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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Helena24 on March 31, 2010, at 9:41:36
Hi,
I suffer from chronic ''atypical'' depression and ADD/lack of motivation/anhedonia and severe chronic dysphroria.I tried almost any psych med available.
The lack of motivation/enthusiasm for life is my biggest problem,because the years of my life pass by with me just doing nothing productive or enjoyable all day.
My life is empty.
I have to force myself to socialize a few times a year just as I have to force myself to pay my bills or going to the bank.
All of this ''feels'' the same.The only med that really ever helped was Ritalin,but I can't get it in my country.
Desipramin (in low doses and for short time) worked good too,but it's also not available.
Nortriptylin was good too,but inferior to Desipramin.
Bupropion gave me memory problems.I have tried almost drug available of all classes.
Now my doctor prescibed me Strattera,10 mg.
I tried this med a few years ago in the 40 mg dosage and it made me severe depressed and I had to quit taking it.
Now I startet with a low dose,but it makes me very dysphoric too.
Now I found out that Atomoxetine has a second metabolite that works as a partial kapppa opioid agonist.This could partially explain the dysphoria it causes.
Kappa opioid agonism,as far as I know,lowers dopaminergic function in the nucleus accumbens (reward center).So my thought is to try Reboxetine,that has a similar mechanism of action,without a known kappa agonism.
This drug is also not available but I could order it online.Now my question:
Is there someone who had tried both these drugs for whatever indication and can tell me if or how they ''feel'' different?
Does Reboxetine cause less dysphoria?I know this drug isn't available in the US so I don't expect much response.
I will try Edronax/Reboxetine anyway,because I'm really desperate with having no motivation and doing nothing all day!
Even if you tried only one of those two drugs (or low dose desipramine) please answer and discribe how they felt like to you.
Thank you
Posted by Viking on March 31, 2010, at 13:24:01
In reply to Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on March 31, 2010, at 9:41:36
Hi
I suffer from pretty much the same symptoms as you, and I have also tried a wide range of meds.Some years ago I tried Reboxetine. At first it worked very well and i was very enthusiastic about it, but after a couple of months it stopped working. I have tried it again several times and in different combos, but I have never been able to make it work again. It should also be said that it gives quite harsh side effects even at low doses.
The best result until now is a combo of Prozac and low dose Abilify. This may not solve all problems, but it has definitely given me more motivation and energy and with very few side effects.
I hope this can help you.
Posted by ed_uk2010 on March 31, 2010, at 17:55:55
In reply to Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on March 31, 2010, at 9:41:36
What country are you in Helena?
> Hi,
> I suffer from chronic ''atypical'' depression and ADD/lack of motivation/anhedonia and severe chronic dysphroria.
>
> I tried almost any psych med available.
> The lack of motivation/enthusiasm for life is my biggest problem,because the years of my life pass by with me just doing nothing productive or enjoyable all day.
> My life is empty.
> I have to force myself to socialize a few times a year just as I have to force myself to pay my bills or going to the bank.
> All of this ''feels'' the same.
>
> The only med that really ever helped was Ritalin,but I can't get it in my country.
> Desipramin (in low doses and for short time) worked good too,but it's also not available.
> Nortriptylin was good too,but inferior to Desipramin.
> Bupropion gave me memory problems.
>
> I have tried almost drug available of all classes.
>
> Now my doctor prescibed me Strattera,10 mg.
> I tried this med a few years ago in the 40 mg dosage and it made me severe depressed and I had to quit taking it.
> Now I startet with a low dose,but it makes me very dysphoric too.
> Now I found out that Atomoxetine has a second metabolite that works as a partial kapppa opioid agonist.This could partially explain the dysphoria it causes.
> Kappa opioid agonism,as far as I know,lowers dopaminergic function in the nucleus accumbens (reward center).
>
> So my thought is to try Reboxetine,that has a similar mechanism of action,without a known kappa agonism.
> This drug is also not available but I could order it online.
