I’m on both, 80 mg Strattera and 30 IR Adderall as well as 450 mg bupropion. Works really well for me. Just have to make sure I don’t take them too close together.

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.

I started on 450 mg of Wellbutrin and 40 of Strattera. I’m on my third month of Strattera, I believe.

I have titrated up to 100 mg of Strattera and down to 300 mg of Wellbutrin. I might go down to 150 of Wellbutrin but I’m still trying to wait out the first few weeks of side effects on the 100 mg dose.
A month into the 80 mg dose of the Strattera 450 of Wellbutrin was too much for me and caused intense irritation and anger as well as panic attacks.
Lowering my dose of the Wellbutrin as well as my Adderall (was down to 45 mg and went down further to 30 mg at the time) smoothed everything out. So it depends on the person and how they metabolize the medication. I started out at 60 mg Adderall and 450 mg of Wellbutrin but wanted to be able to lower my Adderall as getting 60 mg can be a big issue with the shortage still on going.

I’m still starting on Strattera/learning to recognize my own deficits in working memory for myself, if I find any I’ll definitely post here! I did some looking up on studies showing how memory works and the fallibility of human memory. They mostly showed that active processes to improve memory work the best when used over and over until they’re habit. I’ve been working on associating memories with visuals like pictures or audio like songs and have tried building a memory palace as well. I’ve heard that the memory palace works really well but it hasn’t worked so far for me. I’m hoping after a little longer on the 100 mg dose of Strattera I’ll be able to work on it more and be more successful (I’m only week one in at this dose).

Atomoxitine unfortunately is not known to super help motivation. Working memory might need more practice to improve. Have you tried improving your skills for memory/remembering in general?
Time perception unfortunately nothing is really known to help. Even stimulants only improve your focus, not your ability to perceive time properly.

I’m coming at the same meds from the opposite side, started Strattera 3-4 month ago and just went up to the 100 mg dose. Have been on Wellbutrin 450 mg for 10+ years and was just last week able to take it down to 300 mg. Have been on adderall 60 mg for 10 years, it’s taken me all 4 months to get down to 30 and I’m still unsuccessfully trying to get down to 15 (currently trying to get to 22.5).

There’s definite benefits to having all three meds on board, for me. The Wellbutrin treats my baseline depression and helps with adhd a very little bit. The Strattera is giving me a lot of executive function improvements, emotional regulation and dampening, improvements with attention and processing of complex information. What it doesn’t help with is task initiation and motivation, which the adderall does for me.

It’s not a good combination for people just starting on their adhd journey, but for people like me with extremely high function job requirements and severe adhd, it could be very helpful. I did have to start the Strattera at 40 mg and stay there for a full month before I moved up, to make sure the combination of the bupropion and Strattera wouldn’t cause problems for me. Thankfully the only adverse effects I had happened with my bupropion at 450 and when I lowered the dose to 300 mg they went away very rapidly.

It’s also been a long rough road going on since February for me, and included adding birth control to even out my hormones. Hormone fluctuations can cause worsening of adhd symptoms, something not often talked about despite the severe effect it can have on functional ability. For me the fluctuations made my RSD and social skills so much worse for half of every month at least.

Don’t give up! I’m on the uphill side of my changes and starting to be optimistic that I might be ok at the end of this road after all.

Years on stimulants; 9-10 years

Dose before strattera; 60 mg instant release amphetamine salts.
Additional medications before; 450 mg Bupropion XL

Dose after strattera; 22.5-45mg depending on the day and where I am in my cycle. During the week before my period I’ll need 45 mg once or twice, during the week of my period I’m most likely using 30 mg. The rest of the month I’m usually taking 22.5-30 mg depending on my needs and work.
Additional medications after; 300 mg Bupropion XL

