Switching from stimulant to non-stimulant

[Coloradomomof2]

Hi everyone! I am new to the group and wish I would have joined a long time ago. My 7 year old son was diagnosed with ADHD when he was 5. He has been on Concerta ER for 2.5 years. We started at 18mg, went up to 27mg last year and recently went up to 36mg. The 36mg seemed to make him more irritable and frustrated. His pediatrician lowered his dose back down to 27mg and added Intuniv at night. We really haven’t seen a positive change. We recently had the genetic test called Genomind. His doctor said it showed Concerta many not be the right medication for him. She mentioned switching to Strattera only. I am nervous to go from a stimulant that he has been taking for 2.5 years to a non-stimulant. Has anyone ever done this? I have read it take several weeks to see the effects of the non stimulant. I hate to keep changing his medications. I just want to find the right solution. He has issues with controlling his emotions, impulsiveness, focus, etc. He is very smart, he just has a hard time with his behavior. Recently we have been having more trouble with social situations. He gets upset if a classmate doesn’t want to play the same game outside, or if they aren’t following the rules. Help this frustrated mom!

[Onthemove1971]

Thanks for sharing your experience with us. We like you got to a point where our Pediatrician was not able to manage his medication and.. it made all the difference becuase we started seeing a child psychiatrist. She is an amazing doctor who is still helping us today and our son is 15 Years old. They manage medication and think outside the box like giving both a stimulant and non-stimulant together. The reason is the stimulant helps decrease impulsivity and all of those behaviors ( excessive talking, skin picking, repeating things they are worried about) and the non-stimulant which helps with sleep and mood regulation.

This type of medication regiment can only be managed by a psychiatrist. It was very hard to accept that is what we needed a team member who know what we need. She is one of the reasons he is doing do well. Whenever things get rough I express what is happening and she makes amazing recommendations. I do understand not all child psychiatrist are as good. I wish everyone who needed care for a mental health could have it.

As I mentioned before, we had been through a number of medications and once things settled I ask him if he remembered taking other medications and he said Nope.. so I stopped worrying and pushed forward to really make his behavior change.

Best of luck, I hope you find the right combination that works for him. You will know when it is right.

[Snowseeker]

Hello, I can't share an experience of switching because my son has been on Strattera from almost the beginning of his ADHD diagnosis in 3rd grade (he started medication in 4th grade). He has taken it continuously for over 5 years and is in 9th grade now. I've always been curious about the information about Strattera taking days to weeks to notice/determine if it is working. Because that was not the experience for our son. It was immediately noticeable the very first day of taking medication. It made him extremely tired but he could also concentrate and do things we had never seen him do before (for example, sit at a restaurant for an entire meal and color a picture inside the lines of the drawing vs. non-stop movement and excessive fidgeting). In the early months, we switched to giving him the pill before bed so that he wasn't so exhausted during the day. It was a dramatic improvement on all fronts--academically, socially, at home.

Eventually, we transitioned to a morning routine and overall this has worked pretty well for him with very few side effects. Sometimes he gets heartburn that lasts around 30 minutes but almost never with name brand Strattera (it only ever seems to occasionally happen with a generic atomoxetine). But one of the "generic" names is actually manufactured by Eli Lilly (manufacturers of Strattera name brand) and it comes from the same facility in Ireland; so if I'm having trouble with a pharmacy offering Strattera name brand then I try to get the "generic" one that Eli Lilly makes because it's the same.

But now with the increasing academic demands in 9th grade and probably because he is still on the same dose (25 mg/day) that he has been for years, his current medication regimen is not adequate for his needs. We have avoided stimulants because he is very small for his age (5th percentile height & weight) and we don't want his appetite to be affected. So we are in the process of trying to find a psychiatrist to help us with what to try next (increase dose and/or new med). His individual therapy/counseling psychologist has shared that she recommends and very much prefers a psychiatrist to be involved with a medication change, especially at this age. In particular, for monitoring for depression/anxiety/mood changes. That being said, the wait times for psychiatrists are a big challenge right now and many appointments are only virtual (not in person). So we may end up sticking with his pediatrician since we have a history with him and can see him in person and we are also working with a counseling psychologist already. We also are having an updated psychoeducational assessment done by a different psychologist, which the pediatrician can use in understanding where his biggest challenges are. So, like the other reply here mentions, a psychiatrist is probably a very good idea in conjunction with your pediatrician. But finding the right practitioner fit doesn't always work out with the first try. I've also read some very positive experiences of people working with psychiatric Nurse Practitioners who specialize in ADHD.

Best of luck!

[Coloradomomof2]

Thank you both for your input. We actually saw his pediatrician yesterday. She thinks he is dealing with anxiety. He is doing well academically but struggles socially and behaviorally. He gets upset easily if things aren’t going his way. He has trouble recognizing social cues from his classmates. He gets upset and yells if his classmates aren’t following directions, cut him in line, don’t want to play the same games at recess, etc. His pediatrician explained that anxiety in kids can mimic ADHD. She said it’s not always what most of us think of when we think of anxiety (nervous, worrisome, etc). As I mentioned before, we did the Genomind genetic testing. The results showed he is a slow metabolizer. It mentioned that methylphenidate may not be a good fit for him. He has been on Concerta for 2.5 years. It also said SSRI’s are not a good fit. The confusing part to me is with that said, she kept him on the Concerta (saying if he is doing well academically, she didn’t feel the need to change it) and added a low dose of fluoxetine (Prozac/SSRI). She said she always starts with fluoxetine no matter what the genetics results show. So what was the point of doing the genetic test if we are putting him/keeping him on meds that showed aren’t a good fit? She also dropped the Intuniv since we haven’t really seen a change since taking it. That was another question. He has been on the Intuniv for 3 weeks. Is that enough time to see the effects? I am just super frustrated and confused.

[SunnyDayzAhead]

I am in the exact same boat with my just-turned 8 year old son. He was on Concerta 18mg for 1 1/2 years and went up on the dose because of issues at school, behavioural and poor focus, and the teacher reported absolutely no difference. We find that when the medication wears off around 4-5pm he is sooo easily frustrated, then gets angry and then cries, as if his ADHD symptoms return with a vengeance. It can be so hard to keep ourselves calm when trying to deal with him. He has also lost weight so our doctor suggested we change the medication to another stimulant but try an amphetamine based so he is now on Adderall 5mg. We are titrating the dose weekly and will see if it is any better for him. I know it is all just trial and error and every child responds differently but man this is such an emotional ride, it's just nice to know that we're not alone.

[anirush]

My grandson's psychiatrist stopped doing genetic testing. He said more than once it said a medication was not a good fit when the child was doing well on it. So, he said he did not trust testing anymore. Both of my grandsons have severe anxiety along with their ADHD. Intuniv was a wonderful addition to other meds. Neither can take stimulants, too much anger. Besides Intuniv one is on Strattera and Risperidone (for anger), the other on Wellbutrin (which the psychiatrist says helps with ADHD) and Seroquel.

With my 17-year-old grandson his pediatrician did his meds until he started getting unstable. Then the doctor admitted he was not a specialist in ADHD and suggested we take him to a psychiatrist.

It is trial and error. Good luck.