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Discussion Starter #1
I've been on mirtazapine for about a year now with other add-ons along the way, and have success (and am still on) 30mg with Strattera 60mg. I think I have had more improvement with the (minimal) stimulating effects from Strattera (I've always had a tremendously hard time getting myself out of bed in the morning -- for at least the last 10 years, thought school and beyond--and the months I've been on Strattera, this seems to have improved slightly (this also is why I want to try a more conventional stimulant, as all of the other AD meds I have tried in the past only seem to contribute to this)), and in hindsight, feel that if anything the mirtazapine, though it may have helped with the depression, has made me more avoidant/less pro-social than before.

So I'm going to switch things up. I am going to give Prozac a whirl and want to swap out Strattera for a more conventional stimulant (bc it will be cheaper and hopefully more effective) in addressing what I think is ADHD-I or -PI.

I have the script for the Prozac and will get a script for a stimulant in a couple weeks at my next visit.

Obviously, I am able to either simply add the Prozac into my current regime or I can replace the mirtazapine with the Prozac.

I'd like to be on less rather than more meds, so I'd prefer to just be on say the Prozac and dexedrine than those two and the mirtazapine and Strattera.

Sorry for any incoherency in this post, lack of info, etc., but I don't have a lot of time to put it together. Just looking for thoughts, experiences, etc. and hopefully I can address any deficiencies in the post/requests for more information later as they are pointed out. :D Thanks in advance, BB
 

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Good luck! Prozac was stimulating for me, so perhaps waiting on adding a stimulant so you know what its effects are on you would help.
 

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want to swap out Strattera for a more conventional stimulant (bc it will be cheaper and hopefully more effective) in addressing what I think is ADHD-I or -PI.
You might want to get a professional assessment for ADHD before attempting to treat it... far more people believe they have it than actually do. Self-diagnosis is really a horrible idea.
 

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Discussion Starter #4
The 'professionals' I've seen and asked about ADHD type conditions either have said things like-- no, you can't have the sort of grades you have and be ADHD or throw me a questionnaire of situations 'do you ever experience ..., have you ever..., etc'.

So I'm not really sure what a real assessment looks like for ADHD, especially for the non-hyperactive sort-- because I'm certainly not outwardly hyperactive. But I can't tell you the last book I've read cover to cover (including high school and college). Even reading things over 5 pages for work or leisure is a choir because my mental noise/mind wanders.
 

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The 'professionals' I've seen and asked about ADHD type conditions either have said things like-- no, you can't have the sort of grades you have and be ADHD or throw me a questionnaire of situations 'do you ever experience ..., have you ever..., etc'.

So I'm not really sure what a real assessment looks like for ADHD, especially for the non-hyperactive sort-- because I'm certainly not outwardly hyperactive. But I can't tell you the last book I've read cover to cover (including high school and college). Even reading things over 5 pages for work or leisure is a choir because my mental noise/mind wanders.
What kind of professionals have you seen? My psychiatrist actually referred me to a consultant pediatric psychiatrist who specializes in ADHD and developmental disorders. There were no questionnaires, just about 2 hours of talking. I was actually referred there because of difficulty with treating the social anxiety and my psychiatrist wanted to be on the safe side and referred me to him just in case I had a developmental disorder like Asperger's that she wasn't cluing into (I didn't, and he strongly diagnosed me with ADHD-I.)

Hell, I've been in a gifted class all through my childhood, and with inattentive ADHD there are no behavioral problems, so it's not really a surprise that it took too long to catch on. The questionnaires are often bull****, as everybody manifests it in a different way, so you need to talk directly about the things in your history that make you think you have ADHD.

Although... consistently good grades are generally not associated with ADHD, especially as a kind/teenager until you start to progress into becoming an adult and start learning your own coping skills. You can have short periods of getting great grades, but to constantly be a high achiever is really not consistent with ADHD, as it's clearly not causing the necessary impairment.

There are lots of other things that can be the cause of mental wandering, for instance. This is seen in anxiety disorders as well. And psychostimulants will usually just make matters worse.

I don't really expect to convince you of anything over an online forum, but I hope you at least understand that ADHD really isn't one of those things that is usually self-diagnosed accurately. Pretty much every person I met in university either joked about or believed that they had ADHD because they couldn't focus as much as they'd like to! Nobody can focus perfectly, but it needs to be causing significant impairment for your problems to be clinically relevant, and you need to communicate the ways it's impairing your quality of life to whoever is conducting your assessment.

And if you don't mind my asking... how exactly are you so sure that you'll be getting a prescription for a psychostimulant in a few weeks?
 

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Discussion Starter #6
I've already talked about it with my psychiatrist and I have been to a cardiologist to have my heart looked at/tested to make sure I do not have any congenital defects, and it's all clear. I just need to get it in writing from the cardiologist and bring to my psychiatrist at the next visit. It's really just a matter of which one-- I'm inclined to adderall or dexedrine, as I've read that inattentive people respond better to those than to ritalin(-based).

