![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by SLS on August 4, 2005, at 23:13:45
In reply to Do SSRIs work?, posted by FredPotter on August 4, 2005, at 22:03:34
Hi Fred.
I think "poop-out" is a phenomenon separate from the placebo response. People can remain improved on an SSRI for months or even years before experiencing a medication breakthrough relapse. What might contribute to this incidence is a continuation of untreated psychosocial issues, particularly if anxiety is present.
I wish there were reliable statistics to demonstrate the rate of SSRI poop-out in the general population. I think that people who continue to respond well to antidepressants usually aren't motivated to seek out a support group like Psycho-Babble. SSRI poop-out is probably over represented here.
- Scott
Posted by ace on August 5, 2005, at 1:53:06
In reply to Do SSRIs work?, posted by FredPotter on August 4, 2005, at 22:03:34
> My psychiatrist thinks SSRIs work,
tHEY CAN. bUT THEY ARE WAY OVERMARKETED AND AIMED AT AN INCORRECT THEORY (IN A LOT OF CASES- I.E. LACK OF 5HT DISTRIBUTION/LEVEL CAUSES ANXIETY, OCD, DEPRESSION) IN MY MIND. although they may need augmentation, in my case with lithium and Zyprexa.
'
tHAT'S TRUE.Also he says there is no evidence that poop-out exists.
IT ISN'T A MAJOR PROBLEM I THINK, AND CAN ALWAYS BE REVERSED. BUT IT DOES INDEED EXIST.
Although the evidence presented on this board tends to be negative, understandably, the picture I get is that it's not clear that SSRIs work at all or if they do they often as not poop out.
>
> I read once that scientists were working on placebos that gave side effects only, so subjects would not be able to twig what they were on. If this were done we could easily get the picture that SSRIs indeed do not work.
>
> Given that clinical trials are quite short, the placebo response, although this is known to fade with time, could still be active at the end of the trial. Perhaps it's true that poop-out is actually a fading placebo response.
>
> Fred
JUST TRY AN MAOI BRO!ACE!
Posted by med_empowered on August 5, 2005, at 2:17:58
In reply to Do SSRIs work?, posted by FredPotter on August 4, 2005, at 22:03:34
SSRIs do help some people but...let your shrink know that "poop-out" does exist. Before the SSRIs hit the market it was observed with the MAOIs and the Tricyclics. "Poop-out" isn't new; its just that, until recently, no one publicly said that the SSRIs and SNRIs might "poop-out".
Posted by Tom Twilight on August 5, 2005, at 9:44:40
In reply to Re: Do SSRIs work?, posted by med_empowered on August 5, 2005, at 2:17:58
I am not a big fan of SSRIs
Whether you respond to them or not is, in my opinion often deppendent on whether you have to little Seratonin or not.
If your problem is primarily that you have a seratonin shortage then they will probably help, if on the other hand your problems are based in the Noradrenaline or Dopamine systems, then I don't think there much good.
I know this is an over simplification, my apologies if I got it completely wrong!
I strongly suspect that older antidepressants such as Tricyclics and MAOIs are actualy more effective, because they effect more systems
Posted by tecknohed on August 5, 2005, at 17:49:54
In reply to Do SSRIs work?, posted by FredPotter on August 4, 2005, at 22:03:34
I personally have never done well on any drug which directly manipulates serotonin at the synaps. I've tried all SSRIs (except fluvoxamine), Venlafaxine, Clomipramine, Nefazodone and Mirtazepine. With these drugs I ended up feeling lethargic, apathetic and slept excessively. And yet in most doctors minds my symptoms (Social Anxiety, Depression and OCD, etc) would clearly indicate the use of an SSRI.
Nardil did help me a lot, but works 'indirectly' on Serotonin through MAO inhibition, as well as having effects on other neurotransmitters(dopamine, noradrenalin, GABA). Mind you, I still became excessively tired on it.
Yet SSRIs work for some. Especially those with OCD. Also, women seem to benefit from them more than men (dont quote me on that).
Posted by Glydin on August 5, 2005, at 18:28:38
In reply to Re: Do SSRIs work? » FredPotter, posted by tecknohed on August 5, 2005, at 17:49:54
"Do SSRIs work?"I don't think there's a blanket answer to cover that for everyone.
For me, I would say yes, they do work. Can I say it isn't a placebo effect? No. Can I say it's going to last? No.
I have found most head meds have, from person to person, many adjectives and phrases: it works, it doesn't work, it has intolerable side effects, it doesn't have horrible side effects, good, bad, positive, awful, dangerous, gave me life back, took my life away.... I think it's difficult to generalize.
