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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Scott L. Schofield on February 27, 2000, at 9:45:02
At this point, I am still undecided as to whether or not to make reboxetine (Vestra) my next treatment trial. The recent statement issued by Pharmacia & Upjohn regarding the release of reboxetine for marketing in the US is encouraging. I have been weighing the inability to rely on a local drug store for a supply of a drug I may need to take for the rest of my life in making a decision of what to do.
I am hoping that there are some people here in Babble-Land that have had great success with reboxetine for the treatment of depression, especially bipolar depression. I would really like to know how many people have had a continuous long-term response to reboxetine.
Any and all replies are greatly appreciated.
Thanks.
- Scott
Posted by Scott L. Schofield on February 29, 2000, at 7:27:52
In reply to Reboxetine - Long-Term Success Stories ?, posted by Scott L. Schofield on February 27, 2000, at 9:45:02
Hi All.
I take it that nobody here has experienced a continuous long-term response to reboxetine.Or, perhaps nobody likes me any more (if they ever did).
> At this point, I am still undecided as to whether or not to make reboxetine (Vestra) my next treatment trial. The recent statement issued by Pharmacia & Upjohn regarding the release of reboxetine for marketing in the US is encouraging. I have been weighing the inability to rely on a local drug store for a supply of a drug I may need to take for the rest of my life in making a decision of what to do.
>
> I am hoping that there are some people here in Babble-Land that have had great success with reboxetine for the treatment of depression, especially bipolar depression. I would really like to know how many people have had a continuous long-term response to reboxetine.
>
> Any and all replies are greatly appreciated.
>
> Thanks.
>
> - Scott
Posted by dove on February 29, 2000, at 8:50:19
In reply to Re: Reboxetine - Nobody loves me any more., posted by Scott L. Schofield on February 29, 2000, at 7:27:52
We like you, and have liked you from the first time you put your hand to the text window and let your thoughts be known to all of babble-land :-) I have absolutely no experience of any kind to share in regards to Reboxetine, but I will keep my eyes open for anything I can find that might help you in your search for answers.
Take care and I hope someone can answer your inquiry.
dove
Posted by Cindy W on February 29, 2000, at 9:19:05
In reply to Re: Reboxetine - Nobody loves me any more., posted by Scott L. Schofield on February 29, 2000, at 7:27:52
> Or, perhaps nobody likes me any more (if they ever did).Hey, we still like you (we just don't know about Reboxetine!)--Cindy W 8)
Posted by AndrewB on February 29, 2000, at 9:43:56
In reply to Re: Reboxetine - Nobody loves me any more., posted by Scott L. Schofield on February 29, 2000, at 7:27:52
Scott,
I think its unlikely that anyone on this board has, say, a year of experience with reboxetine. You can go back a year in the archives and see that there was little mention of reboxetine then. You may be able to get an answer to your question on a Britsh depression forum that is at deja.com. When you go to deja.com do a key word search under 'reboxetine' to find that forum.
Posted by Scott L. Schofield on February 29, 2000, at 11:30:12
In reply to Re: Reboxetine - Nobody loves me any more., posted by AndrewB on February 29, 2000, at 9:43:56
> I think its unlikely that anyone on this board has, say, a year of experience with reboxetine. You can go back a year in the archives and see that there was little mention of reboxetine then. You may be able to get an answer to your question on a British depression forum that is at deja.com. When you go to deja.com do a key word search under 'reboxetine' to find that forum.
Thank-you all for the reassurances. I’m sure that I have put-off some people because I have a big mouth sometimes. Well, maybe all the time. :-) Anyway, I really do appreciate the positive feedback. Now I can sleep nights (at least for a little while).Adam; I will take your wonderful suggestion of searching the U.K. boards for answers. Thanks.
I have pretty much decided to go with reboxetine. I am excited to try something new and different. It was either that or return to Nardil and play around with more augmenting strategies. My doctor has even suggested that he might combine reboxetine with an MAOI. Theoretically, he said, there should be no more risks involved with this combination than those of adding a tricyclic with an MAOI. Of course, if my head explodes, I would theoretically be dead.
