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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by acer on August 21, 2000, at 0:40:15
Anyone out there experience hostile looks from others,
social anxiety resulting from this, and increased
irritability from Reboxetine?
I am also hardly able to use my computer due to impatience/ lack of concentration and find myself giving up quite easily as a result of this. However I
have had much more energy than on my previous med.
(Parnate) and more motivation generally - two things I had none of on Parnate.
I suffer from social phobia and ADD, Body Dysmophic
Disorder and resulting depression.
What I would like to know is which SSRIs are the safest to combine with Reboxetine? I tried 10mg of
Paxil (called Aropax here in Australia) with Rebox.
before for a couple of days and had a panic attack
the second day. I only get panic attacks from
certain medicine combos - never when Im on nothing.
I hear Citalopram (Celexa in usa?) is supposed to be less 'activating' than Paxil but it is metabolised
by CYP3A enzymes and so is Reboxetine so I am worried
about interactions. None of the psychiatrists out
here will help me as Reboxetine isnt released here yet
and they dont have any experience prescribing it. Plus
they are too scared of legal reprecussions if they
give the wrong advice.
Can anyone help me?
Posted by JohnL on August 21, 2000, at 5:27:02
In reply to Hostile looks/ irritability/anxiety on Reboxetine, posted by acer on August 21, 2000, at 0:40:15
Interesting post Acer. You pose some difficult questions.
Not only in your country, but I think anywhere in the world we would have a hard time trying to find a pdoc who has expertise in combining Rebox with other meds. It's just still relatively new.
Of the SSRIs, Celexa is probably the cleanest in terms of having the fewest interactions with other meds. But if you think it will be metabolized by the same enzymes as Reboxetine, what that means is you'll need reduced dosages of each. The interaction they might have is characterized by an increased blood level of the med. Just as an off the wall example, say for example 10mg Celexa is added to ongoing 8mg Rebox. That 8mg Rebox might now be the equivalent of 12mg. Maybe more. Maybe a lot more. Just a guesstimate for an example. The meds don't actually interact, but they slow down the metabolism of each other, causing a higher level of the med in your system and a longer time to dissipate.
Probably the only realistic way is trial and error. Like what you did with Paxil. Maybe your doc might allow you to sample small quantities of several different meds one at a time to see if you can discover a good match. You'll know a good match when you stumble onto it. There will be no doubt.
Whatever dose of Rebox you are taking, could it be maybe that's it's too much? I mean, the motivation is nice, but not the irritability and restlessness. That's indicative of excess norepinephrine.
I wonder also about taking a completely different attack on your symptoms. Something like antipsychotic+stimulant combination. My gut instinct is that this route could be surprisingly effective for all of your symptoms. Sometimes we don't need to raise neurotransmitter levels, but instead either lower them, turbocharge them, or both. That's what this combo will do. Raising neurotransmitter levels I do not think is the right chemistry for you, because if it was, the Parnate would have worked better than it did. And of course, if this is correct, then Rebox and any other neurotransmitter-increasing med won't be right either. I think the clues from the responses to Parnate and Rebox are very very important. I think it is of key importance to note that increasing neurotransmitter levels with Parnate did not work as hoped. Very important clue.
In the back of my mind, the thought of an antipsychotic like Zyprexa, Risperdal, or Amisulpride immediately came to mind when I saw the comment about "hostile looks". I am pretty sure people aren't in fact giving you hostile looks. People just don't walk around picking you out of a crowd and giving you hostile looks. And they don't usually give hostile looks at all. And if they do, they aren't directed just at you. But your eyes are perceiving it that way. That is a slight hint of psychosis and a touch of paranoia perhaps, or as I prefer to say 'excess neurotransmitters' (dopamine, NE, or both). Since you are already initiated in the arena of trying meds not available in your country, I might suggest you take a good look at Amisulpride. It is excellent for all of the symptoms you have. The only tricky part would be trying different dosage levels to fine-tune it. In the same vein, Adrafinil is a great add-on to Amisulpride for added energy and motivation, without all that irritibility.
At first glance, my gut instinct tells me that in your case it could be good to get away from neurotransmitter-increasing meds, and instead focus on other chemistries. Amisulpride more than any other I can think of could be real good for you, especially if combined with a mild stimulant.
Just thinking out loud. Hope something here might be of help.
