN SELF HARM OR HARM TO OTHERS "
... or harm to others ... means that Paxil can kill you even if you're not taking it. Remember Nicole Simpson and Ron Goldman... 2 victims of O.J. Simpson's Paxil rage ?
[QUOTE=Davidornado]Hey Brig,
How's the new meds mixing with the pain meds? Can you take them together?
[/QUOTE]
yep i checked with dr and pharmacy and i am able to take all, except the ambien which i wont need as my pain meds make me sleepy anyway...i actually was able to up my prozac on friday and can tell a big difference as well...i am glad it is working as i was so depressed for so long...still on the 20mg of ritilin 3 times a day which is also working and my clonazapam 1mg 3 times a day...dont have panic attack breakthroughs so no more xanax...and i also take skelaxin for my back it is a muscle relaxer...my blood pressure and heart rate is normal and i check it at least 3 times a day...so other than my back killing me, i am doing great on my meds....thanks for asking. i was taking 2 lortabs every 4 hours and it did nothing for me for pain so they put me on oxycodone w/ acetaminophen=7.5/500 per tablet....helps some with back if i am still and dont move...i go in for an MRI on the 21st at 6:00 in the morning to find out what else is wrong with my back..
thanks for asking and your concern....greatly appreciated
well then we will have to get some vodka and have a party when you are better, right???[QUOTE=chjones]well then we will have to get some vodka and have a party when you are better, right???
what happened to your back, brigs? did i miss something??? [/QUOTE]
got messed up 6 years ago and is getting worse...so i have an mri set up on the 21st to see how worse it has gotten.....i am stuck in bed, cuz i cant move without screaming in pain....
Umm, no, Paxil is NOT prescribed for ADD. However, if you read my original post (above), Paxil WAS prescribed for anxiety which was definitely aggravated by Strattera IN MY SON's CASE. This parent IS an active participant in the child's "recovery." My point WAS that you cannot assume that strattera will not induce -- or aggravate -- a person's anxiety just because it is not a stimulant. No one was looking for a band-AID. I was simply trying to let other parents know that if your child is complaining of anxiety while on strattera that the drug may not be appropriate. This was not a rant about the bad points of strattera, but rather a message to empower parents/patients who were being told that strattera was not causing their anxiety as we were. We also did not wait until it was a little "to" (sic) late. In fact, we gave this drug the minimum amount of time recommended by our doctor. Be cautious when inferring that a parent hasn't done enough for their child. Enough said?[QUOTE=mommady]My son, 9, was prescribed Strattera for ADD because he also has anxiety. We were told that Strattera would not make him anxious because it's not a stimulant. It made him EXTREMELY anxious. In order to get him out the door of our home, our pediatrician added Paxil to the mix. He was a mess. Now, after 2 days without Strattera, he's fine and we're going to wean off of the Paxil. Beware of choosing Strattera because you think it won't rev your kid up. It sure did ours and no amount of improved learning would be worth the hell this kid went through. We can't be the only ones with this experience![/QUOTE]
they also started me on strattera as i have adult add and said that strattera has a small amount of antidepressant in it....it did not work for me so now i am on prozac and ritilin...which has helped a lot.....i am also on panic attack meds as i have phobias....but strattera is not a good choice for add and anxiety...i wish u luck with what ever you try next....keep us updated and just ignore curuc and balanced as they like to hijack posts and try to scare everyone with there non true info..
but please keep us updated so we know how you are doing with your child...
Thank you Brig for getting the point and sharing relevant info. My son is doing quite well without the strattera. We'll probably try something else for his ADD, but after the bad experience with strattera, we're a little hesitant to try anything else. ADD with anxiety is a tricky combination.[QUOTE=mommady]Thank you Brig for getting the point and sharing relevant info. My son is doing quite well without the strattera. We'll probably try something else for his ADD, but after the bad experience with strattera, we're a little hesitant to try anything else. ADD with anxiety is a tricky combination.[/QUOTE]
OH YES IT IS, I KNOW I HAVE SEVERE ANXIETY DEPRESSION, PHOBIAS AND ADD AS WELL...GOOD LUCK I HOPE U HAVE A GREAT PSYCH DR THAT WILL HELP U DECIDE THE PROPER WAY TO GO.....BEST OF LUCK AND BEST WISHES...LET ME KNOW WHAT U DECIDE AND HOW YOUR SON IS DOING..YOU AND HIM ARE IN MY PRAYERS....
Hey Brig,
How's the new meds mixing with the pain meds? Can you take them together?
Strattera isn't like most SNRIs they'll put you on. Most of them are actually dual SSRIs and SNRIs that actually only give you the SNRI benefit at really high doses. Because of that, some people have reacted very poorly to them. Really those drugs are best used for people who have depression issues first and anxiety issues second. It may be worth a second try.
But you're right to point out the issue with high levels of norepinephrine. People who already have high levels of this will experience major burnout on strattera. The drugs tends to either oversaturate your brain with the chemical, or, even worse, it'll take to targetting other neurotransmittors instead, which can be dangerous. Usually though, if you experience that kind of burnout, you just need to lower your dosage and give it a week or two to recover from burning up your norepinephrine.
Bottom line, as you stated, it works differently for everyone. But if you have co-existing anxiety and ADHD, it may be a good place to start.
KDLMaj-This is a really late reply to the thread, but I figured I'd jump in with a slightly different opinion:
Strattera is an SNRI, and it used to be that SNRIs were the frontline depression meds (before the advent of SSRIs). As such, strattera was originally being developed as an anti-depressant, but they figured out after the second phase (I think it was second) that it worked really well for ADHD symptoms. Realizing there was more of a market for non-stimulant ADHD meds than yet another anti-depresent, Eli Lily reapplied for strattera to be an ADHD med. Norepinephrine (the "N" in SNRIs) is one of the three major neutortransmittors in the brain, and it has been linked to attention, mood, and, you guessed it, anxiety levels.
A few studies have shown that strattera (and SNRIs in general) is actually quite beneficial in helping people with most anxiety disorders (though not as much for panic disorder) in addition to the depression that often accompanies ADHD. So actually, if you are suffering from a co-morbid anxiety disorder with your ADHD, strattera may be a good idea for you. Some people mix it with the more traditional stimulants (at lower doses generally), and that has also been quite effective (since both increase levels of norepinephrine and dopamine) in dealing with co-morbid ADHD and anxiety. Though stimulants, especially with their "come down" effects, are very tricky with anxiety themselves. People with panic disorder in particular may find that coming down from the stimulants triggers panic attacks, and people with generalized anxiety disorder may find increased anxiety while coming down from stimulants. (I'm not sure how true or not true this is with drugs like adderall XR, which tends to have a far less pronounced come down)
ADHD with anxiety is REALLY tricky, but strattera is not at all dangerous for someone with both problems per se. (Though obviously everyone responds differently to the medication)