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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by addinbc on May 25, 2006, at 2:54:39
I am really in need of some moral support here please :)
I am giving Reboxetine another try. My initial response to the drug after a couple of days on it was great! I had energy, and felt really really good! That disappeared the next day, and I seemed to be getting more depressed on it.
I lowered the dose, and am now only taking 2mg in the morning. By the evening, I am noticing that my head is calmer (just like it was on the Strattera that worked so well for my depression/ADD). However, the lowered mood is still there. It is just bearable, and I can stand it for a little while longer if there is hope that it will improve with time.
Please....does anyone know if this can happen with NARI's? Is it worth sticking it out for a little while? So far, I am liking the help I am getting from it for the ADD, and would love it to work like the Strattera did (until it pooped out on me), but would like some idea on whether it is worth it to stay on it...is it possible that the initial response I had to it will return once I am better used to the drug?
Thank you!
Posted by SLS on May 25, 2006, at 7:33:48
In reply to Could initial response come back?, posted by addinbc on May 25, 2006, at 2:54:39
> I am really in need of some moral support here please :)
>
> I am giving Reboxetine another try. My initial response to the drug after a couple of days on it was great! I had energy, and felt really really good! That disappeared the next day, and I seemed to be getting more depressed on it.
I wouldn't presume to be able to predict with certainty how you will respond to reboxetine.My experience with it was negative. It made my depression worse and produced suicidal ideation within the first two weeks. I decided that the degree of worsening was far too much to justify continuing with the drug.
Sometimes, an initial brief improvement seen within the first week is an indicator of an eventual positive response. Reboxetine might yet prove effective for you.
Right now, my opinion of reboxetine is unfavorable. My first reaction to your described experience is that reboxetine will continue to make your depression worse and perhaps even introduce anxiety that was previously absent. I hope I'm wrong. The only way to know for sure is to titrate gradually up to 6-8mg and remain at that dosage for several weeks. If you respond quickly to a lower dosage, that's great. Hopefully, the improvements you see with ADD symptoms will continue.
Today, I encourage you to continue with reboxetine. Other people have had success with it. You will have to evaluate on a day by day basis whether or not the drug is producing a significant worsening of your condition. If it is not, then you will need to be as patient with this drug as you would be with any other antidepressant. Even in an ideal scenario, one would not expect to see a true antidepressant response for 2-3 weeks. It is likely that it will take longer than that.
- Scott
Posted by bassman on May 25, 2006, at 7:33:53
In reply to Could initial response come back?, posted by addinbc on May 25, 2006, at 2:54:39
Several people on this board have mentioned exactly your response to all sorts of psychoactive drugs-and immediate positive effect followed by fatigue, depression, etc. after the first day or so. I start off very low on meds (because I'm a Big Chicken) to try and avoid that effect. Then I increase the dose as I feel my body is getting used to the drug. That makes the period before the drug can be evaluated as useful or not longer, of course, but I find it worthwhile. Maybe that will work you-I sure hope so!
Posted by blueberry on May 25, 2006, at 17:01:05
In reply to Could initial response come back?, posted by addinbc on May 25, 2006, at 2:54:39
I have experienced that phenomenon myself and have seen it many times with other people. There are a good couple days, followed by worsening. This is just a theory, but this is what I think happens...
At first the increased norepinephrine is sensed by the receiving receptors and it feels good. The feedback mechanism doesn't kick in right away, but after a day or two it figures out there is a lot of extra NE and it kicks in shutting down the production of any more NE release. That's when the bad mood hits. After a few more weeks, the feedback mechanism readjusts to the higher levels of NE, and everything returns to the way it was, except that now there is a lot more NE than before starting the med, and hopefully by that point the good mood returns. But since we are all different, maybe the feedback mechanism will not fully readjust and will stay in slow motion. Don't know. Just a theory.
When my mood has plummetted really bad after a few days on a med, following a couple good days, it was so bad that I could not continue.
Starting with ultralow doses and moving up in very tiny steps might help. But that takes a lot longer.
Posted by SLS on May 25, 2006, at 17:32:35
In reply to Re: Could initial response come back?, posted by blueberry on May 25, 2006, at 17:01:05
It may be that the loss of the initial improvement that is sometimes seen within the first week of treatment is the result of accomodation at the postsynaptic neuron rather than the induction of a negative feedback loop presynaptically. Once the concentration of synaptic neurotransmitter reaches a certain threshold, the postsynaptic membrane remains depolarized and can no longer propogate a signal. After a few weeks, the downregulation of postsynaptic receptors allows for repolarization and the production of an action potential.
- Scott
> I have experienced that phenomenon myself and have seen it many times with other people. There are a good couple days, followed by worsening. This is just a theory, but this is what I think happens...
>
> At first the increased norepinephrine is sensed by the receiving receptors and it feels good. The feedback mechanism doesn't kick in right away, but after a day or two it figures out there is a lot of extra NE and it kicks in shutting down the production of any more NE release. That's when the bad mood hits. After a few more weeks, the feedback mechanism readjusts to the higher levels of NE, and everything returns to the way it was, except that now there is a lot more NE than before starting the med, and hopefully by that point the good mood returns. But since we are all different, maybe the feedback mechanism will not fully readjust and will stay in slow motion. Don't know. Just a theory.
>
> When my mood has plummetted really bad after a few days on a med, following a couple good days, it was so bad that I could not continue.
>
> Starting with ultralow doses and moving up in very tiny steps might help. But that takes a lot longer.
This is the end of the thread.
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