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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 45. This is the beginning of the thread.
Posted by borderliner on January 6, 2005, at 9:24:02
hey all, im new here but heres my situation.
i have a borderline personality with social phobia, anxiety and lack of motivation.
I have tried multipal SSRI's (Zoloft etc) and recently just gottin into the SNRI types. My last Effexor XR bought my appetite to a halt at 150mg in the 3rd week of otherwise ok treatment apart from raised anxiety which doesnt bother me as i am more of a hermit (living in a house with 6 other people).
I then went onto Mirtazapine which sedated me heavily and by the 3rd week im over it. I did some research on Reboxetine (NaRI) and matched up my social phobia, bad motivation, decreased drive and poor self concept with the proven benefits of Reboxetine.
With this in mind i went to the Doc and got Reboxetine after convincing him i knew what i was talking about. I now have to go 2 nights mirtazapine free and then start the Rebox.I guess im here looking for a good nudge in the right direction with this drug as a treatment.
any good stories????? Maybe someone can tell me if it will help with concentration???Thanx for any replies.
Posted by sabre on January 6, 2005, at 15:47:21
In reply to Reboxetine?, posted by borderliner on January 6, 2005, at 9:24:02
Hello borderliner
Welcome to Babble.I have had similar experiences with SSRIs. They did nothing for my social anxiety and actually aggravated it.
I haven't tried reboxetine but I have given Tyrosine a go. It is a natural supplement that also has a noradrenergic effect. It has eased my panic and is energising. I have also found it also reduces that panicky early morning wakening and IBS symptoms. If I miss a dose they come back quickly.
I'm very curious to see how you go because I'd like to trial Reboxetine to see if a stronger NA effect will help my social anxiety.
Good luck and let us know how it works out.
sabre
Posted by borderliner on January 7, 2005, at 1:32:27
In reply to Re: Reboxetine?, posted by sabre on January 6, 2005, at 15:47:21
> Hello borderliner
> Welcome to Babble.
>
> I have had similar experiences with SSRIs. They did nothing for my social anxiety and actually aggravated it.
>
> I haven't tried reboxetine but I have given Tyrosine a go. It is a natural supplement that also has a noradrenergic effect. It has eased my panic and is energising. I have also found it also reduces that panicky early morning wakening and IBS symptoms. If I miss a dose they come back quickly.
>
> I'm very curious to see how you go because I'd like to trial Reboxetine to see if a stronger NA effect will help my social anxiety.
>
> Good luck and let us know how it works out.
>
> sabreHey thanx for your concern. Ive also been trying to quit smoking cigarettes but i am convinced my addiction is mostly chemical. after spending 3 hrs waiting the doc wouldnt perscribe me Zyban because of 'side effects'. I almost jumped the desk and strangled the little f*ck. i investigate meds often and know what im talkin about. So im just gonna stick to the reboxetine. im on my last day of mirtazapine washout (really isnt that bad except a really light sensation on my arms all day) i feel like im flying when i walk lol.
I shall start the Reboxetine at 8mg bid tomorow.
I will also be taking a B complex to help the meds get to work and help the nervous system.
I also take Epillim (sodium valproate) a mood stabilizer and Serqoel to knock me out at night.
I have an instinctive feeling that my serotonin levels might need a boost. Does anyone know if Epillim or Serquel(more likely) will help me with that? Or perhaps a natural supplement that will boost serotonin and dopamine? or just serotonin like 5HTP?Anyway keep postin i was so shocked when someone actually replied!
Cheers Borderliner
Posted by borderliner on January 8, 2005, at 2:08:53
In reply to Reboxetine?, posted by borderliner on January 6, 2005, at 9:24:02
Today i started my first day on Reboxetine.
I took 2 seperate doses of 2mg after reading the importance of starting out slow on this med.
I will stay on this dose until i feel comfortable enough to double it up to the perscribed dose.
Today, thankfully no side effects.
I feel a slight sense of vitality and clearance.
Possibly only a placebo effect.