Posted by SLS on August 5, 2005, at 20:06:52
In reply to Re: Do SSRIs work? » FredPotter, posted by tecknohed on August 5, 2005, at 17:49:54
> Yet SSRIs work for some. Especially those with OCD. Also, women seem to benefit from them more than men (dont quote me on that).
According to some authors, men tend to be tricyclic responders and women SSRI responders.
- Scott
Posted by ace on August 5, 2005, at 22:36:23
In reply to Re: Do SSRIs work?, posted by SLS on August 5, 2005, at 20:06:52
> > Yet SSRIs work for some. Especially those with OCD. Also, women seem to benefit from them more than men (dont quote me on that).
>
> According to some authors, men tend to be tricyclic responders and women SSRI responders.
>
>
> - ScottWhat authors? Sounds nonsensical, but I believe you...
Ace
Posted by SLS on August 6, 2005, at 6:16:58
In reply to Re: Do SSRIs work? » SLS, posted by ace on August 5, 2005, at 22:36:23
> > > Yet SSRIs work for some. Especially those with OCD. Also, women seem to benefit from them more than men (dont quote me on that).
> >
> > According to some authors, men tend to be tricyclic responders and women SSRI responders.
> >
> >
> > - Scott
>
> What authors?I'll see if I can dig up some Medline stuff.
Otherwise, Google:
http://www.google.com/search?hl=en&q=tricyclics+men+women
> Sounds nonsensical, but I believe you...Don't place so much confidence in me Ace. I am far from infallable!
What's more, older women begin to show a response pattern closer to that of younger men as they begin to show a trend towards greater tricyclic response. Perhaps this is a postmenapausal hormonal thing.
- Scott
Posted by SLS on August 6, 2005, at 6:19:05
In reply to Re: Do SSRIs work? » SLS » ace, posted by SLS on August 6, 2005, at 6:09:09
Sorry for the semi-double post.
Here is a piece authored by some of the big guys:
- Scott
Posted by saltate on August 6, 2005, at 9:05:15
In reply to Re: Do SSRIs work?, posted by SLS on August 6, 2005, at 6:19:05
I was talking to my mother and she made me think of something. We were discussing the popularity of ssris. She said that tons of people at her office were on them. Now, odds are, there were not dozens of people at her small office that had the kind of serious long term depression problems I have had (unless that job is just really awful!, jk) In fact, my mother happened to know many of those people for years and knew that they were taking ssris for far less severe problems. With the popularity of psychiatry and drug miracle stories, its very probable that people who just have a case of the blues or feel something is missing in their lives or who have been under alot of stress wind up going to the psychiatrists and being diagnosed as depressed. Now, the tool that we use to measure depression is mostly the hamilton scale or some other similar scale. It ocurred to me that this is a very inaccurate tool, as someone who had just experienced a breakup or something could very well score much higher then someone who has chronic depression. Depression is a subjective feeling, not an objective numerative collection of symptoms. In fact, I think that the objective symptoms of depression diminish over time as one has to either cope with one's life or die, or the objective symptoms aren't even noticed because they are so engrained in the depressed person's mind, whereas the subjective feeling of depression remains the same or gets worse. Think about the questions: Have you been sleeping more or less? If you have just noticed a problem, you are going to respond. If you've been oversleeping or undersleeping for years, you won't respond. Have you lost interest in activities? Not if you are a chronich anhedonia sufferer. It seems the test is geared towards people whose problems are recently developed. SSRIS might be broadly successful for people who have minor problems with the blues or transient stress. They promote a feeling of apathy which people might see as "curing" their "depression." From my own experience and ALOT of anecdotal evidence and a few non drug company studies. SSRIs aren't that effective in people with severe, long term, or treatment resistant depression. I am surprised no one ever thinks about this from theis angle.
Posted by ed_uk on August 6, 2005, at 10:31:19
In reply to Re: Do SSRIs work?, posted by SLS on August 6, 2005, at 6:19:05
>Am J Psychiatry. 2000 Sep;157(9):1445-52.
Gender differences in treatment response to sertraline versus imipramine in chronic depression.
Kornstein SG, Schatzberg AF, Thase ME, Yonkers KA, McCullough JP, Keitner GI, Gelenberg AJ, Davis SM, Harrison WM, Keller MB.
