![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Angela5 on June 15, 2000, at 17:33:35
I was on Prozac for 4 years, taking 60 mg/day for the last year. Around Jan. of this year, it seemed to not be working as well (this had happened before and the dosage had been increased, which had helped), but my main complaints were lack of focus and concentration to such a degree that I felt like I couldn't perform job functions because they were too frustrating, and stopped going to work. This feeling wasn't new, but was coming out again after being in a (another)new job for about 3 months.
I began to see a new doctor (I relocated for this job), and he first tried augmenting Prozac with Neurontin, since he thought it may be atypical bipolar as opposed to ADD. This caused some weird side effects, especially with my eyes/vision, so it was stopped quickly.
I then went off Prozac gradually, going to Serzone, eventually up to 450 mg/day with 10 mg/day of Ritalin. I began crying over all kinds of things, and felt like I could only experience calmness and sadness. I only wanted to sleep and my body ached.
I gradually went off serzone, continuing the Ritalin, since it had seemed to help focus a little, although I still couldn't work on any type of reliable basis. My doctor then wanted me to try Celexa, which I did. However, in just the few days that I took it, it seemed to worsen a tightness in my chest that I have been experiencing since a few days after going off the Serzone (but continuing the Ritalin). My crying spells have continued, and I went back on short term disability at work, since I can't be there without extreme anxiety and bursting into tears (only slightly worse than when on Serzone).
I haven't taken anything for a couple days, and now my doctor wants me to try Effexor, since it is known to help improve symptoms in just a few days as opposed to weeks, but the side effects look scary, and I am of course wary of continually trying this stuff, although I guess there is no other choice.
I almost want to go back on Prozac, since at least I didn't feel nearly this bad and non-functional, even if I did still have the inattentional problems, anxiety, and irritability. My doctor thinks there is probably a better drug out there for me, but I don't know how to go on feeling this way and trying things from this state.
I don't know what I'm asking here. I'm not sure if I'm confused about trying to go back on Prozac vs. trying Effexor, or if I'm looking for other options (which I know I can only get from my doctor), or maybe I'm just looking for support? Thanks to anyone who can respond. I don't really know anyone where I live, so I don't really have anyone to talk to about this.
Posted by Cindy W on June 15, 2000, at 22:00:30
In reply to Prozac to Serzone/Ritalin to Celexa to Effexor XR, posted by Angela5 on June 15, 2000, at 17:33:35
> I was on Prozac for 4 years, taking 60 mg/day for the last year. Around Jan. of this year, it seemed to not be working as well (this had happened before and the dosage had been increased, which had helped), but my main complaints were lack of focus and concentration to such a degree that I felt like I couldn't perform job functions because they were too frustrating, and stopped going to work. This feeling wasn't new, but was coming out again after being in a (another)new job for about 3 months.
> I began to see a new doctor (I relocated for this job), and he first tried augmenting Prozac with Neurontin, since he thought it may be atypical bipolar as opposed to ADD. This caused some weird side effects, especially with my eyes/vision, so it was stopped quickly.
> I then went off Prozac gradually, going to Serzone, eventually up to 450 mg/day with 10 mg/day of Ritalin. I began crying over all kinds of things, and felt like I could only experience calmness and sadness. I only wanted to sleep and my body ached.
> I gradually went off serzone, continuing the Ritalin, since it had seemed to help focus a little, although I still couldn't work on any type of reliable basis. My doctor then wanted me to try Celexa, which I did. However, in just the few days that I took it, it seemed to worsen a tightness in my chest that I have been experiencing since a few days after going off the Serzone (but continuing the Ritalin). My crying spells have continued, and I went back on short term disability at work, since I can't be there without extreme anxiety and bursting into tears (only slightly worse than when on Serzone).
> I haven't taken anything for a couple days, and now my doctor wants me to try Effexor, since it is known to help improve symptoms in just a few days as opposed to weeks, but the side effects look scary, and I am of course wary of continually trying this stuff, although I guess there is no other choice.
> I almost want to go back on Prozac, since at least I didn't feel nearly this bad and non-functional, even if I did still have the inattentional problems, anxiety, and irritability. My doctor thinks there is probably a better drug out there for me, but I don't know how to go on feeling this way and trying things from this state.