>
> Now my question:
> Is there someone who had tried both these drugs for whatever indication and can tell me if or how they ''feel'' different?
> Does Reboxetine cause less dysphoria?
>
> I know this drug isn't available in the US so I don't expect much response.
>
> I will try Edronax/Reboxetine anyway,because I'm really desperate with having no motivation and doing nothing all day!
>
> Even if you tried only one of those two drugs (or low dose desipramine) please answer and discribe how they felt like to you.
>
> Thank you
Posted by Helena24 on April 1, 2010, at 6:21:35
In reply to Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on March 31, 2010, at 9:41:36
I live in Greece.
Prozac doesn't do much for me.
Abilify you mentioned gave me a very dark depression in 2-5 mg doses.
It was one of the worst meds I ever took.I had a bad reaction to Concerta,but Ritalin helps but is never prescribed here.
Even Concerta is only prescribed to a few selectet adults from 1-2 doctors in the whole country,practically you can't get a prescription for it.It's easier for me to tell wich drugs I never tried than to give you a list of those I tried.
Reboxetine is one of these and since desipramine did ''something'' it might be helpful.
A should also mention that I take Tianeptine,wich at first gave me motivation,but this effect isn't so strong anymore.It is now something like a mood stabilizer for me,saving me from the deepest dispair.I need something activating to ''augment'' it,since apathy and procrastination are ruling my life.
Modafinil doesn't work anymore either.
Posted by ed_uk2010 on April 1, 2010, at 13:14:44
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on April 1, 2010, at 6:21:35
It's the same in the UK Helena ie. stimulants are not generally prescribed to adults here.
Do you have a list/formulary of drugs which are marketed in Greece?
> I live in Greece.
>
> Prozac doesn't do much for me.
> Abilify you mentioned gave me a very dark depression in 2-5 mg doses.
> It was one of the worst meds I ever took.
>
> I had a bad reaction to Concerta,but Ritalin helps but is never prescribed here.
> Even Concerta is only prescribed to a few selectet adults from 1-2 doctors in the whole country,practically you can't get a prescription for it.
>
> It's easier for me to tell wich drugs I never tried than to give you a list of those I tried.
>
> Reboxetine is one of these and since desipramine did ''something'' it might be helpful.
>
> A should also mention that I take Tianeptine,wich at first gave me motivation,but this effect isn't so strong anymore.It is now something like a mood stabilizer for me,saving me from the deepest dispair.I need something activating to ''augment'' it,since apathy and procrastination are ruling my life.
>
> Modafinil doesn't work anymore either.
Posted by europerep on April 1, 2010, at 14:31:54
In reply to Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on March 31, 2010, at 9:41:36
:) kalispera..
so you're from greece.. though, in your situation, you could probably care less, it's a very very beautiful country.. when I was young, my parents, me and my brother used to go to greece every summer, we always stayed with a family that rented small apartments just outside a tiny town near kalamata.. those were the happiest days of my life, which is why I feel very attached to the country..our symptoms have quite a bit in common, and I do know what it feels like to have the years of your life pass by, especially the ones that were supposed to be among the best years of your life (I'm the same age as you, if your screenname indicates your age).. I cannot really say anything positive or encouraging, since I too am struggling with the very basics of life, and I cannot help you with your questions concerning the drugs you mentioned either, but what I can tell you is this:
through the european union treaties, if any drug is approved or marketed in one member state, it is automatically approved in all other member states.. the fact that some drugs aren't available in greece thus only means that the manufacturer isn't interested in marketing it there.. if you know people in other states, possibly where you did obtain the desipramine before, they could legally provide it to you, if your doctor is willing to prescribe it.. (that doesn't mean that it wouldn't be quite complicated, and that a reimbursement of your bills might become a little difficult, but if it is what has helped you, you might be willing to try this)..
but, if there was a med that has actually really helped you, i.e. ritalin, can you not try to get into contact with one of these docs that prescribe it? or possibly a university clinic or something? you have probably already done all you can to get it, I was just thinking if it is the right one, then you have basically made the biggest step- finding the right med.. now "all" it takes would be a decent doctor - there must be someone out there, no?I hope you will find some way out!
best wishesER
Posted by Helena24 on April 1, 2010, at 15:43:00
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by europerep on April 1, 2010, at 14:31:54
I'm 32 and the best years of my life have past in this way.Medication trial after medication trial.
