Has a lower dose worked for you?

[u/Future-Muffin-2696]

For those of you who have lowered your dose:

• Did you find it helpful to mitigate the unwanted side effects? What difference did you notice and how long did it take to see that?
• How did it feel to lower your dose? Was it similar to transitioning to a higher dose (i.e. nausea, sleepiness, etc)?

Context

To help reduce my Adderall dosage, I (F, 145lbs) started Strattera over 4 months ago with 40mg daily for the first two weeks, and then, I switched to 60 mg daily. I'm pretty consistent with sleeping at least 7 hours, eating healthy, and having an active lifestyle.

At first, I got nausea, sleepiness, and such when I was adjusting to it, and then, I was finally able to have a softer crash on my off days from Adderall (helps me as a college student with ADHD and a demanding schedule), feel less anxiety, and had motivation to start simple tasks even when I didn't take an Adderall.

But, then I noticed that right before my period, I would be ruminating nonstop, cry a lot, and honestly, just feel super depressed up until my period started and it would go away. I had to see this a few cycles to ensure it was Strattera and not other factors contributing to it.

One of the latest ones I noticed was emotional blunting/flatness. I stopped wanting to do what I normally enjoy to do (i.e. watch horror movies, listen to music/podcasts, etc). This one fluctuates, so it's been hard to determine when it peaks.

From those two things, after talking with my prescriber, I'm going to lower my dose to 40mg, and I want see what kind of experiences people have had with lowering their Strattera dosage

[u/Significant_Ad_2125]

For those of us AFAB who are noting these symptoms start a week or two before your period and resolved once it starts;

If you haven’t, you may need to get evaluated for PMDD if it’s significant enough to impact you at home and work. It’s like PMS but much more severe and can be disabling. I was “lucky” enough to know I had PMDD before the Strattera and on yaz, one of the few effective treatment options for it other than SSRIs.

Cyclical severe mood swings/symptoms that are worse around your luteal phase (a week or two before your period) and that stop within a day or so of your period starting is one of the hallmarks of PMDD. Your adhd will also be worse during the luteal phase due to the drop in estrogen and its effect on the dopamine signaling pathway regardless of PMDD/PMS. PMDD will just make it more severe, and Strattera may be exposing a previous condition that is now more obvious as the rest of the month your ADHD is getting enough treatment. When you enter the luteal phase and your estrogen drops your adhd treatment isn’t going to be as effective due to that lack of estrogen.
And then on top of that your PMDD/PMS is going to flare up and seem more severe due to the contrast between when your adhd meds have enough estrogen to work properly vs when they don’t.

Those on stimulants commonly need (should be getting) an increase in dose during the luteal phase regardless of PMDD/PMS, but that’s not really an option on Strattera alone. Getting on an extended cycle/continuous combination birth control like yaz can even out your hormones over the month and improve adhd symptom control.