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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by sabre on March 10, 2005, at 23:00:32
Hello
Week one on Reboxetine - .5mg x 2/day
First four days were generally great. Energy to burn, talkative, happy, able to concentrate and remember. Social anxiety not overly affected but better able to deal with it.Next few days started to experience episodes of fatigue and depression esp early in the morning and just before the second dose.
Second week - upped dosage to .5mg x 3.
Lasted two days and felt progressively awful. The depression was sad and overwhelming. Started crying while running...v early in am. Lost power of concentration - could reverse this a little by drinking strong coffee. Felt like I couldn't raise the energy to talk to people. Felt slow and tired.Last night missed third dose and stared to feel a little better. Still woke this morning feeling depressed but not so physically stuffed - worse than pre drug though.
I feel like chucking my job.
And I'm ready to chuck this drug.It is behaving just like the others...Paxil, Lexapro, Moclobemide and to a lesser extent Serzone. Starts out energising, happy and positive than deteriorates rapidly esp after a dosage increase despite the low dosages I'm using.
What am I doing wrong?
Would using Propranolol affect the function of Reboxetine? R can increase sensitivity to vasoactive drugs like Propranolol. Could R slow the metabolism of P or increase depression via P?
http://circ.ahajournals.org/cgi/content/full/107/23/2949Would a mood stabiliser make more sense? Or are alternative supplements the only way?
Any suggestions?
Thankyou
Sabre
Posted by SLS on March 11, 2005, at 6:52:23
In reply to week 2 - Rebox, posted by sabre on March 10, 2005, at 23:00:32
Hi.
My experience with reboxetine was very similar to yours such that I became suicidal while taking it. This suicidal state disappeared within 36 hours of discontinuating reboxetine. Our experiences are not unusual with this drug.
I don't like reboxetine.
Of course, those people whom respond well to reboxetine will justifiably offer a different opinion.
- Scott
Posted by ed_uk on March 11, 2005, at 8:52:32
In reply to Re: week 2 - Rebox » sabre, posted by SLS on March 11, 2005, at 6:52:23
Hello sabre,
There is something very weird about reboxetine, I think it may have some unknown pharmacological properties. I don't know anyone who has liked it in the long run.
My advice:
Dump the reboxetine and replace it with a better established NRI such as desipramine. Your initial good response to reboxetine suggests that you might do well on a different noradrenergic.
Ed.
Posted by sabre on March 11, 2005, at 14:25:09
In reply to Re: week 2 - Rebox » sabre, posted by SLS on March 11, 2005, at 6:52:23
Thankyou Scott and Ed.
I felt like I was giving up too easily wanting to drop this drug so soon but I just feel so bad...even worse this morning.I felt so relieved at seeing your posts that it made me cry.
This is not me.
I will post again when I get this stuff out of my system.
You two are great people.
Sabre
Posted by ed_uk on March 12, 2005, at 14:44:41
In reply to Re: week 2 - Rebox, posted by sabre on March 11, 2005, at 14:25:09
Hi Sabre!
Yes, reboxetine's a freak! I'd try desipramine if you can. If you live in a country where lofepramine's available, try it, it's a TCA which acts as a NRI. I've taken it for two years and it seems to have helped.
>I just feel so bad...even worse this morning.
Bin it :-)
>You two are great people.
Awww, thank you :-) I hope you feel better in a few days time.
Ed.PS. Did you say you live in Australia. I'm not sure whether lofepramine and/or desipramine are available in Australia, I suppose you could import them if they're not. I think nortriptyline's used in Aus though, the brand name is Allegron, same as in the UK.
Posted by sabre on March 13, 2005, at 23:05:38
In reply to Re: week 2 - Rebox » sabre, posted by ed_uk on March 12, 2005, at 14:44:41
Thanks again, Scott and Ed.
I've stopped blubbering into the keyboard and binned the stuff.My mood started to shift about a day later and I woke up without that desperation, which was a relief. I sort of over shot the mark though and my sympathetic system went into overdrive. Got real chatty, hyped and felt like I could climb mountains. I couldn't sleep and every stressful thought induced a spurt of adrenaline.
I've been taking Propranolol to keep the adrenaline under control.Ed, I'm really wary of the TCAs because of their effect on the heart etc. Running matters to me. I thought Reboxetine was pretty neutral in this regard. I read a PubMed study that looked at cyclists on R. It had no significant effect on their performance. The trouble with these studies is that they always pick 'normal' people and they give them a one off dose (4mg) and then they go off for a long bike ride. I couldn't find anything else to guide me in this respect...other than rats being more motivated to stay afloat in a bucket of water...
I found that the R seemed to constantly stimulate the heart which in the first few days makes you very energetic but after that you start to feel laboured. My running kept getting slower and slower to the point it was hard to even jog. With the dose increase I felt like the blood was pooling in my ankles when I started to run and it took a bit to get going.
As for the depression...it was profound.I was curious about mood stabilisers because I read that they can help if you have no luck with ADs. Lamictal seemed the most side effect free but then some people spoke of fatigue, dizziness etc
The one thing that was v. useful with Reboxetine was the improvement of nerve pain. It took it away completely at the .5 x 3/day and it all came back straight away with the withdrawal of Reboxetine.Back to the drawing board......
Sabre
Posted by SLS on March 14, 2005, at 0:19:36
In reply to Re: week 2 - Rebox, posted by sabre on March 13, 2005, at 23:05:38
Have you ever tried Effexor? What was your response to it?
