Can increasing dose of Strattera increase defiance arguing over-reacting and a child acting like a punk?

Answer 1

Our daughter was changed over to Strattera last fall. There was a definite phase of irritable, defiant, argumentative behavior that got worse on a higher dose. At the same time it was clear that her concentration and focus were better and that she was not experiencing the emotional shut-down that often happens on stimulants. We watched her be able to do her homework AND laugh at the same time. We were motivated to figure out how to fix the problem. As I also am a psychiatrist I looked for the patterns in the behavior and saw fairly quickly that she was at her worst in the morning and nearly as bad in the evening. I suspected that the severe behavior/attitude swings were happening when the med was wearing off. We added an afternoon dose and saw a small improvement. We had to wait a couple of weeks for the med and behavior to stabilize, but they did resolve - completely. All in all there were about three weeks of pretty difficult mornings. In retrospect it is well worth it. She is much closer to a "normal" child. She can choose to do her homework or choose not to. She is eating better and sleeping better. I would add that we did decide that she needed some concerta as well, but it is a quarter of her previous dose. When we added the concerta she was unstable again for a period of time. Not behaviorally, but she had trouble sleeping and troulbe doing homework when the concerta wore off. That also stabilized over the following two weeks. She is back to being able to do her homework whenever she chooses. She may still procrastinate, but it isn't because she can't do the work until the crisis is on.

So yes, our experience is that increasing the dose can result in that type of behavior but it was not the higher dose. It was the crash off of the higher dose. For us increasing the dose by adding an afternoon dose gradually resolved the problem.

I now use strattera as first line with my newly diagnosed adult patients who do even better. I explain that stimulants often flip people right based normal concentration and into hyper-focus where the person can do work, but can't enjoy the rest of their life and can't multi-task. Strattera seems to do a better job of getting to the middle.