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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by garyengelm on January 22, 2008, at 15:02:51
What is Norepinephrine Syndrome ?
I found a brief description about the syndrome on the net and pasted it below. For the last 5 years, I have been on Serzone 150mg twice daily. My brother passed away a year ago this past December. All of a sudden, I developed what I thought was Generalized Anxiety Disorder. My doctors increased my Serzone all the way up to 450mg. I just seemed to get worse and worse as the months went by.
I am a Registered Nurse x 14 years. I tried several times to introduce an SSRI, but every time I tried, I got really sick after 5-7 days and had to stop, but during this 5-7 days, I felt my depresssion get a slight bit better, but not the anxiety.
After 7 Psychiatrists, I decided to go down on the Serzone with the 7th ones approval. Once I got down to 275mg, I introduced Lexapro at just 1.25mg. I know this is nothing, but I didn't get sick. I stayed on this dose for 2 weeks while continuing to taper the Serzone. My depression, once again was lifting and decided to suck it up and go faster on the Serzone taper. I got down to 100mg bid, and increased the Lexapro to 2.5mg with no side effects whatsoever. I'm pleased to announce I'm on my 5mg now, and my anxiety only comes on about an hour after I take the Serzone, but I'm on week 4 of the Lexapro and the Serotonin has really kicked in, I'm augmenting the Lexapro with low dose Risperdal, which also helps with the rapid taper of the Serzone.
I had some blood work done back in July which showed a serum Serotonin level of 35. range is 0-420. My Norepinephrine level was 413. Range is 0-399. Although there is no direct correlation of Cerebral Spinal Fluid levels of these two neurotransmitters, I strongly believe there is some type of correlation. My symptoms have been Severe depression, where I could cry on demand at times, and worst of all Anxiety that lasted all day. I honestly felt like I had an IV drip of adrenaline going all the time over the past year.
I am happy to say, that my Depression lifted within the first week of Starting the Lexapro, and my anxiety is just about 100% gone as of two days ago.
I have done so much research on this stuff down to the molecular level. I have researched all the meds used to treat this disorder, how the neurotransmitters work, the pharmacogentics of all of the drugs, etc. etc. The reading and understanding came easy for me due to my medical background.
I am convinced without a shadow of a doubt that the Serzone caused this anxiety disorder. The question is why didn't I have it for all the years I had been taking it prior to the passing of my brother. I can't say for sure, but I will say, I still had anxiety and panic attacks always on this medication, but it never got as bad as it did, forcing me to be out of work, all the years I had been taking it.
Here is a list of all medications the inhibit the reuptake of Norepinephrine:
Amitriptyline (Elavil)
Amoxapine (Asendin, Asendis, Defanyl)
Clomipramine (Anafranil)
Desipramine (Norpramin)
Dothiepin Hcl (Prothiaden, Thaden)
Doxepin (Adapin, Sinequan)
Imipramine (Tofranil)
Iprindole
Lofepramine (Gamanil)
Nortriptyline (Pamelor)
Opipramol (Insidon)
Protriptyline (Vivactil, Rhotrimine)
Trimiprmanie (Surmontil)
Effexor (venlafaxine)
Cymbalta (Duloxitene)
Serzone (Nefazadone)
A small study from McGill University in Montreal reports on eight subjects taking mirtazapine (Remeron), a selective combined norepinephrine/serotonin enhancer, who developed a "norepinephrine syndrome." The syndrome presented as an "atypical mania" with dysphoria, irritability, insomnia, psychomotor agitation, and abnormal gait, which the authors hypothesize is directly related to a "central norepinephrine hyperactivity."
Above study from : http://pn.psychiatryonline.org/cgi/content/full/37/23/41?etoc
If you have severe anxiety and you are any of the above drugs and it seems like it's getting worse, you may want to take my story and see if it fits to what your experiencing. Feel free to email me at [email protected] I have had alot of help here. Thank you especially to Bleuberry. Linkage, and PolarBear for all of your help and support. I'll be back to work very shortly, but first a well needed and deserved vacation.Regards,
Gary E. BSN, RN
Posted by johnj on January 22, 2008, at 19:25:06
In reply to 'Norepinephrine Syndrome' The Cause of my Anxiety, posted by garyengelm on January 22, 2008, at 15:02:51
Gary,
Glad to see you are doing well, not me. 3 hours sleep last night.
I thought that doxepin and especially trimpramine have very low affinity for nor-reuptake? I think desipramine and the nnortryptiline are higher.
I recall the following numbers from a former post.
Desipramine (Norpramin) 110
Doxepin (Adapin, Sinequan)5
Imipramine (Tofranil) 8
Nortriptyline (Pamelor) 25
Trimiprmanie (Surmontil) 0.2
amitryptline 4I don't know exactly what they measure but it appears some are do not affect NE reuptake very much. Which tca's were the worst for you?
