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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Viking on April 1, 2007, at 18:34:31
Hello babblers
I have followed this board for some time, but this is my first post.
First a little about myself. I am middleaged, male and live in northern Europe. I have been seeing a number of doctors and psyciatrists for the last 30 years, first for fatigue and stress and later on for depression. For many years i was not able to get any proper diagnosis, I was just told that nothinng was wrong with me. I spent lots of time and money on psycological therapy but it did not help very much.
Some 15 years ago it became so bad, I was for the first time referred to a pdoc. He did not put a name on my diagnosis, but hinted that my thoughts about being badly treated or harassed by my colleagues were delusional and I was prescribed an anti-psycotic drug. That definitely did no good. At the end I was fired from my job and could start to relax again.
Later I tried several times to get treatment for depression. I was first prescribed Cipramil which was later augmented with Buspar but it had very little effect. The only time when it really worked well was when I was supposed to have withdrawal symptoms, strange ! Today I realize that I have probably been somewhat hypomanic for 2 weeks during withdrawal, but it was nice.
Later on I was treated with Remeron + Mianserin (strange combo, but in those days I just did as the doc told as I did not know better). After several month and at a high dose I finally saw remission. But it was from one end of the scale to the other in one day. Suddenly all my rumination, anger, frustration and fatigue disappeared. On the other hand I did become rather aggressive and did a few stupid things. Furthermore it was a bit of a rollercoaster ride. most time I was "overspeeded" and when I relaxed I felt sedated (Remeron and Mianserin are both very sedating). I also gained a lot of weight. Medication was later changed to Cipramil + Mianserin but after one year it pooped out.
Later on I have tried a number of other meds including: Effexor, Modafinil, Adrafinil, Marplan, Amisulpride and Zyban. None of them did much good, and Remeron or Mianserin never worked again.
During the last couple of years I have read a lot aboout psyciatry in order to find an explanation. My last pdoc described my condition as "atypical depression/dysthymia and possibly social anxiety/phobia". He also hinted that it had some similarity with narcolepsy.
In order to sum up my symptoms were:
- excessive sleeping
- daytime sleepiness, difficult to stay awake
- mental slowdown
- rejection sensitivity
- stress sensitivity
- inability to exercise influence upon my life
- overeating
- always being accused of "sleepwalking" or "daydreaming"- endless compulsive rumination, anger, frustrations , complaints
- muscle tension, bruxism, headacheI chose to see the first grouop of symptoms as primary and the second group as a consequence of a frustrating live. I remember that I even as a kid was conscious about my lack of ability to have any influence upon things happening around me and I often fell victim to abusive behaviour such as mobbing. There were ups and downs but I believe these were due to external factors.
After a lot of reading I found a fair bit of evidence that stress can have a very damaging effect on the noradrenergic system. The consequences of this could be sleep disorders and increased sensitivity to stress and rejection. If I am to put this into one of those little boxes which doctors call a diagnosis, I would call it "atypical depression". It is possible that a US doc would call it "ADHD inattentive type", but that diagnosis is not used over here. Anyway, how do you distinguish that from a serious sleep disorder ?
To test my hypothesis I bought the most noradrenergic drug I could find: Reboxetine. I am now on week 3 and for the last week I have experienced almost full remission. I sleep easily, I feel fully awake and relaxed during the day and I suddenly find it surprisingly easy to talk to other people. It is very obvious that people treat me differently from what I am used to. I dont have any of the "speedy" feeling or the aggresiveness that Remeron gave me. All rumination etc is gone completely.
I must admit that my life is a mess. My somewhat uneven career has definitely hit the bottom and I am very much alone. But I have accepted it and I can think about it without getting upset. I am optimistic (at least cautiously) and I can think about the future in a constructive way.
Why did the doctors not give me proper treatment 30 years ago when all the evidence was there ? Why did I have to find out for myself ? Well never mind, that is part of the past.
My present medication is Reboxetine (Edronax) 4 mg a day. I did have some sideeffects in the beginning (constipation, restlessness, insomnia) but they are gone by now. I am surprised that such a low dose works so well as I normally need high doses to get any effect at all (I am a big guy). Maybe the bad reputation of Reboxetine is due to too high a dose recommendation ?