Department of Psychiatry, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23298-0710, USA. skornstein@hsc.vcu.edu
OBJECTIVE: The authors examined gender differences in treatment response to sertraline, a selective serotonin reuptake inhibitor (SSRI), and to imipramine, a tricyclic antidepressant, in chronic depression. METHOD: A total of 235 male and 400 female outpatients with DSM-III-R chronic major depression or double depression (i.e., major depression superimposed on dysthymia) were randomly assigned to 12 weeks of double-blind treatment with sertraline or with imipramine after placebo washout. RESULTS: Women were significantly more likely to show a favorable response to sertraline than to imipramine, and men were significantly more likely to show a favorable response to imipramine than to sertraline. Gender and type of medication were also significantly related to dropout rates; women who were taking imipramine and men who were taking sertraline were more likely to withdraw from the study. Gender differences in time to response were seen with imipramine, with women responding significantly more slowly than men. Comparison of treatment response rates by menopausal status showed that premenopausal women responded significantly better to sertraline than to imipramine and that postmenopausal women had similar rates of response to the two medications. CONCLUSIONS: Men and women with chronic depression show differential responsivity to and tolerability of SSRIs and tricyclic antidepressants. The differing response rates between the drug classes in women was observed primarily in premenopausal women. Thus, female sex hormones may enhance response to SSRIs or inhibit response to tricyclics. Both gender and menopausal status should be considered when choosing an appropriate antidepressant for a depressed patient.
That's very interesting Scott, thanks for posting that.
....................................................................................................................................................
This is also interesting (I'm sure you've read it before though!)..........
Acta Psychiatr Scand. 2003 Jul;108(1):20-3.
A differential response to nortriptyline and fluoxetine in melancholic depression: the importance of age and gender.
Joyce PR, Mulder RT, Luty SE, McKenzie JM, Rae AM.
Department of Psychological Medicine, Christchurch School of Medicine & Health Sciences, PO Box 4345, Christchurch, New Zealand. peter.joyce@chmeds.ac.nz
OBJECTIVE: To consider the impact of age and gender on the antidepressant response to nortriptyline and fluoxetine in melancholic depression. METHOD: Of 191 depressed patients, 113 met study criteria for melancholia. All patients were randomized to receive either fluoxetine or nortriptyline. Response rates, defined as an improvement of 60% or more on the Montgomery Asberg Depression Rating Scale over 6 weeks of antidepressant treatment on an intention to treat basis, were examined by age, and by age and gender. RESULTS: Melancholic depressed patients 40 years or older, especially men, had a markedly superior response to nortriptyline compared with fluoxetine. Conversely, melancholic depressed patients, age 18-24 years, especially women, had a markedly superior response to fluoxetine. CONCLUSION: Age and gender appear to be critical variables in understanding differential antidepressant responses to tricyclic antidepressants and selective serotonin reuptake inhibitors in melancholic depression.
..................................................
Another study found that.........'We failed to find evidence of women having a preferential response to SSRI medication or, conversely, of men having a superior response to TCA medication. Older age, however, was associated with a superior TCA response and younger age with a superior SSRI response.'
.......................................................Am J Geriatr Psychiatry. 2000 Spring;8(2):141-9.
Heuristic comparison of sertraline with nortriptyline for the treatment of depression in frail elderly patients.Oslin DW, Streim JE, Katz IR, Smith BD, DiFilippo SD, Ten Have TR, Cooper T.
Section of Geriatric Psychiatry, University of Pennsylvania, Philadelphia 19104, USA. oslin@mail.med.upenn.edu
Studies have demonstrated that the selective serotonin reuptake inhibitor antidepressants have similar efficacy to other agents, such as tricyclic antidepressants. However, data are limited for direct comparisons with other antidepressants. The authors conducted a contemporaneous comparison of nursing home residents treated with open-label sertraline in doses up to 100 mg/day with nursing home residents treated in a double-blind randomized study of low vs. regular doses of nortriptyline. There were 97 patients enrolled in the study (28 treated with sertraline), with an average treatment duration of 55 days. There were no differences in the tolerability of sertraline vs. nortriptyline. However, in this group of frail older adults, sertraline was not as effective as nortriptyline for the treatment of depression.
.................................................................
Int Psychogeriatr. 1999 Mar;11(1):85-99.
Comparative efficacy and safety of sertraline versus nortriptyline in major depression in patients 70 and older.
Finkel SI, Richter EM, Clary CM.