I also felt a lil more at ease and a lil less paranoid in social situations. Again, possibly a placebo effect.
My main worries are anxiety and insomnia, havent experienced either yet but have been ultra prone to it in the past, perhaps the lowered dose will pay off.
Ill keep ya posted.
Borderliner.
Posted by sabre on January 8, 2005, at 14:54:42
In reply to Re: Reboxetine?/day1, posted by borderliner on January 8, 2005, at 2:08:53
So far so good!
I'm keeping my fingers crossed for you.sabre
Posted by borderliner on January 8, 2005, at 16:10:58
In reply to Re: Reboxetine?/day1, posted by sabre on January 8, 2005, at 14:54:42
WOW..... WOW...... WOW..... n yeh WOW again!
I actually felt like going to bed last night and i woke up at 7:30am!!!(understand my usual pattern is 3am-1pm) Even better... when i woke up i wasnt disabled by the craving for a cigarette. Just took my first dose of the 2nd day(this post wont be the post on todays progress). I have a sensation of clarity and well being. I'm not expecting any of this to last and i am cautious of it being a manic state(altho my mania usually only manifests as anxiety or anger).
Dont get too excited tho, remember meds effect everyone differently and that this could easily swing the other way.
keep checkin backBorderliner
Posted by ed_uk on January 8, 2005, at 16:16:27
In reply to Re: Reboxetine?/day1 » sabre, posted by borderliner on January 8, 2005, at 16:10:58
>when i woke up i wasnt disabled by the craving for a cigarette
Hi!
Noradrenaline reuptake inhibitors such as reboxetine are thought to help people quit smoking.
Ed.
Posted by borderliner on January 8, 2005, at 16:22:41
In reply to Re: Reboxetine and Smoking, posted by ed_uk on January 8, 2005, at 16:16:27
> Hi!
>
> Noradrenaline reuptake inhibitors such as reboxetine are thought to help people quit smoking.
>
> Ed.I read a study saying the exact same thing. I am unsure at what stage of dosing i should quit the smokes(something i have been repeatedly faily to do due to the withdrawal) if you have AAANNNYYY extra info about how long i should let the reboxetine stabilize before trying to quit (altho i am sure i will cut down) i would be pleased to hear.
thanx
borderliner
Posted by ed_uk on January 8, 2005, at 17:23:28
In reply to Re: Reboxetine and Smoking » ed_uk, posted by borderliner on January 8, 2005, at 16:22:41
Hi!
I wouldn't try to stop smoking completely until you've been taking the reboxetine for at least 2 months. If you attempt to quit completely in the next few weeks then it may be difficult to distinguish between the start-up side effects of reboxetine and your nicotine withdrawal symptoms. Also, if you wait at least 2 months you will have a good idea of how much the reboxetine is helping your psych symptoms... if you quit smoking in the next few weeks you might think that the reboxetine is not working because you will feel bad due to the nicotine withdrawal. Over the next few weeks you may find that you don't need to smoke as much as usual, because of this I think that it would be a good idea to try to cut down. Then, after you have been on the reboxetine for >8 weeks or so I'd set a date for stopping completely.
When nortriptyline (a tricyclic antidepressant which acts as a noradrenaline reuptake inhibitor) was studied for smoking cessation, participants were asked to quit compltely after 10-14 days. I don't think that qutting so soon would be a good idea for you though because you're not primarily taking reboxetine as an aid to smoking cessation.
Best Regards,
Ed.
Posted by borderliner on January 8, 2005, at 17:31:24
In reply to Re: Reboxetine and Smoking, posted by ed_uk on January 8, 2005, at 17:23:28
Thank you for your advice, and ill follow it. Due to my quick response so far on HALF the perscribed dose, my impatience wont allow for 8 weeks until i quit as i am also overly motivated to quit. I will deffenetely wait at least a month tho for the rebox to stabilize. Its far to early in my treatment to be saying anything however so ill stay calm.
I have no doubt it will help with the process, as ive cut down more even over the last day.