John
Posted by AndrewB on August 21, 2000, at 11:17:14
In reply to Hostile looks/ irritability/anxiety on Reboxetine, posted by acer on August 21, 2000, at 0:40:15
Acer,
Reboxetine can often cause over agitation that can manifest itself in a variety of forms (i.e. anxiety, irritability, impatience, impaired concentration.). One report listed paranoia and irritability as a result of reboxetine. Ask yourself whether the hostile looks you perceive are a reality or a manifestation of paranoia.
There are several possible ways to deal with rebox related over agitation. Some people find that reboxetine is better for them at smaller doses, 4 to 6mg./day. Sometimes a person can up their dosage later on without re-experiencing agitation, as the body has now acclimated to the reboxetine.
Another way to deal with over agitation is to add an SSRI. Unfortunately, the only antidotal report I have on file of using SSRIs for rebox. agitation describes successful augmentation with Paxil. So I am at a loss to suggest what SSRI is best to try next.
My information confirms that rebox is broken down by CYP3A4. Other information I have says that rebox is excreted principally renally, has no inhibitory effects on the major enzymes involved in drug metabolism, and has negligible interference with the pharmokinetics of other drugs, thus fewer drug-drug interactions are expected.
Another possible way of dealing with rebox agitation, and this is pure speculation on my part, is to add clonidine. Clonidine is an alpha 2 andrenergic agonist. It can be effective for anxiety, panic, irritability and impaired concentration. Clonidine can be sedating however so it may compromise some of the arousal effect you derive from reboxetine.
I have a couple of further suggestions further afield. If reboxetine's side effects can't be overcome, there are numerous other arousal agents you can trial. Try not to settle for less from your medicines than full recovery with little or no side effects. Secondly, an experienced psychopharmocologist will more likely be able to give you useful advice concerning rebox (and not hide behind legal concerns). You may also contact a British psychiatrist via phone or email to have your questions answered. Deja.com has a board for Brits with depression. You can pose a question to this board asking for a psych. you can contact.
Best of luck,
AndrewB
Posted by Sigolene on August 21, 2000, at 14:33:14
In reply to Hostile looks/ irritability/anxiety on Reboxetine, posted by acer on August 21, 2000, at 0:40:15
A little more info on combination with Reboxetine.I tried 4mg Reboxetine with 30mg Mianserine (only in Europe I think). Mianserine is a very sedative AD acting only on NE like Reboxetine (because I couldn't sleep with Reboxetine even if I took it in the morning)
And as a result to this combination, I had for the first time panic attacks, and no change in my depression after 2 weeks. So I suppose it's NOT a good combination. Try something else.I wonder if Trazodone (an other sedative AD) could be added to Reboxetine ? Has anyone already tried this ?
Sigolene
> Anyone out there experience hostile looks from others,
> social anxiety resulting from this, and increased
> irritability from Reboxetine?
> I am also hardly able to use my computer due to impatience/ lack of concentration and find myself giving up quite easily as a result of this. However I
> have had much more energy than on my previous med.
> (Parnate) and more motivation generally - two things I had none of on Parnate.
> I suffer from social phobia and ADD, Body Dysmophic
> Disorder and resulting depression.
> What I would like to know is which SSRIs are the safest to combine with Reboxetine? I tried 10mg of
> Paxil (called Aropax here in Australia) with Rebox.
> before for a couple of days and had a panic attack
> the second day. I only get panic attacks from
> certain medicine combos - never when Im on nothing.
> I hear Citalopram (Celexa in usa?) is supposed to be less 'activating' than Paxil but it is metabolised
> by CYP3A enzymes and so is Reboxetine so I am worried
> about interactions. None of the psychiatrists out
> here will help me as Reboxetine isnt released here yet
> and they dont have any experience prescribing it. Plus
> they are too scared of legal reprecussions if they
> give the wrong advice.
> Can anyone help me?
>
Posted by Anna P. on August 21, 2000, at 15:52:07
In reply to Re: Hostile looks/ irritability/anxiety on Reboxetine, posted by Sigolene on August 21, 2000, at 14:33:14
> Hello there,
It was also my idea to try Mianserine with Reboxetine. I tied 4 mg Rebox + 15 mg Mianserine. Mianserine is European substitute for Remeron by the way. I got disoriented and confused for the whole day.
I want to retry it with the smaller dozes of each again.I have another question/suggestion for Acer and Sigolene. I'm not shure about availability at your place, but I've heard about new SNARI in Europe, name Minalcipran or Ixcel. I just ordered samples by prescription. It supposed to have no sedating and sexual effects, yet to be energizing.
I will appreciate any feedback on this.
