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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 38. Go back in thread:
Posted by McPac on June 19, 2003, at 12:17:26
In reply to Re: Reboxetine (not approved in U.S.? FDA blows!), posted by Caleb462 on June 19, 2003, at 12:04:23
"Well, yes.. that is the ACUTE reaction to increased norepinephrine. And in the first few weeks of treatment with Reboxetine, one might experienced increased anxiety. However... the adrenergic system downregulates in response to this increased NE... and after a few weeks, overall stress is DECREASED. That is the theory, anyway".
>>>>>>>>>>>Caleb, but are increased norepin. drugs supposed/recommended to be avoided by most ocd'ers? Are they effective for ocd? Thanks in advance for your reply!!
Posted by Caleb462 on June 19, 2003, at 12:35:15
In reply to Caleb, (not approved in U.S.? FDA blows!), posted by McPac on June 19, 2003, at 12:17:26
> "Well, yes.. that is the ACUTE reaction to increased norepinephrine. And in the first few weeks of treatment with Reboxetine, one might experienced increased anxiety. However... the adrenergic system downregulates in response to this increased NE... and after a few weeks, overall stress is DECREASED. That is the theory, anyway".
>
> >>>>>>>>>>>Caleb, but are increased norepin. drugs supposed/recommended to be avoided by most ocd'ers? Are they effective for ocd? Thanks in advance for your reply!!Well... I suppose that would depend on who you asked. In general, though.. I would say no.. norepinephrine meds do not need to be all out avoided by OCD patients. A selective norepinephrine med will not help OCD... but it may decrease OCD-related stress. As for reducing obsessions/compulsions, selective NRIs are quite ineffective.
Personally, as a GAD/OCD sufferer.. I tried to avoid things that will trigger the "fight or flight" response... rarely drink coffee, for instance.
However.. there is no hard and fast rule that OCD patients need avoid noradrenergic chemicals. For instance, the metabolite of Anafranil - desmethylclomipramine, is a potent inhibitor of norepinephrine reuptake.
Posted by McPac on June 19, 2003, at 13:15:35
In reply to Lilly controls the FDA--NOT, posted by Jack Smith on June 19, 2003, at 12:13:48
"The pharmaceutical companies are the cause of all of our problems."
No they're not.
Posted by stjames on June 19, 2003, at 13:17:31
In reply to Lilly controls the FDA--NOT, posted by Jack Smith on June 19, 2003, at 12:13:48
>
> The pharmaceutical companies are the cause of all of our problems.
>
> JACK
Gee, that is a sweeping generalization !
Posted by McPac on June 19, 2003, at 13:25:31
In reply to SSRI conspiracies--nonexistent., posted by Jack Smith on June 19, 2003, at 12:10:22
The fda is the pharm. co's puppet...not ONE single pharm. co. can control the fda because so many pharm. co's have huge power, when you have MANY co's with huge clout and power no single one will always get their way, but they as a group pull the fda's strings
Posted by McPac on June 19, 2003, at 13:38:33
In reply to Re: Caleb, (not approved in U.S.? FDA blows!), posted by Caleb462 on June 19, 2003, at 12:35:15
"As for reducing obsessions/compulsions, selective NRIs are quite ineffective".
"the metabolite of Anafranil - desmethylclomipramine, is a potent inhibitor of norepinephrine reuptake".
>>>>>>>>>>>>>>> How can the 2nd statement be true IF the 1st one is true too? (Is it because Anafranil also has SRI properties?) Thanks!!