It's absolutly impossible to get a greek doctor do all the paper work to import a psychiatric medication that is also a controled substance.
I have bee to all university clinics.
Most off them say this problem doesn't exist and say I have OCD and prescribe drugs that make the problem 10 times worse!
I can tell you that the psychiatry professors here don't accept ADD as a real condition.
I have been to many university clinics and private practices.I know all the medications available by heart,since I have tried the most of them.
Mirtrazapine helped a lot with motivation but I couldn't tolarate the uncontrolable hunger and weight gain it causes.
Agomelatine caused agitation and worsened my depression.I want to try Low Dose Naltrexone ,but it isn't available either.
I think a drug like Aricept might help me too,because it is known that it improves apathy caused by SSRI.
I don't know if I find a psysician to prescribe it.
Today I'm on a cocktail of Tianeptine,Nortriptylin,Diazepam and alcohol.
I also tried piribedil,
l-dopa,selegillin,moclobemid,amandatin and many others.
Parnate isn't available.I never tried it.
Everyday is a struggle with apathy,procrastination,negative thoughts and dispair.
The fact that I get nothing done makes me even more depressed.
I think a big part of my depression is a reaction to this.
I feel completly useless.
Sorry for any language mistakes.Helena
Posted by ed_uk2010 on April 1, 2010, at 16:37:25
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on April 1, 2010, at 15:43:00
What dose of nortriptyline do you take? Perhaps an adjustment to the dose would help.
Posted by Helena24 on April 1, 2010, at 16:43:39
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax) » Helena24, posted by ed_uk2010 on April 1, 2010, at 16:37:25
25 mg every second day,because it's activating action faids away very quicly.It was the same with desipramine.
Low doses of these drugs seem to work better for ADD then dosages required for an antidepressant effect.
Even if it does ''something'' it's a success for me because most drugs make it all worse,usually.
Posted by ed_uk2010 on April 1, 2010, at 16:58:11
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on April 1, 2010, at 16:43:39
>25 mg every second day, because its activating action fades away very quickly.
Perhaps the activating action would return once you reached a 'traditional' therapeutic dose eg. 75mg per day.
Posted by Helena24 on April 1, 2010, at 17:02:58
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on April 1, 2010, at 16:43:39
Well,maybe I try this.
I'm very sensitive to side effects.
I took desipramine in high dosages but the low dose was better in combination with modafinil.
I will talk to my doctor about it,but he doesn't take me very serious.
Thanks anyway.I'm still waiting for Reboxetine experiences...
Posted by SLS on April 1, 2010, at 18:59:15
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on April 1, 2010, at 17:02:58
> I'm still waiting for Reboxetine experiences...
Reboxetine exacerbated my bipolar depression by the fourth day of treatment. I became anxious and suicidal. When I discontinued the drug, I returned to my baseline within 36 hours. It was hellish.
I guess you won't know how reboxetine will affect you until you try it. It doesn't seem to be gaining in popularity, though. How about maprotiline? It is a tetracyclic that exhibits strong norepinephrine reuptake inhibition.
- Scott
Posted by Helena24 on April 1, 2010, at 19:28:59
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax) » Helena24, posted by SLS on April 1, 2010, at 18:59:15
> > I'm still waiting for Reboxetine experiences...
>
> Reboxetine exacerbated my bipolar depression by the fourth day of treatment. I became anxious and suicidal. When I discontinued the drug, I returned to my baseline within 36 hours. It was hellish.
>
> I guess you won't know how reboxetine will affect you until you try it. It doesn't seem to be gaining in popularity, though. How about maprotiline? It is a tetracyclic that exhibits strong norepinephrine reuptake inhibition.
