Concerta vs. Strattera - Opinions?

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Registered: 07-03-2003
Concerta vs. Strattera - Opinions?
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Sun, 07-06-2003 - 8:41pm
We've had our son on the lowest dose of Concerta for about 4 months - he just turned 7 and finished the 1st grade. It has been working wonderfully and we are pleased with it - the only problem is if there is an activity to do at night...like cub scouts, or a party, whatever. I have given him the Concerta at 9:00 in the morning - so he will still have the effect until about 9:00 at night. But, I can't do that once school starts. I was thinking of asking his doc if she could prescribe a low dosage of ritalin if he has something in the evening. Also, I was wondering about Strattera - does it work "around the clock." Concerta works so well for him now that I'm concerned about trying something new.

Anyone have any opinions/experiences with this?

Avatar for keke0116
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Registered: 03-26-2003
Sun, 07-06-2003 - 9:12pm
If it's working, don't change it. Kevin (my 11 y.o.) was on Concerta (successfully) for 15-16 months, and it was the best thing that happened to him/us. It lost its effectiveness about the beginning of the year, and rather than increasing the dose, the doc suggested we try something new ... So, we did Strattera, increasing the dose 'til he was at 60 mg, without luck. Added other stuff to that, no luck. Right now, after 5-6 months of being a guinnea pig, I took him off of everything ... and it's o.k. But, my point is, if it's not broke, don't fix it. You may find that a small dose of Focalin or Ritalin for those days where he has things later in the day may help. Strattera is advertised as '24 hour protection' but that's not the case ... it's just longer lasting than Concerta or Adderall XR, but in our case, it didn't work at all.

Nancy

Nancy 

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Registered: 08-26-2000
Mon, 07-07-2003 - 12:27am
No experience with Straterra, but my DS is also on Concerta. We ran into the same problem you are seeing when we started playing baseball this spring and had 7:30 games. (When we had 5:45 games, you could watch the concerta wearing off inning by inning until he was spinning in circles in the outfield by the end of the game - LOL).

Anyways, I mentioned it to our ped, and he had no problem with a 5 mg boost of Ritalin on those evenings. We did that with no added side effects.

Good luck!

Karen

 


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Registered: 07-03-2003
Mon, 07-07-2003 - 9:02am
You guys are awesome - thanks for the advice - it makes sense to me.
Avatar for kellystee
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Registered: 04-29-2003
Wed, 07-09-2003 - 9:47am
No go here on the Strattera too. I just started my son in an all-day summer camp and after 4 days of camp, he's been written up the maximum of 3 times and they want to suspend him (which is why I'm not at work today and, needless to say, I've been in tears). I'm frustrated with Strattera and the doctors that prescribe it!! This drug has done NOTHING for us except make my life so much more stressful!! But just as one of the other parents said, Concerta was the best thing that ever happened to my son (and my family), but he became tolerant to the dose (which we continued to up until we could up it no more). Stick to the Concerta. . .I've never seen a drug more effective. And we also did the extra Ritalin at night too, which worked really well for us.

Good luck!

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Registered: 07-03-2003
Thu, 07-10-2003 - 8:19pm
So sorry to hear about the problems at daycamp - I sure have been there myself! I know how hard it is. We went through that before we started on the Concerta. Last summer, my son almost got kicked out of his summer daycamp, but we pulled him out before he did. We went to counseling and things improved for a while - but then he started having problems again this Spring - that's when we went on the Concerta.

How old is your son?

How long did you do the Concerta before it became ineffective?

I know someone (an adult) who takes the max dose of Concerta, plus doses of Ritalin throughout the day - because max dose of Concerta isn't enough. Plus I heard that they are coming out with a higher does of Concerta.

Are you going back to your doctor for advice?

