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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by JahL on October 26, 2000, at 13:10:50
Could anyone with any experience of Reboxetine please give me an idea of how its speed of onset of relief compares with that of other antidepressants (I have tried them all)? Is it the standard 2-3 week wait? I intend to start high & fast and progress to 12mg/day as soon as.
Also, I am currently 1 & 4 weeks into trials of Serzone & Adrafinil respectively. Neither has yet yielded any positive results but in the abscence of any real side effects, I am tempted to keep both on (esp. the Adrafinil) in the hope of a fortuitous interaction with Reboxetine.
I know polypharmacology can be a risky business, especially without the direction of a pdoc, but my need for relief (of dysthymia+social phobia+double depression) is so urgent that I am prepared to trade the risks posed by a shotgun/scattershot approach for a statistically greater chance of success. I am even considering throwing Provigil into the pot.
No pdoc here in the U.K. will prescribe me stimulants (which supposedly offer fast-acting relief)
Any thoughts? Anyone?
Thanx in advance,
ta,
Jah.
Posted by natg on October 26, 2000, at 13:43:51
In reply to Reboxetine onset of efficacy Q more....., posted by JahL on October 26, 2000, at 13:10:50
>Hi,
I tried Rebox with Prozac and a low dose of Zyprexa. I added the Rebox. because the prozac was pooping out and I was constantly exhausted.
It worked right away for me, gave me the extra energy and I was able to function very well. This was really a blessing as I have also tried many meds. over the last 6 years which proved to be quite innefective in the long run.Good Luck
Posted by JohnL on October 26, 2000, at 16:16:02
In reply to Reboxetine onset of efficacy Q more....., posted by JahL on October 26, 2000, at 13:10:50
> Any thoughts? Anyone?
>
> Thanx in advance,
> ta,
> Jah.Jah,
My only thought here is that Serzone and Adrafinil kind of cancel each other out, sort of. Though I'm not sure to what degree. That's because one of Serzone's mechanisms is alpha-1 antagonism. Adrafinil is an alpha-1 agonist, just the opposite. I think Adrafinil is more powerful than Serzone at the alpha-1 site and will probably prevail, though perhaps slightly blunted from the Serzone counteracting it a little bit. Just a guess.I got real depressed with Serzone. I got real good with Adrafinil. I wonder if it had anything to do with their opposite effects at alpha-1.
Reboxetine will probably have additive effects to Adrafinil. Both will potentiate the NE system. So you might find the high dose you want to start with will be too much. It's a possibility to be aware of, that's all.
Even better than Reboxetine though...for the symptoms you described...I would think about Amisulpride instead. I only mention this because Amisulpride+Adrafinil was so effective for me, and my symptoms were exactly like yours. Of course, your mileage may vary. But I personally favor Amisulpride a hundred times better than Reboxetine, especially when combined with Adrafinil. And Serzone for sleep. Sounds good to me.
John
Posted by JahL on October 26, 2000, at 16:41:56
In reply to Re: Reboxetine onset of efficacy Q more....., posted by JohnL on October 26, 2000, at 16:16:02
Hi John (& natg-what I wanted to hear!)
Thanks for your considered response.Based on this, I think I'll drop the Serzone and watch the doses of Rebox+Adrafinil.
Unfortunately I have already tried Amisulpride and found it to be less efficacious than Sulpiride, which helps the social phobia but doesn't touch the depression.
I buy all my meds from farmacia cerati. They are excellent; courteous, helpful and very fast.
Ta,
Jah.P.S. further to yr discussion with SLS re:Jensen, I too have e-mailed the man on occasion and like you, I have found him to be both polite and helpful. No hard sell whatsoever.
Posted by Leonardo on October 27, 2000, at 11:45:25
In reply to Reboxetine onset of efficacy Q more....., posted by JahL on October 26, 2000, at 13:10:50
I have taken reboxetine for more than a year in different combos with Paxil and mirtazapine (in the UK).
Be aware that I had some bad side effects when starting up reboxetine too quickly, ie after the fisrt 4mg pill! Problems include intense irritability and violent outburts. I would recommend starting at 2mg for the first day and working up gradually. I've never taken more than 8mg per day, 4 or 6 usually does the trick for me, taken with paxil. The stimulation effect does wear off after a while though.
Also unless you want insomnia, take your doses in the morning and at lunch time, not later.
> Could anyone with any experience of Reboxetine please give me an idea of how its speed of onset of relief compares with that of other antidepressants (I have tried them all)? Is it the standard 2-3 week wait? I intend to start high & fast and progress to 12mg/day as soon as.
>
> Also, I am currently 1 & 4 weeks into trials of Serzone & Adrafinil respectively. Neither has yet yielded any positive results but in the abscence of any real side effects, I am tempted to keep both on (esp. the Adrafinil) in the hope of a fortuitous interaction with Reboxetine.
