Posting apathy.

[Alex179]

you should take strattera.

I take straterra every day.   You trying to say that I get lobotomized by it?   I know some of my meds hold me back creatively that much is for sure.   I am pretty sure Peter took a form of straterra and it didn't work so well haha.

[SovaNu]

dammit. i meant you shouldn't take strattera. i drank wine.

[SovaNu]

i fixed it sort of.

[Alex179]

dammit. i meant you shouldn't take strattera. i drank wine.

suuure blame teh booze j/k

too bad I quoted it for posterity haha.

[Peter]

you should take strattera.

I take straterra every day.   You trying to say that I get lobotomized by it?   I know some of my meds hold me back creatively that much is for sure.   I am pretty sure Peter took a form of straterra and it didn't work so well haha.

I'm conducting a little experiment with my Straterra.  Here's a copy and paste from my journal:

I've also come to suspect that atomoxetine only works for about 7% of the caucasian population; the 7% identified as 'slow metabolisers' in the double-blind trials.  For these slow metabolisers, not only is the drug's half-life is increased from 5 hours to 24 hours, but there's also a 5-fold increase in peak plasma concentration.

"Atomoxetine is well-absorbed after oral administration and is minimally affected by food. It is eliminated primarily by oxidative metabolism through the cytochrome P450 2D6 (CYP2D6) enzymatic pathway and subsequent glucuronidation. Atomoxetine has a half-life of about 5 hours. A fraction of the population (about 7% of Caucasians and 2% of African Americans) are poor metabolizers (PMs) of CYP2D6 metabolized drugs. These individuals have reduced activity in this pathway resulting in 10-fold higher AUCs, 5-fold higher peak plasma concentrations, and slower elimination (plasma half-life of about 24 hours) of atomoxetine compared with people with normal activity [extensive metabolizers (EMs)]. Drugs that inhibit CYP2D6, such as fluoxetine, paroxetine, and quinidine, cause similar increases in exposure."

Also, the published literature on atomoxetine only claims a 'statistically significant' benefit, rather than providing even minimally detailed quantative data on the benefits, and if only 7% of patients responded favourably to the drug, it would still be a statistically significant result, assuming a reasonable sample size.

My suspicion is reinforced by the anecdotal reports of people on the ADHD site; the ones who found that atomoxetine worked well for them experienced an intense euphoria soon after taking it, and the euphoria reportedly lasts all day long for them, with them describing the drug as being 'always on'; something that should not occur if the drug had a 5 hour half-life in their systems, but which would occur with a 24 hour half-life.  There are other reports on other sites, of people experiencing constant euphoria for 3 months on atomoxetine.  For me, the fatigue and other mental side-effects of atomoxetine only last for 8 hours after taking it, which is consistent with a 5 hour half-life.  Also, the only time I experienced euphoria was when I switched from 40mg to 80mg, and then it was only for a few hours on the day of the switch, further leading me to believe that it's only effective in poor metabolisers, or individuals who're taking CYP2D6 inhibitors.

This raises the possiblity of an intriguing experiment.  I have some paroxetine (a CYP2D6 inhibitor) left over from my unsuccessful trial with it, so taking it together with atomoxetine could replicate the effects of being a slow metaboliser, and provide evidence for or against my theory.  It's presumably fairly safe to do (according to my standards of safety, at least), since people who're naturally poor metabolisers come to no harm.

Actually, upon looking online, it seems someone's already studied the issue:
http://www.freepatentsonline.com/20040176466.html.  I've already taken the paroxetine and atomoxetine though.

Some excerpts from the study:

"Atomoxetine is primarily metabolized in humans by cytochrome P450 2D6 (CYP2D6). Cytochrome P450s generally comprise the major enzymes responsible for oxidative metabolism of drugs (Eichelbaum and Gross, Pharmacol. Ther., 46, 377 (1990)). The CYP2D6 enzyme specifically has a wide range of activity within human populations, with inter-individual rates of metabolism differing by more than 10,000 fold (McElroy, et al., AAPS Pharmsci. 2000, 2(4), Article 33 (http://www.pharmsci.org)). Most individuals are extensive metabolizers, able to metabolize CYP2D6 substrates extensively, whereas 7-10% of Caucasian individuals are poor metabolizers, producing no functional CYP2D6 enzyme. Poor metabolizers across all populations, including Asians and African Americans, comprise 2-10% (DeVane, The American Journal of Medicine, 97(Suppl. 6A), 6A-19S (1994)). A human pharmacokinetic study of atomoxetine revealed two distinct classes of kinetic disposition (Farid, et al., The Journal of Clinical Pharmacology, 25(4), 296-301 (1985)). In a majority of patients, atomoxetine exhibited a mean half-life of 4.5.+-.1.1 hours, whereas atomoxetine had a half-life of 17.1 and 21 hours in two patients."