Avatar for kellystee
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Registered: 04-29-2003
Fri, 07-11-2003 - 5:02pm
Hi, Mary! I thought my son had been on the Concerta for about a year and a half before it started becoming ineffective for him, but I actually went back and checked the prescription and was shocked to learn he started taking it in February of last year!! And I know it was rapidly becoming ineffective by the end of 2002, so maybe like 10 months?? That's just sooooooo depressing to me!!! My son has a LIFETIME illness and these medicines that we find to be "the answer to our prayers" are only effective for such small periods of time. I have met a lot of people, though, who tell me their children don't have these problems at all (rather frustrating, I must say!!), so I guess it is effective for some.

I started Justin on Adderall about two days ago, and that's been rather depressing too. In the past two days I have learned that Strattera DOES curb some of his hyperactiveness - enough as least so that we can live with him (because now in the morning and at night I'm back to living with a monkey - a LOUD monkey that is!!). It didn't help at all though when he is around other children, at school, or even with other groups of people. This is when we saw him really lose control and the medicine just wasn't strong enough to control that. The good things, though, about the medicine (and there are MANY!) is that he had such an 8-year-old personality!! It was like we had a totally new kid!! He wasn't clingy, or shy, or easily embarrassed or upset. He also started eating soooo much better (he gained 8 pounds in 2 months!! He was really under-weight) and sleeping better and even using the bathroom better (kindof gross, but because he ate so little on the stimulants, he was having these "accidents" constantly that suddenly went away). He used to have headaches on the stimulants, so that went away. His crying and whining ceased too. I vowed I would NEVER put him back on a stimulant after what I saw when we took him off of them - I said no more zombie-kid for me, but after two months of pretty much daily notes and calls from the teacher and now the summer camp incident, I've just given up. I think it hurts his confidence and self-esteem so much to constantly be labeled "a bad kid" and have to be constantly disciplined.

Putting him on the medicine, though, has caused all those "bad" symptoms to come back overnight and I've just been in a real state of depression over it. It's a no-win situation for him and I. He's so irritable on the Adderall - cries over the smallest things; he doesn't eat a thing; and I guess the dose has been SO strong for him these past two days and his body is not used to it that he was up from 1am to 4am last night!!! WOW!!! That's a new one for me!!

I read that another parent got her doctor to give her son TWO doses of Strattera (36mg) a day (double our dose), which my doctor forbid. Not that I'm seeing the stimulant side effects again, though, I'm starting to contemplate this. Maybe just a higher dose? I miss my little boy already. :o(

Justin is 8 years old and I can't IMAGINE putting him on a higher dose of Concerta. The high doses are scary to me. He got really bad headaches with it at 54mg and that was the highest dose at the time. I heard another mother mention she was considering 76mg???? wow. The adult you mentioned is my biggest nightmare. Is that what the children are in for. . .just more and more meds? It reminds me of street drugs. . .users to have to keep taking more and more to get the "high."

The therapy thing we've never tried but are now seriously considering it. Did it help?? Does your son still go? I'm such a pessimist about it. . .I've tried many many books and strategies with no such luck. My son's biggest problem is just that he's going so fast he doesn't think; he's bouncing off the walls and doesn't have time to realize he's broken a lamp.
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Registered: 07-03-2003
Sat, 07-12-2003 - 9:45am
I feel like I could have been writing your e-mail in a way - I can really hear how overwhelming and scary this is for you - I can soooooo relate to that!

About therapy - yes it helped and it is still helping. We are still going, but I don't know how many more sessions we have this year - sorry insurance coverage - so we go just once a month until the end of the year.

Typically, psychiatrists - the ones who prescribe meds - don't do a lot of psychological testing. We went to a child psychologist to get our son tested - we found a wonderful one who also as a background in social work. He is very grounded - very real. We started having real problems Spring 2002 - we started going to counseling in Summer 2002. The psychologist tested our son and at the time didn't think he was ADHD, since he scored so high on the IQ test, especially the math portion. He wanted us to keep going to counseling and see what happened - at the time we also went to a psychiatrist and she also encouraged us to keep trying counseling before meds. That is also what we wanted to do at the time. My husband and I both went to parenting classes and we all attended counseling together and sometimes separately. My husband let go of some of his anger - it had been a real battle with him and our son - my husband viewed his behavior as "disrespectful" and it really sent him over the edge. I would find myself defending my son and getting into fights with my husband. Well - this didn't work AT ALL. My husband and I had to learn to work better together and he had to learn to be calm and I got tougher with consequences. This all really helped until Spring 2003.