Miracles apparently still do happen.
I hope this can be of use to somebody else on this board.
Best regards.
Posted by linkadge on April 1, 2007, at 18:43:33
In reply to Reboxetine succes !!!!!, posted by Viking on April 1, 2007, at 18:34:31
Good to hear. Do you have any cardiac side effects from this medication?
Linkadge
Posted by Phillipa on April 1, 2007, at 19:42:17
In reply to Re: Reboxetine succes !!!!!, posted by linkadge on April 1, 2007, at 18:43:33
That's wonderful congratulations!!!!Love Phillipa
Posted by football on April 1, 2007, at 22:05:23
In reply to Re: Reboxetine succes !!!!!, posted by Phillipa on April 1, 2007, at 19:42:17
Yay! It always warms my heart to read a success story.
Posted by stargazer on April 1, 2007, at 22:54:35
In reply to Reboxetine succes !!!!!, posted by Viking on April 1, 2007, at 18:34:31
Hi Viking, is reboxetine only available overseas and what would be a similar drug that I could get my pdoc to precribe here in the uS?
Is noradrenergic the same as norepinephrine? What meds other than reboxetine work on the NE system more than the others?
I too am looking for better solutions as I feel I have been jerked around the med merry-go-round for the last 20 years. The best meds for me have been the MAO's but they stopped working and I am currently on Emsam (5 mos) and Abilify (2 weeks)but want to have a backup plan just in case. Thanks, Stargazer
Posted by stargazer on April 1, 2007, at 22:54:43
In reply to Reboxetine succes !!!!!, posted by Viking on April 1, 2007, at 18:34:31
Hi Viking, is reboxetine only available overseas and what would be a similar drug that I could get my pdoc to precribe here in the uS?
Is noradrenergic the same as norepinephrine? What meds other than reboxetine work on the NE system more than the others?
I too am looking for better solutions as I feel I have been jerked around the med merry-go-round for the last 20 years. The best meds for me have been the MAO's but they stopped working and I am currently on Emsam (5 mos) and Abilify (2 weeks)but want to have a backup plan just in case. Thanks, Stargazer
Posted by Viking on April 2, 2007, at 1:21:06
In reply to Re: Reboxetine succes !!!!!, posted by linkadge on April 1, 2007, at 18:43:33
> Good to hear. Do you have any cardiac side effects from this medication?
>
> LinkadgeI have had a slight increase in blood pressure since yesterday. Apart from that I have not noticed anything.
Viking
Posted by Viking on April 2, 2007, at 1:33:07
In reply to Re: Reboxetine succes !!!!!/Similar meds, posted by stargazer on April 1, 2007, at 22:54:35
> Hi Viking, is reboxetine only available overseas and what would be a similar drug that I could get my pdoc to precribe here in the uS?
>
> Is noradrenergic the same as norepinephrine? What meds other than reboxetine work on the NE system more than the others?
>
> I too am looking for better solutions as I feel I have been jerked around the med merry-go-round for the last 20 years. The best meds for me have been the MAO's but they stopped working and I am currently on Emsam (5 mos) and Abilify (2 weeks)but want to have a backup plan just in case. Thanks, Stargazer
Hi Stargazer
I dont know if rebox is available in US. Maybe someone else can answer that. I buy mine from a european online pharmacy, but due to board policy I cant tell you where. Too bad.
In theory Atomoxetine (Strattera) would do the same, but I have no experience with that drug. Anyway, it is far more expensive than rebox.
MAOs have been the drug of choice for atypical depression for many years due to their effect on noradrenalin.
Noradrenalin is just the european name for norepinephrine.
I hope this can help you. Viking
Posted by Meri-Tuuli on April 2, 2007, at 5:12:27
In reply to Re: Reboxetine succes !!!!!/Similar meds, posted by Viking on April 2, 2007, at 1:33:07
Hello!
There are several of us Northern Europeans around here. I know one in Norway and another in åland and one in Finland (me!).
Welcome to the board.
