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Anyone have experience with Strattera - AND taking weekends off?


My 7yo son has been taking Vyvanse for a little more than year now and it’s working wonderfully for his ADHD, however, we went to the pediatrician yesterday and he told us that my son’s weight loss is “alarming” and that his growth has been stunted by a full inch in the past year.  He stated that only a small population of children don’t react well to stimulants and my son is one of them.

I also learned that our pediatrician doesn’t think highly of the psychiatrist that is prescribing the meds.  He said she focuses only on the ADHD symptoms and not the “whole child”. 

We’ve been using the same pediatrician for all of our kids for the past 12 years and I trust him.  He went to an Ivy League Medical School (not sure how much that matters, but seems impressive) and he has always been straightforward with us with other issues with our kids.

I asked his advice and he said, “If it was my child, I would try Strattera next.  It won’t work as well as Vyvanse for the symptoms, but will definitely help. He’ll still have some loss of appetite but it won’t be as severe as taking stimulants.  By the way, I have three children with ADD.  I would get him off stimulants ASAP!  In the meantime, he needs a medication break, maybe on the weekends so he can put some weight back on.  Definitely no meds in the summer.”

This is completely different than what the psych is saying, but I looked at his growth charts with the pediatrician who has seen him since birth and I’m panicking.  He’s dropped from 90% percentile in height and weight to 70% height and 40% weight.

Advice?

Replies

I agree with your pediatrician.  We see a psychiatrist and she believes in treating the whole child.  With that in mind, we have had really good success in treating our son.

Our son was put on a low dose of Focalin XR (stimulant) when he was 9.  He has been on that medicine going on 5 years now and we have slowly increased it as he has matured.  At one point, we put him on Strattera but he didn’t like the aftertaste (?) so we took him off of it.  The reason for that was to help curb his impulses. He has had “appropriate” weight/height growth.  The doctor has always asked him how he feels when he is on / off the medicine and how he does in school and with his peer-to-peer relationships.  I guess we are the lucky ones to not have to go thru all the medicines as he develops that others have but I also attribute that to our psychiatrist.  His doctor has always told us that she prescribes medicine to help with a symptom not to medicate the child so she is conservative and we are grateful.  Good luck and best wishes for your child that he finds the “right dose.”

Posted by raypecmom on Jan 22, 2014 at 4:55pm

I take Strattera 100 mg but I am an adult.  It has not worked real well for me.  I still do not focus very good.  It did not effect my appetite much.  I still ate my normal meals but I no longer snacked.  In the six months I have been on it I have only lost 5 pounds.

Posted by Mae on Jan 22, 2014 at 6:03pm

Strattera is not a stimulant and does not impact appetite.  It takes 4-6 weeks to see effects (if any) so taking weekends off is not realistic.  Your pediatrician does not seem to be aware of this fact - which to me shows why consulting with a psychiatrist is critical when dealing with these kinds of questions because that is what they are trained to do.  Pediatricians are great at managing well child care - most are not correctly equipped to manage psychiatric medications.  To me the pediatrician’s comment about stimulants not working well for a small percentage of children does not apply in your son’s case because you report that his ADHD symptoms are well controlled - that means the Vyvanse is working, it is just creating an unwanted side effect of reduced appetite/weight loss.  My definition of “not working well” is what we experienced with my son on stimulants which was increased anger, aggression, and mood lability. 

Strattera has not been shown to be as beneficial to most children as was hoped when it was first marketed.  The impact is pretty moderate in comparison to stimulants.  There are other stimulants and dosing strategies such as the Daytrana patch or shorter-acting meds.  Vyvanse is designed to be effective for 12-14 hours - perhaps your son needs to be on a medication with a shorter duration of effectiveness.  There is another non-stimulant as well called Intuniv. 

I would recommend talking with the psychiatrist about other options and take it upon yourself to make sure that “the whole child” is treated.  Is your son seeing a therapist regularly?  Does he get assistance from the school?  Are you educating yourself?  My son’s psychiatrist asks about those things at every appointment.  It is not her job to provide those services, but she is reminding me that those are important components to a total treatment program.  Meds alone are not satisfactory.

Best of luck to you.

