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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by sk85 on May 20, 2012, at 15:29:48
I've tried a numerous drugs boosting noradrenaline and this is what I can summarize:
reboxetine (Edronax) - gloomy thoughts, depressive, dangerously increased heart rate
atomoxetine (Strattera) - c**ppy feeling, increased depression, heart rate up
bupropion (Wellbutrin SR) - emotionality, increased depression, suicidal
milnacipran (Savella) - dangerously increased heart rate
agomelatine (not really an NRI but increase NA tone) - depressive ruminations, increased pessimismSo the overall pattern seems to be pro-depressogenic effects and IMO cardiovascular sensitivity. What I don't get is that a lot of people find NRI-s very effective for depression without pumping their resting heart rate to 110 and feeling like a whale **** on the bottom of the ocean. Could this be some sort of a sensitivity? And would this suggest something about my underlying psychiatric condition (I still don't have a clear diagnosis after 7 years)?
-Ikaros
Posted by bleauberry on May 21, 2012, at 5:22:46
In reply to Unable to tolerate NRI-s - confused as to why, posted by sk85 on May 20, 2012, at 15:29:48
Well, it's hard to tell.....either your chemistry absolutely does not want any more of the adrenaline circuit stuff, or else it is so whacked out of shape it will take very gentle nudging to begin to turn the titanic around. My personal opinion is that when we are dealing with NRIs we are dealing with a totally different animal than SSRIs. The effects of NE throughout the body seem to have more far reaching global impacts on other biologies than serotonin does.
If you were of the suspicion that NRIs would help you, then the way to approach it would be the same way my Lyme doctor does it....start at super low doses....far below the lowest dose...and then increase it slowly in tiny steps, allowing time for bodily adjustments with each step. Some of the people in the clinical trials had bizarre side effects such as the heartrate thing (savella) but somewhere in the 6-9 month range the med finally balanced out everything involved in the NE circuits. In the trials they made it that far because they were in the trials. In my doctors office they make it that far by dosing very gently.
Me and Savella, as an example.....it feels like the best psych med I've ever tried....BUT....it has to 6mg-9mg in a 24 hour period, which is only 1/2 of the lowest starting dose! Someone else commented that 6mg was their best dose. What happened to them if they went higher? What happened to me if I went higher? Depression much worse! A dark gloomy worthless hopeless kind of depression, like a thunder cloud pushing down on my head. A very low dose feels good, a regular dose feels very bad.
So take that as you will. Just sharing.
Posted by Dinah on May 21, 2012, at 8:01:39
In reply to Unable to tolerate NRI-s - confused as to why, posted by sk85 on May 20, 2012, at 15:29:48
They were dreadful for me. I suspect I have quite enough adrenaline and cortisol floating in my system, and am best with medications that lower or counteract it.
Does anxiety play a role in your depression?
Posted by sk85 on May 21, 2012, at 15:59:37
In reply to Re: Unable to tolerate NRI-s - confused as to why, posted by Dinah on May 21, 2012, at 8:01:39
> Does anxiety play a role in your depression?
It does, although it's atypical, more of a mix of OCD and low grade panic.
>My personal opinion is that when we are dealing with NRIs we are dealing with a totally different animal than SSRIs. The effects of NE throughout the body seem to have more far reaching global impacts on other biologies than serotonin does.
If you were of the suspicion that NRIs would help you, then the way to approach it would be the same way my Lyme doctor does it....start at super low doses....far below the lowest dose...and then increase it slowly in tiny steps, allowing time for bodily adjustments with each step. Some of the people in the clinical trials had bizarre side effects such as the heartrate thing (savella) but somewhere in the 6-9 month range the med finally balanced out everything involved in the NE circuits. In the trials they made it that far because they were in the trials. In my doctors office they make it that far by dosing very gently.
Me and Savella, as an example.....it feels like the best psych med I've ever tried....BUT....it has to 6mg-9mg in a 24 hour period, which is only 1/2 of the lowest starting dose! Someone else commented that 6mg was their best dose. What happened to them if they went higher? What happened to me if I went higher? Depression much worse! A dark gloomy worthless hopeless kind of depression, like a thunder cloud pushing down on my head. A very low dose feels good, a regular dose feels very bad.
So take that as you will. Just sharingFor me serotonergics have a very predictable course of effects beginning with a "down" feeling after acute taking and then progressing increasingly towards their end effect, which I find generally anxiolytic and neutralizing towards negative mindset (I specifically don't use anti-depressive because they don't really make me "happy" just more neutral...which however balanced correctly does lead to perhaps more happiness).
However pure NRI-s seem to just switch me to a dark state which doesn't shown any progressive improvement or change that accompanies SRI-s. Perhaps I've also been impatient with these drugs, and as you say should've started more gradually and used lower doses.-Ikaros
Posted by SLS on May 22, 2012, at 2:15:31
In reply to Re: Unable to tolerate NRI-s - confused as to why, posted by sk85 on May 21, 2012, at 15:59:37
It is very possible that you are guessing right regarding your sensitivities to NRIs. They are very powerful drugs that can activate the sympathetic nervous system as it courses throughout the body.
Sometimes, we guess right - sometimes not. Reboxetine (categorized a NRI) made me suicidal within a week of starting it. If I had tried reboxetine as my first drug AND decided that I was smart enough to guess right based upon such limited understanding of drug mechanisms, I would never have gone on to respond to other NRIs (desipramine and nortriptyline). Yet, I found that protriptyline made me feel worse. Strattera was neutral. So, some NRIs make me feel better, some make me feel worse, and some have no effect at all. There must be more to these drugs than a singular and uniform action of norepinephrine reuptake inhibition throughout the brain.
So, the question becomes, how smart are we? I was fortunate to learn early in my career as a patient that I was not smart enough to make absolute decisions based upon incomplete understandings of the etiologies of mental illnesses and the mechanisms involved in their treatment. Very few, if any, neuroscientists are smart enough to do this, so I guess we are in good company.
By the way, chronic treatment with desipramine can reduce the secretion of cortisol in response to stress.
- Scott
Posted by sk85 on May 23, 2012, at 12:08:52
In reply to Re: Unable to tolerate NRI-s - confused as to why, posted by bleauberry on May 21, 2012, at 5:22:46
Did you manage do develop tolerance to the rapid heart rate from NRI-s (i.e Savella in your case), or you didn't get that at all. E.g. I've tried clomipramine which did work well for me except the rapid pulse (which seemed to go very high so I stopped). Perhaps I should've just waited longer and my body would have adjusted. I just got the impression that this side-effect just doesnt't disappear, although, I built tolerance to all the other anticholinergic and antihistamine SE-s.
Posted by creepy on May 30, 2012, at 8:09:16
In reply to Unable to tolerate NRI-s - confused as to why, posted by sk85 on May 20, 2012, at 15:29:48
NRI's and NDRI's dont help me with depression. They increase anxiety also.
Unfortunately I need serotonin to address my depressive symptoms.
This is the end of the thread.
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