Our son started doing impulsive things - hitting other kids, chewing up his pencils, running around at inappropriate times, yelling, not paying attention in class (but still able to maintain an "A" average - but I am sure there would have come a point where he couldn't keep up). These are all classic ADHD signs.

We went back to the psychologist and went back to the psychiatrist. The psychologist wanted to do all his testing again and have us back in the counseling. We agreed. But, we also asked the psychiatrist to put him on meds. She agreed and gave us the choice between Strattera and Concerta. I picked the Conterta because it was more time-tested and I didn't want to wait 2 or 3 weeks for our son to see improvements. It was a lucky choice, I guess because for 4 months, it has been helping so much. He is taking 18 mg per day.

We explained to our son exactly what we were doing. He understands and he LIKES being on the meds. He said he likes being able to go slower. He likes not getting into trouble and he likes getting along with other kids. It is so much better for him, for us, and for our other son, too.

I, too, am sad about the thought of him being on meds - maybe for life (see my other posting about Sad About Diagnosis - you'll see - I think most moms feel this way). But, I tell you - I am sadder about the thought of him NOT going with treatment. If he doesn't have treatment, he'll keep getting into trouble and getting these HORRIBLE messages from his teacher and just about everyone around him.

Last Spring, I was at a school function and I watched him across a large auditorium. He was jumping around and kicked the kid in front of him - not aggressivly, just being a monkey - and I saw this really mean look a teacher give him. She grabbed his arm and took him to his 1st grade teacher. The 1st grade teacher really got after him and they both stood there looking angry with him. The thing is - these are both really good teachers - but, they'd had it with him. They were tired of him and his behavior and they really showed it. My heart broke for my son - and my instinct was to be protective of him. But, the reality is - I knew just how those teachers felt and I have probably had that same look on my face when I got after him.

So - what is better to be on the meds, to get treatment - or to live with these negative feelings, negative messages, and turmoil? I vote for the treatment.

For you and maybe for me later on and for lots of people - it is hard to find the right treatment. If you've never had your son thoroughly evaluated by a child psychologist, I would highly recommend it - for us, I believe it was a combination of things:

Medication - this is the key and the firstline treatment - nothing as made as much of a difference.

Parenting Classes - these helped us to learn different techniques about parenting.

Counseling & Testing - This is helping us to get a picture of our whole child and it is helping us to get behind our actions and confront our own issues.

Support - Places like this website helps me stay strong.

Education - I read whatever I can find - books and internet.

And - as far as the adult I know - he is happy. He can tells stories about being very sad as a child and getting all these really bad messages and feeling stupid, etc,etc. Now he is happy and he can feel normal.

So - here is a really, really long answer - but I hope it helps and maybe gives some ideas.

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Registered: 03-26-2003
Sat, 07-12-2003 - 11:37am
Hi Kelly,

I replied to your post to me in the folder below, but I wanted to comment on one more thing you said here: You said that I "got my doctor to prescribe the 36 mg (18 mg twice a day) dose". Not exactly. I, like you, was *very* hesitant to go to a higher dose of ANYTHING ... especially in the case of Strattera, where the dosing appeared to be so "black and white" (so many mg of the drug per kg of the child's weight). The suggestion to try the higher dose totally stemmed from our p-doc (child psychiatrist specializing in ADD and ODD). As I think I might have mentioned before, I called our PED before filling the new script. He (our PED) confirmed for me that there is a lot of movement right now toward these increased doses, and that everything he had read and seen substantiated the safety and increased effectiveness of this type of use. It was only *then* that we filled the script and tried that dose of Strattera for our ds.