Posted by McPac on June 19, 2003, at 14:52:25
In reply to SSRI conspiracies--nonexistent., posted by Jack Smith on June 19, 2003, at 12:10:22
http://www.zoloft-side-effects-lawyer.com/default.htm
No pharmaceutical company would EVER try to keep these side effects from being well-known would they,lol, they don't BOMBARD you with the "happy,pleasant" info and commercials and try to dismiss this stuff, why don't they use some of the school-shooters on ssri's in their commercials, lol, show all those dudes during their shooting rampages pausing to plug their ssri's, lol, those pharm. co's could probably teach the tobacco co's a few tricks,lol,...politicians are never crooked either! I'm not anti-Zoloft, just showing that it and the ssri's and the pharm. co's have another side as well, it works great for me in some ways, but there is another side for some, not as simple as "then don't take it", what if you have a problem where not taking it is even worse, then you pick your "poison", i.e. take this and suffer or don't take it and suffer, not much of a choice, Zoloft has been great for me for ocd/depression but ohhhhhh those extreme side effects, it works great for my niece too (without side effects) and anything that keeps that precious little squirt feeling better definitely cannot be all bad, gotta run, take care all!!!
Posted by Caleb462 on June 19, 2003, at 15:00:30
In reply to Caleb, (not approved in U.S.? FDA blows!), posted by McPac on June 19, 2003, at 13:38:33
> "As for reducing obsessions/compulsions, selective NRIs are quite ineffective".
>
> "the metabolite of Anafranil - desmethylclomipramine, is a potent inhibitor of norepinephrine reuptake".
>
> >>>>>>>>>>>>>>> How can the 2nd statement be true IF the 1st one is true too? (Is it because Anafranil also has SRI properties?) Thanks!!
>Exactly... clomipramine (anafranil) is a highly potent SRI... the metabolite desmethylclomipramine being the highly potent NRI
Posted by Jack Smith on June 19, 2003, at 15:51:09
In reply to Re: Lilly controls the FDA--NOT, posted by stjames on June 19, 2003, at 13:17:31
> >
> > The pharmaceutical companies are the cause of all of our problems.
> >
> > JACK
>
>
> Gee, that is a sweeping generalization !
>Sarcasm. Read the post in full and what it is in response to.
Posted by Jack Smith on June 19, 2003, at 15:55:23
In reply to Re: SSRI conspiracies--nonexistent., posted by McPac on June 19, 2003, at 13:25:31
> The fda is the pharm. co's puppet...not ONE single pharm. co. can control the fda because so many pharm. co's have huge power, when you have MANY co's with huge clout and power no single one will always get their way, but they as a group pull the fda's strings
Reboxetine was probably not approved because it was not that effective. Note that Lilly did not attempt to get straterra approved for depression probably because they knew that it was not effective enough. Norepinephrine only agents have proven less effective for depression.
Check through the archives of this site and you will see that reboxetine did not exactly get reviewed well here.
JACK
Posted by Snoozy on June 19, 2003, at 16:46:56
In reply to Re: SSRI conspiracies--nonexistent., posted by Jack Smith on June 19, 2003, at 15:55:23
I'm wondering if the FDA has guidelines on how effective a drug must be to get approval. If there were no or few other drugs on the market to treat a specific condition, would they approve something that had a lower efficacy rating as opposed to a proposed drug for which there are many alternatives available?
I'm also wondering what, if any, type of political appointments (other than commissioner) are made there.
> Reboxetine was probably not approved because it was not that effective. Note that Lilly did not attempt to get straterra approved for depression probably because they knew that it was not effective enough. Norepinephrine only agents have proven less effective for depression.
>
> Check through the archives of this site and you will see that reboxetine did not exactly get reviewed well here.
>
> JACK
Posted by turalizz on June 19, 2003, at 17:19:36
In reply to Re: Reboxetine (not approved in U.S.? FDA blows!), posted by McPac on June 19, 2003, at 10:54:04
> tura, but how can you get it if not approved in US (are you outside of US?)
Yes I am. (Outside US I mean)
Posted by NikkiT2 on June 19, 2003, at 17:25:26
In reply to Re: Reboxetine (not approved in U.S.? FDA blows!), posted by Caleb462 on June 19, 2003, at 12:04:23
I tried reboxatine a good couple of years ago (so its been lisenced in UK alot longer than this past summer) and only lasted 3 weeks.. and for the three weeks I was on it, I cried and cried and cried the whole time.. and I am not someone who cries easily..