Anna
>
>
> A little more info on combination with Reboxetine.
>
> I tried 4mg Reboxetine with 30mg Mianserine (only in Europe I think). Mianserine is a very sedative AD acting only on NE like Reboxetine (because I couldn't sleep with Reboxetine even if I took it in the morning)
> And as a result to this combination, I had for the first time panic attacks, and no change in my depression after 2 weeks. So I suppose it's NOT a good combination. Try something else.
>
> I wonder if Trazodone (an other sedative AD) could be added to Reboxetine ? Has anyone already tried this ?
>
> Sigolene
>
>
>
>
>
>
>
>
> > Anyone out there experience hostile looks from others,
> > social anxiety resulting from this, and increased
> > irritability from Reboxetine?
> > I am also hardly able to use my computer due to impatience/ lack of concentration and find myself giving up quite easily as a result of this. However I
> > have had much more energy than on my previous med.
> > (Parnate) and more motivation generally - two things I had none of on Parnate.
> > I suffer from social phobia and ADD, Body Dysmophic
> > Disorder and resulting depression.
> > What I would like to know is which SSRIs are the safest to combine with Reboxetine? I tried 10mg of
> > Paxil (called Aropax here in Australia) with Rebox.
> > before for a couple of days and had a panic attack
> > the second day. I only get panic attacks from
> > certain medicine combos - never when Im on nothing.
> > I hear Citalopram (Celexa in usa?) is supposed to be less 'activating' than Paxil but it is metabolised
> > by CYP3A enzymes and so is Reboxetine so I am worried
> > about interactions. None of the psychiatrists out
> > here will help me as Reboxetine isnt released here yet
> > and they dont have any experience prescribing it. Plus
> > they are too scared of legal reprecussions if they
> > give the wrong advice.
> > Can anyone help me?
> >
Posted by Sigolene on August 22, 2000, at 6:57:01
In reply to Re: Acer/Sigolene, posted by Anna P. on August 21, 2000, at 15:52:07
Mianserine is not exactly like Remeron, because Remeron also acts on Serotonine (5 HT).
But I think if you try less than 15 mg Mianserine and 4 mg Rebox, it won't be enough to treat depression because it's less than a half normal dosage (i.e 70 mg Mianserine and 8 mg Reboxetine.
Why not to try an other combination ?Sigolene.
> > Hello there,
>
> It was also my idea to try Mianserine with Reboxetine. I tied 4 mg Rebox + 15 mg Mianserine. Mianserine is European substitute for Remeron by the way. I got disoriented and confused for the whole day.
> I want to retry it with the smaller dozes of each again.
>
> I have another question/suggestion for Acer and Sigolene. I'm not shure about availability at your place, but I've heard about new SNARI in Europe, name Minalcipran or Ixcel. I just ordered samples by prescription. It supposed to have no sedating and sexual effects, yet to be energizing.
>
> I will appreciate any feedback on this.
>
> Anna
> >
> >
> > A little more info on combination with Reboxetine.
> >
> > I tried 4mg Reboxetine with 30mg Mianserine (only in Europe I think). Mianserine is a very sedative AD acting only on NE like Reboxetine (because I couldn't sleep with Reboxetine even if I took it in the morning)
> > And as a result to this combination, I had for the first time panic attacks, and no change in my depression after 2 weeks. So I suppose it's NOT a good combination. Try something else.
> >
> > I wonder if Trazodone (an other sedative AD) could be added to Reboxetine ? Has anyone already tried this ?
> >
> > Sigolene
> >
> >
> >
> >
> >
> >
> >
> >
Posted by Anna P. on August 22, 2000, at 13:09:19
In reply to Re: Acer/Sigolene » Anna P., posted by Sigolene on August 22, 2000, at 6:57:01
> Hi Sigolene,
Mianserine is not exactly like Remeron, because Remeron also acts on Serotonine (5 HT).> > I have always thought that Mianserine acts on serotonin system because of its efficacy for OCD.
But I think if you try less than 15 mg Mianserine and 4 mg Rebox, it won't be enough to treat depression because it's less than a half normal dosage (i.e 70 mg Mianserine and 8 mg Reboxetine.
Why not to try an other combination ?
>
> > What else can we try? I'm open to suggestions.Sigolene, one more question. Do you have in your country Minalcipran (brand name Ixcel)?
Please, let me know.Anna P.
> Sigolene.