> I don't know what I'm asking here. I'm not sure if I'm confused about trying to go back on Prozac vs. trying Effexor, or if I'm looking for other options (which I know I can only get from my doctor), or maybe I'm just looking for support? Thanks to anyone who can respond. I don't really know anyone where I live, so I don't really have anyone to talk to about this.Angela5, people are all different, but will let you know my experiences. I took Prozac for l0 years, and after a while, it didn't help the OCD or the depression, even at 60 or 80 mg/day. Then I tried Serzone, which helped my depression and social anxiety but not OCD. The weird emotions lasted for me for about 2 weeks, then I felt great. But it didn't help my OCD, so my pdoc added Luvox, which made me unable to get aroused or climax (also a problem with Prozac but not Serzone). Then, tried Zoloft, which made me a zombie and asexual. Next, went to Effexor-XR and have been quite happy with it. The only side effects I have experienced were some dizziness, at first, and some insomnia. The dizziness went away after a few weeks. The insomnia went away after I started taking Serzone 50 mg/night. My current dose is 375 mg/day of Effexor-XR. A lot of people have written about Effexor-XR so you might want to search the archives. Best wishes!
Posted by JohnL on June 16, 2000, at 4:12:40
In reply to Prozac to Serzone/Ritalin to Celexa to Effexor XR, posted by Angela5 on June 15, 2000, at 17:33:35
Angela5,
Wow, that is deeply frustrating. I've been in your shoes exactly and I know what a nightmare it is.I would normally suggest continuing medication trials under a speeded up process of sampling this and sampling that for one to two weeks each. The purpose is to increase the odds of stumbling onto something that is perfect for one's own unique chemistry (noted by quick response, few side effects) or to gather clues needed to understand what chemistry we're dealing with in order to make more refined med choices in the future.
That's what I would normally do myself. BUT like I said, I've been in your shoes. And in that situation, I found personally the best thing for me to do was return to stability, regain some footing, and then try something new again with renewed vigor. In other words, in your shoes, I probably would start the Prozac again, maybe just for a couple weeks, just to get stable. We already know from your past experience that it isn't the ideal med, but at least it provides a temporary place to rest, regain strength, and then move on. When I've returned to a previous med just because I needed a rest and I needed functional stability, I never did it with the intention of staying with it indefinitely. It was always with the approach that it would be a stepping stone to something better. Sometimes returning to our functional depressed selves is a welcome relief from being in a state of being nonfunctional depressive. Yeah?
Effexor by the way can and has been combined with Prozac. It doesn't have to be a one or the other proposition. I know most doctors would say combining them doesn't make any sense, because they do the same thing. But that's not true. There is a girl named Racer who used to hang out here a lot. She was suicidally depressed for quite a while with Effexor ongoing. She added Prozac to it and improved dramatically in days. It was astonishing. Anyone that was here at the time can remember, there were posts like "Whew!". It was such a relief to see her get better so fast. It was the combination of Prozac and Effexor that did it. And in Dr Bob's 'Tips' there is a case of another patient who did the same thing while self medicating with leftover prescriptions.
I'm not suggesting directly that you try Effexor + Prozac. I am suggesting that once you return to Prozac just for stability and relief from the whole thing, then adding in Effexor might be something to try, because it has worked before. Or Desipramine, Nortriptyline, small dose Lithium, overseas Adrafinil, or a host of other things that target different chemistries. You could consider Prozac as your 'home base', from which you can venture out and try other things, always keeping one foot near the front door of home base, just in case. At least that way you might be able to remain stable and functional for long enough periods to explore other medications. I don't know, I guess there are a bunch of different ways to deal with your situation, and everybody has a way they prefer, and I'm just sharing what I would, and have, done in your shoes. I hope you might find something here helpful.
Whatever you do, I sure am wishing you a smooth day. Hang in there. If you were a boxer, I would be in your corner!
