Help! I’m so confused! | ADHD Information

[QUOTE=Diane V]

I think I'd give the increased dose of Strattera a shot. It seems when people stop it and ever try to go back it's not the same. Why not completely rule it out if you can. He is going to feel SO different on and off the Concerta. Are you willing to try the optimum Strattera dose and not use Concerta for a while. I am not sure you'll ever know how the Strattera is doing if you're always comparing it to how he feels with and without the Concerta on weekends.

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I have decided to call the doctor back tomorrow and see what she thinks about upping the Strat before giving up on it.

I'm not sure I understand your comment about the Concerta - are you saying that to see how he really does on Strat we should have him off of the Concerta for awhile? Would that really make a difference? He feels really hyper without the Concerta and we can see his hyperness as well. If it were summer I wouldn't have a problem going without the Concerta but I'm scared to do it during the school year especially with all the problems we have been having at this year. We do have long break coming up in March - would 5 days off of the COncerta be enough time to see how he really feels on the Strat? If we upped the Strat dose now, he would be on it about a month by the time we got to that break from school.

THanks for your input. I would rather keep trying with the Strat and make sure it doesn't work before I give up on it.

I guess what I'm trying to say is that if you plan to use both together thats fine, obviously, but any time you take a break from the concerta I feel like it'll just feel to him like he's not really on meds. That change is so dramatic with stimulants that you're calm and focused when in your system to SO hyper and unfocused. You have to more try to compare how he was without the Strattera when the Concerta was out of his system. You're Concerta free weekends will still be difficult (IMO). To know if the Strattera is doing anything you have to think about him completely unmedicated to to how he is on the Strattera. Does that make one ounce of sense?

WE have been using Strattera alone for three months. The plan was to use both, but I wanted to get her off stimulants if possible so we have ramped to target dose (it wasnt as bad as I thought) without a stim, and she did great, but lately is definitley not soo great. So I am hoping beyond hope we can do a dose increase and that'll do it and it's not fizzling out for us like it does with so many others. She doesnt want to go back on stim, but even she is complaining lately .

[QUOTE=Diane V]

YES, THAT DOES MAKE SENSE. I HADN'T THOUGHT ABOUT THAT WAY AND IT IS A VERY GOOD POINT.

UNFORTUNATELY I REALLY DON'T HAVE A CLEAR PICTURE OF HIM NOT ON MEDICATION ANYMORE - ANYTIME WE FORGOT HIS CONCERTA HIS BEHAVIOR DROVE US SO CRAZY THAT WE RARELY FORGOT AND WE DIDN'T TAKE MED BREAKS (HE IS ACTIVE IN SPORTS YEAR ROUND SO ATTENTION AND BEHAVIOR WERE STILL IMPORTANT EVEN IN THE SUMMER). NOW THAT I THINK OF IT THOUGH WE WOULD TAKE A BREAK ON VACATION BUT IT WAS EASY BECAUSE HE WAS SO ENGAGED WITH THE BEACH ACTIVITIES THAT HE WAS EASIER TO DEAL WITH. EVEN ON THE WEEKENDS WHEN WE HAVE BEEN TAKING BREAKS HE HASN'T BEEN AS BAD (SO MAYBE THE STRAT HAS HELPED SOME....) BUT HE IS TOTALLY ENGROSSED IN SOME COMPUTER ACTIVITIES SO HE ISN'T DRIVING ANYONE CRAZY - WHEN HE GETS BORED THOUGH HE STARTS ACTING UP. I DIDN'T MEAN TO GO ON AND ON, JUST THINKING OUT LOUD I GUESS.

THERE IS NO WAY I WOULD SEND HIM TO SCHOOL WITHOUT HIS CONCERTA AT THIS POINT. WE ARE IN A NEW SCHOOL AND HE IS HAVING A LOT OF TROUBLE WITH BULLYING AND MAKING FRIENDS (I DON'T THINK THIS IS ADHD RELATED BUT IS JUST THE AGE AND WHERE WE LIVE - SMALL TOWN NOT ACCEPTING OF OUTSIDERS). ALSO, HE IS HAVING SOME CONCENTRATING ISSUES AND HIS TEACHER HAS BEEN VERY DIFFICULT ABOUT IT. WE'VE TRIED TO TALK TO THE TEACHER AND PRINCIPAL BUT IT HASN'T HELPED. SO ANYWAY, I WOULDN'T WANT TO SET HIM UP FOR MORE FRUSTRATION BY NOT GIVING HIM HIS CONCERTA. IF IT WAS SUMMER (OR WE WERE AT OUR OLD SCHOOL) I WOULDN'T HAVE A PROBLEM WITH GOING OFF THE CONCERTA TO SEE HOW IT GOES.

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I HOPE YOU CAN GET A DOSE CHANGE AND THAT IT CONTINUES TO WORK FOR YOUR DD.

ONE OTHER QUESTION... WHEN I GO TO THE STRATTERA SITE, IT SAYS MAX DOSE SHOULD NOT EXCEED 1.4 MG/KG/DAY, YET I HAVE HAD PEOPLE ON THIS SITE SAY YOU COULD GO UP TO 1.8MG/KG/DAY. DO YOU KNOW WHERE THIS INFO COMES FROM? ALSO, THE CLINICAL TRIALS NOTED ON THE SITE SAY THAT FOR CHILDREN UNDER 70KG, THEY DIDN'T SEE ANY BENEFIT WHEN THE DOSE WAS INCREASED BEYOND 1.2 MG/KG/DAY. ANY THOUGHTS?

