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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Sac on March 18, 2014, at 18:55:55
Does anyone know of a good norepinephrine reuptake inhibitor for low motivation, low energy depression not responding to ssri alone?
Posted by phidippus on March 19, 2014, at 11:18:18
In reply to Any good NRI's?, posted by Sac on March 18, 2014, at 18:55:55
Straterra - also because its an nmda antagonist.
Eric
Posted by tom2228 on March 19, 2014, at 12:13:39
In reply to Re: Any good NRI's? » Sac, posted by phidippus on March 19, 2014, at 11:18:18
> Straterra - also because its an nmda antagonist.
>
> EricDoes the NMDA antagonism interfere with learning/ memory? Funny combination for an ADHD med..
Posted by phidippus on March 19, 2014, at 12:38:04
In reply to Re: Any good NRI's? » phidippus, posted by tom2228 on March 19, 2014, at 12:13:39
>Does the NMDA antagonism interfere with learning/ memory?
No.
The role of NMDA-receptor antagonism in atomoxetine's therapeutic profile remains to be further elucidated, but recent literature has further implicated glutaminergic dysfunction as central in ADHD pathophysiology and etiology.
Eric
Posted by tom2228 on March 19, 2014, at 12:51:19
In reply to Re: Any good NRI's?, posted by phidippus on March 19, 2014, at 12:38:04
hmm, okay that's cool! Strattera is on my list of asking the new pdoc to augment Marplan with in case it's only the SRI aspect of TCA's that she has a problem with.
Is it qualitatively different from other NRIs in terms of antidepressant efficacy (independent of other actions), i.e., is an NRI an NRI is an NRI, or do different NRIs affect different brain areas, etc.?
Posted by brk23 on March 19, 2014, at 17:55:06
In reply to Any good NRI's?, posted by Sac on March 18, 2014, at 18:55:55
I posted this a while back,when they published a article on how to fight treatment resistant depression one was a maoi at high doses and the other was to add a small dose of a adhd stimulant to ssri therapy since from what they "say" highered serotonin levels DECREASE dopamine levels.So in vitro the small amount of say ritalin in the study worked well in combo with the ssris.
Posted by Christ_empowered on March 19, 2014, at 18:19:44
In reply to Any good NRI's?, posted by Sac on March 18, 2014, at 18:55:55
Ritalin/focalin, Provigil, amphetamines...
...straterra, wellbutrin, maybe a stimulating tca (pamelor, vivactil) ?
Just throwing thoughts out there for you. SRI drugs can cause apathy and amotivational syndrome.
Posted by bleauberry on March 21, 2014, at 10:45:05
In reply to Any good NRI's?, posted by Sac on March 18, 2014, at 18:55:55
There are various TCA's to try. But in my experience the best way to hit norepinephrine hard is with Savella. It has a ratio of 3:1, norepinephrine:serotonin. Cymbalta on the other hand is only 1 part norepinephrine to 30 parts serotonin. Effexor is 1:9, mostly serotonin.
I found that really small doses of Savella, as in 6mg or so roughly (custom home made doses) have a fairly pronounced and rapid norepinephrine boost, almost sort of similar to a smooth weaker version of ritalin maybe. I got the antidepressant "blahs" at higher doses of Savella. But at lower doses it was a nice norepinephrine boost that felt good.
This is the end of the thread.
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