>
> I know polypharmacology can be a risky business, especially without the direction of a pdoc, but my need for relief (of dysthymia+social phobia+double depression) is so urgent that I am prepared to trade the risks posed by a shotgun/scattershot approach for a statistically greater chance of success. I am even considering throwing Provigil into the pot.
>
> No pdoc here in the U.K. will prescribe me stimulants (which supposedly offer fast-acting relief)
>
> Any thoughts? Anyone?
>
> Thanx in advance,
> ta,
> Jah.
Posted by JahL on October 27, 2000, at 16:15:38
In reply to Re: Reboxetine onset of efficacy Q more..... » JahL, posted by Leonardo on October 27, 2000, at 11:45:25
> I have taken reboxetine for more than a year in different combos with Paxil and mirtazapine (in the UK).
>
> Be aware that I had some bad side effects when starting up reboxetine too quickly, ie after the fisrt 4mg pill! Problems include intense irritability and violent outburts. I would recommend starting at 2mg for the first day and working up gradually. I've never taken more than 8mg per day, 4 or 6 usually does the trick for me, taken with paxil. The stimulation effect does wear off after a while though.
>
Hi Leonardo.Just wondering. What does Paxil/Remeron add to the Reboxetine? Is bad maths in evidence (sum > parts)? How good is the Rebox. alone and what doesn't it do for you?
Thanx v much,
Jah.
Posted by AndrewB on October 28, 2000, at 4:50:14
In reply to Re: Reboxetine onset of efficacy Q more....., posted by JahL on October 27, 2000, at 16:15:38
JahL,
I am tracking peoples’ responses to amisulpride and sulpiride. In particular I would like to know how amisulpride compares to sulpride. Any details of your experience with the two would be appreciated. If you prefer, email me at [email protected] with this information. Thank you.
I've taken reboxetine and have followed the posts on it and can perhaps pass some useful information on to you. Reboxetine is notorious for causing a variety of side effects at first, most of which are transient. But people have found out the hard way that it is important to move up slowly in dosage. This means a trial at 4mgs. for 2 weeks. If side effect are too much reduce the dosage down to two. Only when the side effects subside somewhat, move up to 6mg.s and eventually onto 8mgs.
If the side effects fade away for the most part, you may find reboxetine a useful arousal agent that will increase your motivation toward action, including socialization. My impression is that it has limited if any effectiveness in reducing social anxiety. I'm also under the impression that it provides an antidepressant response for only an isolated number of patients. I know company literature touts it as being efficacious for depression and social anxiety, but I take this with a grain of salt.
Me and others have noted that reboxetine’s arousal effects may wear off after a number of months. I wonder how common this poop out is.
I would suggest you keep you drug trials separate. Not only do you multiply the likelihood of drug interactions by taking a 'pot full' of meds but it becomes hard to distinguish which drug is doing what for you. Drug trials should be a learning process from which your experience with one drug gives you clues as to what meds may finally give you relief. I know you want relief now, but a systematic approach is more likely to locate what you need in the long run.
On an unrelated note, the combo of dysthymia with social anxiety can often be indicative of dopaminergic dysfunction. I believe a trial with dopaminergics is indicated for this symptomology when a trial of one or two SSRI has provided no mood or anxiety relief. The fact that sulpride has helped your anxiety further indicates that you may suffer from dopaminerigic dysfunction.
Drugs to try in this class include stimulants (i.e. adderall), low dose selegiline at 5mg/day (it may take 45 days or longer to take effect but the results can be dramatic). Mirapex also, studies indicate, can be another drug that helps with depression. I found pramipexole not to work for me (while amisulpride has), but your results may differ. Pramipexole is started at 1/4mg. doses taken three times a day. As nausea or other side effects subside, the dose is increased by 1/4mg. Effective dosage may be as high as 5mg/day. Farmacia Cerati sells Mirapex. Requip, seems to be similar and may act in the same manner but it lacks studies to support its efficacy as an AD.
I wouldn’t bother with tianeptine or (especially) piramacetam. Neither seems to have the track record to justify trying them except as a last resort as an AD. Do a search of previous posting on this and other boards if you don’t believe me.
I have to add, in my opinion you need a locate a qualifeid psychopharmocologist to give you counsel and help you in your search for effective medication. People with social anxiety tend to avoid psychiatrists like the plague, but believe me, there is expertise out there that will work with you to best identify the meds that can help with atypical disorders such as yours while making sure you don’t poisen yourself.
Best wishes,
AndrewB
Posted by JahL on October 28, 2000, at 12:11:26
In reply to Re: Reboxetine onset of efficacy Q more....., posted by JahL on October 27, 2000, at 16:15:38
Thanks for your responses everyone. Think I've got what I was after (tho' I'd still like to hear from you, Leonardo)
Just to clarify. I know low & slow's the preferred method but I am doing this on the direction of my pdoc. He knows I'd rather put up with the side effects and find out as quickly as possible if the drug's gonna work. I've got dozens more meds to get through....!