Nikki
Posted by Caleb462 on June 19, 2003, at 18:31:20
In reply to Re: SSRI conspiracies--nonexistent., posted by Jack Smith on June 19, 2003, at 15:55:23
> > The fda is the pharm. co's puppet...not ONE single pharm. co. can control the fda because so many pharm. co's have huge power, when you have MANY co's with huge clout and power no single one will always get their way, but they as a group pull the fda's strings
>
> Reboxetine was probably not approved because it was not that effective. Note that Lilly did not attempt to get straterra approved for depression probably because they knew that it was not effective enough. Norepinephrine only agents have proven less effective for depression.
>
> Check through the archives of this site and you will see that reboxetine did not exactly get reviewed well here.
>
> JACKTrue, but what about nortryptiline and desipramine? Aren't these approved and considered effective for depression. And isn't imipramine's main mode of action norepinephrine reuptake inhibition (over serotonin uptake inhibition, that is). These are mainly noradrenergic agents, although I may be mistaken.
Posted by turalizz on June 19, 2003, at 19:27:15
In reply to Re: Reboxetine (not approved in U.S.? FDA blows!), posted by NikkiT2 on June 19, 2003, at 17:25:26
> I tried reboxatine a good couple of years ago (so its been lisenced in UK alot longer than this past summer) and only lasted 3 weeks.. and for the three weeks I was on it, I cried and cried and cried the whole time.. and I am not someone who cries easily..
>
> NikkiSee, that's what reboxetine does. It somehow seems to "intensify" the emotions. I became very emotional myself when I was on reboxetine.
But remember that apathy is a synptom of depression, and SSRI's are no good for that.Don't forget that depression is not like flue, symptoms change from person to person.
So why leave out something that can be useful to many patients?
Posted by McPac on June 19, 2003, at 20:34:08
In reply to Re: Reboxetine (not approved in U.S.? FDA blows!) » NikkiT2, posted by turalizz on June 19, 2003, at 19:27:15
I spent 3 hrs last night reading one clinical study after another on Reboxetine from sites all over the world, including US, it was found AT LEAST as good as Prozac in every study and better for many depressive, anxiety, & social phobic conditions and much better for severe depression WITH significantly less side effects in every study.........it wasn't approved because many people would have switched and ditched their ssri's (of course now, after 10 years of being bombarded with ssri marketing hype, some folks wouldn't give up their ssri's for an actual vaccine CURE, lol,......Anafranil was available in TONS of countries for MANY, MANY years before the fda SOMEHOW approved it...TONS of ocd sufferers who had NOTHING before that suffered endlessly for YEARS when they could have been greatly and easily helped......oh yeah, all politicians are completely moral, upstanding people who could NEVER be involved in crooked shenanigans either, lol...financial executives too (Enron, Global Crossing, Imclone, World Com, and scores of others, they were all guys that would NEVER do anything crooked for a buck, lol, show me ANY industry where HUGE bucks can be made and you'll find some shenanigans, thank goodness for drugs and the co's that make and sell them, but there is good and bad shenanigans in that industry too, you don't think a multi-BILLION $$$$ company and guys with HUGE stakes at hand would try to hide and twist a few 'unpleasant' facts....some people believed Bill Clinton too ("I never had sexual relations with that woman").....swampland in Florida for sale, TAKE CARE EVERYBODY!!!!!!!
Posted by zeugma on June 19, 2003, at 21:45:33
In reply to Re: Reboxetine (not approved in U.S.? FDA blows!) » NikkiT2, posted by turalizz on June 19, 2003, at 19:27:15
> > I tried reboxatine a good couple of years ago (so its been lisenced in UK alot longer than this past summer) and only lasted 3 weeks.. and for the three weeks I was on it, I cried and cried and cried the whole time.. and I am not someone who cries easily..
> >
> > Nikki
>
> See, that's what reboxetine does. It somehow seems to "intensify" the emotions. I became very emotional myself when I was on reboxetine.
