My initial freakout with Strattera

For my current experiences, go here; it's working pretty well for me now. This text was written the day after the worst of my first try at the drug.

Warning: this missive contains two or three lines about sexual side effects. Don't read on if you're offended by that sort of thing, etc.

I'd been taking Wellbutrin (bupropion) SR 150mg bid for ADHD and depression for about two months, when my psych got back from an Eli Lilly conference on a new ADHD drug, Strattera (atomoxetine) and suggested I may want to try it.

Strattera isn't a "conventional" ADHD drug in that it's neither a stimulant nor scheduled (!). Its structure is kinda funky - (-)-N-methyl-3-phenyl-3-(o-tolyl-oxy)-propylamine HCl - so it resembles some recreational phenethylamines - e.g. MDMA/Ecstasy - in some ways. Furthermore, like Wellbutrin, Strattera is a SNRI [selective norepinephrine reuptake inhibitor], but it doesn't affect mood (they claim). Concentration per body weight is an important factor; the ideal dose is around 1.2mg/kg. It's metabolized by CYP2D6. As usual, they don't know why it works.

Anyway, enough fascinating chemistry. It's a once-a-day medicine, so my first day, Tuesday, I swallowed a raver-blue 40mg capsule on an empty stomach, and went to lunch two hours later. Big mistake, I ended up barfing lunch. So much for that day of ramping up titration to 80mg/day. Felt a little down and anxious, figured that was par.

The second day, Wednesday, I had 40mg with lunch, and it seemed OK, no nausea. After a few hours, I got a whole-head tingle which wasn't unpleasant. Wanking, however, was quite strange; it was quite difficult to stay erect, and far more stimulation than usual seemed necessary. Orgasm was milder than usual but extended for a longer period of time. Went to bed that evening feeling fine.

Thursday. For my third day, I woke up feeling not very hungry at all, but went to lunch anyway, downed my tasty Wellbutrin and Strattera, and picked at my food for a while - I didn't like what I ordered, but I wasn't really that hungry anyway. A few hours later, I went to a cafe and drank some iced tea; it tasted weird, like it had been brewed too long. At the cafe, I noted that my gums were kinda achy - similar to my bad reaction to Effexor, erection was really fucking difficult, and that while I still wasn't hungry I could drink all the soda pop I liked.

Friday, the fourth day. I woke up, a bit mopey but not depressed, and attempted to eat lunch at Carl's Jr. Had my tasty 40mg of Strattera, 200mg of Wellbutrin, and downed it with Coke. I think I maybe ate a third of my sandwich - it was greasy and funny-tasting and the fries were all nasty, but I was able to drink a fair amount of soda (despite the worse than usual corn syrup tang.) Walked around town for a while (ah, the life of the unemployed) and laid in the sun on the grass, as I was getting a bit anxious and stressed. A couple of hours later, it was just about time to head to my friend's house, so I tried eating. Peanut butter was sorta vile and made me want to vomit, but I ate a few tablespoons anyway. The Coke tasted foul, but I figured I needed the calories, as I was getting lightheaded when I stood. In the car, I started majorly freaking out and worrying about eating and that my life essence was being sapped and all sorts of other stuff. At friends' house, the cookies seemed really sweet, the pretzels were tasty, and the garlic bread had some weird lemony flavor. My outward behavior was relatively normal, but I was still not terribly well. At dinner, I tried to eat a spanish omelette; the tomato sauce was amazingly sour and awful, the green chilis - something I love - were all vinegary and nasty, the olives had some weird oxidized flavor. The eggs and cheese themselves weren't too bad. A few hours later, I was talking to a friend online and I got majorly fucking anxious and upset, and ended up bawling, then going fetal, squealing, and rocking back and forth with the occasional sob. She talked me down, eventually.

Today, I woke up, went "what the FUCK?" and felt like I was mentally hungover. I thought about my behavior from the previous evening and couldn't believe how I acted. I'd decided last night not to up my dosage to 80mg, as the schedule had dictated, and it seemed to be still a wise decision. In retrospect, I can say that the effects were probably due to the combination of wellbutrin and strattera; wellbutrin has contraindications for anxiety, and as they're both SNRIs it's well within the realm of possibility that one had an amplifying effect on the other. The 'taste perversion' was kinda interesting; I think that overall, sour foods were affected the most. About 4pm today, my hunger and GI tract came roaring back into life, and my tastebuds seemed to be back to normal.

What can I say in general about my experience? I think that if I weren't taking the Wellbutrin that the Strattera might have worked - my handwriting was noticably neater, my flow of thought easier - but that the combination of Wellbutrin and Strattera is something to either avoid or have only under close supervision.