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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by MB on September 2, 2003, at 16:59:47
I had a doctor tell me that the more an antidepressant affects norepinephrine, the better it is at alleviating anxiety. He told me that because Lexapro is so selective for seratonin reuptake pumps, that it wouldn't be as effective an anxiolytic as an antidepressant that blocked reuptake of norepinephrine to some extent (I guess even some of the SSRIs bind to NE transporters to some degree). Has anyone heard of this Norepinephrine-antianxiety connection. In a beginner's psychology class, we learned that too much NE released from the Locus Coeruleus causes anxiety, so I was really surprised when he told me this. He mentioned Effexor, but I've already had a nightmarish experience with *that* drug. He keeps mentioning Remeron. It's my understanding that Remeron sedation/anxiolysis is due to its antihistamine properties, and it seems that when people with anxiety issues reach that magical 45mg dose (where the noradrenergic properties kick in) their anxiety is exacerbated. So am I being too arrogant to think that maybe this doctor is wrong about the increased NE=decreased anxiety. It is a bad pattern of mine to think that I'm smarter than the doctors, and it has alienated me from quite a few. Any input?
MB
Posted by Caleb462 on September 2, 2003, at 23:47:25
In reply to Antidepressants, norepinephrine and efx on anxiety, posted by MB on September 2, 2003, at 16:59:47
> I had a doctor tell me that the more an antidepressant affects norepinephrine, the better it is at alleviating anxiety. He told me that because Lexapro is so selective for seratonin reuptake pumps, that it wouldn't be as effective an anxiolytic as an antidepressant that blocked reuptake of norepinephrine to some extent (I guess even some of the SSRIs bind to NE transporters to some degree).
Your docotor shouldn't be stating this as absolute fact, like everything - it varies from person to person. The only SSRI that binds to the NE transporter with any signifigant affinity is Paxil.
> Has anyone heard of this Norepinephrine-antianxiety connection. In a beginner's psychology class, we learned that too much NE released from the Locus Coeruleus causes anxiety, so I was really surprised when he told me this. He mentioned Effexor, but I've already had a nightmarish experience with *that* drug. He keeps mentioning Remeron. It's my understanding that Remeron sedation/anxiolysis is due to its antihistamine properties, and it seems that when people with anxiety issues reach that magical 45mg dose (where the noradrenergic properties kick in) their anxiety is exacerbated. So am I being too arrogant to think that maybe this doctor is wrong about the increased NE=decreased anxiety. It is a bad pattern of mine to think that I'm smarter than the doctors, and it has alienated me from quite a few. Any input?
>
> MBIt is not neccesarily a bad pattern, I've certainly believed myself to be smarter, or at least more educated about meds, than some doctors - including my current one.
But anyway... increased NE, in the SHORT-TERM, can increase or cause anxiety - yes. However, long-term effects of inhibiting NE reuptake show the opposite effect - decreased anxiety. The NE system "downregulates" in response to all this extra NE.
As for Remeron... I'm skeptical about it's anti-anxiety effect at high doses. Taking a alpha-2 antagonist (which Remeron is), has a strong effect, and seems too much like taking a stimulant on a regular basis. For instance, yohimbine is an alpha-2 antatgonist, but I've never heard anyone touting any anti-anxiety effects from it whether long-term or short-term. Quite the opposite, in fact. But I'm no pharmacologist, and this is just some thinking off the top of my head.
Posted by MB on September 3, 2003, at 1:33:13
In reply to Re: Antidepressants, norepinephrine and efx on anxiety, posted by Caleb462 on September 2, 2003, at 23:47:25
> Your docotor shouldn't be stating this as absolute fact, like everything - it varies from person to person. The only SSRI that binds to the NE transporter with any signifigant affinity is Paxil.
Hmmm, Paxil...interesting. With its affinity to NE transporters and transporter downregulation, I wonder if that is why it was the SSRI that was approved by the FDA to treat GAD. Have any others been approved for GAD (I haven't kept up)? I *did* read in the PDR that there is some NE transporter downregulation with chronic Zoloft treatment. I wonder what the mechanism is. It is the next in line behind Paxil (I looked it up) as far as NE transporter binding goes, but it is still way behind Paxil (looks like it binds to DA transporters before it binds to NE transporters). Maybe it affect NE transporter density indirectly via modulation of the seratonin system. It just goes to show that these systems (the 5HT system, the NE system and the DA systems) are interconnected networks rather than isolated pathways: tinker with one, affect another, etc.
The downregulation thing makes sense, though. That must be why I first felt more anxious on Paxil before it helped the anxiety.> As for Remeron... I'm skeptical about it's anti-anxiety effect at high doses. Taking a alpha-2 antagonist (which Remeron is), has a strong effect, and seems too much like taking a stimulant on a regular basis. For instance, yohimbine is an alpha-2 antatgonist, but I've never heard anyone touting any anti-anxiety effects from it whether long-term or short-term. Quite the opposite, in fact. But I'm no pharmacologist, and this is just some thinking off the top of my head.
I've taken an alpha-2 adrenoceptor agonist before and found it very sedating (I took it to assuage the withdrawal symptoms of stopping methadone). The idea of taking an alpha-2 antagonist gives me piloerection just thinking about it. Yuck.
MB
Posted by Kacy on September 3, 2003, at 17:30:54
In reply to Re: Antidepressants, norepinephrine and efx on anxiety » Caleb462, posted by MB on September 3, 2003, at 1:33:13
I take Straterra. It's an NE reuptake inhibitor. It wasn't prescribed for anxiety, although I do have that problem. It helps a lot.
I told my doctor that it was helping with anxiety. Others posted the same comment here in the early Straterra thread with the same comments and I shared those with him. Here are a couple I saved:
>Posted by ciejae on April 27, 2003, at 8:04:29>I've also noticed that I don't seem to be as afraid of things as I used to be. For instance, it usually drives me crazy to be a passenger in someone else's car. When my husband and I are driving long distances, I'm always nervous about going over bridges, sitting under bridges, driving next to big trucks, driving to close to the car in front of us, etc, etc, etc. Well, now that I think of it, we were driving around the other day, and I don't recall being concerned at all. Isn't that different!
>Also, I've always had a fear of flying (though I have to do it anyway), and for some reason, it's not bothering me lately. Is Strattera ever used as an anti-anxiety drug?
>Posted by teacherkris on April 25, 2003, at 14:19:36>I've now been on Strattera for about two and a half months, three weeks at 80 mg, next week I'll meet with the doc and likely try 100mg to see the difference. I finally went completely off my Concerta two days ago. Although I'm feeling tired I think that's a result of the Concerta withdrawl. I tapered down but my body still needs time to get used to waking up on it's own after 6 years on stims.
>I find that I'm much calmer on strattera. Things that used to bother me (ie noise, traffic, etc) no longer bother me. On Concerta I was able to control the impulses that normally would have led me to lose my temper and complain constantly about things but I was still annoyed by them. However, on Strattera I am simply not bothered by them at all. It's wonderful.
This is the end of the thread.
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