Northwestern University Medical School, Department of Psychiatry & Behavioral Sciences, Chicago, IL 60611-3317, USA. sfinkel104@aol.com
BACKGROUND: Few randomized, double-blind studies that examine antidepressant treatment in patients 70 years and older are available. To provide additional data on the safety and efficacy of antidepressants in this rapidly growing population segment, a subgroup analysis of a larger sertraline vs. nortriptyline elderly depression treatment study was performed. METHODS: Outpatients (N = 76) who met DSM-III-R criteria for major depression with a minimum Hamilton Depression Rating Scale (HAM-D) severity score of 18 were randomized to 12 weeks of flexible dose treatment with sertraline (50-150 mg) or nortriptyline (25-100 mg). RESULTS: Both treatments significantly improved depression as measured by the HAM-D and Clinical Global Impression scales. At Weeks 10, 12, and endpoint, sertraline demonstrated a significantly greater reduction in depression severity compared to nortriptyline as measured by improvement on the 24-item HAM-D (mean adjusted change score of 14.8 vs. 7.6, respectively, at Week 12; p = .001). Sixty-five percent of sertraline-treated patients were responders by Week 12 (50% or greater reduction from baseline in 24-item HAM-D score) compared to 26% of nortriptyline-treated patients (p < .05). Sertraline treatment had a significantly more positive effect, when compared to nortriptyline, across almost all associated measures of cognitive function, energy, anxiety, and quality of life and was better tolerated than nortriptyline, with a lower attrition rate/side effect burden. CONCLUSION: The efficacy advantage of sertraline appeared to be even greater in this subgroup of older patients drawn from a larger treatment study of depression that included elderly individuals over the age of 60.
CONFUSED? I am!
~Ed
Posted by ed_uk on August 6, 2005, at 10:38:16
In reply to Re: Do SSRIs work?, posted by saltate on August 6, 2005, at 9:05:15
>It seems the test is geared towards people whose problems are recently developed.
Good point. I also think it's important to consider whether such tests are a good measure of AD efficacy eg. if an AD improved subjective symptoms of depression but reduced appetite and caused insomnia etc... it might be deemed ineffective according to the HAM-D.
On the other hand, if an AD improved sleep and increased appetite etc... it might appear to be an effective AD despite the fact that patients' subjective depressive symptoms were not improved.
~Ed
Posted by Racer on August 6, 2005, at 11:56:53
In reply to Re: Do SSRIs work? » SLS » ace, posted by SLS on August 6, 2005, at 6:09:09
> > > > >
> Don't place so much confidence in me Ace. I am far from infallable!
>
>
> - ScottSeems to me you're telling a little fib here, Scott, since you informed us recently that you are never wrong -- even that you thought you were wrong, once, but were mistaken...
(Forgive me for not finding a link to that post.)
Oh, well, infallible or not, you certainly are one hunky fellow. And you got a great heart.
Posted by Racer on August 6, 2005, at 12:28:36
In reply to Re: Do SSRIs work? » saltate, posted by ed_uk on August 6, 2005, at 10:38:16
OK, I have way too much to say about this, but I'll try to keep it short. Forgive me. I will, however, try to keep this in outline form, so you can skip anything that doesn't interest you...
1. Studies have shown that pretty much ALL the different sorts of antidepressants are equally effective. That doesn't mean that they'll all work as well for every person who takes them, it only means that they all work -- to some degree -- for about the same percentage of people studied. Usually, that works out to about 70%.
Now, those studies are usually short term, and what happens clinically is different from what happens in a study lasting 9 weeks.
2. Most all of the antidepressants will poop out. Those that target serotonin most preferentially tend to poop out more consistently, because of serotonin's role in various body systems. Most of it is used in the gut, for digestion, so the body will "normalize" the sensitivity of the various receptor types, and badabing -- poop out. Changing drugs within a class can help.
3. These days, most anyone who gets overstressed will end up with a prescription for an SSRI. They're the Magic Pill that allows you to go back to living a full, happy life -- didn't you see the commercial for it? That will skew the stats a lot, especially since those mild-to-moderate depressive episodes are likely to resolve with or without treatment in about nine months. Think of it from the point of view of Big Pharma: make a drug, any drug, and most people who take it will be "cured" WITHIN NINE MONTHS! Big Winner, huh? The rest of us may not have the same experience.
4. Most of us on this board have a somewhat different set of problems from the basic lifestyle blues. I know that I've tried virtually EVERY antidepressant on the market, and probably half the people on this board have, too. And my depressive episodes may resolve in nine months -- but if they do, they start up again a week later... We're gonna give the world a very different view of the effectiveness of any psychotropic med, you know?
