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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by jono_in_adelaide on October 31, 2011, at 19:47:19
There have been a few posts poo pooing reboxetine as an useless drug etc of late, which I think is unfair.
I found the following in the british National Institute for Clinical Excelence evidence guidelines for major depression"
Given its noradrenalin profile, reboxetine is likely to be more useful in the rarer endrogenous deep depressions, where as the SSRI's and Effexor are more likely of use in the neurotic and atypical type depressions - I think reboxetines place is as a second line agent, when an SSRI doesnt work, or as an addition to the SSRI's in difficult to treat cases.
Personaly i found it as good as nortriptyline and bupropion.
"Clinical evidence statements for reboxetine compared with placebo130
Effect of treatment on efficacy outcomes
There is strong evidence suggesting that there is a clinically important difference
favouring reboxetine over placebo on increasing the likelihood of achieving a 50%
reduction in symptoms of depression as measured by the HRSD (K 3; N 479;
RR 0.61; 95% CI, 0.51 to 0.73).
There is some evidence suggesting that there is a clinically important difference
favouring reboxetine over placebo on increasing the likelihood of achieving remission
by the end of treatment (K 1; N 254; RR 0.71; 95% CI, 0.59 to 0.87).
Acceptability and tolerability of treatment
There is insufficient evidence to determine whether there is a clinically important
difference between reboxetine and placebo on any measure of acceptability or
tolerability.
Clinical evidence statements for reboxetine compared with other antidepressants131
Effect of treatment on efficacy outcomes
There is evidence suggesting that there is no clinically important difference between
reboxetine and other antidepressants on:
● increasing the likelihood of achieving a 50% reduction in symptoms of depression
as measured by the HRSD (K 5; N 1068; RR 0.87; 95% CI, 0.76 to 1.01)
Pharmacological interventions
379
128Details of standard search strings used in all searches are in Appendix 8. Information about each study
along with an assessment of methodological quality is in Appendix 17c, which also contains a list of
excluded studies with reasons for exclusions.
129Study IDs in title case refer to studies included in the previous guideline. References for these studies
are in Appendix 18.
130The forest plots can be found in Appendix 19c.
131The forest plots can be found in Appendix 19c.
● increasing the likelihood of achieving remission by the end of treatment (K 4;
N 895; RR 0.96; 95% CI, 0.84 to 1.09)
● reducing symptoms of depression by the end of treatment as measured by the
HRSD or MADRS (K 3; N 618; SMD 0.09; 95% CI, 0.24 to 0.07).
Acceptability and tolerability of treatment
There is evidence suggesting that there is no clinically important difference between
reboxetine and other antidepressants on increasing the likelihood of patients reporting
side effects (K 4; n 895; RR 0.98; 95% CI, 0.9 to 1.06).
There is insufficient evidence to determine whether there is a clinically important
difference between reboxetine and other antidepressants on reducing the likelihood of
leaving treatment early for any reason or on reducing the likelihood of leaving treatment
early due to side effects.
Clinical summary
Reboxetine is superior to placebo and as effective as other antidepressants in the treatment
of depression. There is insufficient evidence to comment on reboxetines tolerability
compared with placebo or alternative antidepressants.
Posted by jono_in_adelaide on October 31, 2011, at 19:57:57
In reply to Reboxetine, posted by jono_in_adelaide on October 31, 2011, at 19:47:19
For those of you who havent guessed, I am a bi fan of the mixed appraoch when a single drug doesnt work, combining an SSRI with one of the drugs that works on noradrenalin (reboxetine, nortriptyline, bupropion)
This cocktail saved me from suicide, and a well known Australian psychiatrist (Dr Ken Gillmore of Psychotropical.com) is a big fan of this approach as well.
Its funny, we will use multiple drugs quite happily for the common cold (there are 3 or 4 drugs in most cold remedies) but for a serious, life threatening illness like depression, we seem to expect total releif from just one
Posted by Laney on October 31, 2011, at 20:29:36
In reply to Re: Reboxetine, posted by jono_in_adelaide on October 31, 2011, at 19:57:57
Jono,
I like the approach of hitting more than one neurotransmitter myself. So far Savella is only side effects for me with paxil. I'm hopeful though.
I have skyped with Dr. Gillman on a few occasions. I personally like him except for the fact that I think he doesn't really think I should have any kind of serious withdrawl syndrome with paxil. Hello? I mean there is a website (Paxil Progress). All of those people suffering withdrawl and even extended withdrawls can't be making this crap up.Thanks for your input!
Laney
Posted by Phillipa on October 31, 2011, at 23:20:50
In reply to Re: Reboxetine, posted by Laney on October 31, 2011, at 20:29:36
Laney no they are not and you have been on paxil a long time I have the same problem with luvox. Paxil took two years bit off a small piece and dc'd over two weeks no problems. Now luvox different story like you. Phillipa
Posted by jono_in_adelaide on November 1, 2011, at 1:27:13
In reply to Re: Reboxetine » Laney, posted by Phillipa on October 31, 2011, at 23:20:50
If the symptoms persist for more than a few weeks, or three months at the outside, then its likely they are the symptoms of the original disorder that you were taking the Paxil for, not the withdrawl symptoms.
To put it another way, if a doabetic stops using insulin, they will become very ill, and could possibly die, however, these arnt withdrawl symptoms, they are the symptoms of the disease they were using the insulin for comming back
Posted by rculater on November 1, 2011, at 4:54:16
In reply to Reboxetine, posted by jono_in_adelaide on October 31, 2011, at 19:47:19
Maybe OK for female patients.
I had terrible "shrinkage" down below which scared me.
Posted by Christ_empowered on November 1, 2011, at 6:30:30
In reply to Re: Reboxetine, posted by rculater on November 1, 2011, at 4:54:16
Its kind of unfortunate that the SSRIs hit it big and clogged the market with me-too drugs. Kind of strange for someone to be termed "treatment-resistant" for failing on drugs that, as a group, often fail to outperform placebo. Of course, this is psychiatry, so the problem lies with the patient.
Anyway, these newer drugs seem interesting, although I kind of question mixing and matching reuptake inhibitors. Didn't the STAR*D trial, or whatever its called, show a really unimpressive response rate to multiple ADs? Of course, I'm sure it works in some patients, but it seems like the practice has been extended to most patients who demonstrate "treatment-resistance," just from what I've seen on here and heard from my acquaintances.
Posted by JONO_IN_ADELAIDE on November 2, 2011, at 19:39:27
In reply to Re: Reboxetine, posted by Christ_empowered on November 1, 2011, at 6:30:30
I guess if you have failed an SSRI an SNRI and Remeron, its worth trying a combo (SSRI plus Welbutrin, Reboxetine or Nortriptyline, Remeron plus Effexor) or adding an adjuvant (atypical antipsychotic, Buspar, thyroid etc)
Which of these stratergies should be tried first seems to be anyones guess!
I also think clomipramine deserves to be used a lot more than it is in resistant patients, sure it causes drowsiness and weight gain, but its a damned fine antidepressant from what I hear, if its taken in adequate doseage (150mg per day)
Posted by pedr on November 9, 2011, at 13:22:24
In reply to Re: Reboxetine, posted by jono_in_adelaide on October 31, 2011, at 19:57:57
> This cocktail saved me from suicide, and a well known Australian psychiatrist (Dr Ken Gillmore of Psychotropical.com) is a big fan of this approach as well.
FWIW reboxetine resulted in 24x7 obsessional suicidal ideation in me for the 2+ weeks I took it. One man's meat is another man's poison, as they say.
Pete
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