Andrew, thanx 4 the detailed reply. I am intrigued by the low dose selegeline (like the sound of 'dramatic results') However I could not commit to a 45+ days trial w/o some guarantee of success.
How compatible would such a low dose be with other agents? I am thinking of course of running concurrent trials (with the requisite caution) Bear in mind I am only talking about 1 other agent at a time (not my previous 5!) I know polypharmacy can cloud results but with just 2 agents a simple process of elimination should separate things (?)
Thanx for any thoughts,
Jah.
Posted by JahL on October 28, 2000, at 13:16:27
In reply to Re: Selegeline/Rebox. AndrewB/leonardo, posted by JahL on October 28, 2000, at 12:11:26
.
Posted by Noa on October 28, 2000, at 13:19:58
In reply to BTW-how'd u do the double arrow thingy 4 names?np., posted by JahL on October 28, 2000, at 13:16:27
> .
You click the box marked "add name of previous poster" (it is under the box where you put in the subject line).
Posted by Leonardo on November 1, 2000, at 10:53:56
In reply to Re: Reboxetine onset of efficacy Q more....., posted by JahL on October 27, 2000, at 16:15:38
> > I have taken reboxetine for more than a year in different combos with Paxil and mirtazapine (in the UK).
> >
> > Be aware that I had some bad side effects when starting up reboxetine too quickly, ie after the fisrt 4mg pill! Problems include intense irritability and violent outburts. I would recommend starting at 2mg for the first day and working up gradually. I've never taken more than 8mg per day, 4 or 6 usually does the trick for me, taken with paxil. The stimulation effect does wear off after a while though.
> >
> Hi Leonardo.
>
> Just wondering. What does Paxil/Remeron add to the Reboxetine? Is bad maths in evidence (sum > parts)? How good is the Rebox. alone and what doesn't it do for you?
>
> Thanx v much,
>
> Jah.Sorry for the delay replying, I don't get on this group every day. By chance and random experimenting I found that rebox + paxil worked quite well for me. Rebox + remeron did very little.
For rebox + paxil, it was definitely the sum is more than the individual parts. I didn't get any noticeable antidepressant effect from either alone, but together I felt pretty good (mostly).
Reboxetine alone gave me a short term energy boost, and sometimes made me feel edgy or 'wired' as I think some people call it. At worst I became quite manic, irritable and sometimes aggressive. This was the only time in my life I have enjoyed shouting at shop assistants and the like when their service was poor, usually I'm too shy! However, this is not a desirable behaviour really, and I had to come off the rebox. Note this happened when I was slavishly taking 8mg per day when 4 would probably have been plenty for me. The paxil seems to control the manic/anxiety tenedencies of the rebox, while the rebox combats the lethargy I got from paxil. My steady dose was only 4mg rebox (2mg morning, 2mg midday) plus 5mg paxil (evening).
How are you getting on?
Leonardo
Posted by Leonardo on November 1, 2000, at 11:05:04
In reply to Re: Selegeline/Rebox. AndrewB/leonardo, posted by JahL on October 28, 2000, at 12:11:26
FYI I happen to have just started a low dose trial of selegiline. I recently dropped the rebox/paxil and tried wellbutrin 300mg for 3 weeks, with no improvement. I am now trying selegeline 2.5mg per day, and noticed a big boost in energy on the first day. I also took 2mg rebox later that day, which seemed to make things worse, so I've dropped that now. Its early days of course, but I am getting much better mental clarity and help with motivation than with any of the other ADs I've tried so far. If this works, it could be the dopamaine effect, the others I've tried don't have a strong dopamine effect (paxil, rebox, wellbutrin, remeron).
Leonardo
> Thanks for your responses everyone. Think I've got what I was after (tho' I'd still like to hear from you, Leonardo)
>
> Just to clarify. I know low & slow's the preferred method but I am doing this on the direction of my pdoc. He knows I'd rather put up with the side effects and find out as quickly as possible if the drug's gonna work. I've got dozens more meds to get through....!
>
> Andrew, thanx 4 the detailed reply. I am intrigued by the low dose selegeline (like the sound of 'dramatic results') However I could not commit to a 45+ days trial w/o some guarantee of success.
>
> How compatible would such a low dose be with other agents? I am thinking of course of running concurrent trials (with the requisite caution) Bear in mind I am only talking about 1 other agent at a time (not my previous 5!) I know polypharmacy can cloud results but with just 2 agents a simple process of elimination should separate things (?)
>
> Thanx for any thoughts,
>
> Jah.
This is the end of the thread.
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