5. Because most of us here have tried so many meds, we are a hell of a lot more sophisticated in our perspectives on them. The first time I was on an antidepressant, nortriptyline, I was so relieved that I was willing to put up with lousy sleep, gaining 70 pounds in a couple of months, being constipated beyond belief, lethargy a sloth would have been proud of, etc. Twenty years later, I'm not. I know that there are drugs that would relieve the depression itself -- but if I can't function when I take them, I do not consider them effective treatment. They're not worth it.
6. "Major Depressive Disorder" and "Bipolar Disorder" are diagnoses made based on a constellation of symptoms -- they are not discrete diseases. While the symptomology may be the same, the biochemical processes involved may be very different for everyone. I have never had much response to the medications that target serotonin alone, for example, but have generally responded well to those meds that preferentially target norepinephrine, with a side shot of serotonin. Other people might need a drug that is more balanced between those two neurotransmitters, or something else entirely. That's because, while the disorders may look the same, the underlying processes may be very different.
7. There's another point I was going to make here, but then my husband came in to talk to me, and I forgot it... That's because my mind is like a steel -- sieve!
Sorry for being long and all, I just gots so much to say, and no where else to say it all... Thanks for putting up with me. This really is a great place.
Posted by ed_uk on August 6, 2005, at 13:02:40
In reply to Got a bit too long..., posted by Racer on August 6, 2005, at 12:28:36
Racer,
I can't believe I'm saying this but.........
Have you ever tried reboxetine?
>The first time I was on an antidepressant, nortriptyline, I was so relieved that I was willing to put up with lousy sleep, gaining 70 pounds in a couple of months, being constipated beyond belief, lethargy a sloth would have been proud of, etc.
Like nortriptyline, reboxetine preferentially inhibits the reuptake of NE. Although reboxetine is almost certainly more likely to cause insomnia (hello Ambien) than nortriptyline...... weight gain is unlikely. Reboxetine can be constipating but not as much as nortriptyline. Lethargy would be less likely - some people find reboxetine stimulating. Reboxetine should (theoretically) be less likely to induce apathy than Cymbalta ie. it's not serotonergic.
Although numerous people on this board have had bad experiences with reboxetine, I wondered whether you might be interested in trying it - given your treatment-resistance.
IMHO, reboxetine is best initiated at a very low dose - considerably lower than the manufacturer's recommended starting dose. One babbler is currently finding low-dose reboxetine to be effective for her depression.
Btw, have you ever taken Strattera?
~ed x
PS. I know reboxetine's not marketed in the US but you can still get hold of it if you want to.
PPS.
"Major Depressive Disorder" and "Bipolar Disorder" are diagnoses made based on a constellation of symptoms -- they are not discrete diseases. While the symptomology may be the same, the biochemical processes involved may be very different for everyone. I have never had much response to the medications that target serotonin alone, for example, but have generally responded well to those meds that preferentially target norepinephrine, with a side shot of serotonin. Other people might need a drug that is more balanced between those two neurotransmitters, or something else entirely. That's because, while the disorders may look the same, the underlying processes may be very different.
WELL SAID!
Posted by ed_uk on August 6, 2005, at 13:09:51
In reply to Got a bit too long..., posted by Racer on August 6, 2005, at 12:28:36
Hi Racie,
Despite the fact that numerous babblers have taken (and hated) reboxetine, some people really like it.........
http://www.dr-bob.org/babble/20050728/msgs/535557.html
Starting at a really low dose seems to help.
Ed xx
Posted by SLS on August 6, 2005, at 15:14:29
In reply to FIBBER!!! » SLS, posted by Racer on August 6, 2005, at 11:56:53
LOL!
Thanks for making me laugh, Racer. It has been a lonely day for me. Your affectionate posts always make me feel wanted.
Love,
Scott> > > > > >
> > Don't place so much confidence in me Ace. I am far from infallable!
> >
> >
> > - Scott
>
> Seems to me you're telling a little fib here, Scott, since you informed us recently that you are never wrong -- even that you thought you were wrong, once, but were mistaken...
>
> (Forgive me for not finding a link to that post.)
>
> Oh, well, infallible or not, you certainly are one hunky fellow. And you got a great heart.
Posted by SLS on August 6, 2005, at 15:17:52
In reply to Got a bit too long..., posted by Racer on August 6, 2005, at 12:28:36
Great post!