Posted by krtsinohio on Jan 22, 2014 at 6:04pm

Oh my, that’s a pickle.  It is tough when your experts aren’t all on the same page.  What does the psychiatrist say about his weight?  He ought to be concerned about that too.

But I would not change meds based on what my pediatrician said because this is not their area of expertise.  These are psychiatric medications and you want a specialists advice, not a generalist.  Weight loss is a concern but maybe you can find an alternative to changing meds.  Also, what your pediatrician may not know is that Strattera is a non-stimulant med and works primarily for SCT kids NOT ADHD kids.  It is a whole separate bag of symptoms that Strattera works on so it is not an apples to apples situation.

If the meds are working then why would you change them?  Maybe the psychiatrist would be willing to lower the dose or change the way it is administered so that there are times of the day where he is hungry? 

We no longer give our daughter medicine holidays regularly.  She is now 9.  But the reason is that it causes chaos in the household when we do.  Her brother can’t tolerate her emotional outbursts, they can’t successfully play together, and it generally ends in tears, sometimes all the way around!  But you will have to decide for yourself how much medicine holiday your child needs.  I certainly don’t think a whole summer is a good idea.  ADHD is much much more than school work.

And if you can identify the foods your son enjoys eating then let him have them. Unless of course it is ice cream only or something like that!  But our daughter loves rice, so I make extra and that is her main dish at lunch.  We tired of forcing sandwiches on her when it just doesn’t work.  Our daughter has gained only about 1/2lb in the two years she has been on meds.  She weighs less than before she started but she is growing taller.  This may just be her body type but the psychiatrist is not worried about it so long as we see her eating.  If your son is refusing to eat or you just don’t witness him eating at all, anything, then you have a major concern.  But if he is eating and you see it, you are probably OK.

Also, we give meds AFTER she’s eaten breakfast which seems to help both on the timing part - they last longer into the school day - and the appetite part.

Posted by YellaRyan on Jan 22, 2014 at 6:54pm

My dd 11 takes 10mg of Strattera & it works well at keeping her focused.  She was mildly inattentive.  I don’t believe that you can take weekends off because it takes 3-4 weeks to build up. 
Holly

Posted by hal6242 on Jan 22, 2014 at 7:34pm

I agree with many above. If the medication is working well on your child’s ADHD symptoms, try to find a way to help with appetite before changing. My son took cyproheptadine with his stimulant for a while to boost his appetite. This is a common addition for a kid with ADHD who is not eating enough on stimulants. I think he took it about a year and gained about 10-12 pounds. (He had lost 7 pounds when he started stimulants.)

My son is in the 12-20% on height and weight growth charts. However, he has grown a ton in both height ans weight since starting medication 5.5 years ago. He currently takes Quillivant and has a much better appetite on it than he did on Concerta, so he doesn’t need the cyproheptadine anymore. I feel like what is important is that he continues to grow and that he’s not malnourished. Remember too, 40%tile on the growth chart is just below average—he may have dropped a good bit but that doesn’t mean he’s unhealthy now necessarily.

Another note is to give him highly nutritious but high calorie food when he’s hungry. I used to always put Carnation Instant Breakfast in my son’s milk at breakfast to give it a boost, and I gave him whole milk and full fat versions of everything. Here are some articles full of these types of tips on ADDitudeMag.com:

http://www.additudemag.com/adhd/article/1813.html
http://www.additudemag.com/adhd-web/article/750.html
http://www.additudemag.com/adhd/article/10240.html
http://www.additudemag.com/adhd/article/762.html

Here’s an FAQ on Straterra as well: http://www.additudemag.com/q&a/ask_the_add_medical_expert/1245.html.

Good Luck!
Penny
ADDconnect Moderator & Mom to Tween Boy with ADHD and LDs

Posted by adhdmomma on Jan 23, 2014 at 1:42pm

My 7 year old daughter has been on Strattera for a year and I don’t think it does much of anything. The developmental pediatrician who prescribed it, though, won’t try anything else because she is small (25% on both height and weight) and doesn’t have the greatest appetite. Also, you can’t take time off Strattera because it has to build up (and conversely, when a kid stops taking it, it takes more than a few days for the effects to disappear)

Posted by bkm on Jan 23, 2014 at 9:19pm

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