>
>
> - Scott
I tried maprotiline 9 years ago,alone not in a combo.
I discontinued after a week or so,since it made me very tired and I had no doctor to encourage me to continue taking it (I bought it on my own,since doctors very rarely prescribe it).
It feels completly different than desipramine.
It is very sedative.
Have you have experience with it?You're experience with Reboxetine is very similar to mine with Atomoxetine.It worsened my depression immensely.
It seems that the mechanism of action,the ''how'' exactly a med act on the NE receptors can make these drugs differ in their actions very much.
Posted by Viking on April 2, 2010, at 1:07:09
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on April 1, 2010, at 19:28:59
Maybe I can add a little more to my post about Reboxetine.
One combo I tried with some success was Beboxetine + Mianserin + Prozac. As far as I remember this had fewer side effects than either med in itself. You did mention, that you had some help from Mirtazapine which is almost the same as Mianserin, so maybe this is worth a try. My dosage was:
Prozac 20 mg
Reboxetine 4 mg
Mianserin 60 mgAnyway if you try Reboxetine I suggest you titrate up very slowly to avoid side effects. I started at 2 mg and had lots of effect at 4 mg. Going up to 12 mg just gave me more side effects.
Another thing you could try is to combine Nortriptyline with an SSRI. Zoloft is often used.
Posted by Helena24 on April 2, 2010, at 5:57:20
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on April 1, 2010, at 19:28:59
Mianserin has been withdrawn from the market in most european countries.
Anyway I planned to take a very low dose of Reboxetine,because I believe there is something like a dopamine/norepinephrine balance:
to much NE slows DA down,in my experience,and that would be bad for me.
SSRI's are very bad for me and worsen my apathy to an extreme degree.
I would only try them in combination with stimulants,wich I can't get.
Posted by SLS on April 2, 2010, at 6:26:51
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on April 1, 2010, at 19:28:59
Re: Maprotiline
> Have you have experience with it?
Maprotiline is one of the only antidepressants that I haven't tried yet. I have avoided it mostly because it doesn't have a great reputation for being effective. I am currently trying milnacipran (Savella). I experienced a bit of an improvement in depression for a few days. Not so much now. I will increase the dosage to 150mg by Monday if there is no return of an antidepressant response.
- Scott
Posted by Helena24 on April 2, 2010, at 6:31:35
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by SLS on April 2, 2010, at 6:26:51
I also don't think that maprotiline is very effective.I don't know how it works on the long term though.
Is Savella similar to Effexor or Cymbalta?
I can't tolarate these drugs.
They make my apathy ten times worse.
Posted by SLS on April 2, 2010, at 7:37:03
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on April 2, 2010, at 6:31:35
Hi.
> I also don't think that maprotiline is very effective.I don't know how it works on the long term though.
> Is Savella similar to Effexor or Cymbalta?
In the sense that Savella is labeled a SNRI, I guess so. However, the ratios of NE/5-HT reuptake inhibition are different for the three drugs.
> I can't tolarate these drugs.
> They make my apathy ten times worse.I really wouldn't venture to state categorically that Savella would treat you as badly as the others. So far, I have experienced a bit of apathy and amotivation, but not much. You might very well be surprised by Savella. For any one antidepressant, there are a plethora of ways that individuals react to them.
- Scott
Posted by Katabatic on May 20, 2010, at 21:11:06
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by europerep on April 1, 2010, at 14:31:54
.
Posted by Conundrum on May 25, 2010, at 22:28:42
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on April 1, 2010, at 15:43:00
I have very similar problems, I have no motivation, energy, or excitement about life anymore. Everything is a struggle. I hope reboxetine works for you. Worst comes to worst you could go back on mirtazapine or that other combo you said helped. Its better to be fat and happy than thin and miserable if you ask me. As long as you are not about to have a heart attack. Its odd that they don't have desipramine and parnate there.