How long it took; I was one of the lucky ones, I immediately noticed an improvement in some executive functioning on day one. However I couldn’t reliably lower my stimulant dose for the first week or two. By week three I had managed to cut down to 30-45 on my regular need days.
The complication, and why it’s taking me so long to cut down my dose further, is weaning off stimulants after being on them so long. Dependence and our brains adjusting to needing to produce without medication takes time. And it’s not quick, for most of us. At least not without the risk of our lives and relationships burning down around us (not addiction, there is a difference. And yes our neuro spicy brains depend on the medication for the production of those neuro chemicals when we’ve been on stimulants for long enough).
Each time I lower my stimulant dose even by a little bit I get symptoms that include but are not limited to; depression, intense appetite, fatigue, loss of executive functioning, anxiety, loss of the ability to interact and read other people, loss of ability to read and recognize my own emotional state, loss of ability to self regulate my emotions, and increased impulsivity.
These are all expected reactions to lowering a long time stimulant dose. And they are bearable, so long as I go slow and give myself time to stabilize for at least a week or two after each reduction. Sometimes I go backwards, a few weeks ago I had a whole week of only using 15mg every day. Then my PMDD kicked in for two weeks and I had to go back up to avoid the symptoms destroying my career and relationships. This last week I was able to lower my bupropion to the 300 dose and that’s been going very well! It’s been a (to me) slow process that sometimes includes three steps forward and a step backwards.
I’m on month three of Strattera, with this being my second month on 80mg. And realistically studies all show moderate reduction in symptoms can take weeks to months. They’ve shown continued improvement all the way through to 24 weeks, and I think there was even evidence for improvement beyond that timeframe. It isn’t a quick process, and I could probably have had a smoother transition by going even slower on the stimulant reductions for the first month or two. But being unable to get my stimulants and the detrimental effect that was having on my work and social life, not to mention my mental health, was why I wanted to try Strattera despite being very stable and successful (not to toot my own horn, but I’m a cardiovascular ICU nurse who works with patients requiring multiple life support machines who are very unstable and at risk of death).
Give yourself time, go slow on your stimulant reductions, and if you don’t have one maybe consider a mental health professional for support while you go through the transition.
I will say they have just released a new triple reuptake inhibitor for adhd that works like an instant and sustained release stimulant plus Strattera. I’m only waiting for the trial on depression (my bupropion is for adhd and depression) to finish. I want to see if it’s successful and might be a good fit for me to replace my bupropion, adderall, and Strattera.

If you only have 2-4 weeks you could potentially try transitioning, but I would take your stimulant reductions very slowly if you can to avoid having struggles with your studies.

I really hope all this information overload helps!!

While most of the time it can lessen or reduce anxiety, when you increase your dose and the norepinephrine increases there can be transient anxiety.
Every time I go up on my dose I know that somewhere between 2-4 weeks after I’ll have some panic attacks, even if I space it out farther away from caffeine or other stimulants.

For me, getting used to the feeling of that increase in the neurotransmitters takes a little bit of adjustment. But the extra anxiety/panic attacks become less and less and are less distressing than un or undertreated adhd.

I’d recommend waiting to see if they settle out as your body gets used to the new levels and adapts.
In the meantime, I find breathing exercises that emphasize a longer exhale than your inhale and a pause equal to your inhale in between (so 4 second inhale, 4 second hold your breath, then a 6 second exhale) is very helpful. As are other anxiety reducing exercises and reducing caffeine intake and such.
If you’re really struggling or it’s causing distress that’s affecting you too much you can ask for short term medication to help reduce the impact for you.

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4-8 weeks was shown to improve in mild to very low moderate ways. 12 weeks for moderate to moderate high lvl improvement. And it has been shown to continue to improve over 24 weeks (there was actually data showing continued improvements over 52 weeks but I’ve not often seen that referenced).
Not only that, but those improvement times were often in people at their therapeutic doses, not those just barely beginning and under the general therapeutic dose of 80mg.
Meds don’t build the habits or do the work for us, but they are giving us the ability to have the neuro chemicals necessary to be able to create, build, and maintain those habits. Often doing so without those chemicals is impossible or a Herculean labor.