JohnL
Posted by Angela5 on June 16, 2000, at 12:46:27
In reply to Re: Prozac to Serzone/Ritalin to Celexa to Effexor XR, posted by JohnL on June 16, 2000, at 4:12:40
Thanks for the responses, Cindy and John. John, I see what you mean about Prozac. My doctor cautions against going back on it due to the long half-life; he says I probably wouldn't feel better on it for about 2-3 wks, and also, the half-life being an issue for going off of it again. Given that, do you think I can really use Prozac as a baseline? I'd like to - I definitely need some help, and I don't want to keep crying constantly.Furthermore, since I'm on short-term disability right now, I can't really afford to stay where I am at. I can't figure out if I should try to find new living conditions here, i.e. a roomate in my house or elsewhere (which I am afraid would make things worse) or if I should move back to Illinois with my family. The way that they are, that could very well make things even worse than I can imagine, but at least I wouldn't be alone. I also don't know if I'll ever really be able to return to this particular job, when (hopefully?) I can work again, due to all of the factors there. I already tried to return to work once and failed. How do you make a decision like this when you can't even manage to pack your stuff for 10 minutes at a time without being overwhelmed? Can I really go live with people who don't understand and think it will all get better if I just "deal with it" and maybe take some fish oil (side issue, I guess)? Can I survive alone and without any friends, though? Unfortunately, I can't really postpone the decision, and I have to do something. Anyone have any personal experiences?
Posted by Jonathan on June 17, 2000, at 20:11:01
In reply to Prozac to Serzone/Ritalin to Celexa to Effexor XR, posted by Angela5 on June 15, 2000, at 17:33:35
> I was on Prozac for 4 years, taking 60 mg/day for the last year. Around Jan. of this year, it seemed to not be working as well (this had happened before and the dosage had been increased, which had helped), but my main complaints were lack of focus and concentration to such a degree that I felt like I couldn't perform job functions because they were too frustrating, and stopped going to work. This feeling wasn't new, but was coming out again after being in a (another)new job for about 3 months.
> I began to see a new doctor (I relocated for this job), and he first tried augmenting Prozac with Neurontin, since he thought it may be atypical bipolar as opposed to ADD. This caused some weird side effects, especially with my eyes/vision, so it was stopped quickly.
> I then went off Prozac gradually, going to Serzone, eventually up to 450 mg/day with 10 mg/day of Ritalin. I began crying over all kinds of things, and felt like I could only experience calmness and sadness. I only wanted to sleep and my body ached.
> I gradually went off serzone, continuing the Ritalin, since it had seemed to help focus a little, although I still couldn't work on any type of reliable basis. My doctor then wanted me to try Celexa, which I did. However, in just the few days that I took it, it seemed to worsen a tightness in my chest that I have been experiencing since a few days after going off the Serzone (but continuing the Ritalin). My crying spells have continued, and I went back on short term disability at work, since I can't be there without extreme anxiety and bursting into tears (only slightly worse than when on Serzone).
> I haven't taken anything for a couple days, and now my doctor wants me to try Effexor, since it is known to help improve symptoms in just a few days as opposed to weeks, but the side effects look scary, and I am of course wary of continually trying this stuff, although I guess there is no other choice.
> I almost want to go back on Prozac, since at least I didn't feel nearly this bad and non-functional, even if I did still have the inattentional problems, anxiety, and irritability. My doctor thinks there is probably a better drug out there for me, but I don't know how to go on feeling this way and trying things from this state.
> I don't know what I'm asking here. I'm not sure if I'm confused about trying to go back on Prozac vs. trying Effexor, or if I'm looking for other options (which I know I can only get from my doctor), or maybe I'm just looking for support? Thanks to anyone who can respond. I don't really know anyone where I live, so I don't really have anyone to talk to about this.Hello Angela.
Your symptoms sound very much like mine, especially the lack of focus
and concentration while taking Prozac, the failure of serotonin reuptake
inhibitors to stop you feeling depressed, and constantly wanting to sleep.
I wouldn't advise you to try Effexor next: it didn't work for me as an
antidepressant, it made my fatigue and inattention problems more serious,
and coming off it was worse than stopping Prozac (though nothing like
as bad as some patients have reported -- see the many posts here and on
www.rxlist.com/rxboard/effexor.pl). Of course, we're all different,
so Effexor just might be right for you, but there are other drugs that
I recommend you should try first because they're more likely to work.Effexor is also unlikely to work quickly for you, because your serotonin
transporters are already adapted to Celexa. It's usual to start with a
low dose (75mg/day) of Effexor and then increase over a month or more to
225mg/day or higher. The low starting dose behaves very much like a low
dose (say 20mg) of Prozac, only significantly blocking serotonin reuptake,
so if Prozac has stopped working for you at 60mg you'd probably have to
wait for the higher dose of Effexor before having much hope of it doing
you any good. At higher doses the weaker inhibition of noradrenaline
reuptake, and still weaker of dopamine reuptake, begin to kick in.
