12 yr old with ADHD on Strattera

My 12 yr old son was diagnosed wtih ADHD when he was 8. We tried Ritalin, then Adderall (adderrall) both caused severe mood changes-he became angry and depressed.  After seeing a psychiatrist for these medication problems,(who said he was overmedicated because he is small)he was put on Dexedrine 2.5mg twice a day and seemed to do very well for 2 years when we had to increase it to 5mg twice daily. He was still somewhat fidgety and needed some help staying on task, but was happy and doing well in school. When we started him back on the Dexedrine 5mg(after a summer drug holiday) before 6th grade, he had a SEVERE depressive reaction, this lasted 13 hours on what should have been a 4hour dose. We had to give him Benadryl to counteract it and he "snapped out of it" in 20 minutes. We stopped all meds and he really struggled through the first half of sixth grade.  Then at the end of January, he started on the new med Strattera 40 mg/day.  He did awesome and his handwriting even changed. He woke up everyday without problems, did well in school and with homework(from B's and C's to all A's)...until 3 weeks ago(we didn't change anything) when even he noticed difficulty focusing again and was fidgety again and avoiding school work, etc. He is 63 lbs and on the max dose for his size.  Anyone have any suggestions or information on why he did so well, hit a plateau and then start sliding backward? Sorry for how long this is.....

[Kevin Kennedy, Ph.D.]

It may well be that the initial dose indicates the benefit of Strattera for your son, but that he requires a higher dose for the medication to continue to be useful. However, as you point out, with a recommended dose of 1.4 mg/kg, he really should not be prescribed more than 40 mg/day. Since Strattera targets the neurotransmitter norepinephrine, your son may do well on Desipramine, a tricyclic antidepressant that used to be prescribed more frequently than it is these days to treat ADHD (primarily Inattentive type). Desipramine's effect occurs because it targets norepinephrine (the typical stimulant medications target the neurotransmitter dopamine). In your son's case, it appears that norepinephrine might well be the neurotransmitter to target.

[sharon999]

A related discussion, my son thomas was started.