"Inter-individual variability in drug metabolism poses a challenge in predicting dosing, safety, and efficacy of a drug. Pharmacokinetic factors, as well as substantial intersubject pharmacodynamic variability, have been proposed as a factor in cases of therapeutic failure of methylphenidate (DeVane, et al., Journal of Clinical Psychopharmacology, 20(3), 347 (2000)). In a recent study, atomoxetine was demonstrated to be robustly better than placebo in the treatment of ADHD, regardless of whether the patients' CYP2D6 status was as an extensive or poor metabolizer. Surprisingly, poor metabolizer ADHD patients demonstrated a greater response to atomoxetine treatment, most improving to the point of being clinically asymptomatic."

I wonder here if observed 'improvement' of extensive metaboliser patients came from reduced hyperactivity and anxiety through the sedating and apathy-inducing effects on those individuals.

It's about 30 minutes on now, and all I feel is the heartburn of the atomoxetine and the fatigue I get from both atomoxetine and paroxetine.  I wonder how long it takes for the paroxetine to inhibit the CYP2D6 pathway.  It may take until my next dose of atomoxetine to notice any effects.

[Alex179]

So you are trying to make yourself a slow metaboliser so the drug actually effects you in a more efficient manner?   Sounds interesting.   I wouldn't mind hearing more, since they doulbed my straterra dosage I noticed no difference whatsoever.

[Peter]

So you are trying to make yourself a slow metaboliser so the drug actually effects you in a more efficient manner?   Sounds interesting.   I wouldn't mind hearing more, since they doulbed my straterra dosage I noticed no difference whatsoever.

I noticed no difference when I doubled my dosage from 40mg to 80mg, except for the first day, when I was a bit high for a few hours.  Taking the paroxetine with it could be equivalent to a 5-fold increase in the dosage; possibly substantially more.  I'm definitely feeling something now; there's fatigue there, but also a focused feeling, and a tingling sensation at the back of my head.  The results will be complicated a bit by the effects of the paroxetine, which I find induces a lot of fatigue on it's own, so presumably I'll feel more fatigued than a natural poor metaboliser would.

[Alex179]

I would hate to see how much I slept if I was more fatigued lol.   I already sleep too much at every opportunity I get.

[Peter]

Most meds I've taken have made me very tired.  Fluoxetine, paroxetine, sertraline, venlafaxine, lofepramine, mirtazapine, cetirizine and atomoxetine have all made me feel tired.  Mirtazapine's ok though, since it's a more pleasant, stoned sort of tired, and is quite mild now that I'm used to it, whereas the other ones all gave me horrible urgh kinds of tiredness.

[Alex179]

Every antidepressant I have taken has made me tired.   Zoloft mainly, but Effexor did also.   I did not take Prozac for long.    Lamictal and Depakote when I first started taking them did make me drowsy somewhat.   Zoloft just had the mother of all withdrawal effects.

[DirtDawg]

aren't you supposed to lose your sense of humor with lobotomy?

My guess is that she's being sarcastic about being lobotomized because I don't find MarkingDawg funny. That, or her way to inspire me to concoct the notion that I'm slow on the uptake -- a reference to being lobotomized.

Nah, you just seem to have a slightly lower measure of compassion for some of the lower functioning, like myself. Case in point: my response to your telling me this thread was an oxymoron. I somehow missed that that was a spank.  Most people recognize that my education is lacking and I am in over my head most of the time, but someone here usually throws me a rope every time I get into trouble. I may not be able to interpret as well as some and it is easy to tell when I miss the point, so the collective of sympathy shows itself, each time. I am a baby bird in a nest protected from the cuckoo.

Either that or maybe some of us have lost our youthfully exuberant, bright-eyed idealism, which you seem to be capable of replenishing constantly in yourself. I am in awe.

[The_P]

Lower-functioning? Are you taking the piss? You may be currently unemployed, but you have a family, some talents that I don't have, and earned the respect some people I know of here on Intensity.

Refrain from the bullshit. I know I'm a tool at times, but I'm not that big of a tool.

[purposefulinsanity]

You should know peaguy that you can't judge people by appearances.

[Calandale]

Refrain from the bullshit. I know I'm a tool at times, but I'm not that big of a tool.

I'd say 'tis a fairly large tool

[The_P]

Refrain from the bullshit. I know I'm a tool at times, but I'm not that big of a tool.

I'd say 'tis a fairly large tool

Oh, hush up. No-one asked a non-sensical bird.