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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 jms600 on May 7, 2011, at 9:28:14
I am going to ask my doctor about prescribing a norepinephrine reuptake inhibitor. I am having a terrible time with motivation at the moment. I just don't seem to have any enthusiasm for anything right now. From what i've read it could be low norepinephrine. I also suffer from depression, GAD and severe panic disorder.
My current meds are 150mg Effexor, 40mg buspirone and 600mg lithium.
I'm worried about trying a norepinephrine med though as when I tried high doses of Remeron I got an increase in anxiety which I attributed to it's effect on norepinephrine. However, Amitriptyline didn't seem to aggravate my anxiety - even though it affects the norepinephrine transporter.
Why do some norepinephrine drugs aggravate anxiety and some not? Would it be a wise choice - considering my anxiety - to take something like reboxetine along side my current meds?
Thanks
Posted by SLS on May 7, 2011, at 9:46:55
In reply to Why do some norepinephrine drugs cause anxiety??, posted by jms600 on May 7, 2011, at 9:28:14
Have you tried to raise the dosage of Effexor to 300mg? I would try that first. If you tolerate the dosage and you are still dissatisfied with the results, you can then add nortriptyline to boost NE along with its other effects on 5-HT2a blockade, etc.
Reboxetine is less likely to give you results than the tricyclics. It is usually more anxiogenic than desipramine.
- Scott
Posted by mtdewcmu on May 7, 2011, at 13:13:28
In reply to Re: Why do some norepinephrine drugs cause anxiety??, posted by SLS on May 7, 2011, at 9:46:55
> Have you tried to raise the dosage of Effexor to 300mg? I would try that first. If you tolerate the dosage and you are still dissatisfied with the results, you can then add nortriptyline to boost NE along with its other effects on 5-HT2a blockade, etc.
That's a good conservative way to explore the NE hypothesis.
>
> Reboxetine is less likely to give you results than the tricyclics. It is usually more anxiogenic than desipramine.Drugs that don't do well in studies are usually not worth bothering with (other than as 4-th, 5-th, nth-line treatments). The FDA evidently thought this about Reboxetine. Neurotransmitter theories are only useful insofar as they are backed up with evidence.
Posted by creepy on May 8, 2011, at 0:51:34
In reply to Why do some norepinephrine drugs cause anxiety??, posted by jms600 on May 7, 2011, at 9:28:14
wellbutrin helped my depression a lot before it pooped out. but it made my anxiety a lot worse. desipramine was good but it didnt do too much on the depression.
Posted by bleauberry on May 8, 2011, at 5:23:40
In reply to Why do some norepinephrine drugs cause anxiety??, posted by jms600 on May 7, 2011, at 9:28:14
Norepeniphrine can worsen anxiety or improve it. It depends on the particular mechanism involved. Something that releases more of it, such as remeron and sometimes antipsychotics, yohimbe, etc, anything that blocks the receptors causing more release, that kind of mechanism can cause worsened anxiety.
Reuptake can be different. It forms a pool of NE which in turn causes the feedback loops to slow down the release of NE. So you're getting more NE at the synapse, but less globally. Keep in mind, NE turns to epinephrine and adrenaline, so you don't necessarily want more of it except at the synapse.
I will use Milnacipran as my own personal example. Yes, for the first three days, the increased NE did in fact worsen everything you would expect adrenaline to worsen....nervousness, on edge, anxiety, agitation, disturbed sleep. But at about 3 days the feedback loops kicked in. Things started to adjust. Now for the first time in a very long time, my waking morning anxiety crap was gone. My days were calm, yet with improved energy.
So whether NE will worsen your symptoms or not is, in my opinion, dependent upon the particular mechanism of the med.
Nortriptyline above 10mg seriously worsened my anxiety and in fact created some that wasn't there previously. Milnacipran did the opposite. That is, at the right dose. Too high of a dose and there are problems. We might need some NE to help us feel better, but too much is just as bad as not enough. So it's not just a mechanism thing, but a dosing thing also. I think you have to go into it open minded and completely disregard what others tell you are "normal" doses. Remeron frequently comes with complaints of agitation and feeling wired. Same with antipsychotics. I remember on all the antipsychotics it was so bizarre for me....on one hand I was calm and sedated, yet on the other hand wired and nervous....all at the same time. Bizarre. Some might call that akathesia. I call it too much NE being released.
Posted by jms600 on May 8, 2011, at 9:02:46
In reply to Re: Why do some norepinephrine drugs cause anxiety??, posted by bleauberry on May 8, 2011, at 5:23:40
If I were to try say 300mg of Effexor, is such a high dose likely to cause excessive anxiety??
This is the end of the thread.
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