> But remember that apathy is a synptom of depression, and SSRI's are no good for that.
>
> Don't forget that depression is not like flue, symptoms change from person to person.
> So why leave out something that can be useful to many patients?
>I wish there was more written on the differential aspects of these drugs instead of searching wildly for the "magic bullet" that will cure depression. Reboxetine and the noradrenergic TCA's have a different 'feel' to them which fits some personality types and disorders better than the SSRI's. The emotional intensification these drugs can induce is probably what makes them less suitable for OCD types, as OCD'ers already have enough emotional investment in their surroundings and don't need that level boosted even further. Similarly people undergoing a profound transient depression could probably use some of the apathy SSRI's can deliver.
This reasoning was behind the introduction of the concept of 'endogeneous depression' to explain what the TCA's reversed. Someone who is endogeneously depressed is not reacting to external circumstances in a functional way: the TCA's intensify emotional response in these people to bring them back to the normal variation in mood that people generally feel. It's clear that not all, or even most, depression can be 'endogeneous' or the SSRI's could never have displaced the TCA's in popularity. But the supposition that there is a type of depressed individual who responds best to NE reuptake inhibitors remains a tenable one.
Posted by Barbara Cat on June 19, 2003, at 21:52:48
In reply to tura Reboxetine (not approved in U.S.? FDA blows!), posted by McPac on June 19, 2003, at 20:34:08
Yep, follow the money and you'll see who is beholden to whom. Even (especially) the Vatican. Unlike most corporations, I think the majority of drug company employees, researchers, etc., have good intentions at heart and really want to help. However, by the time it gets to marketing and the CFO, the whole intention has changed to one of greed. If the product helps someone, great, but overall do what it takes to lead the market share. I don't think everyone is evil necessarily, just scared. They have families to support and we live in an integrity-challenged time because we've come to believe that's the only way we can survive.
There is such disinformation and shenanigans in the business of antidepressants, et al, that the whole picture is very distorted. Sometimes the picture only starts becoming clear through anectdotal experience.
What really makes me laugh is how, when a med starts getting near the end of it's patent, copyright protection, they tweak a little isomer here and there and presto, it's a whole new 'improved' med protected for another 10 years and no competing generics are released. Or when the waters start getting too crowded with similar acting drugs, why, then gee, our drug is the best for social anxiety, ours is the best for PMS, ours is indicated in OCD -- even though they're basically the same friggin drug!!
Call me cynical, but in these very strange times, it's foolish to trust what any advertisment says about their product, or any research funded by the developing pharm company has to say about their trials. And don't forget how salespeople from pharm companies woo doctors and how many doctors get their scholarship money from - guess who - and how many symposiums on various mental disorders are sponsored by pharm companies (although you really have to sleuth this out) and the presenters might be a little biased. Or at the very least, influenced, because drug companies, whether directly or hidden, turn out to be the primary educators of our physicians. -- BarbaraC
> I spent 3 hrs last night reading one clinical study after another on Reboxetine from sites all over the world, including US, it was found AT LEAST as good as Prozac in every study and better for many depressive, anxiety, & social phobic conditions and much better for severe depression WITH significantly less side effects in every study.........it wasn't approved because many people would have switched and ditched their ssri's (of course now, after 10 years of being bombarded with ssri marketing hype, some folks wouldn't give up their ssri's for an actual vaccine CURE, lol,......Anafranil was available in TONS of countries for MANY, MANY years before the fda SOMEHOW approved it...TONS of ocd sufferers who had NOTHING before that suffered endlessly for YEARS when they could have been greatly and easily helped......oh yeah, all politicians are completely moral, upstanding people who could NEVER be involved in crooked shenanigans either, lol...financial executives too (Enron, Global Crossing, Imclone, World Com, and scores of others, they were all guys that would NEVER do anything crooked for a buck, lol, show me ANY industry where HUGE bucks can be made and you'll find some shenanigans, thank goodness for drugs and the co's that make and sell them, but there is good and bad shenanigans in that industry too, you don't think a multi-BILLION $$$$ company and guys with HUGE stakes at hand would try to hide and twist a few 'unpleasant' facts....some people believed Bill Clinton too ("I never had sexual relations with that woman").....swampland in Florida for sale, TAKE CARE EVERYBODY!!!!!!!