- Scott
Posted by AndrewB on February 29, 2000, at 16:04:12
In reply to Re: Reboxetine - Nobody loves me any more., posted by Scott L. Schofield on February 29, 2000, at 11:30:12
Scott,
I've read that an MAOI may be combined with reboxetine and that the combo. may eliminate the need for dietary restrictions.
Posted by Cam W. on February 29, 2000, at 16:25:04
In reply to Re: Reboxetine - Nobody loves me any more., posted by Scott L. Schofield on February 29, 2000, at 11:30:12
Scott - Keep us posted on your progress. You are now the Babblers' official reboxetine tester. Good luck - Cam W.
Posted by Scott L. Schofield on February 29, 2000, at 17:24:58
In reply to Re: Reboxetine - Nobody loves me any more., posted by AndrewB on February 29, 2000, at 16:04:12
> I've read that an MAOI may be combined with reboxetine and that the combo may eliminate the need for dietary restrictions.
Adam,
Thanks again for the info. The fact that this combination has been tried before without calamity is very, VERY exciting. I can't wait!
Thanks again for the info. Oh, I said that already.
Quite a few years ago, one of my doctors mentioned that tricyclics, desipramine (Norpramine) in particular, could provide a "buffer" against the "cheese-reaction". My guess is that the physiology behind this involves the dilation of peripheral blood-vessels. I don't know. Last I read, the mechanism(s) responsible for this reaction were not well understood. That both reboxetine and desipramine are rather potent and selective norepinephrine (NE) reuptake inhibitors may explain the association of both of these drugs with a reduced potential for a tyramine-induced hypertensive crisis.
At this point, I feel that the key word here is "reduced". Unless there are reliable studies and sufficient statistics demonstrating that dietary restrictions can indeed be eliminated, I wouldn't want to test the hypothesis.
I would like to point out that moclobemide (Mannerix), a reversible MAO-inhibitor that is selective for MAO type-A, is not supposed to have a need of dietary restrictions, nor a contraindication of combining it with an SSRI. If you do a quick search on Medline, you will see anecdotal reports indicating otherwise.
Thanks again for the info.
- Scott
Posted by Phil on February 29, 2000, at 18:12:30
In reply to Re: Reboxetine - Nobody loves me any more., posted by Scott L. Schofield on February 29, 2000, at 17:24:58
Scott, I've been on it a whole week! I started at 2mg twice a day instead of 4mg and am going to take it slow.
I wasn't able to find much info on it across the pond...if you can, please let me know. The boards there are very interesting though.Phil
Posted by JohnL on March 1, 2000, at 3:25:23
In reply to Reboxetine - Long-Term Success Stories ?, posted by Scott L. Schofield on February 27, 2000, at 9:45:02
Scott,
I saw some interesting data recently. Out of a pool of 250 psychiatric patients during a year who achieved complete wellness with medication, bar graphs were created showing what percentage of certain classes of drugs achieved the complete remission of symptoms. Different bar graphs and statistics were compiled for various psychiatric conditions.
Across the entire spectrum of psychiatric disorders the SSRIs had the highest success percentage, either as monotherapy or as the primary medication in a combination. Depending on the psychiatric condition, the SSRIs accounted for success in 40% to 60% of the cases. The remaining patients achieved total remission with varying percentages of norepinephrine antidepressants, stimulants, mood stabilizers, antipsychotics, thyroid treatment, or estrogen treatment, or blends of any of these.
What surprised me was that the percentage of patients who responded to norepinephrine antidepressants was the smallest percentage of all. Stimulants, antipsychotics, and mood stabilizers had a much higher pecentage of success stories than NE antidepressants. I was also surprised to see how useful stimulants actually are, as well as antipsychotics. Based on this one psychiatrist's statistics, these two classes of drugs have a much larger role in treating depression than most physicians realize.