Just didn't want you to get the impression that I am trying to medicate my son into oblivion ... He is truly an awesome kid, and I love his "nearly-7-year-old-ness" a whole lot, too! Heck, I was leery when his Ritalin dose went from 10 mg to 15 mg per day; I did a whole lot of reading and talking to the PED (who was prescribing the Ritalin) before we made *that* change!! Again, as I said in my post below, if you haven't consulted a child psychiatrist who specializes in patients like our kids, that might be a route to consider. Not that you would just blindly accept a script from *anyone* for your son without reading and doing some research, but these doctors just tend to be much more current on the drugs and their usage than the average (or even not-so-average) all-around-PED.

Take care, and hang in there!! It might not happen overnight, but you will find something that works for all of you!

iVillage Member
Registered: 03-26-2003
Sat, 07-12-2003 - 12:02pm
What a great post, Mary! You saved me a lot of typing, LOL! We, too, use a combo of medical therapy and psychological counseling and it seems to be a great integrated approach! We haven't done any specific parenting classes at this point, but our work with ds' psychologist has certainly included this element, which has been terrific. She has also seen us by ourselves (without ds) a few times. My son is ADD-inattentive and ODD and gifted, so we are kind of balancing a lot of balls in the air when it comes to his therapy anyhow. This whole process is just so much trial and error with regard to the meds and therapy - that is probably one of the toughest things for me to deal with, "control-freak who seeks a black-and-white solution" that I am! ;o)

I agree wholeheartedly with seeking the care of a child psychiatrist for med management; our PED -- who I absolutely adore and trust implicitly -- was actually the one who recommended that we go that route, when he reached the outer limits of his comfort zone with these meds. We are always sure, though, to have all reports and files from the specialists copied to our PED. Our psychologist, as you said, was the one who did the testing on ds (we had figured he was probably gifted, and she concurred, but the testing corroborated that fact as well as "turning up" his ADD. The ODD dx was made later.) Ideally, each faction will support and complement the efforts of the others - if not (as happened in one case with us), it's probably best to seek out a "team" of specialists for the child who *will* work well together and respect each others' efforts.

Oh, WRT the "Concerta vs. Strattera" issue: We tried Concerta for ds as an alternative to going to a three-times-a-day dose of ritalin. The concerta just didn't cut it - we now suspect (and are looking further into) the possibility that ds' body is metabolizing things much more quickly than "average". When the ritalin started to cause him facial tics, we moved him onto the Strattera dosed at the amount recommended by the manufacturer for ds' weight (he took 25 mg). When that wasn't doing a bang-up job, our p-doc moved him onto a higher total dose, split up so that he takes 18 mg twice a day. That seems to have helped, which sort of supports the whole "quick metabolism" theory.

As far as effectiveness, the "best" for us was the four days that the ritalin and strattera overlapped (when we were weaning down and up on the two drugs). I know that is a common combo, and we are going to see if it is possible for our ds to take maybe a lower dose of ritalin with the strattera without any neuro (tic) effects. The Strattera seems to be okay at mitigating some of ds' impulsivity/oppositional issues (both of which are almost exclusively manifest with dh and me, virtually never at school or camp or other scenarios) but it is not at all effective in the realm of improved focus (ds is ADD inattentive, no hyperactivity component; again, no behavioral issues stemming from the ADD). I have heard from others about the lack of effectiveness of Strattera with regard to focus, so I don't think it's just my son. Maybe you could investigate the possibility of a COMBINATION of drugs?

Again, great post! Wishing you the best of luck on this journey we are all undertaking -- sounds as though your child has a wonderful start, though, and awesome advocates in you and your dh!!

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Registered: 04-11-2003
Sun, 07-13-2003 - 11:07am
My DS (14) has been on Strattera for about 3 months. It's the first med he's been on as he ws jsut recently diagnosed. Just this week he came to me and told me he didn't think his medicine "was working any more" - he said that by suppertime he felt totally out of control an that he hated it - after he said it I noticed it too - (I work nights but as on vaca this week) - I called his pediatrician and he upped his dosage from 60mg to 100mg - seems alot to me - today was his first day with the new dosage - I'll keep you all posted. Oh - by the way - I shoudl mention that he's about 5'8" and 125 lbs (big weight loss with strattera - he is never hungry).

paula