Is Cymbalta available?
> Got real chatty, hyped and felt like I could climb mountains.
This phenomenon is known as a drug discontinuation rebound improvement. I don't know if this is a sign of bipolarity or not, but you might want to try Lamictal and perhaps move on to other mood-stabilizers during the course of your looking for an effective antidepressant.
- Scott
Posted by ed_uk on March 15, 2005, at 8:34:48
In reply to Re: week 2 - Rebox, posted by sabre on March 13, 2005, at 23:05:38
Hi Sabre!
>............binned the stuff.
Good choice :-)
>Ed, I'm really wary of the TCAs because of their effect on the heart etc.
TCAs often cause sinus tachycardia. I doubt that desipramine would be much more likely to cause sinus tachycardia than reboxetine though - possibly slightly more likely because it's weakly anticholinergic. Sinus tachycardia is not a serious arrhythmia, expect in people with coronary heart disease. I've had sinus tachycardia for the last 2 years, mainly because I'm so unfit. I stopped lofepramine for a while, heart rate was still about 100 at rest.
Very rarely, TCAs can cause life-threatening arrhythmias such as torsades de pointes. If you suffer from certain types of heart disease, TCAs are best avoided. Also, if you have a family history of sudden death, you'd need to be evaluated for congenital long QT syndrome before being prescribed a TCA.
If you can get hold of desipramine and you'd like to try it, I'd suggest starting out with a very low dose, say 10mg/day, given the dramatic effects of low-dose reboxetine.
>I found that the R seemed to constantly stimulate the heart which in the first few days makes you very energetic but after that you start to feel laboured.
.....but do you think you felt laboured due to the effect it was having on your mood? ie. rather than on your heart.
>The one thing that was v. useful with Reboxetine was the improvement of nerve pain.
You suffer from neuropathic pain? What caused it? TCAs can be helpful for neuropathic pain.
>...Lamictal
Could be useful. Lamictal is sometimes prescribe off-label for neuropathic pain.
OK, I'm gonna shut up about desipramine now because I'm starting to sound like a sales rep. To be fair, I would be a bit concerned about you trying it because there's a chance that it might make you more depressed, like reboxetine, after all it is essentially an NRI. I don't know what's wrong with reboxetine though. How come SLS got more depressed on rebox when he benefits from desip? I think we have a lot to learn about rebox, it could be affecting some receptors that we don't even know about yet.
Best regards,
Ed.
Posted by sabre on March 16, 2005, at 1:19:54
In reply to Re: week 2 - Rebox » sabre, posted by ed_uk on March 15, 2005, at 8:34:48
Thankyou Ed and SLS
To be honest I feel very freaked out about trying anything now.
Ed,
The Reboxetine had an effect on strong running efforts in particular. I could not get my heart rate up sufficiently. In the first few days I ran 40sec faster over an 8k course by the end of the 2 wks I was running 1.5minutes slower. This is a huge difference in competitive running.
According to some sudies including: http://www.reboxetine.com/anticholinergic.html'Reboxetine increased heart rate and blood pressure and reduced the HF power of RRI and 3,4-dihydroxyphenylglycol (DHPG) plasma concentrations.'
Since I have come off the reboxetine my heart rate seemed v easily set off by adrenaline - not under social stress. It seems to be slowly returning to normal. I am also running better now.
Wanting to run well may seem greedy but I have found it helps so much to keep depression at bay and gives me something tangible to look forward to, plan, dream about and to distract...not to mention the health benefits.
I have decided to take the pikers route and find another job. Avoidance? I'll stick with the Propranolol and wait until the sting of another failed drug fades.
.
Thankyou both
Sabre
PS Ed, The pain is mainly in my heels and trigger driven headaches..it's coming back slowly
Posted by ed_uk on March 16, 2005, at 9:18:17
In reply to Re: week 2 - Rebox, posted by sabre on March 16, 2005, at 1:19:54
Hi Sabre!
>To be honest I feel very freaked out about trying anything now.
Yes, I can understand that, perhaps you should take a break from new treatments for a while.
>Wanting to run well may seem greedy but I have found it helps so much to keep depression at bay and gives me something tangible to look forward to, plan, dream about and to distract...not to mention the health benefits.
I think it's good that you run. I'd like to be able to run, I think it would really help me if I could.
Keep in touch, post soon, I'll be sad if you don't,
Ed.
Posted by sabre on March 16, 2005, at 19:50:38
In reply to Re: week 2 - Rebox » sabre, posted by ed_uk on March 16, 2005, at 9:18:17
Ed,
I think you'd make a great pdoc.
sabre
Posted by ed_uk on March 17, 2005, at 9:32:04
In reply to Re: week 2 - Rebox, posted by sabre on March 16, 2005, at 19:50:38
Hi!
>I think you'd make a great pdoc.
LOL, thanks :-) I won't ever be a pdoc though!
Ed.
Posted by sabre on March 17, 2005, at 17:57:21
In reply to Re: week 2 - Rebox » sabre, posted by ed_uk on March 17, 2005, at 9:32:04
Why not, Ed?
Posted by ed_uk on March 18, 2005, at 7:07:20
In reply to Re: week 2 - Rebox » sabre, posted by ed_uk on March 17, 2005, at 9:32:04
Hi!
>Why not?
Because I'm not doing medicine!
Ed.
This is the end of the thread.
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