Saturday, March 24, 2007

From Strattera to Wellbutrin XR

There are two main classes of ADD medications: stimulants and antidepressants. I haven't taken neurology yet, but it appears that both drugs have the same net effect in the end: they act on neurotransmitters and/or their receptors. "Stimulants" may sound like an odd choice, but the way I understand it, they stimulate (activate) your brain's "braking" mechanisms. Stimulants have shown to be more effective than antidepressants for treating ADD, although this is a trend and there is variation person-to-person.

As a medical student, there is a perceived career risk to taking stimulants, which are subject to special legal restrictions beyond those for other prescription drugs. To be honest, I don't understand how it can be that taking legally prescribed stimulants for legitimate conditions could be risky when applying for residency, etc., but health care workers with ADD often prefer non-stimulants to be avoid such issues.

The only non-stimulant FDA-approved for ADD is Strattera. Dr. Hallowell in his new edition of Driven to Distraction (or maybe Delivered from Distraction, another book of his) went from being very hopeful that Strattera would replace stimulants, to being hopeful that Strattera would show its promise once the dosing was fine-tuned, to recommending Wellbutrin (an antidepressant) instead.

There is a lot of information online about individuals' disappointments and success stories with various drugs. With medications for mental health, it is sometimes difficult to gauge if a medication is causing a problem or if it is the complexity of life.

While taking Strattera, my emotions were all over the place, but yet some things in my personal life were also. I experienced the common side effect of queasiness, but I was generally more productive. I was still very distractable, but a decreased appetite and a reduction in feelings of anxiety helped with efficiency. However, I did not take the Strattera on a consistent schedule: I was to take it twice a day, 12 hours apart, and I frequently disturbed the schedule. Like for any drug, consistency is very important (and is a notoriously big problem for people with ADD).

There has been promising research that once-a-day Wellbutrin XR is an effective treatment for adults with ADD, and this fits with Dr. Hallowell's experience. However, Wellbutrin is not FDA-approved for treating ADD and is so prescribed "off label."

Like other antidepressants, it can take weeks before Wellbutrin (or Strattera, for that matter) makes its full effect. My physician decided with me to switch to Wellbutrin XR from Strattera instead of adjusting the Strattera dosing schedule to take it once a day. I've been very consistent taking Wellbutrin, and I feel much better emotionally. Interestingly, Wellbutrin acts an inhibitor for the enzyme that metabolizes Strattera, so the two drugs should not be taken together (or the Strattera should at least be decreased).

It is too soon to tell if the Wellbutrin XR will help me with my ADD, but I am keeping my fingers crossed. I already feel more like myself again, which makes me think that the Strattera was not working for me, at least not as I was taking it.


Anonymous said...

I have a niece who tryed Stattera and she ended up punching a girl out. NOTE: My niece is a beautiful Pamela Sue Anderson look alike (no kidding), and is a soft spoken feminine type of women. Since I am her aunt, and was interested in trying Stattera instead of my usual low dose quick-release formula Adderal (5mg)twice daily, After reading some really weird side effects about Stattera, I decided against it! I just can't take the chance, cause my system is so sensitive. So I quess I'll stay with my one cup of coffee, and low dose adderall!

Anonymous said...

I am currently taking wellbutrin XL and Strattera. To treat ADD and anxiety disorder. I feel like combined they work wonderful for me. However, I am on the lowest dosage of both. At any rate the meds together, make me feel so much better! Good luck

Anonymous said...

Hey, awesome blog. I am also a med student (2nd year) with ADD. I shall come back and read everything here when the pathology quiz I am studying for is over..!

I wonder if you could point me towards any information about discrimination/disadvantages to taking stimulants, especially concerning applying for residencies.

I am 2/3 the way through "Driven to Distraction." Does this book mention anything about the subject?

I was diagnosed a couple of years ago, but I just started Concerta today.

Also, maybe my understanding is incorrect, but since Straterra (and probably also Wellbutrin) take a long time before you see any effects, you can't stop taking them on days you don't need them, and start taking them again expecting them to work instantly right? This would mean that if you want to turn off the meds (and possibly turn on the creativity), it would take a few weeks.

Stimulants, on the other hand, work on the same day that they are taken and don't require the same build-up period.

So do let me know why you went with Straterra and Wellbutrin over stimulant medications...!


Anonymous said...

Can you tell me more about what concerns there are with stimulants and a medical career, i.e. residency? I just got diagnosed with ADD, and have been trying Adderall. I can't decide fully about whether it's the best medication for me, since I only started taking it and haven't gotten into a schedule (surprise!). I don't want to change unless it's not working.

What should I be concerned about regarding stimulants and residency? I don't plan to take medication for many years. Maybe 2nd year and 3rd year.