>
>
> > >
> > >
> > >
> > >
> > >
> > >
Posted by Sigolene on August 22, 2000, at 15:00:33
In reply to Re:Sigolene, posted by Anna P. on August 22, 2000, at 13:09:19
Ana P,
I've never heard about Minalcipran here in Switzerland.
For the new combination with Reboxetine, it depends why you want to add something to Reboxetine, is it to improve Rebox primary effects on depression, or because you can't sleep with Rebox, or something else...
Let us know about that.
Sigolene> > Hi Sigolene,
>
>
> Mianserine is not exactly like Remeron, because Remeron also acts on Serotonine (5 HT).
>
> > > I have always thought that Mianserine acts on serotonin system because of its efficacy for OCD.
>
> But I think if you try less than 15 mg Mianserine and 4 mg Rebox, it won't be enough to treat depression because it's less than a half normal dosage (i.e 70 mg Mianserine and 8 mg Reboxetine.
> Why not to try an other combination ?
> >
> > > What else can we try? I'm open to suggestions.
>
> Sigolene, one more question. Do you have in your country Minalcipran (brand name Ixcel)?
> Please, let me know.
>
> Anna P.
> > Sigolene.
> >
> >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
Posted by Anna P. on August 22, 2000, at 17:30:23
In reply to Re:Sigolene » Anna P., posted by Sigolene on August 22, 2000, at 15:00:33
> Ana P,
>
> I've never heard about Minalcipran here in Switzerland.
> For the new combination with Reboxetine, it depends why you want to add something to Reboxetine, is it to improve Rebox primary effects on depression, or because you can't sleep with Rebox, or something else...
> Let us know about that.
> Sigolene
>
> > > Hi Sigolene,
> >
> > I want to add something to Reboxetine, as I get the partial response from it.
> >
> >
> > > > I have always thought that Mianserine acts on serotonin system because of its efficacy for OCD.
> >
> > But I think if you try less than 15 mg Mianserine and 4 mg Rebox, it won't be enough to treat depression because it's less than a half normal dosage (i.e 70 mg Mianserine and 8 mg Reboxetine.
> > Why not to try an other combination ?
> > >
> > > > What else can we try? I'm open to suggestions.
> >
> > Sigolene, one more question. Do you have in your country Minalcipran (brand name Ixcel)?
> > Please, let me know.
> >
> > Anna P.
> > > Sigolene.
> > >
> > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
Posted by Anna P. on August 22, 2000, at 17:31:48
In reply to Re:, posted by Anna P. on August 22, 2000, at 13:29:59
> > Hello again Acer,
>
> I was going to ask you do you have in Australia
> Minalcipran (brand name Ixcel?)
>
> About your problems with Reboxetine, I would reduce the doze and see how it goes.
> If no improvement with depression, I would add something else like Paxil to it.
>
> Anna P.
Posted by acer on August 23, 2000, at 0:28:51
In reply to Re:ACER, posted by Anna P. on August 22, 2000, at 17:31:48
Hi Anna P.,
We dont have milnacipran/Ixcel in Australia. I have heard of it but as far as I knew it was still
in trials and not even released overseas yet -
dont really know for sure though. The thing is with the Rebox. I have already been on a low dose
- 4mg per day for the past week, then 3mg for 2
weeks before that, then 2mg per day to start with for a week. This is because I read another post
about how its better to go up really slowly if
you are getting hard to tolerate side-effects. I
dont know how much longer I can stick it out.
Ive read in other posts and in professional
journals that sometimes it can take up to six weeks to respond - Ive given up Rebox. (and a few others) once before after only two and a half weeks so I thought I had better try and stick it out this time.The only meds that make me feel
better also take away any motivation I have (esp.
the SSRIs and Parnate). Ritalin and Dexamphetamine
are addictive for me. So I will probably try to
give Rebox. another week or so and if the hostile
looks(which I realise sitting here are all in my
head but when Im 'out there' cant dispute) dont
lessen then Ill either try a bit of Paxil with it or call it quits with Reboxetine. Thanks for your
help.
Also , Id be interested to here if you find any more about Milnacipran.acer.
Posted by Anna P. on August 23, 2000, at 12:15:55
In reply to Re:ACER » Anna P., posted by acer on August 23, 2000, at 0:29:19
> Hi Acer,
Have you ever tried Aurorex or Sulpiride for your depression?
I've ordered Minalcipran by prescription from
Victoria Apotheke (See my post above).Also, when I first tried Reboxetine, I was affraid to talk. I had a feeling that everyone stares at me, but it went away.
Good luck with whatever you decide.Anna
>
>
This is the end of the thread.
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