However, I suspect that you might do better to try something that affects
noradrenaline, or possibly dopamine, without raising serotonin levels.Since coming off Effexor in April I've been taking reboxetine (Edronax in
Europe, Vestra in the USA) for the past two months. This does work for me,
though slowly -- it's still too early to say whether it will cure my
inattention problem to the extent that I'll be able to work normally,
or whether I'll need psychological therapy and/or other medication.
Before reboxetine I couldn't have posted this and I've recently been able,
for the first time in the past year, to read a work-related scientific paper
to the end: before I would read the first few pages and then have to keep
going back and starting from the beginning, because I just couldn't hold
enough of what I had read in my mind to make sense of what followed.
It definitely works for me as an antidepressant: I coped better with the
disaster of losing my job a couple of weeks ago than with minor upsets
like having to pay fines on overdue library books when I was on Effexor!I see from a later post that you're thinking of moving back home to Illinois,
so you're probably elsewhere in the USA now. The bad news is that the FDA
still hasn't approved reboxetine, though you can legally order it from abroad
with a prescription from your doctor. It should be available soon, but in the
meantime the drug that I'd guess is most likely to work for you is desipramine.In the seventies, before Prozac and other SSRIs, the most benign
antidepressants belonged to a group called tricyclics. A useful rule of
thumb for deciding which of the two most popular tricyclics to prescribe
was that patients with symptoms like yours and mine -- fatigue, hypersomnia,
etc. -- were more likely to respond to imipramine whilst the majority, for
whom early morning insomnia was more of a problem, were given amitryptilene
(though lazy prescribers just tried amitryptilene first for every patient).
We now know that amitryptilene, like Effexor, inhibits reuptake of serotonin
more than noradrenaline, whilst SSRIs have almost no effect on noradrenaline.
Imipramine, however, blocks reuptake of noradrenaline more than serotonin;
desipramine, available then but only for research, is even more selective.
Reboxetine is a new(ish) noradrenaline reuptake inhibitor (NARI) with fewer
side effects than a tricyclic on other neurotransmitters like acetylcholine:
the anticholinergic action of desipramine may make it less suitable than
reboxetine for someone with inattention and memory problems. It's the same
kind of improvement over desipramine that SSRIs are over amitryptilene.
Although reboxetine is only used as an antidepressant, a closely related
NARI called tomoxetine is currently undergoing clinical trials for ADD.Another antidepressant you might like to try is bupropion (Wellbutrin),
which has been used to treat both SSRI-induced fatigue and ADHD.
I don't know much about it -- it will be available here in England soon,
but not for depression: the only way I can try it is to find an anti-emetic
so powerful that it will enable me to deceive my GP that I, a lifelong
non-smoker whom the smell of tobacco smoke makes physically sick, am a
compulsive smoker desperate to give up :) Its merit is that, like
reboxetine and desipramine, it has no effect on serotonin levels:
I suspect that raised serotonin levels may exacerbate the inattention
problems of depression in a minority of susceptible people like us.
Bupropion seems to inhibit the reuptake of both noradrenaline and dopamine.
There are theoretical reasons why I'd prefer a NARI to bupropion if I
could choose, though I'm not sure which I'd try first out of bupropion
and desipramine.My own depression started after a fall in which I fractured my right cheekbone
a year and a half ago. By far the most frustrating symptom was my total
inability to cope with even the simplest decision; this made me miss the
deadline for a conference paper I was writing, an upset I took rather badly.
Prozac seemed to control the depression, or perhaps I just had a spontaneous
partial remission, until I missed another conference deadline just before
Christmas and the depressive symptoms came back. This was what made the
consultant put me on venlafaxine for four months, which proved disastrous:
I was sleeping twelve hours or more each day and had the attention span of
a goldfish.Although Prozac may have alleviated the depression it did nothing for my
writer's block. Decisions remained almost as difficult as when I was most
depressed, and I developed additional problems in concentrating and putting
thoughts into words. The latter were subjectively quite different from the
attention problems I experienced when depressed but before starting Prozac:
I'm convinced that Prozac was part of the cause, and that Effexor made these
problems much worse.The most obvious thing that Prozac and Effexor have in common is that both
inhibit serotonin reuptake: at the doses I was taking -- 20 mg/day Prozac
vs. 225 mg/day Effexor -- Effexor is the stronger SRI. I know that this
doesn't prove conclusively that my attentional problems were caused by
serotonin, but it was enough to make me determined to try an antidepressant
that doesn't raise serotonin levels, like reboxetine, before another SRI.
