Posted by LouisianaSportsman on October 1, 2013, at 14:53:51
In reply to Re: Savella » LouisianaSportsman, posted by phidippus on October 1, 2013, at 14:32:16
> No one needs NE. Its role in depression is not well understood, but it doesn't keep drug manufacturers from exploiting the marketing possibilities. If anything, NE helps more with reward paradigms, which makes it invaluable in treating executive disfunction.
>
> If you want more NE, look no further than Reboxetine, a potent NRI (norepenephrine reuptake inhibitor). Strattera is another NRI worth checking out.
>
> If you want a robust NE solution, try Wellbutrin.
>
> EricThanks for a speedy response! I was hoping to kill two birds with one stone by switching Pristiq to Savella to avoid adding bupropion as well. The thing is, I respond well to more NE, I assure you. That's why I have done better with Pristiq than another antidepressant.
It is a SNRI as well that approved for depression in the European Union (the same way Lyrica is approved for anxiety in the European Union). Savella has minimum withdrawal symptoms compared to Pristiq and may be more effective. It is approved in the United States for fibromyalgia pain similar to Cymbalta. I believe that NE helps my ADHD tremendously and at the lower dosage of Pristiq, there is little NE actionit mostly acts as a SSRI. Whereas, Savella is inhibits the reuptake of serotonin and norepinephrine in an approximately 1:3 ratio, respectively; in practical use this means a relatively balanced action upon both neurotransmitters. Increasing both neurotransmitters concentration simultaneously works synergistically to treat depression very effectively. It is still a powerful SSRI and increases serotonin in the brain similarly to venlafaxine while having a stronger effect on NE, which I strongly desire. You suggested Wellbutrin and it primarily works on NE (and dopamine to a lesser extent). Savella has actually been proven to be an anxiolytic, especially in terms of social anxiety anecdotally. I dont want to increase to Pristiq 100, even though I think it would help, due to the nasty discontinuation symptoms compared to Savellas milder one. Adult Attention-deficit/hyperactivity disorder alleviated by Milnacipran study has shown efficiency in treating ADHD. I havent wanted to mention this because its embarrassing, but Pristiq causes unwanted sexual side effects which are not severe. Savella is also used successfully at 50mg. twice a day for depression.
Id like to add the following excerpt about Savella:
In a pooled analysis of 7 comparative trials with imipramine,[1] milnacipran and imipramine were shown to have comparable efficacy while milnacipran was significantly better tolerated. A pooled analysis of studies comparing milnacipran and SSRIs [2] concluded a superior efficacy for milnacipran with similar tolerability for milnacipran and SSRIs. A more recent meta-analysis of 6 studies involving more than 1,000 patients showed no distinction between milnacipran and SSRIs in efficacy or discontinuation rates, including discontinuation for side effects or lack of efficacy.[3] A meta-analysis of a total of 16 randomized controlled trials with more than 2200 patients [4] concluded that there were was not a statistically significant difference in efficacy, acceptability and tolerability when comparing milnacipran with other antidepressant agents. Compared with TCAs, significantly fewer patients taking milnacipran dropped out due to adverse events. As with other antidepressants, 1 to 3 weeks may elapse before significant antidepressant action becomes clinically evident.This means that Savella is easy to handle and better than TCAs in this study. Another reason Id like to replace the Pristiq with Savella is because it actually causes weight loss which might be avoid to need to use Topamax. Also, Savella is proven to prevent migraines that I suffer from time to time according to literature. I do not understand why it is not approved for depression in the United States. I dont see how it would hurt to try Savella. As an SNRI, the transition from Pristiq to Savella would also be more smooth than transferring from Pristiq to a SSRI. I have some time of research examining the best antidepressant, and I have my intuition and want to give it a shot. The prescribing dose for depression is 50mg, BID. There is not an extended release version. I would take it at morning and at night
poster:LouisianaSportsman
thread:1051278
URL: http://www.dr-bob.org/babble/20130930/msgs/1051513.html