Thanks for the input.borderliner
Posted by ed_uk on January 8, 2005, at 17:52:13
In reply to Re: Reboxetine and Smoking » ed_uk, posted by borderliner on January 8, 2005, at 17:31:24
Hi!
>Thanks for the input.
You're welcome :-)
You might find that half the prescribed dose may be enough, conventional doses of reboxetine are too high for some people.
Ed.
Posted by borderliner on January 8, 2005, at 22:28:06
In reply to Re: Reboxetine and Smoking, posted by ed_uk on January 8, 2005, at 17:52:13
Hey, you defenetelly know what your talking about. Are u a professional? Perhaps u know, if i was to 'taper on' to the perscribed dose, just to check out and see how it feels, how many days would u recommend between each step up? Im on 4mg a day and am perscribed 8mg. the only dose available in between is 6mg and that would mean quartering tablets.
Borderliner
Posted by borderliner on January 8, 2005, at 22:54:10
In reply to Reboxetine?, posted by borderliner on January 6, 2005, at 9:24:02
soooo day 2 of rebox.
i think ive got a winner.
Negative Effects - slight constipation, pain after ejaculation and an un motivated 'member' so to speak he has become very lazy and contricted.
Positive Effects - a complete reset in sleeping pattern. i felt like going to bed early last night and felt like getting up early. ive almost halved my intake of smokes over the last 2 days as well. I have a sense of vitality and concentration that i dont think ive ever had.well, i can take metamucil for the constipation if it gets worse... and if i have to obstain from sex for happiness... bring on buddhism!!!
til next time,
Borderliner
Posted by borderliner on January 9, 2005, at 3:14:15
In reply to Reboxetine?, posted by borderliner on January 6, 2005, at 9:24:02
Possible side effect noted at end of 2nd day of treatment - mild flu like symptoms, dont know if it means my body doesnt like it???? any input would be helpful.
Maybe i just got a cold...Borderliner
Posted by ed_uk on January 9, 2005, at 11:07:41
In reply to Re: Reboxetine?/day2, posted by borderliner on January 8, 2005, at 22:54:10
Hi Mr. B!
It sounds like you're doing well!
>Perhaps u know, if i was to 'taper on' to the perscribed dose, just to check out and see how it feels, how many days would u recommend between each step up? Im on 4mg a day and am perscribed 8mg. the only dose available in between is 6mg and that would mean quartering tablets.
How quickly you decide to step up depends on what you are trying to acheive....
1) From a safety point of view it would probably be ok to go up to the prescribed dose now, most people initiate treatment with 8mg/day in two divided doses.
2) If you want to find out whether your current dose will be adequate you'll need to wait at least four weeks before considering whether you actually need a dose increase or not.
3) If you want to be sure that you can tolerate the side effects of your current dose before you increase, I'd suggest waiting a few more days. With reboxetine, most side effects seem to appear quickly- within the first week or so.
>Im on 4mg a day and am perscribed 8mg. the only dose available in between is 6mg and that would mean quartering tablets.
You could always buy a tablet cutter from a pharmacy. I expect that it would be fine to take 2mg three times a day, rather that 3mg twice daily, if that was more convenient for you.
>Negative Effects - slight constipation, pain after ejaculation and an un motivated 'member' so to speak he has become very lazy and contricted.
You could treat the painful ejac with tamsulosin (Flomax) if it becomes a problem. Flomax has side effects of its own though eg. fatigue.
Here is a list of reboxetine side effects, you may already have been given this list by the pharmacy.........Common adverse events causing withdrawal at least twice as often on reboxetine than placebo include insomnia, dizziness, dry mouth, nausea, sweating, sensation of incomplete bladder emptying (males only), urinary hesitancy (males only) and headache.
The information below refers to short-term controlled studies. Very common or common adverse events that are at least two times higher on reboxetine than placebo are listed below.
