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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by ggggg123 on November 7, 2010, at 13:47:22
hi has anyone taken an NRI longterm? like Reboxetine or any of the non stimulant adhd drugs, if so did they lose their effect over time or did they provide a sustained level of treatment? Also were they effective and did you find them tolerable. Cheers
Posted by Conundrum on November 7, 2010, at 14:00:00
In reply to Who has taken an NRI long-term??, posted by ggggg123 on November 7, 2010, at 13:47:22
> hi has anyone taken an NRI longterm? like Reboxetine or any of the non stimulant adhd drugs, if so did they lose their effect over time or did they provide a sustained level of treatment? Also were they effective and did you find them tolerable. Cheers
I haven't, but reboxetine is probably the one with the least side effects, and probably the least effective. It wasn't approved in the U.S. because it failed to prove effective and if you put any stock in meta analysis, reboxetine did the worst out of 12 new antidepressants, worse than all the SSRIs.
Desipramine would probably be a better bet, or nortriptyline.
From what I've read reboxetine has anti-cholinergic effects anyway, so you'd probably save money taking a generic TCA. The nice thing about reboxetine, is that you can order it online with no rx in the U.S. since it has not been approved here.
I'd go with a TCA first and if the side effects were too terrible, try reboxetine.
Posted by ggggg123 on November 7, 2010, at 15:28:54
In reply to Re: Who has taken an NRI long-term??, posted by Conundrum on November 7, 2010, at 14:00:00
ye you might be right conundrum, I'm still taking my dwindling supply of wellbutrin with a small amount of bromocriptine. As I need to replace the wellbutrin as I don't want to pay for it. I will be getting the drugs on prescription, as we have a national health service so all drugs are a fixed cost of £7.50, so generics are pretty much always used, if they are available. The only thing is i really don't want to increase serotonin directly, but I suppose I may have to, also I imagine the half life is much longer on the tca's, I think the reason reboxetine was found ineffective is most people seem to respond to serotonin, I am the opposite, I may be in a small subset, but my depression is defo more norep and dop and always was but ssri's made it even more so. It is estimated that only a small subset of depressed people need norepinephrine and dopamine, wouldn't this account for some of the ineffectiveness reported?
I only want to try the drugs with the least serotonergic properties. This is why I would like to try reboxetine not so much because of the anticholinergic.
But I suppose nortriptyline and desimpramine have relatively weak serotonergic activity.
Maybe a tca would be the best option, at this moment in time I don't care I just want some norepinephrine lol
Its abit of a dilemma, I kinda just want to get back active and interested in life, then I hope the rest will fall into place and the brain my start to heal.
My theory is that ssri's treat people with emotional and personality disorders, whilst those with endogenous depression have a large norepinephrine component, if a person with severe endogenous depression takes an ssri, they become even more anhedonic, they lose every last bit of nor and dop, whilst a person with high emotions and hysteria, would feel much better and relaxed. Only my theory. Maybe it is the broad definition of depression that is at fault in these trials and not the actual drug. If a person with normal norepinephrine levels takes an nri, it would be hell, like you've just drank 10 espressos, but a person with non may feel normal.
Posted by ed_uk2010 on November 7, 2010, at 15:53:08
In reply to Re: Who has taken an NRI long-term??, posted by Conundrum on November 7, 2010, at 14:00:00
>From what I've read reboxetine has anti-cholinergic effects anyway, so you'd probably save money taking a generic TCA.
It actually has no anticholinergic effects, but its noradrenergic side effects can be very similar to anticholinergic side effects.... which has lead to some confusion.
Posted by ggggg123 on November 7, 2010, at 16:24:05
In reply to Re: Who has taken an NRI long-term?? » Conundrum, posted by ed_uk2010 on November 7, 2010, at 15:53:08
The fact is norepinephrine is a very important neurotransmitter in the brain, without it you won't feel normal, hence you will have some kind of "depression" Experts say this can be caused due to a complete lack of norep and/or serotonin, or it can be caused by an abnormal ratio, hence too much serotonin too little NE due to ssri use. Either way the right balance needs to be restored to feel normal. Venlafaxine could be a good option, in high doses for people who are termed treatment resistant, it is the gold standard here in the uk and is regularly used on the psych ward. I may try it but, the problem is i will feel like crap till i get to the high doses. I imagine reboxetine works very quick like wellbutrin, this way we start to feel better quicker and can concentrate on recovering rather than going through weeks of hellish side effects, like with the ssri's.