Obviously most patients seem not to have this problem with SRIs but
there's evidence that some of us do, including me and, it appears, you.
The added evidence that reboxetine seems to be working makes me suggest
that you try it, or desipramine or bupropion, before yet another drug
that increases serotonin levels, as Prozac, Celexa and Serzone all do.Here's how I tried to cope with the problem of getting back to work,
until it became too late and I lost the job at the end of last month.
I had a sympathetic GP who was willing to write a sick note for me any
time I needed it, but advised me that it would be better for my recovery
if I tried to go in. This meant that I was technically on sick leave
(or could be if I so wished), so that any work I did, however little,
was an unexpected bonus for my employer.Similarly, you can use your time on short-term disability as an opportunity
to ease yourself back into work, protected by the knowledge that you don't
have to worry about failing to meet your employer's expectations because
they have no right to expect any work from you. There are probably some
aspects of your job which you can still do well, so start with these.My immediate boss was very supportive, helping to remove possible sources
of stress, such as deadlines and meetings with well-meaning but insensitive
collaborators, except my impending redundancy which was beyond his control.
He also allowed me to work at home most of the time -- I'm lucky in that
95% of my work can be done at home. I have mixed feelings about this now:
home is a better place for getting things done but the more I stayed away,
the harder it became to go back. One thing that helped me was going in at
about 7 pm, planning to stay an hour but often running for the last train
home at 11:30, when almost no-one else was around except Security. I found
this easier than going during the day when I was certain to meet colleagues,
and my confidence got a boost from meeting busy people who were working late
and from handling this better than I'd have expected.Please don't give up just because you tried once to go to work and couldn't.
The fact that you applied successfully this job and relocated so recently --
something I couldn't have dealt with -- proves that the job must mean a lot
to you and that you have the strength to go back.Good luck, Angela, and please let us know how you get on.
Best wishes,
Jonathan.
Posted by Angela5 on June 18, 2000, at 1:41:10
In reply to Re: Prozac to Serzone/Ritalin to Celexa to Effexor XR » Angela5, posted by Jonathan on June 17, 2000, at 20:11:01
Jonathan -
Thank you so much for your post and support; I really need that support right about now, as you were able to tell. I will write you a post in more detail later - as I know you understand, I just don't feel like writing at the moment. Thanks again - you reminded me of a perspective on my job that I sometimes forget.
Thanks so much,
Angela
Posted by KarenRB53 on August 11, 2008, at 13:52:58
In reply to Re: Prozac to Serzone/Ritalin to Celexa to Effexor XR » Angela5, posted by Jonathan on June 17, 2000, at 20:11:01
> > I was on Prozac for 4 years, taking 60 mg/day for the last year. Around Jan. of this year, it seemed to not be working as well (this had happened before and the dosage had been increased, which had helped), but my main complaints were lack of focus and concentration to such a degree that I felt like I couldn't perform job functions because they were too frustrating, and stopped going to work. This feeling wasn't new, but was coming out again after being in a (another)new job for about 3 months.
> > I began to see a new doctor (I relocated for this job), and he first tried augmenting Prozac with Neurontin, since he thought it may be atypical bipolar as opposed to ADD. This caused some weird side effects, especially with my eyes/vision, so it was stopped quickly.
> > I then went off Prozac gradually, going to Serzone, eventually up to 450 mg/day with 10 mg/day of Ritalin. I began crying over all kinds of things, and felt like I could only experience calmness and sadness. I only wanted to sleep and my body ached.
> > I gradually went off serzone, continuing the Ritalin, since it had seemed to help focus a little, although I still couldn't work on any type of reliable basis. My doctor then wanted me to try Celexa, which I did. However, in just the few days that I took it, it seemed to worsen a tightness in my chest that I have been experiencing since a few days after going off the Serzone (but continuing the Ritalin). My crying spells have continued, and I went back on short term disability at work, since I can't be there without extreme anxiety and bursting into tears (only slightly worse than when on Serzone).
> > I haven't taken anything for a couple days, and now my doctor wants me to try Effexor, since it is known to help improve symptoms in just a few days as opposed to weeks, but the side effects look scary, and I am of course wary of continually trying this stuff, although I guess there is no other choice.
> > I almost want to go back on Prozac, since at least I didn't feel nearly this bad and non-functional, even if I did still have the inattentional problems, anxiety, and irritability. My doctor thinks there is probably a better drug out there for me, but I don't know how to go on feeling this way and trying things from this state.