Kind regards
Meri-Tuuli
Posted by Quintal on April 2, 2007, at 10:13:52
In reply to Re: Reboxetine succes !!!!!/Similar meds » Viking, posted by Meri-Tuuli on April 2, 2007, at 5:12:27
What is that >å (?) and how did you make it?Is Tensor the Norwegian or the ålander? I thought for a while Viking might be Tensor in disguise since he too is doing well on reboxetine.
How much are you taking Viking? I've been wondering for a while if reboxetine would help motivation and focus with the Mirapex (pramipexole) I'm on. Your story inspired me to take the plunge, so I took 2mg an hour ago (teeny weeny staring dose because I had a bad reaction to it last time). Fingers crossed.
Q
Posted by Viking on April 2, 2007, at 10:55:15
In reply to Re: Reboxetine succes !!!!!/Similar meds » Meri-Tuuli, posted by Quintal on April 2, 2007, at 10:13:52
No, I have not posterd earlier under some other name.I am taking 4 mg a day. I tried 8 mg but that did not feel so good. 2 mg may bee a good start for you.
It sure has helped me to focus. Motivation is improving, but it takes some effort. Old habits die hard.
Reboxetine should not be combined with ergot-derived dopamine agonists, as it may cause elevated blood pressure. This should not apply to Mirapex, so it could be a good idea. I cant say for sure as I have no experience with Mirapex.
Dont give up to soon because of sideeffects. They will disappear again.
Good luck.
Posted by Ines on April 2, 2007, at 12:24:58
In reply to Re: Reboxetine succes !!!!!/Similar meds, posted by Viking on April 2, 2007, at 1:33:07
Hello Viking,
Thanks for posting a success story, they're nice to read! I'm really glad you found something that works for you- and it give the rest of us motivation to keep trying.
I'm not sure I agree with you that MAOIs have been the drug of choice for atypical depression due to their effect on noradrenaline (norepinephrine) though. As far as the older drugs go, it is the tricyclics that tend to concentrate on noradrenaline (along with serotonin). MAOIs increase serotonin, noradrenaline and dopamine, and noone really knows why they seem to work better for atypicals. As far as I'm aware reboxetine is considered more similar to a tricyclic than to a MAOI (although different from both obviously because it is so selective and is a reuptake inhibitor).
I have pretty much the same symptoms you report (with the addtition of some ocd symptoms) and reboxetine made me get quite a bit worse, even after the dose was reduced to 4 mg. It increased my anxiety to an unbearable level and gave me wild mood swings and frequent suicide ideation. This is not to discourage anyone- I'm sure reboxetine will work great for many people, but not all atypicals.
Oh, in response to stargazer's question, reboxetine wasn't approved in the US, noone quite knows why.
I hope rebox continues doing the trick for you Viking!
Ines
Posted by Iansf on April 2, 2007, at 13:07:48
In reply to Re: Reboxetine succes !!!!!/Similar meds » Quintal, posted by Viking on April 2, 2007, at 10:55:15
> Dont give up to soon because of sideeffects. They will disappear again.
>I tried Reboxetine when it first came out, but it took me 15 minutes to urinate, and forget about getting an erection - absolutely impossible. The situation was so extreme, I couldn't continue. So what side effects did you experience, and how long before they disappeared?
Posted by Quintal on April 2, 2007, at 13:10:41
In reply to Re: Reboxetine succes !!!!!/Similar meds » Viking, posted by Iansf on April 2, 2007, at 13:07:48
Tensor is having success with tamsulosin to counteract these side effects.
Posted by Meri-Tuuli on April 2, 2007, at 13:41:41
In reply to Re: Reboxetine succes !!!!!/Similar meds » Meri-Tuuli, posted by Quintal on April 2, 2007, at 10:13:52
Hey!
Its a charactor they have in Swedish and some other Scando languages - I even have a key for it on my laptop (which was purchased here in Finland) although I've changed the virtual keyboard to a british layout but with the scando keys - so often charactors aren't were they should be! Confuses the hell out of anyone borrowing it...anyway...
Å:
http://en.wikipedia.org/wiki/%C3%85
Åland islands:
well you can do that bit yourself.
I just press alt then 'a'. But I have a mac, so its different.
