Posted by JohnL on August 21, 2000, at 5:27:02
In reply to Hostile looks/ irritability/anxiety on Reboxetine, posted by acer on August 21, 2000, at 0:40:15
Interesting post Acer. You pose some difficult questions.
Not only in your country, but I think anywhere in the world we would have a hard time trying to find a pdoc who has expertise in combining Rebox with other meds. It's just still relatively new.
Of the SSRIs, Celexa is probably the cleanest in terms of having the fewest interactions with other meds. But if you think it will be metabolized by the same enzymes as Reboxetine, what that means is you'll need reduced dosages of each. The interaction they might have is characterized by an increased blood level of the med. Just as an off the wall example, say for example 10mg Celexa is added to ongoing 8mg Rebox. That 8mg Rebox might now be the equivalent of 12mg. Maybe more. Maybe a lot more. Just a guesstimate for an example. The meds don't actually interact, but they slow down the metabolism of each other, causing a higher level of the med in your system and a longer time to dissipate.
Probably the only realistic way is trial and error. Like what you did with Paxil. Maybe your doc might allow you to sample small quantities of several different meds one at a time to see if you can discover a good match. You'll know a good match when you stumble onto it. There will be no doubt.
Whatever dose of Rebox you are taking, could it be maybe that's it's too much? I mean, the motivation is nice, but not the irritability and restlessness. That's indicative of excess norepinephrine.
I wonder also about taking a completely different attack on your symptoms. Something like antipsychotic+stimulant combination. My gut instinct is that this route could be surprisingly effective for all of your symptoms. Sometimes we don't need to raise neurotransmitter levels, but instead either lower them, turbocharge them, or both. That's what this combo will do. Raising neurotransmitter levels I do not think is the right chemistry for you, because if it was, the Parnate would have worked better than it did. And of course, if this is correct, then Rebox and any other neurotransmitter-increasing med won't be right either. I think the clues from the responses to Parnate and Rebox are very very important. I think it is of key importance to note that increasing neurotransmitter levels with Parnate did not work as hoped. Very important clue.
In the back of my mind, the thought of an antipsychotic like Zyprexa, Risperdal, or Amisulpride immediately came to mind when I saw the comment about "hostile looks". I am pretty sure people aren't in fact giving you hostile looks. People just don't walk around picking you out of a crowd and giving you hostile looks. And they don't usually give hostile looks at all. And if they do, they aren't directed just at you. But your eyes are perceiving it that way. That is a slight hint of psychosis and a touch of paranoia perhaps, or as I prefer to say 'excess neurotransmitters' (dopamine, NE, or both). Since you are already initiated in the arena of trying meds not available in your country, I might suggest you take a good look at Amisulpride. It is excellent for all of the symptoms you have. The only tricky part would be trying different dosage levels to fine-tune it. In the same vein, Adrafinil is a great add-on to Amisulpride for added energy and motivation, without all that irritibility.
At first glance, my gut instinct tells me that in your case it could be good to get away from neurotransmitter-increasing meds, and instead focus on other chemistries. Amisulpride more than any other I can think of could be real good for you, especially if combined with a mild stimulant.
Just thinking out loud. Hope something here might be of help.
John
poster:JohnL
thread:43428
URL: http://www.dr-bob.org/babble/20000811/msgs/43439.html