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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by kribensis on July 14, 2015, at 13:50:37
I think that norepinephrine is my issue and I have trouble finding an AD that works. Any suggestions for ones that act mostly in norepinephrine? (Do not tolerate Wellbutrin). Also needs to be one available in Canada.
Posted by SLS on July 14, 2015, at 14:35:41
In reply to AD for norepinephrine, posted by kribensis on July 14, 2015, at 13:50:37
> I think that norepinephrine is my issue
How did you come to that conclusion? Just curious.
> and I have trouble finding an AD that works. Any suggestions for ones that act mostly in norepinephrine? (Do not tolerate Wellbutrin). Also needs to be one available in Canada.
The most selective and potent NE reuptake inhibitor is desipramine (Norpramin). Nortriptyline (Pamelor) is predominantly selective for NE also. Both of these drugs are tricyclic anidepressants. Another selective NE reuptake inhibitor is atomoxetine (Strattera). However, it is a better treatment for ADHD / ADD than it is for depression.
An alternative pro-NE strategy is to block NE alpha-2 autoreceptors. Mirtazapine (Remeron) and mianserin (Athymil) both have this property. Of the two, mirtazapine is the least sedating.
Personally, I found venlafaxine (Effexor) 300 mg/day to be more effective with the addition of nortriptyline 75 mg/day. Others do better with the addition of mirtazapine to venlafaxine. Mirtazapine is a better antidepressant at doeages of 45 mg/day or higher.
- Scott
Posted by kribensis on July 14, 2015, at 17:08:19
In reply to Re: AD for norepinephrine » kribensis, posted by SLS on July 14, 2015, at 14:35:41
Thanks for your reply, Scott.
I came to the conclusion that epinephrine *might* be my issue b/c I tried a few AD's that had mainly action on serotonin (and herbs) and do terrible on those. Also not good at all on wellbutrin.
Anything that is very sedating or has a high probability of weight gain I cannot do.
I actually think that a type of a stimulant would actually perhaps be best but no one will prescribe me something like adderall.
I once took Silbutramine and I found that it was the best thing I ever took and I did not have the 'poop out'. Unfortunately, I only took that in a product that was promoted as "natural" but a TCM dr only later to find out it actually had sibultramine in it and was pulled.
Before that I had a few great years on Effexor. I needed about 300 dose before it really worked for me but when it worked it was great. When it started to poop out my dr added wellburtin which made things worse. I have since tried wellbutriin on its own and it still made things worse for me.
Pristique gave me a little perk and then nothing. I've tried effexor again without the same great effect I had years ago. Tried zoloft, manerix, paxil, modafinil all of which did not work or made me worse.
Posted by europerep on July 14, 2015, at 18:48:34
In reply to Re: AD for norepinephrine, posted by kribensis on July 14, 2015, at 17:08:19
Hey there,
just a few quick thoughts:
One, back when you were on venlafaxine, did you try to go higher than 300mg/d when it started to lose efficacy? 375mg/d is the official maximum daily dose, but treatment successes on higher doses are documented as well.
Secondly, if I'm not mistaken, sibutramine is a triple reuptake inhibitor. So is venlafaxine at very high doses. Maybe a second reason to take another look at venlafaxine.
And lastly, I would say, don't forget the MAOIs. Phenelzine and tranylcypromine also hit those three neurotransmitters, although in a very different way that may produce very different results.
ER
Posted by kribensis on July 14, 2015, at 18:59:52
In reply to Re: AD for norepinephrine » kribensis, posted by europerep on July 14, 2015, at 18:48:34
Posted by linkadge on July 14, 2015, at 19:55:15
In reply to Re: AD for norepinephrine, posted by kribensis on July 14, 2015, at 17:08:19
Have you tried Cymbalta? It is similar to Effexor with more affinity for norepinephrine.
Linkadge
Posted by kribensis on July 14, 2015, at 22:07:15
In reply to Re: AD for norepinephrine, posted by linkadge on July 14, 2015, at 19:55:15
I have not tried cymbalta so that is something to consider. I just googled fetzima and I *think* it may be available in Canada now and am thinking of asking my dr to try that first.
Posted by phidippus on July 15, 2015, at 7:49:05
In reply to Re: AD for norepinephrine » kribensis, posted by SLS on July 14, 2015, at 14:35:41
Don't forget Reboxetine.
Eric
Posted by kribensis on July 15, 2015, at 10:25:41
In reply to Re: AD for norepinephrine » SLS, posted by phidippus on July 15, 2015, at 7:49:05
Hi Eric,
I don't think reboxtine is available in Canada.
Posted by SLS on July 15, 2015, at 11:49:33
In reply to Re: AD for norepinephrine » SLS, posted by phidippus on July 15, 2015, at 7:49:05
> Don't forget Reboxetine.
>
> EricI'm not a big fan of reboxetine. It is my impression that it makes more people feel worse than it does make people feel better. I can't remember more than two people respond favorably to reboxetine. Of course, if I were one of these people, I would consider it a miracle drug, and would want to have it be available forever. The drug company lobbied hard to get reboxetine approved by the US FDA, but the numbers just weren't there.
...Not that Strattera is such a brilliant drug for depression. I am convinced that it works for adult ADD. I don't know how effective it is for pediatric ADD / ADHD, though.
- Scott
Posted by SLS on July 15, 2015, at 11:51:04
In reply to Re: AD for norepinephrine » kribensis, posted by europerep on July 14, 2015, at 18:48:34
> Hey there,
>
> just a few quick thoughts:
>
> One, back when you were on venlafaxine, did you try to go higher than 300mg/d when it started to lose efficacy? 375mg/d is the official maximum daily dose, but treatment successes on higher doses are documented as well.
>
> Secondly, if I'm not mistaken, sibutramine is a triple reuptake inhibitor. So is venlafaxine at very high doses. Maybe a second reason to take another look at venlafaxine.
>
> And lastly, I would say, don't forget the MAOIs. Phenelzine and tranylcypromine also hit those three neurotransmitters, although in a very different way that may produce very different results.
>
> ERThese are good ideas.
- Scott
Posted by phidippus on July 15, 2015, at 12:11:26
In reply to Re: AD for norepinephrine » phidippus, posted by SLS on July 15, 2015, at 11:49:33
Straterra did nothing for my ADHD. I suffered no side effects, however. I might as well have been taking a sugar pill.
Eric
Posted by Christ_empowered on July 15, 2015, at 12:40:09
In reply to Re: AD for norepinephrine, posted by kribensis on July 14, 2015, at 17:08:19
I think SLS already recommended this, but..California Rocketfuel (effexor+remeron) ? I don't know how you do dosing, but its supposed to be quite effective on a number of different symptoms, even for some people w/ treatment resistant depression.
What was the problem with Wellbutrin?
Posted by kribensis on July 15, 2015, at 13:26:52
In reply to Re: AD for norepinephrine, posted by Christ_empowered on July 15, 2015, at 12:40:09
I actually felt "worse" on wellbutrin. Sort of the opposite that people say you are supposed to feel: more lethargic and depressed, weight gain, weird heavy head feeling and then just more depressed and felt like lying in bed all day.
Posted by SLS on July 15, 2015, at 14:32:46
In reply to Re: AD for norepinephrine, posted by kribensis on July 15, 2015, at 13:26:52
> I actually felt "worse" on wellbutrin. Sort of the opposite that people say you are supposed to feel: more lethargic and depressed, weight gain, weird heavy head feeling and then just more depressed and felt like lying in bed all day.
I did worse on Wellbutrin also. I experienced most of the same symptoms that you did, but dysphoria was pretty severe.
- Scott
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