THANKS!

I think or docotr told us 1.8 was max too. He otld me she was 82 pounds so target would be between 45 and we could go up as far as 60. 60 would be more than 1.4. She is at 54 right now, so I know he'll let us go to 60mg, I hope that's going to be enough. I dont know if 6mg can make that much difference, but I want to try. I really, really dont want to add a stimulant if we dont have to. She cant stay like this though. She has been so happy, it wont last like this though, she even said a few times lately I dont know whats wrong with me, and she was happy we were seeing the doctor next week, so she can tell him her "head gets spinny". I have a feeling he's going to want me to add back a small stimulant dose..................Yes, it would be enough time, and possibly make a huge difference. it's worth a shot. greyhoundmom, wanted to update you. We're increasing the Strattera. Saw doctor this morning and he was happy that we are having pretty much NO negatives with the Strattera. We're going up to 80 mg. He said he knows it's above recommended for her weight, but he has used this much before. He has even gone to 100mg, but wont with her. We'll go to 80 and if that's perfect, GREAT, if better but still not quite cutting it for school, we'll add Provigil rather than a stimulant. So we'll be tweaking with the Strattera and/or Strattera/Provgil combo. He says the Provigil has the same side effects as stims, but to a lesser degree and it's more easily tolerated with "stim breaks" than stimulants. So we could stop the Provigil for vacations and summers (he recommended not doing just weekends, but we could if we wanted to). So that's our plan. I am VERY happy with this plan. I was so worried about going back to stimulants, especially with how well she tolerates the Strattera.

Keeping my figures crossed that the 80 mg of Strattera works for your DD! I have never heard of Provigil. Glad you have a plan you feel good about.

Good luck!

thanks. The Provigil would be prescribed off label. It's FDA approved for narcolepsy, but is used often for ADHD. As it has stimulant qualities. He's thinking she'll do better adding this to the Strattera rather than a stim. Since we're seeing no negatives for now with the Strattera and she has many on stims.I hear you, I've sort of been waiting for this day. It's just discouraging when it comes. I dont like her on stimulants, but it looks like we dont have a whole lot of choice.

Diane V,

Let me know how your DD does on the increase of Strattera, if your doctor goes that route. My DS weighs 83lbs and the doctor is increasing his dose to 60mg. By the time we get to Easter break he will have been on it for over 4 weeks and I will stop the Concerta for the 4 days (it was supposed to be 5 days but we have to make up a snow day now) and see how he is. Do you think 4 days will be enough time off of the Concerta to really see if the Strat is working? I wish we had never started the Strat but had waited until summer when I didn't have to worry about school! I can't afford to keep him on the Strat if it isn't working (it costs me over 0/month and I guess it will be more now that he is on a higher dose. Doctor gave me 2 weeks of samples to start.).

Well actually today I got a report from her teacher and the reports from her recent academic evaluations. She did horribly and has been having issues at school the past couple of weeks. We've been seeing this inconsistency at home. Impulsiveness returning, inattention, not able to get through even a simple task. She's complaining her head is "all spinny". I cant imagine increasing her Strattera by 6 mg will change all that much. I am thinking we will probably have to add or switch back to stimulant and deal again with the side effects . Not what I wanted, but this is how it goes right. When she's happy, eating and sleeping she cant function

Sorry to hear things have gone soooo downhill with your DD on Strat, especially when it had been working. That is so disappointing. I guess if it ends up working for my DS we'll enjoy it while it works but be prepared to have to try something else. I'm not holding out a lot of hope but at least I can say we tried.

DS has been taking Concerta with great results for a number of years. This school year he has been having trouble staying focused. He is 12 yrs old and I understand that puberty can mean going back to square one with meds. I should also mention that we moved this summer so he is at a new school with new kids, new teachers and different ways of doing things - so basically lots of new things in his life. Anyway, in late October the doctor suggested trying Strattera (while keeping him on his Concerta until the Strattera started working). He is on 50 mg (I believe his target dose is between 45 and 65mg) and has been on this dose for about 6 weeks. I don't think it is doing any good. I know that on the weekends when I don't give him his Concerta he says he still feels very hyper and can't focus. I talked to the doctor today and she says to stop the Strattera and we will just increase his Concerta. I am now wondering if it is worth taking the time to increase the Strattera to 60mg and see if that works or if we should just bag it. I feel like I've spent so much money and time on the Strattera over the last several months that we should increase it and give it more time. But...I hate spending soooo much money on meds that aren't working (Strat and Concerta cost me 0/mo) and I'd really like to get his focus back on track in school - it has been a tough year so far. His grades are still good but he is frustrated with his inability to concentrate and it bothers his teacher which has caused some difficulties. So would you just bag the Strattera and go back to a higher dose of Concerta (which tends to make it hard for him to sleep) or would you keep trying with the Strat to make sure it really doesn't work before stopping it? This is all so frustrating!

Thanks!