Adderall versus Strattera?

[Blueberry_Pie]

Hi. Our eleven year old boy, who has ADHD and dyslexia, has done pretty well on 5 mg of Adderall daily. His focus has improved significantly, and he's less hyperactive. But his loss of appetite is serious enough that, at our doctor's recommendation, we're considering Straterra. The research suggests that Straterra tends to be less effective, and that it, too, also sometimes causes appetite loss. Because of that, and because it takes a few weeks to take effect, we're not sure whether to switch to Straterra. I would be grateful to hear from anyone who has used both Straterra and a stimulant medication. In your experience, how do the two medications compare, both in terms of effectiveness and side effects? Thanks so much!

[kdali]

We are only 2 weeks into Strattera as a first med, so I don't have the experience you are looking for, but I'll say appetite has not changed much and focus/attention has improved. Would an appetite stimulant be an option for your son? Seems like that's his only problem 🤔

[Blueberry_Pie in reply to kdali]

You're thinking is on the mark. But we don't want to add another med to his regimen. Thanks!

[Joyceymc]

My doc who also has ADHD had strong opinions about Strattera, she said it works and then it doesn’t. I’m assuming this is her experience in her clinic only. Seemed more open to Guanfacine but we are not there yet.

We are on 5mg of Adderall XR as well and have similar concerns relating to appetite suppressant. We’ve been trying to catch him while he’s hungry and feeding more high caloric foods.

[Blueberry_Pie in reply to Joyceymc]

Thanks. Our doc is enthusiastic about Strattera. Partly because of that, we're seeking additional opinions.

[Snowseeker]

Hi, our 15 year old used Strattera for about 7 years (start of 3rd grade) and switched to Ritalin about a year ago (end of 9th grade). He was less than 5th percentile for height & weight, until last year, when puberty finally started. In his case, I think it is more genetics for his delayed puberty because everything was fine on endocrinology front; slow growth on his dad’s side. And even pre-medications, he was never a big eater either. So ADHD w/ hyperactivity seems to, by itself, result in reduced appetite for our son.

So we delayed trying stimulants due to his slow growth. Straterra worked very well for him for a long time. But eventually, his moods became sort of more more dark and it wasn’t helping him enough with concentration and attention by 8th grade. Increasing the dose made him really withdraw and isolate socially, which was very unlike him!

In hindsight, I wished we had switched a little sooner because his moods really improved and his focus got so much better with Ritalin. But it was so tough to know what to do at the time because his very small stature and delayed puberty was really affecting his moods too and how he felt about himself. So we didn’t want to risk him eating even less.

And yeah, it’s such a tough call to make a switch when something is working well in several aspects. Have you tried to put a more focused effort on a high calorie and high fat diet for when he does eat? Lots of butter on everything, nut butters, high protein, etc. lots of snacks, take snacks everywhere. Reduce sugary foods that reduce appetite. Also, maybe consult with an endocrinologist and dietician just to cover bases. My son’s endocrinologist explained that the fat is very important for puberty and hormones. Also, if he hears the information from a professional about the importance of calories, sometimes it works better than hearing it from parents.

Take care!

[Blueberry_Pie in reply to Snowseeker]

Thanks. We worry about our son's height growth, although he isn't naturally small in stature. We do try to get food into him whenever he's hungry--which is as soon as the Adderall wears off. And we do aim for high-fat foods. We're guilty of letting him eat too much sugar, as we are simply happy when he's eating.

[Hidden in reply to Blueberry_Pie]

I’d say whatever your decision- switching or carrying on with stimulant, this is a very good summary of Periactin and how it can help. I wouldn’t have given it to my child just on recommendation of other parents but this is a very comprehensive medical journal article about it.

cambridge.org/core/journals...

[Hidden]

My son was on a stimulant for 8 months and he completely lost joy of eating, it was heartbreaking, we had to start giving him high energy specialist medical drinks like Paediasure… But he also had a range of other side effects and it just wasn’t agreeing with him. He was on Methylpenidate and my husband and I when we asked for a change we didn’t even consider trying Amoheymains. We wanted to change straight to a non stimulant. Atomoxetine was a life changer for us. First day he took Atomoxetine he said ‘I like this medication because it makes me want to eat.’ Of course he was started on a very low dose so it wasn’t therapeutic yet but he already was somewhat happier and more normal child (he was very unwell neurologically on stimulants). He has never had a big appetite and he also used to suffer form functional nausea, feeling full, he has always been a slow eater (distracted, trying to read books whilst eating so nothing gets eaten). I had my son checked with 2 paediatric gastroenterologists in the past so I know he has no allergies, he doesn’t even have Coliac disease gene! They checked him for reflux- no reflux. I was explained that many children who are ‘neurodiverse’ have functional dyspepsia, tummy aches etc (gut-brain connection). So yes I was worried commencing him on Atomoxetine because side effects listed stomach ache. I give my son daily a capsule with ginger (gastroenterologist was rolling eyes but he said it won’t harm a child). I noticed that it helped with feeling nausea, makes digestion quicker.

