Cheers for the reply, mate.
1. The effects took approximately one month to develop. They were related to an increase in dosage.
2. The side-effects abated quickly upon cessation, approximately 2-3 days after ceasing Methylphenidate.
There doesn't seem to be residual effects per say, more that whenever I restart some of the higher doses of Methylphenidate, or simply go on it again, the increased anxiety and the SI seems to come much quicker - it doesn't take more than a few days on the higher doses (which I use when there is more work - note also that I am on a very low dose usually, because of the Side-effects - the efficiency is quite limited at this dose tho'. 18+5+5 mg's.)
3. I fear that Strattera will induce a stronger dysregulation, since the SI side-effect seems to be more pronounced, and common, among those treated.
Discontinuing when I feel it coming on is of course a good idea - I did not know that Strattera doesn't need to be tapered like SSRI's, actually. I thought I'd be stuck with SI and anxiety for WEEKS, while trying to get off the med'. Apparently not so. An interesting list btw, I think I actually knew most of it already tho'.
Is there something I can do, pharmacologically, to BLOCK the negative effects of Strattera tho'? Usually one goes to SSRI's when it comes to the anxiety and SI from Methylphenidate, and I did notice some improvements there, while being prescribed Sertraline to counteract the emotional side-effects of Methylphenidate.
(once I got up in dosage however, it worsened my insomnia however, so I had to cease it, as the insomnia-effect was causing burn-out. I noticed very accute and severe cognitive decline upon tapering out Sertraline however - I seem to be fairly sensitive to discontinuation-syndrome, it seems.)
1. How quickly and severely did the effects develop?
2. Did the effects quickly and completely abate or resolve, or is there some residue?
3. If they abated and weren't severe, do you fear strattera will induce a more severe and permanent dysregulation, if so why?
If they develop slowly, just keep an eye out, and discontinue when you notice any signs.
Possible mechanisms behind the increased SI, to which you are apparently susceptible:
1) unbearable akathisia: restlessness, anxiety, irritability, insomnia, agitation etc contribute to patient's suicidal tendencies
movement disorder, usually associated with antipsychotic medications, has been reported as a rare side effect of SSRIs. This intense restlessness can be so dysphoric for patients that they might consider suicide rather than endure the restlessness. This is something that practitioners should warn patients about, and look for closely, as it is quite treatable with adjunctive medication.
2) The second mechanism involves the natural history of recovery from depression. Depression is a disorder with numerous symptoms, and when the disorder is treated effectively, the symptoms do not resolve all at the same time. Classically, the physical symptoms of depression (including lack of energy, difficulty concentrating, and sleeping and eating disturbances) resolve first and the subjective depressed mood resolves last. As a result, patients who are being treated for depression can have increased energy and increased functionality as they recover, while still struggling with subjectively depressed mood. This increases their suicide risk; they may have lacked the energy or the ability to attempt suicide prior to starting treatment, but as they begin to recover they regain ability and motivation before they have a subjective sense of improvement. As a result, patients are usually at greatest risk a week to 10 days after starting medication, and by 2–3 weeks later, that risk is resolved. Experienced clinicians understand this as a function of the disease, not the specific treatment, and are careful to watch for it and to instruct family and friends to also be aware of it. The problem may be exacerbated by the trend of primary care physicians treating depression. They usually see patients for 10- or 15-minute periods of time and very rarely more frequently than once a month.