[Very common ( 1/10, Common ( 1/100, < 1/10)]
Nervous system disorders:Very common: insomnia, Common: vertigo
Cardiac disorders:
Common: tachycardia, palpitation, vasodilation, postural hypotension
Eye disorders:
Common: abnormality of accommodation
Gastrointestinal disorders:
Very common: dry mouth, constipation
Common: lack or loss of appetite
Skin and subcutaneous disorders:
Very common: sweating
Renal and urinary disorders:
Common: urinary hesitancy, sensation of incomplete bladder emptying, urinary tract infection
Reproductive system and breast disorders:
Common: erectile dysfunction (males only), ejaculatory pain (males only), ejaculatory delay (males only), testicular disorder-primarily pain (males only)
General disorders and administrative site conditions:
Common: chills
In addition there have been spontaneous reports of aggressive behaviour, cold extremities, nausea, vomiting and allergic dermatitis/rash.
As for long-term tolerability, 143 reboxetine-treated and 140 placebo-treated adult patients participated in a long term placebo controlled study. Adverse events newly emerged on long term treatment in 28% of the reboxetine treated patients and 23% of the placebo-treated patients and caused discontinuation in 4% and 1% of the cases respectively. There was a similar risk of the development of individual events with reboxetine and placebo. In the long term studies, no individual events were seen which have not been seen on short term treatment.
In short-term controlled studies of patients with depression, no clinically significant between-gender differences were noted in the frequency of treatment emergent symptoms, with the exception of urologic events (such as the sensation of incomplete bladder emptying, urinary hesitancy and urinary frequency), which were reported in a higher percentage of reboxetine-treated male patients (31.4% [143/456]) than reboxetine-treated female patients (7.0% [59/847]). In contrast, the frequency of urologic-related events was similar among male (5.0% [15/302]) and female (8.4% [37/440]) placebo-treated patients.
In the elderly population, frequency of total adverse events, as well as of individual events, was no higher than that reported above.
Signs and symptoms newly reported on abrupt discontinuation were infrequent and less frequent in patients treated with reboxetine (4%) than in those treated with placebo (6%).
In those short-term studies in depression where heart rate was assessed with ECG, reboxetine was associated with mean increases in heart rate, compared to placebo, of 6 to 12 beats per minute.
In all short-term controlled studies in depression, the mean change in pulse (in beats per minute) for reboxetine-treated patients was 3.0, 6.4 and 2.9 in the standing, sitting and supine positions respectively, compared with 0, 0, and –0.5 for placebo-treated patients in the corresponding positions. In these same studies, 0.8% of reboxetine-treated patients discontinued the drug because of tachycardia compared with 0.1% of placebo-treated patients.
Ed.
PS. What country do you live in?
Posted by sabre on January 9, 2005, at 16:20:08
In reply to Re: Reboxetine » borderliner, posted by ed_uk on January 9, 2005, at 11:07:41
Good for you, borderliner!
I think having that early feeling of a drug agreeing with you fills with you so much hope.I'm really interested to learn what effect Reboxetine has on your social anxiety. I suppose it would be too early to know yet?
Thanks for letting us know how you are progressing. I hope the good things keep coming.
sabre
Posted by borderliner on January 9, 2005, at 22:02:46
In reply to Reboxetine?, posted by borderliner on January 6, 2005, at 9:24:02
ok, day 3 of treatment, feeling pretty average.
Was motivated enough to get out of the house and do a few things including get a present for the partner(something i dont often do). The stimulant effect i was experiencing before hand has gone down a bit, possibly an indicator to step up the dose once more. I'll see how it goes.
Negative effects - something i might have over looked are some flu like symptoms. more like a cold. i thought it was from having the window open the other night but i noticed they symptoms started the day i started rebox.
Positive effects - still have a sense of clarity. less clouded in the mind, so far nothing new.
As far as my social anxiety... im not too sure maybe a bit too early, less paranoia,the fact i got up and left the house may be an indication of improvement. i just didnt really notice it.
I still walk around with a frown on my face and often shake my head at people who appear to be doing something i dont approve of, which is nothing new to me, i still dispise most people. I think that whole scenario will take some time and therapy(something i havent looked into as yet).