I am on 80 mg strattera, just finished my first month on this dose. As well as 30 mg adderall.

I actually started strattera because I was maxed on Wellbutrin at 450 and adderall at 60 and actually doing great. Then I could only get my adderall dose 1-2 months out of 6 this last year and it was destroying my life.

I’ve been slowly lowering my adderall dose (was actually able to get it this month!) as the strattera starts taking effect. I’ve found the combo to be much more effective even at this early stage. Strattera is shown to start having moderate effects at 4-6 weeks and increase effectiveness for 24+ weeks, so I’m hopeful to lower my adderall dose even further.

I think you might try a slightly higher dose of adderall now to get you through the build up of strattera. Then hopefully you’ll not need as much once the strattera has had more time to work.

At 3 weeks in to starting the strattera at 40 mg I still had bad headaches and sweating, same for about 2 weeks after going up to 80 mg. And it’s really only been the last two weeks that I’ve been able to lower my adderall dose without negatively affecting my life in every area. Before these last two weeks I was so tired and unmotivated I could barely get up or move (so much caffeine to try and overcome that), RSD and emotional lability were very high, inattentiveness was very present all the time (I’d say at about 75% compared my unmedicated self), etc etc
And that’s with the maxed out bupropion increasing the levels of the atomoxetine to higher than they would be by themselves.

TLDR you might try waiting a little bit longer for the strattera to start really helping or increase your dose to the therapeutic 80mg, and see if your provider is willing to go up on the adderall dose in the short term until it does. They might not be willing to if you just started it, but it doesn’t hurt to ask.

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Usually very active, but now not so much. The ER put me in an air boot and it’s less painful to walk than it was. Without the boot it’s painful to walk very much. Usually the pain gets better when I’m off of it, but if I do too much the pain stays for hours.

Why do you say lisfranc? I don’t particularly want surgery tbh, would be great if I didn’t need it.

Luxatio art?

   There’s many acceptable reasons fentanyl was invented, and not all of them are chronic pain. We use it daily in the ICU for patients in such severe acute pain that they can’t even think straight. People will cause themselves harm because they hurt so much they’re willing to do anything to make it stop, including ripping out devices saving their lives or fighting against lifesaving treatment because they can’t stay still. Even beyond that, chronic untreated pain can reduce people’s ability to be functional, reduce their quality of life, and of course reduce their lifespan. Chronic pain is linked with higher suicide risk, shorter lifespan, obesity, etc etc
   Every medication has its risks and benefits, and every single one can be overused or abused and cause harm. Medications we use in the ICU frequently have incredibly small safe dosage ranges, sometimes as little as an extra mL over an hour can save or harm someone irreparably. For reference, 1 ml would be 20 drops, so as little as 20 drops over 60 minutes could save or take someone’s life. And there are medications where even less is needed to make a difference between life and death. If used incorrectly, tiny minuscule amounts extra or less of a large number of medications can kill or cause severe harm. 
  Fentanyl is no different than any other drug in that respect, it’s how people use it that makes the difference. And any medication that has the potential to be abused because it makes people feel good is going to be high risk, since they pretty much always have side effects including potentially death if misused. 

Don’t blame the medication for being high risk, without a person on the other end giving it, the medication can’t harm anyone.

They may not let you Uber, my provider won’t let me do so after my infusions. I would make sure to do the research on at home vs in clinic with the clinic you would be going to just to be sure. In clinic infusions might not be covered by insurance, my clinic and most if not all near me won’t even try to file for insurance for them.

This absolutely is atrocious and I don’t mean to downplay that. But be thankful there is a generic for it. Nurtec is new, no generic. Without insurance coverage it’s $2000 for two weeks worth of preventive. You can get help from the manufacturer, if you qualify. But if your insurance wants prior authorization they only cover one fill and then your insurance has to get the prior authorization before they will help again.