> > I don't know what I'm asking here. I'm not sure if I'm confused about trying to go back on Prozac vs. trying Effexor, or if I'm looking for other options (which I know I can only get from my doctor), or maybe I'm just looking for support? Thanks to anyone who can respond. I don't really know anyone where I live, so I don't really have anyone to talk to about this.
>
> Hello Angela.
>
> Your symptoms sound very much like mine, especially the lack of focus
> and concentration while taking Prozac, the failure of serotonin reuptake
> inhibitors to stop you feeling depressed, and constantly wanting to sleep.
> I wouldn't advise you to try Effexor next: it didn't work for me as an
> antidepressant, it made my fatigue and inattention problems more serious,
> and coming off it was worse than stopping Prozac (though nothing like
> as bad as some patients have reported -- see the many posts here and on
> www.rxlist.com/rxboard/effexor.pl). Of course, we're all different,
> so Effexor just might be right for you, but there are other drugs that
> I recommend you should try first because they're more likely to work.
>
> Effexor is also unlikely to work quickly for you, because your serotonin
> transporters are already adapted to Celexa. It's usual to start with a
> low dose (75mg/day) of Effexor and then increase over a month or more to
> 225mg/day or higher. The low starting dose behaves very much like a low
> dose (say 20mg) of Prozac, only significantly blocking serotonin reuptake,
> so if Prozac has stopped working for you at 60mg you'd probably have to
> wait for the higher dose of Effexor before having much hope of it doing
> you any good. At higher doses the weaker inhibition of noradrenaline
> reuptake, and still weaker of dopamine reuptake, begin to kick in.
> However, I suspect that you might do better to try something that affects
> noradrenaline, or possibly dopamine, without raising serotonin levels.
>
> Since coming off Effexor in April I've been taking reboxetine (Edronax in
> Europe, Vestra in the USA) for the past two months. This does work for me,
> though slowly -- it's still too early to say whether it will cure my
> inattention problem to the extent that I'll be able to work normally,
> or whether I'll need psychological therapy and/or other medication.
> Before reboxetine I couldn't have posted this and I've recently been able,
> for the first time in the past year, to read a work-related scientific paper
> to the end: before I would read the first few pages and then have to keep
> going back and starting from the beginning, because I just couldn't hold
> enough of what I had read in my mind to make sense of what followed.
> It definitely works for me as an antidepressant: I coped better with the
> disaster of losing my job a couple of weeks ago than with minor upsets
> like having to pay fines on overdue library books when I was on Effexor!
>
> I see from a later post that you're thinking of moving back home to Illinois,
> so you're probably elsewhere in the USA now. The bad news is that the FDA
> still hasn't approved reboxetine, though you can legally order it from abroad
> with a prescription from your doctor. It should be available soon, but in the
> meantime the drug that I'd guess is most likely to work for you is desipramine.
>
> In the seventies, before Prozac and other SSRIs, the most benign
> antidepressants belonged to a group called tricyclics. A useful rule of
> thumb for deciding which of the two most popular tricyclics to prescribe
> was that patients with symptoms like yours and mine -- fatigue, hypersomnia,
> etc. -- were more likely to respond to imipramine whilst the majority, for
> whom early morning insomnia was more of a problem, were given amitryptilene
> (though lazy prescribers just tried amitryptilene first for every patient).
> We now know that amitryptilene, like Effexor, inhibits reuptake of serotonin
> more than noradrenaline, whilst SSRIs have almost no effect on noradrenaline.
> Imipramine, however, blocks reuptake of noradrenaline more than serotonin;
> desipramine, available then but only for research, is even more selective.
> Reboxetine is a new(ish) noradrenaline reuptake inhibitor (NARI) with fewer
> side effects than a tricyclic on other neurotransmitters like acetylcholine:
> the anticholinergic action of desipramine may make it less suitable than
> reboxetine for someone with inattention and memory problems. It's the same
> kind of improvement over desipramine that SSRIs are over amitryptilene.
> Although reboxetine is only used as an antidepressant, a closely related
> NARI called tomoxetine is currently undergoing clinical trials for ADD.
>
> Another antidepressant you might like to try is bupropion (Wellbutrin),
> which has been used to treat both SSRI-induced fatigue and ADHD.
