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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Tony P on September 23, 2008, at 14:24:59
Does anyone have any experience in substituting Reboxetine for Effexor or Cymbalta, e.g. relative dose/ potency?
I have been on Cymbalta 60 mg/day + Remeron 30 mg/night for several months & became concerned both re continuing weight gain and (I thought) liver pain one night. As I am between pdocs and am having trouble getting in to see my MD, I tapered the Cymbalta to 30 mg./day & started to cut it out altogether (but didn't in the end, just skipped a few days).
To substitute for the lower Cymbalta I tried various meds & supplements, including Reboxetine (Ne agonist) 8 mg/day, SAMe oral .4 - 1.2/day, 5-HTP 100 mg/day, Selegeline 5-10 mg (only on days I took no Cymbalta).
The most consistent one I kept up was the Reboxetine @ 8 mg/day. However, I got progressively more depressed over about 2-3 weeks, started isolating, sleeping a lot, missing commitments etc.
Does anyone have experience with coming off Cymbalta (or Effexor which I presume would be similar) and substituting Reboxetine? The latter is not an ideal solution if I do have to stop the Cymbalta as it's not available in Canada so I'd have to import -- expensive & chancy.
However, apart from the supplements, and Selegeline which is risky in combination, about the only other possibilities are Effexor, which I found gave me very high mid-day anxiety (fairly short trial -- 3 months?), and Cipralex/Lexapro, which was very low in S/E but didn't give me the boost in energy that Cymbalta did.
I'm also wondering if my depression/apathy/hypersomnia in the past week or so might be because I'm taking Seroquel every night (25-50 mg) instead of just occasionally.
Any suggestions?? I see my MD Thursday, if I can force myself out of bed....
Tony P
Posted by azalea on September 23, 2008, at 15:48:33
In reply to Reboxetine vs Effexor, Cymbalta, posted by Tony P on September 23, 2008, at 14:24:59
I don't think Reboxetine would be a good substitute for Cymbalta. Cymbalta inhibits norepinephrine and serotonin reuptake, while reboxetine inhibits norepinephrine reuptake only. Perhaps combining Lexapro + Reboxetine would be a good solution. Kind of like making your own Cymbalta.
Also, are you taking both Seroquel and Remeron at night? This could cause hypersomnia.
Have you tried Wellbutrin (buproprion)? It is generally an energizing anti-depressant, best taken in the morning.
> Does anyone have any experience in substituting Reboxetine for Effexor or Cymbalta, e.g. relative dose/ potency?
>
> I have been on Cymbalta 60 mg/day + Remeron 30 mg/night for several months & became concerned both re continuing weight gain and (I thought) liver pain one night. As I am between pdocs and am having trouble getting in to see my MD, I tapered the Cymbalta to 30 mg./day & started to cut it out altogether (but didn't in the end, just skipped a few days).
>
> To substitute for the lower Cymbalta I tried various meds & supplements, including Reboxetine (Ne agonist) 8 mg/day, SAMe oral .4 - 1.2/day, 5-HTP 100 mg/day, Selegeline 5-10 mg (only on days I took no Cymbalta).
>
> The most consistent one I kept up was the Reboxetine @ 8 mg/day. However, I got progressively more depressed over about 2-3 weeks, started isolating, sleeping a lot, missing commitments etc.
>
> Does anyone have experience with coming off Cymbalta (or Effexor which I presume would be similar) and substituting Reboxetine? The latter is not an ideal solution if I do have to stop the Cymbalta as it's not available in Canada so I'd have to import -- expensive & chancy.
>
> However, apart from the supplements, and Selegeline which is risky in combination, about the only other possibilities are Effexor, which I found gave me very high mid-day anxiety (fairly short trial -- 3 months?), and Cipralex/Lexapro, which was very low in S/E but didn't give me the boost in energy that Cymbalta did.
>
> I'm also wondering if my depression/apathy/hypersomnia in the past week or so might be because I'm taking Seroquel every night (25-50 mg) instead of just occasionally.
>
> Any suggestions?? I see my MD Thursday, if I can force myself out of bed....
>
> Tony P
Posted by ricker on September 23, 2008, at 18:22:05
In reply to Re: Reboxetine vs Effexor, Cymbalta » Tony P, posted by azalea on September 23, 2008, at 15:48:33
Hi Tony,
I've not tried Reboxetine so I can't comment on it...sorry. Daytime anxiety was a problem for me as well on effexor. I was taking 75mg - 2x day. I increase my clonazepam from 0.5mg bid to 0.5mg - 4x day. I was able to reduce the clonazepam back down to 2x day after 3 or 4 months. I tolerated effexor much better than cymbalta over all as far as side effects. I am a "nervous depressive" so I thought the cymbalta would be easy to tolerate, not so for me.