I will go with which ever med the doc agrees on prescribing, probably with reboxetine number one followed by the most noradrenergic tca.
Posted by ggggg123 on November 7, 2010, at 16:26:47
In reply to Re: Who has taken an NRI long-term??, posted by Conundrum on November 7, 2010, at 14:00:00
if you search reboxetine on google, and go on the reboxetine website, written buy good drug guides, it gives it an ok write up for anhedonia.
Posted by linkadge on November 7, 2010, at 16:59:26
In reply to Re: Who has taken an NRI long-term??, posted by ggggg123 on November 7, 2010, at 16:26:47
While the good drug guide is well written, there is a lot of "theoretical" conjecture.
In theory, strattera would be an effective AD but it is not.
Linkadge
Posted by 10derheart on November 7, 2010, at 17:53:55
In reply to Who has taken an NRI long-term??, posted by ggggg123 on November 7, 2010, at 13:47:22
Yup.
I have taken Strattera (atomoxetine) 80 mg q day for 7 years this January. No SE except for on startup and it is still effective and completely tolerable.
In fact, I could say it became more effective over time, BUT that probably does not take into account the huge positive impact of good therapy and other coping skills I gained through life changes (better sleep, richer spiritual life). All working together *with* the Strat I have had an excellent experience with this med.
I think I have been in the minority on Babble with this med, unfortunately for others who hoped it would work for them. i know I am VERY fortunate. A combo of methyphenidate/Prozac helped my ADD initially, but the Strattera is smoother and w/o any cardiovascular concerns (I have HTN.)
Search archives and there are several other threads on Strattera over the past few years.
Posted by 10derheart on November 7, 2010, at 18:04:18
In reply to Re: Who has taken an NRI long-term?? » ggggg123, posted by 10derheart on November 7, 2010, at 17:53:55
You didn't come right out and say so, but from context and other things, I'm guessing you're looking for someone who has had success mainly treating **depression** with one of these meds? Not so much ADD?
My ADD/depression/anxiety were (sometimes 'are' but I am 80-90% better) clearly comorbid, particularly the depression which I think came 75% out of the ADD problems and 25% from situational stuff that overwhelmed the system, so to speak. Once the ADD was understood, treated, manaaged with Strat and therapy, the depression slowly and steadily disappeared.
Anxiety still flares up some, but is manageable. I think this is quite a bit unrelated to the ADD piece of my puzzle anyway. Long story...
Anyway...sorry if my experience doesn't fit. Maybe there will be something helpful to someone in here anyway. Hope so :-)
Posted by ggggg123 on November 7, 2010, at 19:18:45
In reply to sorry...depression vs. ADD, posted by 10derheart on November 7, 2010, at 18:04:18
Thanks for the response, it has helped me, I am glad to hear your having success. I just wanted to know if these drugs are sustainable, or if they wear out after a few years. Strattera, was meant to be an antidepressant, but nri's get such a hard time as ad's. do you think its helped your depression, as I imagine it helps with motivation and keeps you interested and focused, which is all the things I am lacking with my retarded depression.
Thanks for the response its much appreciated! George.
Posted by Conundrum on November 7, 2010, at 21:40:51
In reply to Re: Who has taken an NRI long-term??, posted by ggggg123 on November 7, 2010, at 15:28:54
> I only want to try the drugs with the least serotonergic properties. This is why I would like to try reboxetine not so much because of the anticholinergic.
Wasn't it taking the drug that had the most serotonergic properties that caused the problem? Now you want to go to the other extreme? The drug that increases the stress hormone the most? Maybe the balance of a TCA would be better. Maybe not. Something to think about.