> I don't know much about it -- it will be available here in England soon,
> but not for depression: the only way I can try it is to find an anti-emetic
> so powerful that it will enable me to deceive my GP that I, a lifelong
> non-smoker whom the smell of tobacco smoke makes physically sick, am a
> compulsive smoker desperate to give up :) Its merit is that, like
> reboxetine and desipramine, it has no effect on serotonin levels:
> I suspect that raised serotonin levels may exacerbate the inattention
> problems of depression in a minority of susceptible people like us.
> Bupropion seems to inhibit the reuptake of both noradrenaline and dopamine.
> There are theoretical reasons why I'd prefer a NARI to bupropion if I
> could choose, though I'm not sure which I'd try first out of bupropion
> and desipramine.
>
> My own depression started after a fall in which I fractured my right cheekbone
> a year and a half ago. By far the most frustrating symptom was my total
> inability to cope with even the simplest decision; this made me miss the
> deadline for a conference paper I was writing, an upset I took rather badly.
> Prozac seemed to control the depression, or perhaps I just had a spontaneous
> partial remission, until I missed another conference deadline just before
> Christmas and the depressive symptoms came back. This was what made the
> consultant put me on venlafaxine for four months, which proved disastrous:
> I was sleeping twelve hours or more each day and had the attention span of
> a goldfish.
>
> Although Prozac may have alleviated the depression it did nothing for my
> writer's block. Decisions remained almost as difficult as when I was most
> depressed, and I developed additional problems in concentrating and putting
> thoughts into words. The latter were subjectively quite different from the
> attention problems I experienced when depressed but before starting Prozac:
> I'm convinced that Prozac was part of the cause, and that Effexor made these
> problems much worse.
>
> The most obvious thing that Prozac and Effexor have in common is that both
> inhibit serotonin reuptake: at the doses I was taking -- 20 mg/day Prozac
> vs. 225 mg/day Effexor -- Effexor is the stronger SRI. I know that this
> doesn't prove conclusively that my attentional problems were caused by
> serotonin, but it was enough to make me determined to try an antidepressant
> that doesn't raise serotonin levels, like reboxetine, before another SRI.
> Obviously most patients seem not to have this problem with SRIs but
> there's evidence that some of us do, including me and, it appears, you.
> The added evidence that reboxetine seems to be working makes me suggest
> that you try it, or desipramine or bupropion, before yet another drug
> that increases serotonin levels, as Prozac, Celexa and Serzone all do.
>
> Here's how I tried to cope with the problem of getting back to work,
> until it became too late and I lost the job at the end of last month.
> I had a sympathetic GP who was willing to write a sick note for me any
> time I needed it, but advised me that it would be better for my recovery
> if I tried to go in. This meant that I was technically on sick leave
> (or could be if I so wished), so that any work I did, however little,
> was an unexpected bonus for my employer.
>
> Similarly, you can use your time on short-term disability as an opportunity
> to ease yourself back into work, protected by the knowledge that you don't
> have to worry about failing to meet your employer's expectations because
> they have no right to expect any work from you. There are probably some
> aspects of your job which you can still do well, so start with these.
>
> My immediate boss was very supportive, helping to remove possible sources
> of stress, such as deadlines and meetings with well-meaning but insensitive
> collaborators, except my impending redundancy which was beyond his control.
> He also allowed me to work at home most of the time -- I'm lucky in that
> 95% of my work can be done at home. I have mixed feelings about this now:
> home is a better place for getting things done but the more I stayed away,
> the harder it became to go back. One thing that helped me was going in at
> about 7 pm, planning to stay an hour but often running for the last train
> home at 11:30, when almost no-one else was around except Security. I found
> this easier than going during the day when I was certain to meet colleagues,
> and my confidence got a boost from meeting busy people who were working late
> and from handling this better than I'd have expected.
>
> Please don't give up just because you tried once to go to work and couldn't.
> The fact that you applied successfully this job and relocated so recently --
> something I couldn't have dealt with -- proves that the job must mean a lot
> to you and that you have the strength to go back.
>
> Good luck, Angela, and please let us know how you get on.
>
> Best wishes,
>
> Jonathan.
>Hi Jonathan: I know this is an old post but was wondering if you're still taking the reboxetine and are you still doing well on it? I have been on Prozac for many years and its stopped working and have tried several other AD's but none are working and my symptoms are very similiar to yours. Thanks for any suggestions you might wish to share.
Karen
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.