Posted by Caleb462 on June 19, 2003, at 22:51:59
In reply to Re: Lilly controls the FDA--NOT » stjames, posted by Jack Smith on June 19, 2003, at 15:51:09
Don't get me wrong... I hate the pharm. companies just as much as you, but I think you should read Jack's original post again. Reboxetine was developed by, you guessed it... a pharmaceutical company. A big famous one with lots of money and power. I can't tell you why reboxetine was never approved... but I can tell you it probably was not because of any FDA/pharm. company conspiracy to keep the SSRI drugs on top.
Posted by McPac on June 19, 2003, at 23:36:38
In reply to Follow the money » McPac, posted by Barbara Cat on June 19, 2003, at 21:52:48
AWESOME post Barb! Awesome! And so true.
You have great writing skills for a conspiracy theorist, lol, just kidding. You just told it like it is and not how we just wish it was. I could add so many more details of shenanigans but I won't, typing sucks, lol; there is plenty of good too, without a doubt.
So many great points you touched on...the line that particularly stood out to me was the second line within this point of yours, "There is such disinformation and shenanigans in the business of antidepressants, et al, that the whole picture is very distorted. Sometimes the picture only starts becoming clear through anectdotal experience". There's nothing quite like first-hand personal experience!
Take care!!!!!!
Posted by Barbara Cat on June 20, 2003, at 0:12:18
In reply to BarbCat, Re: Follow the money, posted by McPac on June 19, 2003, at 23:36:38
Hi Guy,
Have a question for you. In your experience, does OCD seem like an overfocussing problem, like you focus on one obsessive refrain over and over? Does it seem like OCD is very different from ADD/ADHD which seem like not enough focus, losing the train of thought, etc. If so, it makes me wonder if meds for ADD would be counterproductive for OCD, i.e., you want to focus less rather than more. If that's the case, then I'd think that norepineprine enhancing drugs would not be your first drug of choice. Here's my reasoning: ADD seems to have poor blood supply to the frontal lobes and stimulants wake up that area, mainly through enhancing dopamine. Norepinephrine increases dopamine - I can't remember which is a precursor to which, but they're very intimately related. So, you probably wouldn't want the same drug that someone with ADD would use, namely, anything that increases dopamine. I may be way off base here, it's just a supposition, but if true, Reboxitine would not be a good drug for you. Good old rotten SSRI's would seem a better choice. Do you know what brain system is implicated in OCD?Thanks for your kind words about my post. If you think I've got conspiracy leanings, you ought to talk to my husband! The man is a walking encyclopedia on things I'd rather not know but probably should. Take care. -BCat
Posted by McPac on June 20, 2003, at 0:25:26
In reply to McPac...., posted by Caleb462 on June 19, 2003, at 22:51:59
What's up Brother Caleb!
Don't get me wrong... I hate the pharm. companies just as much as you, but I think you should read Jack's original post again. Reboxetine was developed by, you guessed it... a pharmaceutical company.