I also take Remeron 15mg and had a pretty good run with the effexor/remeron combo.Regards, Rick
Posted by Tony P on September 24, 2008, at 2:56:47
In reply to Re: Reboxetine vs Effexor, Cymbalta » Tony P, posted by azalea on September 23, 2008, at 15:48:33
> I don't think Reboxetine would be a good substitute for Cymbalta. Cymbalta inhibits norepinephrine and serotonin reuptake, while reboxetine inhibits norepinephrine reuptake only. Perhaps combining Lexapro + Reboxetine would be a good solution. Kind of like making your own Cymbalta.
TP} Lexapro may well be the best choice - v. low side effects when I took it before, except for the usual SSRI sexual S/E.
>
> Also, are you taking both Seroquel and Remeron at night? This could cause hypersomnia.
>
TP} Yes lately I have been taking both Seroquel & Remeron at night - the Remeron seems to have lost some of its sleep-inducing effect, but I also think you're right & the combination (esp. with 50 mg or more Seroquel) is driving the hypersomnia -- I graphed it in Excel and the increase in average Seroquel pretty much mirrored the hypersomnia.> Have you tried Wellbutrin (buproprion)? It is generally an energizing anti-depressant, best taken in the morning.
TP} Yes, tried it several times a few years ago. I like what it does for me, but I am abnormally sensitive to it, so the generally recommended dose (300 mg/day) drives me into full mania (I didn't believe it, but my family let me know - independently - in no uncertain terms that I was acting crazy!) I can tolerate about 25-50 mg/day, maybe 75 mg tops, but it's only available nowadays, in Canada at least, in SR or long-acting dose forms that are larger than that. I tried splitting the tabs, even though you're not supposed to, and that was fairly OK. Still experienced quite a lot of anxiety & insomnia even at low doses. However, maybe it's worth another try. I'll double-check with my pharmacist (who is always very helpful) whether they can get any low dose or splittable short acting tabs.My MD is away but I'm going to see whoever's on duty at his clinic today or tomorrow, and I have an appointment with a government-funded counselor that I hope will lead to a referral (fairly promptly) to a staff psychiatrist. Experimenting with a statistical sample of one is interesting for a while, but internet drugs are e-x-p-e-n-s-i-v-e, even presuming you find a reliable source, whereas at least some of my meds are covered by the govt. (not Cymbalta, though, - it's too new in Canada & is probably being classed as a "me-too" substitute for Effexor).
Posted by azalea on September 24, 2008, at 11:28:04
In reply to Re: Reboxetine vs Effexor, Cymbalta » azalea, posted by Tony P on September 24, 2008, at 2:56:47
There's a publication about splitting bupropion. I was unable to access the text of the document, but here's the information if you want to research it or bring it to your MD or pharmacist.
Title: Splitting bupropion extended-release tablets.
Source: American Journal of Health-System Pharmacy. 56(6):575, March 15, 1999.
Author: Cochren, Brad E. BCPPWere you on a mood stabilizer like Lamictal (lamotrigine) or Lithium at the time bupropion caused mania? Anxiety and insomnia can be a side effect, especially for patient with bipolar who are not also taking a mood stabilizer.
I hope you can get an appointment with an MD soon. Best wishes.
> > Have you tried Wellbutrin (bupropion)? It is generally an energizing anti-depressant, best taken in the morning.
> TP} Yes, tried it several times a few years ago. I like what it does for me, but I am abnormally sensitive to it, so the generally recommended dose (300 mg/day) drives me into full mania (I didn't believe it, but my family let me know - independently - in no uncertain terms that I was acting crazy!) I can tolerate about 25-50 mg/day, maybe 75 mg tops, but it's only available nowadays, in Canada at least, in SR or long-acting dose forms that are larger than that. I tried splitting the tabs, even though you're not supposed to, and that was fairly OK. Still experienced quite a lot of anxiety & insomnia even at low doses. However, maybe it's worth another try. I'll double-check with my pharmacist (who is always very helpful) whether they can get any low dose or splittable short acting tabs.
>
> My MD is away but I'm going to see whoever's on duty at his clinic today or tomorrow, and I have an appointment with a government-funded counselor that I hope will lead to a referral (fairly promptly) to a staff psychiatrist. Experimenting with a statistical sample of one is interesting for a while, but internet drugs are e-x-p-e-n-s-i-v-e, even presuming you find a reliable source, whereas at least some of my meds are covered by the govt. (not Cymbalta, though, - it's too new in Canada & is probably being classed as a "me-too" substitute for Effexor).
Posted by bleauberry on September 24, 2008, at 17:18:53
In reply to Reboxetine vs Effexor, Cymbalta, posted by Tony P on September 23, 2008, at 14:24:59
Not much comment on the other stuff, except that you gotta follow your instincts on what meds make you depressed or not. No one knows you better than you.
If you are going to order meds from out of country, and you are in the norepinephrine/serotonin market, I would strongly suggest Milnacipran over Reboxetine.
This is the end of the thread.
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