Posted by Conundrum on May 25, 2010, at 22:35:52
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Helena24 on April 2, 2010, at 6:31:35
It sounds like you do well on drugs that block serotonergic receptors like mirtazapine and poorly on drugs that increase activation of these same receptors. I'm kinda the same way. SSRIs make me feel totally flat, prozac used to help but now it just makes me wanna do nothing, kills my libido, and give me the sh!ts. I wonder what would happen if you combined Desipramin with mirtazapine? Serotonin blocking action, which causes more DA and NE release and at the same time NE reuptake blockade.
Posted by SLS on May 26, 2010, at 5:20:35
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax) » Helena24, posted by Conundrum on May 25, 2010, at 22:35:52
> I wonder what would happen if you combined Desipramin with mirtazapine? Serotonin blocking action, which causes more DA and NE release and at the same time NE reuptake blockade.
I don't know how well desipramine and mirtazapine would work together. They very well might. Someone had an interesting idea to combine clomipramine and mirtazapine. I agree that desipramine would be a better choice than the other selective NE reuptake inhibitors. It just seems to help more people.
- Scott
Posted by Conundrum on May 26, 2010, at 8:12:50
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by SLS on May 26, 2010, at 5:20:35
I don't know either, seems like it would be a new combo on this board. I mean if two things work moderately well, why not combine them and see what happens? I think desipramine would keep her from getting too hungry and too tired. Mirtazapine would potentiate the amount of norepinephrine and dopamine released. Also to Helena24, its important to know that even selective reuptake of norepinephrine by desipramine increases dopamine 3 fold. Mirtazapine, also increases DA via its antagonistic effects at the 5 HT2A/C, 5HT3, and Alpha-2 adrenergic receptors. I think the worst thing that could happen with this regimen is it could be too stimulating.
http://www.springerlink.com/content/e860538255551m32/
Chronic desipramine and fluoxetine differentially affect extracellular dopamine in the rat prefrontal cortex
ianluigi Tanda1, Roberto Frau1 and Gaetano Di Chiara1
(1) Department of Toxicology and CNR Centre for Neuropharmacology, University of Cagliari, Viale A. Diaz 182, I-09126 Cagliari, Italy
Received: 8 December 1995 Accepted: 25 March 1996Abstract The effect of chronic administration of desipramine or fluoxetine (10 mg/kg IP once a day for 2 weeks) on extracellular noradrenaline, serotonin and dopamine in the rat prefrontal cortex was studied by transcerebral microdialysis. Chronic desipramine increased extracellular noradrenaline and dopamine by three-fold as compared to saline controls. Acute challenge with 10 mg/kg desipramine increased by more than three-fold extracellular noradrenaline and dopamine in saline controls, but failed further to increase extracellular noradrenaline and dopamine in rats chronically administered desipramine. Chronic fluoxetine more than doubled the extracellular concentrations of serotonin but failed to change the extracellular concentrations of dopamine as compared to saline controls. Challenge with 5 mg/kg fluoxetine while almost doubling extracellular serotonin and dopamine concentrations in saline controls, failed further to increase extracellular serotonin and did not change extracellular dopamine in rats chronically exposed to fluoxetine. In contrast, challenge with 10 mg/kg desipramine normally increased extracellular dopamine in rats chronically exposed to fluoxetine. Therefore, chronic fluoxetine is associated with normal presynaptic dopamine transmission in the prefrontal cortex as a result of tolerance to fluoxetine-induced increase of extracellular dopamine; in contrast, chronic desipramine is associated with an increase of pre-synaptic dopamine transmission in the prefrontal cortex up to a level that cannot be further elevated by acute desipramine challenge. The results suggest that prefrontal cortex dopamine plays a different role in the antidepressant properties, of desipramine and fluoxetine.
Posted by Deneb on May 27, 2010, at 21:29:18
In reply to Re: Atomoxetine(Strattera) versus Reboxetine(Edronax), posted by Katabatic on May 20, 2010, at 21:11:06
Hello Katabatic!
Welcome to Psycho-Babble! Feel free to post.
Deneb
This is the end of the thread.
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