>>>>>>Believe me, I thought the same EXACT thing even before Brother Jack wrote that (I thought it last night after I read all the studies and then saw that it was not approved....there may very well be a great explanation why it wasn't approved (odd that the FDA offered NO explanation though)....maybe people started dying left and right after being on the stuff or started growing a third ear or something, lol.....I even thought, well, maybe the ssri giant co's, as a group, were able to put enough pressure to keep one co from taking a 'potentially' large bite out of their revs.....maybe, maybe not....but it's no different in any private business sector....Cisco Systems will do anything in its power and use whatever clout it has to make sure that Ciena Corp's new router doesn't make it and take market share....same with Microsoft (or tons of other companies in tons of other industries and sectors) using whatever influence it can to ensure that Sun Microsystem's operating software doesn't take any of its market share.....they are all competing co's competing with each other in the same sector....I'm not saying they're all paying off hit men to knock off the other guys' top personnel, lol, just that where huge $$$ is at stake that you will find shenanigans, some more crooked than others.....but Jack raised an EXCELLENT point (as did you)...I don't know the exact innerworkings.....what I mostly meant was the type of stuff that Barb elaborated on.....you can bet there are shenanigans and deception galore in this industry and any other....where there is HUGE money to be made and peoples livelihoods on the line, there will always be crooked dealings....there'd be no jails if everybody and everything was always legit.....can't believe I typed so much on the subject, wasted too much time,lol, this one-finger typing is for the birds, take care all!!!!!!!
Posted by Barbara Cat on June 20, 2003, at 0:28:45
In reply to emotional effects of NE reuptake inhibitors » turalizz, posted by zeugma on June 19, 2003, at 21:45:33
NE is excitatory, but as I understand it, any nerve/ligand that is stimulated will eventually reach its threshhold and then settle into a 'discharged' state, not quite inhibitory, but more in the middle of the stimulation spectrum (hmmm, this is sounding obscene). So perhaps there is an initial wired phase before the evening out, antidepressant phase is reached.
I am Bipolar II, at least so it seems, and I have that same effect with SSRIs, totally wired at first and then apathetic. Of course, I now take a couple of mood stabilisers and no more SSRI's for me. I take the TCA nortriptyline and did not have any of the NE stimulating effects at all that I was expecting. I hate to push NE any further on myself because of a dread of anxiety or hypomania. I'm hear you re the frustrating quest for the magic bullet. Why doesn't some of our military spending get funnelled into decent diagnostic/brain imaging equipment? After all, we'd have far less need of weapons and such if we were all a tad better well-adjusted.
> I wish there was more written on the differential aspects of these drugs instead of searching wildly for the "magic bullet" that will cure depression. Reboxetine and the noradrenergic TCA's have a different 'feel' to them which fits some personality types and disorders better than the SSRI's. The emotional intensification these drugs can induce is probably what makes them less suitable for OCD types, as OCD'ers already have enough emotional investment in their surroundings and don't need that level boosted even further. Similarly people undergoing a profound transient depression could probably use some of the apathy SSRI's can deliver.
>
> This reasoning was behind the introduction of the concept of 'endogeneous depression' to explain what the TCA's reversed. Someone who is endogeneously depressed is not reacting to external circumstances in a functional way: the TCA's intensify emotional response in these people to bring them back to the normal variation in mood that people generally feel. It's clear that not all, or even most, depression can be 'endogeneous' or the SSRI's could never have displaced the TCA's in popularity. But the supposition that there is a type of depressed individual who responds best to NE reuptake inhibitors remains a tenable one.
>
Posted by HenryO on June 20, 2003, at 3:28:47
In reply to Reboxetine (not approved in U.S.? FDA blows!), posted by McPac on June 19, 2003, at 2:27:41
I would not set to much store by Reboxetine. I got some via a Canadian pharmacy three years ago. I found it very fast acting and pretty unpleasant. It may be God's gift to somebody but not for me. I read all about it and got very excited to try it. Frankly I can see why the FDA hasn't approved it. It had a very speedy feel to it and I was very concious of being medicated really buzzed, which is something I hate in a med. It wacked my sleep and gave me a very odd and uncomfortable sexual side effect. It was as if my genitals were in cold water, quite contracted while the med lasted. It even seemed to alter the pitch of my voice. I would not recomend Reboxetine. There are much better meds out there. That's my two cents worth.
Posted by HenryO on June 20, 2003, at 3:35:23
In reply to Re: Reboxetine (not approved in U.S.? FDA blows!), posted by HenryO on June 20, 2003, at 3:28:47
I can't recomend Reboxetine. Read above post.
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Dr. Bob is Robert Hsiung, MD,
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