Other parents on this forum were sharing that they give children Cyproheptadine and it does improve appetite and helps with functional dyspepsia, it also helps with sleep. I totally agree. I’d say read about it in medical journals for yourself and then ask your child’s doctor.

My son has started Atomoxetine last summer and he’s now on 60th centile for weight and 50th for hight (my husband and I are both short so that’s good enough). My son looks healthy and amongst his class peers he looks healthy average. He enjoys his food, we go for all inclusive holidays and he enjoys trying all the different food, we go to restaurants and we have lovely time (this wouldn’t be enjoyable when he was on stimulants). It gave us back this aspect of life- we are quite a ‘foody’ family, we have a whole library of cookery books and we are adventurous trying food from all around the world. I would never go back to suffering we endured as a family when my son was on stimulants.

One other major positive change is that my son is constantly stable- 24/7 he has good mood, he wakes and already is able to get on with the morning chores, then school and then after school clubs, sports etc. He goes to bed with no problem and he stooped waking too early. His focus is okay, but equally he’s now more sociable, stopped being anxious, he is not irritable. He still might have not as perfect impulse control(but there is no ADHD medication that can fix impulse control fully) - only recently he punched a boy at school (that boy has been bullying my son for over a year now and on this occasion they were lining up to go into the classroom and so my son couldn’t remove himself from the situation when the bully kept telling into his ear that he is ‘weak’ and ‘psycho’). I told my son that it wasn’t justifiable to punch the bully and also I made sure that my son was spoken to by the headteacher because whatever the reason he needs to know that violence is not the answer. What I would say- on Atomoxetine he is more resilient. I mean, I don’t approve punching, but he stood up to the class bully who is double my son’s size.

So anyway, for us Atomoxetine gets top marks.

[Blueberry_Pie in reply to Hidden]

Thanks so much for the detailed feedback on Atomoxetine. We're looking to hear from people who have seen its use make a difference in their child's life.

[SlbO]

Have you heard of Journay which is taken at night? My almost 9 year old is on that and has done much better with eating and her mood is not suppressed either. She was on Focalin before. With Journay she wakes up 10 hours afterwards and is ready to do life.

I have been on Strattera for over 15 years, myself, and it was such a “God save” at the time and still is with adjusting mood and focus….for me.

[Blueberry_Pie in reply to SlbO]

Thanks for the feedback on Strattera. We are hesitant to add an additional med, but we remain open to possibilities.

[GoDukes]

We started our son on stimulants when he was about 7. It seemed to help but it definitely took away his appetite and likely increased his anxiety. As he grew we increased his dosage and saw the side effects get worse. When he was 13 we finally decided to change to Straterra. It absolutely helped restore his appetite and seems to help reduce his anxiety. Of course it's hard to draw a line directly to the meds as he is getting older and maturing as well but we are happy we made the switch. I don't think the Straterra helps as much with his focus issues as the stimulants but we are OK with the trade off. Good luck to you! I know it's a lot to research and it's nerve racking to make changes but hang in there!

[Blueberry_Pie in reply to GoDukes]

Thanks for the feedback. Does the Strattera help at all with his focus? We'd be hesitant, I think, to lose the help in focusing ability that we've gained from Adderall. But I totally understand your choice!

[GoDukes in reply to Blueberry_Pie]

It does help some but I don't think as much as the stimulants. The negative side effects of the stimulants were too much for him though and we tried multiple different ones.

[AlexaKmom]

My 11 year old daughter is also on Ritalin and having similar issues. Does your son take 5mg twice a day? We did, but went down to 5mg in the am and 2.5 ( half a tablet) at lunch. She gets hungry for dinner and eats all night long. Evenings are a little scattered but worth it.

[Blueberry_Pie in reply to AlexaKmom]

Thanks for the feedback. Right now, he's primarily using only 5mg in the morning, but we've started giving him an additional 5mg around 2:30. Your solution sounds like a good one. It might be the next step we take.

[Peerandparent]

Straterra worked beautifully for my ADHD, but unfortunately I had one of those 1 in 10000 side effects. It sucks, because it was, for me, by far, the most effective med for addressing the ADHD and concurrent mood disorder.

There's nothing saying you can't do a cross-taper, so you can gradually reduce the stimulant a week or two into taking straterra (unless my med knowledge is out of date)

Depending on their response, you might be able to keep a low dose of the stimulant to compliment the straterra.

My biggest beef with psychiatry in general is that you can never be certain about how someone will react to a med until they're not. Even then things can change. I was stable on my meds for about a decade when suddenly an interaction started giving me life-threatening drops in blood pressure.

All I can say is that straterra could be wonderful, or it could be useless. You really can't tell until you try.

My one recommendation is to keep all involved (e.g. teachers) in the loop so they know that behaviour change is due to a med change and is something where the focus needs to be on short term accomodation, not correction.

[Blueberry_Pie in reply to Peerandparent]

Thanks for your thoughts. You are absolutely correct about the need to keep teachers and other helpers in the loop.