Posted by Conundrum on November 7, 2010, at 21:58:26
In reply to Re: Who has taken an NRI long-term??, posted by Conundrum on November 7, 2010, at 14:00:00
I gotta, say I hope an NRI helps me. There isn't much left in the bag of tricks as far as drugs go. I felt pretty good on pristiq for awhile and that has a very weak effect on NE, so hopefully a full blown adrenergic TCA might help.
Stablon is turning out to be a lot like an SSRI without sexual dysfunction.
Posted by ggggg123 on November 8, 2010, at 10:20:54
In reply to Re: Who has taken an NRI long-term??, posted by Conundrum on November 7, 2010, at 21:40:51
yes unfortunately all your comments are based on guess work conundrum, the balance is so strong in one direction it is vital to hit it hard into the other direction.
My theory, which is as valid as any bodies on here, is that I don't have a serotonin deficiency
If you knew anything about psychopharmacology you would understand that NRI's increase serotonin indirectly, I have told you this many many times. I thank you for making me go back to an nri, as it is my saviour, but your tone and your attitude seriously let you down. 7 years is way to long, i can understand why you have such a bad attitude, but come on man go and get better and lighten up. If people only knew the importance of ne and da in anhedonia, they are absolutely fundamental, as
I said it could take a year of consistent nri use to ensure the body starts functioning completely normally. But an nri is so much more likely to increase serotonin than vice versa, not just due to its action on serotonin in the brain but due to the fact it gets you and about which in turn will produce higher quantities of all neurochemicals.
I have been taking 300mg of bupropion and it doesn't make me in the slightest bit anxious but it makes me feel normal.
TCA's will have a terrible side effect profile, and their serotonergic side effects will further add to this. Its trial and error for anybody, basing things completely on guess work isn't always accurate, the bupropion has been working so well for me this week. Serotonin may work for some people, but for me it is utter useless, case closed.
Posted by ggggg123 on November 8, 2010, at 10:31:22
In reply to Re: Who has taken an NRI long-term??, posted by Conundrum on November 7, 2010, at 21:58:26
In the good drug guide, which reflects my experience of using medical drugs down to a t, therefore I trust it, they state tianeptine is good for anxiety but not anhedonia. That site could wipe the floor with the info people give on here. Any serotonergic activity will only further prevent a person with anhedonia from recovering. Drugs are only half the deal, you need to get active and participative in some of lives fun activities.
any benefit from stablon's dopaminergic and noradrenergic dis-inhibition will only help people who do not have severe anhedonia, as the chemicals are so far depleted its negligible, plus the serotonin activity balancing the overall effect would make it side effect free and anhedonia free only in people who aren't in asevere state of anhedonia. You've got to kick it hard, even if your scared to do so, its the only way. Anhedonia is due to a chemical imbalance, an abnormal ratio, how can you fix the ration by further increasing serotonin and noradrenaline? this would'nt make sense these drugs provide an equal effect, to treat an imbalance you need a drug that can target and raise a specific neurotransmitter system.Depression is about neurochemical processing, where as parkinson's is to do with dopamine receptor depletion. The difference is depression is not organic and this is why anti depressants treat it and can bring about recovery, you just need the right ones. Good luck in your recovery.
Posted by ggggg123 on November 8, 2010, at 12:34:39
In reply to Re: Who has taken an NRI long-term??, posted by ggggg123 on November 8, 2010, at 10:31:22
No body has ever proven that serotonin plays a role in depression, at least not a major role. Do people just feel better on ssri's or do they feel completely normal?, remission? responder? all means nothing, flawed with subjectivity. The only good test would be that a patient is fully functioning and is fulfilled in every aspect of his/her life, unless they have organic constraints.
Another theory could be that ssri's help a person feel better whilst the body recovers from depression naturally.
