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Dr. Bob is Robert Hsiung, MD,
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Posted by John k on April 21, 2001, at 2:42:55
I wonder if anyone has any experience in adding reboxetine to an SSRI? If so, should the dosage of the SSRI (Zoloft in my case) be lowered before adding the reboxetine (in case reboxetine would increase the blood concentration of Zoloft) and how much reboxetine should I start at? My doctor doesn't have any experience in this but she told me to try 4 mgs per day initially. Is this a good strategy?
Any comments would be greatly appreciatedJohn
Posted by AndrewB on April 22, 2001, at 19:21:55
In reply to Any info on augmentation with reboxetine?, posted by John k on April 21, 2001, at 2:42:55
John,
An SSRI and reboxetine can sometimes be a very effective combination for treatment resistant depression. On one hand the combo can lead to greater mood improvement than either med would alone, but also they can cancel out each other's side effects. For example, the reboxetine may deal with low motivation or concentration induced by an SSRI and an SSRI can deal with a feeling of agitation caused by reboxetine.
Reboxetine is primarily metabolized by the CYP3A4 liver enzyme (CYP). Since sertraline (Zoloft) has no effect or a weak effect on CYP3A4, no significant interaction should be expected beween the two drugs concerning the blood levels of either or their metabolism.
Sunnely suggested that perhaps the most effective SSRI to combine with reboxetine would be Celexa because Celexa is the most selective SSRI.
Sunnely went on to cite a small case study of four treatment-resistant patients that were treated with the combo of Celexa and reboxetine.
Devarajan S, Dursun SM: Citalopram plus reboxetine in treatment-resistant depression (letter to the editor), Canadian Journal of Psychiatry 2000;45:489-490.
Concerning reboxetine dosage, 8mg. to 10mg./day is the effective dosage. However transient side effects are common with reboxetine so it should be titrated up slowly. A conservative approach would be one week at 2mg./day, 2 weeks at 4mg/day, and, if any side effects have subsided, then go up to 8mg/day.
Best wishes,
AndrewB
Posted by John k on April 24, 2001, at 1:34:14
In reply to Re: Any info on augmentation with reboxetine?, posted by AndrewB on April 22, 2001, at 19:21:55
Thanks a lot Andrew!
I certainly did notice some side-effects on a starting dose of 4 mg reboxetine per day (constipation, impotence, anxiety, insomnia)! 2 mg per day, however, seems just fine. I may actually stay at this dosing since it seems to do what I wanted it to do (it's energizing and makes me interested in doing things).
John
This is the end of the thread.
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