Posted by SLS on January 22, 2009, at 6:37:11
In reply to Re: Desipramine vs Strattera for adult ADD., posted by jrbecker76 on January 21, 2009, at 19:05:16
Two things occur to me:
1. I have personally seen Strattera work a miracle for a middle aged man with ADD who was originally diagnosed with depression. He went through drug after drug without success. He was unemployed and behaviorally challenged. Within a month of starting Strattera (atomoxetine), he reported feeling "normal" for the first time in his life. He found an apartment and a job. One drug. My point here is that statistically, it might be that atomoxetine does not help as many people as psychostimulants do - although I have seen no evidence that is true - but when it works, it can produce robust improvements in ADD.
2. A NE reuptake inhibitor is not a NE reuptake inhibitor, etc. Surely, atomoxetine, desipramine, reboxetine, viloxazine, and nisoxetine all have different clinical profiles. Preclinical studies demonstrated that they all had antidepressant properties during development. Clearly, atomoxetine and reboxetine are not as potent as desipramine when treating depression. So, different is different. Here, I suggest that it is not only what a drug does neurochemically that matters, but also where it does it. Atomoxetine accumulates in the prefrontal cortex more than it does elsewhere. This is probably why it is not an effective antidepressant for most people. Here, its inhibition of the NE transporter results in a simultaneous rise in diffused interstitial dopamine as it is taken up by the NE transporter there. I think one needs to look at the localization of drugs in the brain and the circuits they represent. Determining circuitry is equally important to determining what neurotransmitters and receptors facilitate those circuits.
- Scott
poster:SLS
thread:875152
URL: http://www.dr-bob.org/babble/20090104/msgs/875393.html