Mild depression is completely different from severe depression, the body can heal in a matter of months with moderate depression, I've seen it first hand. Severe depression is a new ball game and one could argue it is these patients who may respond to ne*. In other patients it may be excessive and adverse reactions like heart palps,sweating and panic. I don't think any evidence suggests that norepinephrine is inhibitory, therefore maybe it is does not attenuate other neuro systems and is why a selective serotonin drugs, no matter which one can cause post drug anhedonia. The ssri's are chemically unrelated but all have similar effects on serotonin, therefore would it not be safe to say the main causal factor precipitating our unfortunate outcome, would be serotonin itself and not the properties of the drug. and is it not chronic inhibition which attenuates NE in a vulnerable depressed brain and then leaves the brain ne deficient, with very low ne processing. Maybew this is why the complaint is less with the tca, as the equilibrium they pprovide with both SE/NE provents this inhibition and thus prevents diminished ne processing. Fluoxetine, what you took is unrelated to citalopram which I took, but they both intensify serotonergic neurotransmission, with this being the only common link, in our identical symptom syndrome, it is this action that is fundamentally responsible. I think for people with anhedonia the ratio should be something like 1:5 serotonin to noradrenaline, maybe at a push a tca with the lowest affinity for serotonin may prove beneficial.
Do you not think that these drugs are mostly serotonergic because it makes them safer, easier to dose, therefore much easier to get fda approvable, they can be marketed to a mass audience unlike nris, ndris and maoi,s, therefore the reason serotonin is at the forefront of being causative in "depression" is due to a variety of profitability and societal/official acceptability.NDRI'S do not sell well, gp's rarely prescribe them, but for the severely depressed anergic people they might be life changing.
You can't dish out nri's they cause anger, mania and anxiety if the dose is slightly to high, with the small window of therapeutic benefits, whilst things can go down hill pretty quickly if thew dosing is wrong, much more quickly and much worse than if the ssri is too high.
Is it not these factors which have lead to ssri's being at the forefront of treating depressive illness?
I think low dose nri, maybe a dopaminergic combined with a good healthy lifestyle. Especially for people with anhedonia. Anhedonia is a horrible state to be in, people don't understand the severity of the condition, you are stuck in no mans land, you feel nothing, you have no life, yet you are alive and walking like everybody else. In my opinion its one of the worst conditions, and really deserves effective treatment.
Posted by creepy on November 8, 2010, at 12:53:24
In reply to Who has taken an NRI long-term??, posted by ggggg123 on November 7, 2010, at 13:47:22
Ive been taking desipramine at a low dose for a couple of years. Its been pretty good on pain and a little helpful with fatigue and some other symptoms I have like congestion and transient low blood pressure when Im too sedentary.
It hasnt really pooped out on me because I never really took it for its AD effects.
AD effects that I have gotten from it and the adderall Im on, are pretty mild. Those probably pooped out a long time ago.
Posted by ed_uk2010 on November 8, 2010, at 14:05:59
In reply to Who has taken an NRI long-term??, posted by ggggg123 on November 7, 2010, at 13:47:22
>hi has anyone taken an NRI longterm? like Reboxetine or any of the non stimulant adhd drugs, if so did they lose their effect over time or did they provide a sustained level of treatment? Also were they effective and did you find them tolerable. Cheers
Yes, I've taken lofepramine. It was useful for a couple of years. It caused increased heart rate and sweating, but was tolerable.
Posted by emmanuel98 on November 9, 2010, at 21:07:06
In reply to Re: Who has taken an NRI long-term??, posted by ggggg123 on November 8, 2010, at 12:34:39
My p-doc would never prescribe TCAs for me because they can be fatal in overdose and I have a history of suicide attempts and severe suicidal ideation when depressed. SSRIs are far less dangerous than TCAs.
Posted by ed_uk2010 on November 10, 2010, at 13:27:14
In reply to Re: Who has taken an NRI long-term??, posted by emmanuel98 on November 9, 2010, at 21:07:06
> My p-doc would never prescribe TCAs for me because they can be fatal in overdose and I have a history of suicide attempts and severe suicidal ideation when depressed. SSRIs are far less dangerous than TCAs.
In the UK we have lofepramine, a TCA which is not very dangerous in overdose.
Posted by Conundrum on November 10, 2010, at 15:12:35
In reply to Re: Who has taken an NRI long-term?? » emmanuel98, posted by ed_uk2010 on November 10, 2010, at 13:27:14
> In the UK we have lofepramine, a TCA which is not very dangerous in overdose.
>
>The effects are similar to desipramine, correct?
This is the end of the thread.
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