My psychiatrist is pretty open to prescribing whatever I think is best because of the different things I've tried, etc, etc.

I had great grades until college then fell off the map by my standards (C's, withdrew from a class because I couldn't get myself to write a paper, a D+ here and there). I am an only child so not having siblings or much of a social life allowed me to put lots of inattentive time into school work and do well with the intelligence I have.
 

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I've been on mirtazapine for about a year now with other add-ons along the way, and have success (and am still on) 30mg with Strattera 60mg. I think I have had more improvement with the (minimal) stimulating effects from Strattera (I've always had a tremendously hard time getting myself out of bed in the morning -- for at least the last 10 years, thought school and beyond--and the months I've been on Strattera, this seems to have improved slightly (this also is why I want to try a more conventional stimulant, as all of the other AD meds I have tried in the past only seem to contribute to this)), and in hindsight, feel that if anything the mirtazapine, though it may have helped with the depression, has made me more avoidant/less pro-social than before.
I've always had the exact same problem with getting myself out bed, most AD's have only made this worse.

I'm also starting to agree with you that mirtazapine has made me more avoidant/less pro-social than before. These days all I want to do is sit around, and do as little a possible. :S

Anyway my advice, since you want to try as little meds as possible and I respect that, is maybe try swapping the mirtazapine for prozac, then a month or 2 down the track if you find yourself getting insomnia, or your depression returning then add back mirtazapine, and see if the two will balance each other out.

Good luck anyway.
 

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Discussion Starter #8
Thanks-- that's what I'll try to do. Just started my 20mg dose of Prozac tonight (though I guess I should have taken it in the morning). Will update...
 

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Thanks-- that's what I'll try to do. Just started my 20mg dose of Prozac tonight (though I guess I should have taken it in the morning). Will update...
Keep an eye on your blood pressure for this combo...Although mine didn't seem to rise exceptionally, it felt like it did. Don't know if this another symptom or what not , but it definitely worried me.
 

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Discussion Starter #11
Keep an eye on your blood pressure for this combo...Although mine didn't seem to rise exceptionally, it felt like it did. Don't know if this another symptom or what not , but it definitely worried me.
I guess another question to you/all is what was getting off mirtazapine like (porcess, taper, withdrawals, etc)?
 

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I guess another question to you/all is what was getting off mirtazapine like (porcess, taper, withdrawals, etc)?
I found that stopping it cold turkey braught on insomnia in full force, I promptly went back on it and have since been tapering down by 15 mg increments every 7 days, and with this method I havnt had any problems.
 

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Discussion Starter #13
It's been about a week now of adding 20mg Prozac to mirtazapine and Strattera and so far all I have noticed is a day with abnormal joint pain (hand), extremely flat emotion, and an almost complete loss of sexual thoughts/desire/arousal/etc.

I know I should give it 4+weeks to adjust, but I just wanted to see if others that have tried it and had similar experiences saw these side effects go away with time.

Also wondering if dropping the mirtazapine might help. Thanks, BB
 

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Discussion Starter #16
No just had the two together.
db0255, did you experience any of these side effects with prozac (or prozac with remeron) and if so, did they go away after the first week(s)? I am seeing flat emotion, dull thoughts, and an almost complete loss of sexual thoughts/desire/arousal/etc.
 

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db0255, did you experience any of these side effects with prozac (or prozac with remeron) and if so, did they go away after the first week(s)? I am seeing flat emotion, dull thoughts, and an almost complete loss of sexual thoughts/desire/arousal/etc.
Hmmm....My reaction was a bit different. I think I've explained my reaction to Prozac to you before, though. Prozac killed my ability to get an orgasm, made me very amotivational, and somnolescent. I saw more of a sensitivity change, i.e. I was way more in control of my emotions; but wouldn't really call it dulling of emotion.

Hope that helps bluster!
 

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It's been about a week now of adding 20mg Prozac to mirtazapine and Strattera and so far all I have noticed is a day with abnormal joint pain (hand), extremely flat emotion, and an almost complete loss of sexual thoughts/desire/arousal/etc.

I know I should give it 4+weeks to adjust, but I just wanted to see if others that have tried it and had similar experiences saw these side effects go away with time.

Also wondering if dropping the mirtazapine might help. Thanks, BB
If anything dropping the mirtazapine would theoretically make the sexual dysfunction worse. Might help slightly with energy/lack of drive though.

Prozac is a tricky drug to use in combination, take into account that it could theoretically increase levels of mirtazapine in the blood stream due to it's various CYP inhibiting properties, infact prozac even begins to inhbit it's own metabolism after chronic administration.
 

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Discussion Starter #19
Hmmm....My reaction was a bit different. I think I've explained my reaction to Prozac to you before, though. Prozac killed my ability to get an orgasm, made me very amotivational, and somnolescent. I saw more of a sensitivity change, i.e. I was way more in control of my emotions; but wouldn't really call it dulling of emotion.

Hope that helps bluster!
Apparently I was selectively remembering only your positive effects from being on Prozac and not the side/ill effects. Thanks for a quick response though.
 
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