Posted by SLS on May 1, 2001, at 12:18:06
In reply to Why is Reboxetine apparently ineffective for most?, posted by PhoenixGirl on April 24, 2001, at 16:16:01
> And how can it be distinguished from desipramine, other than it has less anticholinergic side effects? I wonder if getting a good response to desipramine predicts a good response to reboxetine. Because I have a better response to desipramine than to the more serotonergic antidepressants. If anybody knows a good article showing the effectiveness rate of reboxetine in a controlled study, I'd appreciate hearing about it.
Hi PhoenixGirl.Yes, reboxetine has been shown to be a selective norepinephrine (NE) reuptake inhibitor in the laboratory as has desipramine. However, these two drugs cannot be considered to be interchangeable. Different drugs are, well, just plain different, regardless of how we as humans struggle to classify them. One may experience an improvement in depression with desipramine, yet experience a severe worsening of depression with reboxetine. I am an example of this. I don't think there is enough experience with reboxetine to observe a trend in an association between reboxetine and desipramine, negative or positive.
If desipramine is providing you with as much of an antidepressant effect as you could hope for, and the side effects are really nothing more than a nuisance, I would be reluctant to encourage you to try to cross-over to another drug. Reboxetine is not without side effects, many of them being similar to those of desipramine. I have read some rather optimistic projections of the efficacy of reboxetine that infer that it is generally superior to the SSRIs. I really haven't seen this to be obvious on Psycho-Babble, although the numbers of people who have tried it are small because of its lack of availability in the United States. I am not particularly impressed with reboxetine overall, though it is a miracle drug for some.
If you have not experienced a satisfactory improvement with the other drugs you have tried, I would not hesitate to suggest that you give reboxetine a try. If desipramine has produced only a partial improvement, I believe that it would be worthwhile to investigate nortriptyline. Understand that unlike other tricyclics, the dosage of nortriptyline needs to be fine-tuned to stay within your individual therapeutic range. Blood tests will help determine that you are taking the right amount. It is a great drug.
As far as clinical trials are concerned, all of the studies that the FDA had to work with were those conducted in Europe. So they mandated that Pharmacia-Upjohn, the pharmaceutical company pursuing approval in the United States, conduct clinical trials in the U.S. It was anticipated that the results would be available by January, 1999. Unfortunately for the drug company, the first trial resulted in a "failed study". It failed because when comparing reboxetine to Prozac to placebo, neither reboxetine nor Prozac were any better than placebo. It is accepted that Prozac is better than placebo, so something obviously went wrong. So, new clinical trials were conducted. I don't know if the results are in yet. I am all but sure that reboxetine will show itself to be better than placebo.
If you feel the need to continue looking at NE drugs, Ludiomil (maprotiline) should appear on your list along with Effexor, other tricyclics, and MAO-inhibitors. Wellbutrin is thought to act on NE pathways. At higher dosages, Remeron potentiates NE neurotransmission.
I hope this helps.
- Scott
poster:SLS
thread:61039
URL: http://www.dr-bob.org/babble/20010424/msgs/61254.html