Posted by pecos on November 12, 2003, at 0:18:38
In reply to Re: Cymbalta/Duloxetine timing, posted by pseudonym on July 21, 2003, at 13:44:22
In reading these posts, it sounds as if SE & NE are the end all be all of effective Anti depressents in this chat area.
What about Wellbutrin?? It is the only AD that address Dopamine reuptake and Norepinephrine reuptake.
There are more than 2 neurotransmitters in the brain!!
The monamone neurotransmitters include:
CATECHOLAMINES:
1) Norepinephrine
2) Epinephrine
3) DopamineAND
INDOLAMINES:
1) SerotoninRemember Effexor XR has serotonin which adds sexual dysfunction and weight gain. Wellbutrin has minimal sexual dysfunction and it is weight neutral. In fact some doctors are using it off label to lose weight...go figure.
Lexapro can make its claims but you still can't get it up and you will get poop out after about 4 to 6 months, which ties into the time you see weight gain of 10 pounds plus for most people.
Also if you are trying to address the max number of neurotransmitters. Dr Stahl (considered a thought leader of depression) has a cartoonish bubble presentation of the three primary neurotransmitters involved in depression showing Dopamine/ Norepinephrine/ Serotonin. This simplied presentation (because it is all really still theory)shows Serotonin is ideal for obsession and compulsion. Yes SE elevates Mood but long term use of SE suppresses Dopamine which leaves to food cravings and weight gain, SE causes loss of sexual libido (even a vibrator/ or long sessions of masturbation are futile...remember Sex & The City when Charlotte's sexaholic guy was put on Prozac. He did stop obsessing about sex and but he stated he couldn't have sex anymore! IT IS TRUE!) and the famous SSRI poop out. Plus Serotonin really affects sleep! People say SSRI's cause crazy dreams but the fact is SSRI's don't allow deep REM. Sleep studies show patients wake up many times when on SSRI's. The result of these awakenings is that patients remember all their dreams. Losely translated you have alot of wild dreams you just don't remember them, but if remembering is your goal start a SSRI.
Dopamine helps with pleasure, motivation, focus, reward, and mood. Dopamine's down side is psychomotor activation and aggravation of psychosis so schizophrenia patients should avoid it.
Norepinephrine helps with alertness, energy, mood, and believe it or not anxiety. Norepinenephrine's down side is tremor, tachycardia, dry mouth, and insomnia.
Wellbutrin has two transmitter reuptake inhibitors which both help with mood. For depressed people with anxiety caused by depression, this really helps.
Biggest factor about Wellbutrin is that many doctors use it with a SSRI to get even better results for treatment resistant depressed people.
Remember that with Effexor and Cymbalta that is it. There is no effective dopamine reuptake inhibitor being used as an add on. Also now Wellbutrin is now once a day so when combine with a once a day SSRI..treatment is all day.
Hey Wellbutrin is not the end all be all of AD's either. REMEMBER the American Psychiatric Assoc. states all anti depressants work equally well. Remission rates are basically the same.
> Manipulating SE and NE is such a broad and diverse area of research. Your dismissive statement of "just manipulating SE and NE" seems to conclude that any research into these two neurotransmitters is a failed avenue of research. Wrong.
>
> For one, duloxetine has much lower K(i) values, which indicates it prevents re-uptake much more potently than Effexor, in vivo. Furthermore, it takes a lot less of it to do so, as indicated by much lower ED-50 values. Finally, it prevents re-uptake of NE at much lower dosage levels than Effexor. The clincal trial data is also promising, but I'm not going to reiterate that here. My prediction: You're going to come back with a mea culpa in 6-9 months, and be happy to do so.
poster:pecos
thread:208072
URL: http://www.dr-bob.org/babble/20031111/msgs/278836.html