How did you titrate up on lexapro without anxiety going throught the roof. Paxil and luvox were horrible for me. Paxil being the worst. I wonder if lexapro is better? I can't take benzo's so I don't know how to start a med.
Do you know anything about anafranil? I do know that remeron increased anxiety for me and made me a jerk.
That sure doesn't leave very many meds to try for anxiety.
Congrats Gary. You deserve to feel better.
johnj
Posted by mav27 on January 22, 2008, at 20:21:18
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety » garyengelm, posted by johnj on January 22, 2008, at 19:25:06
Since nortiptyline is just a metabolite of amitriptyline then shouldn't they have the same NE numbers?
Same with Imiprimine and desiprimine.
Posted by Phillipa on January 22, 2008, at 21:43:01
In reply to 'Norepinephrine Syndrome' The Cause of my Anxiety, posted by garyengelm on January 22, 2008, at 15:02:51
Gary just to let you know so happy the lexapro is working for you. And you do have my e-mail maybe you could help me too? And have you gotten any grief theraphy I know how close you and your Brother were and bet in soul and spirit you're still together. Love Phillipa
Posted by your#1fan on January 22, 2008, at 21:49:46
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety » garyengelm, posted by Phillipa on January 22, 2008, at 21:43:01
NEVER take strattera and Prozac together. You want know what overload of norephenprine feels like? a sting when you wake up, irrtible, dont find things fun much anymore.
Just a warning.....
taken it, got off.
fan
Posted by tensor on January 25, 2008, at 3:54:20
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety » johnj, posted by mav27 on January 22, 2008, at 20:21:18
> Since nortiptyline is just a metabolite of amitriptyline then shouldn't they have the same NE numbers?
It would be interesting to know how you came to that conclusion.
/Mattias
Posted by jms600 on January 29, 2008, at 16:57:57
In reply to 'Norepinephrine Syndrome' The Cause of my Anxiety, posted by garyengelm on January 22, 2008, at 15:02:51
Hi Gary,
Hope you are OK?!?
I think I have gone through something similar, although perhaps not quite as severe. I'm currently on 30mg of Mirtazapine, but up until around 10 days ago was on 45mg.
I've tried 45mg of Mirtazapine twice now - each time over a period of about seven days, and both times my anxiety seems to have worsened. Both times I have come back down to 30mg; however, this time my anxiety hasn't seemed to improve that much. I saw my psychiatrist yesterday who decided to pull me off the Mirtazapine - it was also making me quite aggressive!
He's now started me on 10mg Cipralex, so hopefully (along with 100mgs of Seroquel) that will help.
Take care.
Posted by KarenRB53 on March 1, 2011, at 19:40:02
In reply to 'Norepinephrine Syndrome' The Cause of my Anxiety, posted by garyengelm on January 22, 2008, at 15:02:51
> What is Norepinephrine Syndrome ?
>
> I found a brief description about the syndrome on the net and pasted it below. For the last 5 years, I have been on Serzone 150mg twice daily. My brother passed away a year ago this past December. All of a sudden, I developed what I thought was Generalized Anxiety Disorder. My doctors increased my Serzone all the way up to 450mg. I just seemed to get worse and worse as the months went by.
>
> I am a Registered Nurse x 14 years. I tried several times to introduce an SSRI, but every time I tried, I got really sick after 5-7 days and had to stop, but during this 5-7 days, I felt my depresssion get a slight bit better, but not the anxiety.
>
> After 7 Psychiatrists, I decided to go down on the Serzone with the 7th ones approval. Once I got down to 275mg, I introduced Lexapro at just 1.25mg. I know this is nothing, but I didn't get sick. I stayed on this dose for 2 weeks while continuing to taper the Serzone. My depression, once again was lifting and decided to suck it up and go faster on the Serzone taper. I got down to 100mg bid, and increased the Lexapro to 2.5mg with no side effects whatsoever. I'm pleased to announce I'm on my 5mg now, and my anxiety only comes on about an hour after I take the Serzone, but I'm on week 4 of the Lexapro and the Serotonin has really kicked in, I'm augmenting the Lexapro with low dose Risperdal, which also helps with the rapid taper of the Serzone.
>
> I had some blood work done back in July which showed a serum Serotonin level of 35. range is 0-420. My Norepinephrine level was 413. Range is 0-399. Although there is no direct correlation of Cerebral Spinal Fluid levels of these two neurotransmitters, I strongly believe there is some type of correlation. My symptoms have been Severe depression, where I could cry on demand at times, and worst of all Anxiety that lasted all day. I honestly felt like I had an IV drip of adrenaline going all the time over the past year.