Granted the data is based on just one psychiatrist's experience. But the pool of 250 patients adds validity since anything over 100 is needed for decent statistical relevance. The particular psychiatrist is one who makes sure patients have tried all classes of drugs and have found their favorite within each class. So the end result has given each class of drugs a fair shake. In this setting, NE antidepressants were among the least useful across a wide variety of psychiatric disorders, including depression. Reboxetine was not one of the drugs used, but since it is a NE antidepressant, it makes me wonder just how useful it is in the real world.
Posted by dove on March 1, 2000, at 13:31:28
In reply to Re: Reboxetine - Long-Term Success Stories ?, posted by JohnL on March 1, 2000, at 3:25:23
My response to the hard evidence showing NE ADs to be less efficacious is, wow! I can't believe it. All my good or positive responses have been to NE ADs. I've responded very negatively to the straight SSRI's (Prozac, paxil, zoloft). Even the CNS Stimulants have done nothing for my depression except agitate it. I'm taking Adderall, with Amitriptyline, and Nefazodone (Serzone). I responded well to Bupropion (Wellbutrin), and have responded very quickly and strongly to Serzone. I've been reading everything I can get a hold of on Reboxetine, and have seen very impressive results so far. I'm looking at this med with a lot of hope.
dove
Posted by Noa on March 1, 2000, at 15:16:57
In reply to Re: Reboxetine - Long-Term Success Stories ?, posted by dove on March 1, 2000, at 13:31:28
Statistically less efficacious.
But there still were people who responded well.
We all know how different our meds responses are. Some of us are bound to be in the minority in a study of trends in medication effectiveness.
Posted by Leighwit on March 1, 2000, at 16:00:11
In reply to Re: Reboxetine - Nobody loves me any more., posted by Cam W. on February 29, 2000, at 16:25:04
Scott,
I hesitated to respond because I was a very short-term Reboxetine "starter". Discontinued after only 3 1/2 weeks.
I've been on ALL of the SSRIs, (Prozac, Zoloft, Paxil, Celexa etc.) plus Effexor, Norpramin, Serzone, Wellbutrin, Ritalin (as an augmentation -- I'm not ADD), Dexedrine, and Aricept (another augmentation).
I had high hopes for the Rebox and went through a lot to get a prescription through a US doctor who would monitor it.
It made me so irritable I couldn't tolerate it. I went down to only 2 mg/day and the relief from the agitation was only minor. I'm a great Mom -- and found even my reactions to my child (let alone my husband!) unacceptable. I could have put up with the stomach side effects (which were pretty tough -- worst of the drugs I've been on), but the irritability just wasn't worth it. I'd feel so uptight (and I do well with stimulating ADs. I don't do well with "calming" ones!!) that I thought I was going to have a heart attack, and I'm someone who has routinely average to low blood pressure levels!
I'm not sure that I would have shared this if it were imminent (and I for one do not think from the sounds of it that it is -- "another" study takes time and money and the results will again be subject to analytical scrutiny which could lead to same labeling issue.) that it would be on the market in the US sometime soon.
But for people who are "waiting" in lieu of trying other drugs, perhaps this perspective will remind people that there doesn't appear to be a record-breaking panacea of any kind on the horizon yet. There are a few people responding extremely well to Reboxetine in Europe. BUT they are not statistically as significant as the respondent efficacy levels of other drugs studied by the FDA over the past ten years or so.
On the other hand, who cares about statistical significance if you are one of the few that it works very well for? (I DO understand that feeling -- which is exactly why I tried it.)
LW
Posted by AndrewB on March 1, 2000, at 19:53:55
In reply to Re: Reboxetine - Nobody loves me any more., posted by Leighwit on March 1, 2000, at 16:00:11
LW,
Irritability and other signs of overstimulation are fairly common side effects with reboxetine. People have had success overcoming this by stopping the reboxetine and restarting it in combination with a SSRI.
This is the end of the thread.
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