I tracked down a good multi vita/mineral/anti oxidant today called "Tresos B Pluse". it was in the homeopathic section of the pharmacy. I consider this line of treament basic. How can u get any better without the basics?For now ill just keep posting and see how it goes, hopefully this cold is just a cold or some transient symptoms that will go away.
Borderliner
Posted by borderliner on January 9, 2005, at 22:22:49
In reply to Re: Reboxetine » borderliner, posted by ed_uk on January 9, 2005, at 11:07:41
Hey ed, thanx for the huge input. I live in australia. Which is unfortunate considering most research on this drug i beleive is done in the UK. I often have trouble finding information within australia. I am yet to discover information on flu like symptoms with reboxetine except for when it comes to withdrawal. Hopefully i just have a cold and it will pass either way.
Say reboxetine restored my NA levels(after time of course) and i still felt off peak, ill defenetely be looking into further augmentation. I did once try californian rocket fuel (mirtazapine and effexor) but the force was a bit too much, nausia followed.
What are the usual drugs for augmentation with reboxetine and more importantly how would i know if it were my dopamine or serotonin levels that needed a boost? Im leaning towards dopamine because SSRI's tend to only work so far and often leave me with side effects.
keep up the good work, ur a champ.
Borderliner
Posted by borderliner on January 10, 2005, at 1:34:49
In reply to Reboxetine?, posted by borderliner on January 6, 2005, at 9:24:02
just something to add... my average day got worse. after watching SpiderMan 2 i cant stop sobbing. its amazing how much one can have in common with a superhero. hit a nerve relationship wise and now my eyes keep glazing over at the thought. i dont know y us humans as a species even try to exist, when many of our own emotions can tear us to shreds inside. i feel so guilty about the way i behave and dont want to blame myself.... but really who else is there to blame? spiderman cant save me from this sh*t
Posted by darkhorse on January 10, 2005, at 6:38:40
In reply to Re: Reboxetine?/day3, posted by borderliner on January 10, 2005, at 1:34:49
> just something to add... my average day got worse. after watching SpiderMan 2 i cant stop sobbing. its amazing how much one can have in common with a superhero. hit a nerve relationship wise and now my eyes keep glazing over at the thought. i dont know y us humans as a species even try to exist, when many of our own emotions can tear us to shreds inside. i feel so guilty about the way i behave and dont want to blame myself.... but really who else is there to blame? spiderman cant save me from this sh*t
Hello borderliner:
I hope that rebox will be the pro- social drug for you.
I do not want to make you feel bad,but everyone is different and my trial with rebox was for the same reasons..however I got an opposite effect...apart from urinary difficulties,constipation and sweating,the worst side effect I had after several days of use was hypersensitivity to everything and feelings of despaire,incompetence, crying spells,and intense ideas about how this world is harsh and horrible,but without being aggresive...hopelessness..etc. in a nutshell : severe depression...after 48 hours of last dose I returned back to normal...I just wanted to tell you my own experience just be a bit cautious...and I really hope that you'll prove the company's claim about this drug's potential for motivation and pro-social actions,and that my experience is the exception.
Good luck and take care,
Dark Horse
Posted by sabre on January 10, 2005, at 14:51:42
In reply to Re: Reboxetine?/day3, posted by darkhorse on January 10, 2005, at 6:38:40
Hi borderliner
Don't despair. Have you read this:
http://www.beatcfsandfms.org/html/NaStrategy.htmlWellbutrin is another drug you could consider if you think your problem is an NA and dopamine problem.
Have you looked at the Babble Alternative pages?
I have tried tryptophan and found it awful but my experiments with tryosine, phenylalanine and magnesium have yielded more positive results.This page lists some of the major neurotransmitters and associated supplements (although the table at the bottom doesn't list tyrosine as a supplement for NA):
http://incrediblehorizons.com/Balance1devel%20page.htm
Besides the obvious benefits of being natural, supplements seems to give you hints as to where your biochemistry might be failing without having to endure using the trial and error prescription drug pathway.