Posted by Viking on April 2, 2007, at 15:06:10
In reply to Re: Reboxetine succes !!!!!/Similar meds » Viking, posted by Iansf on April 2, 2007, at 13:07:48
> > Dont give up to soon because of sideeffects. They will disappear again.
> >
>
> I tried Reboxetine when it first came out, but it took me 15 minutes to urinate, and forget about getting an erection - absolutely impossible. The situation was so extreme, I couldn't continue. So what side effects did you experience, and how long before they disappeared?
>
I am sorry you had so bad sideeffects but they are completely unlike mine.
In the beginning I had insomnia, sweating, sort of "edgy" or "speedy" feeling (cant really find a better word), increased heartrate and some headache. I could imagine some people could interpret this as anxiety and be frightened by it, but anxiety has never been my problem.
I never had the slightest urinary problems but did have some constipation.
All that is gone by now (week 3).
I did not worry so much about sexual problems, as there was little left to destroy anyway. During the last week I have actually noticed improvement.
It does show that people respond very differently to meds. But as long as you have not found the right med you can only go on trying. I dont think any med should be left out just because few people benefit from it. It may be the right one for you.
Posted by stargazer on April 3, 2007, at 16:35:10
In reply to Re: Reboxetine succes !!!!!/Similar meds » Iansf, posted by Viking on April 2, 2007, at 15:06:10
Other than Straterra,are there other meds that work like Reboxetine? Are TCA's similar? Wellbutrin?
I just want to compile a list of similar meds for my file just in case.
Thanks...SG
Posted by Quintal on April 3, 2007, at 16:53:26
In reply to Meds like Reboxetine????, posted by stargazer on April 3, 2007, at 16:35:10
Nortriptyline/desipramine? Both have strong NRI action.
Q
Posted by Viking on April 4, 2007, at 10:11:53
In reply to Meds like Reboxetine????, posted by stargazer on April 3, 2007, at 16:35:10
> Other than Straterra,are there other meds that work like Reboxetine? Are TCA's similar? Wellbutrin?
>
> I just want to compile a list of similar meds for my file just in case.
>
> Thanks...SGHere is an article about Reboxetine. It mentions some other possibilities.
http://neurobio.drexel.edu/PageWeb/CNS%20RBX.pdf
Mirtazapine (Remeron) and Mianserin are also somewhat noradrenergic. I experienced them as fairly similar. Remeron may give more "punch" pr mg but is far more expensive. I needed huge doses before they kicked in (60+ mg Remeron plus some Mianserin, as far as I remember) and they only worked once. The good thing is that they are both pro-sexual.
http://www.preskorn.com/columns/0003.html
However there seems to be some dispute about their effectiveness.
http://www.psychotropical.com/Antidepressants_mirtazapine.shtml
General info about many ADs.
http://www.psychotropical.com/Latest_PUN_Notes.shtml
Viking
Posted by stargazer on April 5, 2007, at 8:10:41
In reply to Re: Meds like Reboxetine???? » stargazer, posted by Viking on April 4, 2007, at 10:11:53
Thanks for suggestions. Just when I think Nardil will be my next trial I am interested in these NRI's too. So Strattera would be a good one to try since reboxetine is not available in the US. Else the TCA's.
To this day, the only TCA I tried was amitriptylline/Elavil and I had too many side effects like dilated pupils, dry mouth, etc.
It looked like I had just had my eyes examined every day or used drugs which is not a good way to look at work.Thanks all. SG
Posted by Quintal on April 5, 2007, at 9:57:36
In reply to Re: Meds like Reboxetine????, posted by stargazer on April 5, 2007, at 8:10:41
>To this day, the only TCA I tried was amitriptylline/Elavil and I had too many side effects like dilated pupils, dry mouth, etc.
It looked like I had just had my eyes examined every day or used drugs which is not a good way to look at work.This can happen with SNRIs too. My pupils have been like saucers since I started reboxetine.
Q
Posted by stargazer on April 5, 2007, at 21:05:45
In reply to Re: Meds like Reboxetine???? » stargazer, posted by Viking on April 4, 2007, at 10:11:53
This is the end of the thread.
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