- Scott
Posted by linkadge on August 6, 2005, at 16:14:50
In reply to Re: Got a bit too long... » Racer, posted by SLS on August 6, 2005, at 15:17:52
As clean as they make the SSRI's out to be, I think their dirtyness can set one up for a relapse.
For instance if I take an SSRI, and can't concentrate in school and can't learn properly, then it is likely that I am going to start falling behind again, which may put me in an emotionally unstable place.
Somtimes they are disruptive enough to prevent you from taking the steps necessary to get things back on track.
To me, insomnia is not an acceptable side effect from an AD. Your brain cannot heal itself, if it is waking up every 10 minautes. SSRI's for me were insomnia pills. Thats not good for the brain, or the "underlying condition"
Linkadge
Posted by MidnightBlue on August 6, 2005, at 16:38:39
In reply to Got a bit too long..., posted by Racer on August 6, 2005, at 12:28:36
Racer,
That's a great post and I really agree with you, I just don't think I could get my words together that good right now! Thanks for saying what so many of us are feeling.
MB
Posted by Racer on August 6, 2005, at 19:41:29
In reply to Re: Got a bit too long... » Racer, posted by ed_uk on August 6, 2005, at 13:02:40
> Racer,
>
> I can't believe I'm saying this but.........
>
> Have you ever tried reboxetine?No -- I did look it up, but when I found that it wasn't approved by the FDA, I just figured it was a lost cause and didn't pursue it. Any idea how others are getting it over here? It did look as though it might be helpful, and I'm always interested in learning about things that might actually work out long term for me.
So tell me what you know about it, and why you say you can't believe you're saying it?
>
> >
>
> Btw, have you ever taken Strattera?
>
> ~ed xI did. I know it helped, but I don't know how much -- this was in the days of Dr EyeCandy and his "let's try three new medications this time, and see if you feel better. Then we'll know that you'll need those three..." It's hard to know if the Strattera was the culprit for the problems I had then or not, although I know that it affected my uh you know menstrual cycle. (It was normal for the first time since I "learned to control my eating" at 14...) Although I don't remember what problems I was having on it, I do know that I completely fell apart on Christmas Day, and that I didn't really recover from that for several weeks. I also know that I was pretty antsy, fidgetty.
But I also know that the period I was on it was the last period of anything approaching reasonable response that I had until late last year when Dr CattleProd started the Wellbutrin.
>
> PPS.
>
> "Major Depressive Disorder" and "Bipolar Disorder" are diagnoses made based on a constellation of symptoms -- they are not discrete diseases. While the symptomology may be the same, the biochemical processes involved may be very different for everyone. I have never had much response to the medications that target serotonin alone, for example, but have generally responded well to those meds that preferentially target norepinephrine, with a side shot of serotonin. Other people might need a drug that is more balanced between those two neurotransmitters, or something else entirely. That's because, while the disorders may look the same, the underlying processes may be very different.
>
> WELL SAID!Thank you. That's very nice to hear.
Posted by ed_uk on August 7, 2005, at 6:46:23
In reply to Re: Got a bit too long... » ed_uk, posted by Racer on August 6, 2005, at 19:41:29
Hi Racie!
>........when I found that it wasn't approved by the FDA, I just figured it was a lost cause and didn't pursue it.........
It's approved in the UK and many other countries.
>So tell me what you know about it, and why you say you can't believe you're saying it?
I was hesistant to recommend it because numerous babblers have found that it aggravated their depression.
Reboxetine is a (very) selective NE reuptake inhibitor. Since nortriptyline and (possibly) Strattera have helped your depression, I was wondering whether reboxetine might help. If you do try it, I'd definitely recommend starting at a very low dose and increasing gradually.
Ed xx
Posted by SLS on August 7, 2005, at 9:01:20
In reply to Re: Got a bit too long... » Racer, posted by ed_uk on August 7, 2005, at 6:46:23
> If you do try it, I'd definitely recommend starting at a very low dose and increasing gradually.
What would you consider low? I think anything above 2mg would be starting too fast. I don't even know if it comes in 1mg pills.
- Scott
Posted by ed_uk on August 7, 2005, at 14:47:48
In reply to Re: Got a bit too long..., posted by SLS on August 7, 2005, at 9:01:20
Hi Scott,
>What would you consider low?
1mg in the morning - 1/4 of a 4mg tablet.
>I think anything above 2mg would be starting too fast.
I agree.
>I don't even know if it comes in 1mg pills.
It comes as 4mg tabs. Meri-tulli started at 1mg (bd?) so I guess it's possible to cut them into 4!
~ed
This is the end of the thread.
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