>
> I am happy to say, that my Depression lifted within the first week of Starting the Lexapro, and my anxiety is just about 100% gone as of two days ago.
>
> I have done so much research on this stuff down to the molecular level. I have researched all the meds used to treat this disorder, how the neurotransmitters work, the pharmacogentics of all of the drugs, etc. etc. The reading and understanding came easy for me due to my medical background.
>
> I am convinced without a shadow of a doubt that the Serzone caused this anxiety disorder. The question is why didn't I have it for all the years I had been taking it prior to the passing of my brother. I can't say for sure, but I will say, I still had anxiety and panic attacks always on this medication, but it never got as bad as it did, forcing me to be out of work, all the years I had been taking it.
>
> Here is a list of all medications the inhibit the reuptake of Norepinephrine:
>
> Amitriptyline (Elavil)
> Amoxapine (Asendin, Asendis, Defanyl)
> Clomipramine (Anafranil)
> Desipramine (Norpramin)
> Dothiepin Hcl (Prothiaden, Thaden)
> Doxepin (Adapin, Sinequan)
> Imipramine (Tofranil)
> Iprindole
> Lofepramine (Gamanil)
> Nortriptyline (Pamelor)
> Opipramol (Insidon)
> Protriptyline (Vivactil, Rhotrimine)
> Trimiprmanie (Surmontil)
> Effexor (venlafaxine)
> Cymbalta (Duloxitene)
> Serzone (Nefazadone)
>
>
> A small study from McGill University in Montreal reports on eight subjects taking mirtazapine (Remeron), a selective combined norepinephrine/serotonin enhancer, who developed a "norepinephrine syndrome." The syndrome presented as an "atypical mania" with dysphoria, irritability, insomnia, psychomotor agitation, and abnormal gait, which the authors hypothesize is directly related to a "central norepinephrine hyperactivity."
> Above study from : http://pn.psychiatryonline.org/cgi/content/full/37/23/41?etoc
>
>
> If you have severe anxiety and you are any of the above drugs and it seems like it's getting worse, you may want to take my story and see if it fits to what your experiencing. Feel free to email me at [email protected] I have had alot of help here. Thank you especially to Bleuberry. Linkage, and PolarBear for all of your help and support. I'll be back to work very shortly, but first a well needed and deserved vacation.
>
> Regards,
>
> Gary E. BSN, RNIn your posting (I realize its old) you said you had blood levels done of seratonin and norepinephrine...I didn't know you could have that done. Can you just get it done in a regular lab? Thanks and wondering what meds you are on now? Hopefully you're doing well.
Posted by Cydnie on March 14, 2011, at 8:54:58
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety » garyengelm, posted by KarenRB53 on March 1, 2011, at 19:40:02
I was just going to write in to ask the same question that you did! I couldn't believe it. I heard of urine and saliva testing with naturopaths, things like that. But I also heard there's some skepticism behind it, and it often costs (well, for most of us) a fortune! I just had a reaction to emsam similar to my reaction to wellbutrin (irritability, leading to rage, which is so unlike me!) I asked my doctor if it could by the dopamine or norepinephrine, do they act similarly, and maybe I could rule out which one of these was getting too high and could figure out what both of these meds might increase, but he didn't know and just replied, "Yes, it was too much of a good thing." So I thought I would come on here and see if anyone knew what these two things increase the most (unless it depends on each one's chemistry) and found this response. Boy, would I love to hear back about this! Take care!
Posted by paranoid_android on March 17, 2011, at 17:37:24
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety » KarenRB53, posted by Cydnie on March 14, 2011, at 8:54:58
I think the same thing happened to me with Remeron. I took it for several months without any problems, but after someone in my family died, while I was on 30 mg, my anxiety went through the roof. The doc upped me to 45 mg and I got even worse. Had a constant panicked feeling for months, especially in the morning (after the sedation wore off). The anxiety I experience is physical, heart racing, palms and feet sweating, and from what I know this is caused by adrenaline, which makes me suspect the norepinephrine action of Remeron.
Anyway, it seems the sudden stress, combined with the 45 mg Remeron, put me in a bad way with anxiety for several months. Through looking at sites like this, I see other people have had anxiety with Remeron, and we are now reducing the dose, and have added Lexapro, which has always worked well for my anxiety.
Posted by Phillipa on March 17, 2011, at 22:16:11
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety, posted by paranoid_android on March 17, 2011, at 17:37:24
Been trying lexapro with the 50mg of luvox taken for about ll years and so far all I have are horrible nightmares all of a sudden but not from the meds I don't think. Any ideas? Phillipa
Posted by paranoid_android on March 18, 2011, at 1:04:27
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety » paranoid_android, posted by Phillipa on March 17, 2011, at 22:16:11
Two SSRIs? Is that unsusual?