I hope things get better.
sabre
Posted by ed_uk on January 10, 2005, at 18:07:27
In reply to Re: Reboxetine » ed_uk, posted by borderliner on January 9, 2005, at 22:22:49
Hi,
>What are the usual drugs for augmentation with reboxetine?
It's much too early to being thinking about augmentation! You're still in the very early stages of treatment. It can take weeks for the therapeutic effect to stabilise. Don't give up hope :-) To be honest, since reboxetine is still so new, there aren't really any 'typical' drugs which are used to augment it. There are many options which you could try though.
>how would i know if it were my dopamine or serotonin levels that needed a boost?
There is no definate way that you can know. You can get a good idea of which type of med you would respond to based on which symptoms you have. What are your main symptoms?
Stay hopeful, it's still early days...
Ed.
Posted by borderliner on January 10, 2005, at 23:08:05
In reply to Reboxetine?, posted by borderliner on January 6, 2005, at 9:24:02
well its day four. i feel like crap. 5 hours sleep last night, an annoying cold and i feel like all my other problems have intensified. Yet they havent changed. its still the same, i gotta get back into gear, get a job and move out of this stress centre of a household. Somewhere along there i gotta quit smoking. and atm most of my anxiety(thats come out of no where today) is centred on not smoking. I want to give up but i fail. *scratches head* after hours of research over a long period of time on the subject of tobacco and nicotine withdrawal and meds to help, herbs to help, vitamins to help. Ive got them all up in my cupboard, to be used as i pleased but i dont seem to be able to.
i feel extremely hindered. an anxiety charged mind in a tired body isnt the greatest.
i really dunno anymore
Posted by cache-monkey on January 11, 2005, at 11:29:34
In reply to Re: Reboxetine?/day4, posted by borderliner on January 10, 2005, at 23:08:05
Hi Borderliner,
I just want to echo something that, I believe, has already been said in this thread. It's really important to get your mental health (primarily anxiety, right?) in order *before* a quit attempt.
It sounds like smoking is really contributing to your anxiety. So, I can understand the temptation to hurry up and quit. I was in the same boat a year and a few months ago. The thing for me was that quitting smoking really destabilized an already stressful situation. Sent me on a strong downward spiral into the depths of anxiety and panic. I started smoking again, and I have made a concious decision to wait until I'm in a stable place to try to quit again.
You should consider doing the same. The more anxiety you pack into your smoking habit, the harder it will be to recover mentally to a place where you're actually prepared to quit. (A kind of catch-22.) It might be useful to do something like telling yourself: this isn't a sign that I'm weak, it's just something I have to do for now. I think of it as a form of medicine almost.
Hopefully, you and I will both get medicines in place to get a basic stability from which a quit attempt seems reasonable. I, myself, am looking into Wellbutrin and low-dose selegiline. Wellbutrin (along with nortryptiline, the TCA) have been repeatedly demonstrated to show benefits for smoking cessation. There is starting to small-sampled clinical evidence on selegiline.
I don't know about Reboxetine, but since its mechanisms of action are similar to Wellbutrin it might help you out. I'd really suggest giving it a full trial, and then seeing how it's treating you once the start-up side effects diminish and it settles into whatever the therapeutic effect ends up being. This can take a few weeks, so be patient. (Which is often the hardest thing when you have so much anxiety, trust me, I know.)
Best of luck,
cache-monkey
Posted by borderliner on January 11, 2005, at 17:30:05
In reply to Re: Reboxetine?/day4 » borderliner, posted by cache-monkey on January 11, 2005, at 11:29:34
all of my problems are escalated by living here, i cant leave here until my head is in gear and im working... what do i do except run a warm bath and die it red with my own blood. i really dont think reboxetine is for me. im in too much of a state. i went and saw my GP yesterday and told him ive been feeling worse physically(flu symptoms) and mentally (am being pulled towards suicide by the second.
i dont know what to do.
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