Posted by Phillipa on March 18, 2011, at 20:27:41
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety, posted by paranoid_android on March 18, 2011, at 1:04:27
I was told a while back almost a year that two SSRI's could cause serotonin syndrome, and one said it's not done? So I'm confused safe or not? Phillipa
Posted by Diana_in_CA on March 31, 2011, at 1:03:41
In reply to 'Norepinephrine Syndrome' The Cause of my Anxiety, posted by garyengelm on January 22, 2008, at 15:02:51
I'd be interested in knowing what lab did your test. I had one thru Sanesco. It showed I was low on serotonin, dopamine, and epinephrine. I was high on norepinephrine. (I wasn't as low as you on serotonin though.) I believe my anxiety and severe insomnia issues are due to the high norepinephrine. I am currently, and was at the time of the test, on Effexor 150mg but doc would willingly change it.
I started taking SAM-e about 10 days ago along with L-theanine and they are helping with the depression (caused by 3 deaths in my family in the last 6 months). I didn't want to increase the Effexor. I tried Abilify but went manic at about the 4th day and stopped it at about day 8. I was one happy camper on it though. That tells me I need to up the dopamine levels.
Having trouble trying to figure out what to replace the Effexor with to keep the serotonin where it needs to be and up the dopamine. I'm hoping the norepinephrine will return to a normal level once off the Effexor. Any ideas anyone?
Posted by Cydnie on March 31, 2011, at 8:39:28
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety, posted by Diana_in_CA on March 31, 2011, at 1:03:41
If you are taking natural supplements, is that what you want? 5-htp works for serotonin, but I don't know if you can take it with sam-e. Rhodiola rosea is something I take, and have been taking with a lot of things (my doc thinks I am low on dopamine) and Gaba should be helped by l-theanine I think (I think it also works on dopamine, but am not sure how - there's a book you can find at the library which talks about a lot of nutritional supplements and conventional medications: How to use herbs, nutrients, & yoga in mental health care). It talks about medications for bipolar, depression, anxiety, add/adhd, cognitive impairment and memory, and one of my favorites - women problems (also men) which includes libido, things like that, and also has a suggestion of things that you can do or take for conventional medication side effects (for me, weight gain! libido) I like it so far, and my doc just suggested maca, not just for libido, but for mood! I don't know if it works on dopamine or what, but he thinks I am low in dopamine because of how well I do on adderall. Hope that helps! Cydnie
Posted by matthewdavid on March 31, 2011, at 16:02:46
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety, posted by Diana_in_CA on March 31, 2011, at 1:03:41
Hi Cydnie, I'm extemely interested in the lab test you had done, I didn't know this type of thing could be tested and measured. How does the process work and how would someone go about getting this test done?
thanks,
Posted by Diana_in_CA on March 31, 2011, at 22:50:35
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety » Diana_in_CA, posted by matthewdavid on March 31, 2011, at 16:02:46
> Hi Cydnie, I'm extemely interested in the lab test you had done, I didn't know this type of thing could be tested and measured. How does the process work and how would someone go about getting this test done?
>
> thanks,Matthew -
I think you meant to direct that to me, Diana. The test is done thru Sanesco and their website is sanesco.net . The test is actually processed thru NeuroLabs but I don't know if you can order it directly thru them or not. Would be better if you could, IMHO, since Sanesco interprets it and does a report based on which of their supplements would work best per the test results. The HPA Profile is the test you want. If you don't care about the cortisol and DHEA, you can get the HP Profile. These are saliva tests - no blood needed. There is some controversy as to whether saliva reflects true bodily values but it's the only testing available to the majority of us. You can look at neurolabtory.net for more info on the tests. Any medical professional can order them including a chiropractor or acupuncturist but you do need a medical professional to accept the results.
Be aware, my acupuncturist charges me at his cost plus like $10 which is about 1/2 what another doctor charged for it. My acupuncturist isn't interested in making money off these tests while many others are.
Posted by MatthewDavid on April 2, 2011, at 8:10:00
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety, posted by Diana_in_CA on March 31, 2011, at 22:50:35
Thank you so Much!
Posted by MatthewDavid on April 2, 2011, at 13:12:45
In reply to Re: 'Norepinephrine Syndrome' The Cause of my Anxiety, posted by Diana_in_CA on March 31, 2011, at 22:50:35
I saw this has to be ordered by a dr, what was the approximate cost whe you ordered the test and results?
thanks,
This is the end of the thread.
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