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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by kribensis on August 3, 2014, at 13:10:41
I know that this is not supposed to be that effective of an AD, but I keep coming up with not only was it ineffective in trials but it might actually cause more harm than good. But I can't find what harm it causes, if any. Does anyone know? Anyone using this?
Posted by phidippus on August 3, 2014, at 14:12:22
In reply to reboxetine, posted by kribensis on August 3, 2014, at 13:10:41
Reboxetine (Edronax) is a relatively well-tolerated, relatively selective "noradrenergic" agent. Crudely, whereas serotonin plays a vital role in anxiety and mood, noradrenaline is essential to maintaining drive, self-assertiveness and the capacity for reward. There's a fair bit of evidence that chronically depressive people have dysfunctional and atypical noradrenergic systems - particularly their alpha 2- and beta-adrenoceptors. Reboxetine itself typically doesn't have the disruptive effects on cognitive function or psychomotor performance common to older, tricyclic clinical mood-brighteners - though alas antimuscarinic effects are still not completely absent. Indeed for one sub-population of depressives, the new NorAdrenaline Reuptake Inhibitors (NARIs) are possibly under-used. Unfortunately, catecholaminergic strategies to combat depression were eclipsed in the late 1980s and 1990s by the marketing hype surrounding selective serotonin reuptake inhibitors (SSRIs).
Reciprocal interactions between the different monoamine systems make it hard to target one neurotransmitter system without triggering a cascade of effects on the others. But NARIs - and "dopaminergics" like amineptine (Survector) - may be especially useful in drive-deficient "anergic" states where the capacity for sustained motivation is lacking; in the treatment of "retarded" depression; and for melancholic depressives with a poor ability to cope with stress. Anxious depressives, on the other hand, may do better on Servier's neuroprotective and anxiolytic antidepressant tianeptine (Stablon), though comparative clinical trials are lacking.
Reboxetine may be safely combined with an SSRI, though there is evidence that NARIs themselves indirectly enhance central serotonin function by a mechanism that doesn't depend on reuptake inhibition. More surprisingly perhaps, preliminary studies suggest reboxetine can actually reverse tranylcypromine-induced hypertensive crises. The "cheese effect" is usually triggered by ingesting tyramine-rich foods. Thus NARIs plus MAOIs may prove a potent form of combination-therapy if other options fail. Newly-licensed (2006) EMSAM, the transdermal selegiline patch, is probably the safest choice of MAOI.
Reboxetine may also be used off-label to treat low back pain and fibromyalgia.
By early 2007, reboxetine was licensed worldwide in over 60 countries. In May 2001, however, the FDA declined Pharmacia's license application for the North American market. The grounds for the decision have not been officially disclosed...
Eric
Posted by jrbecker76 on August 19, 2014, at 11:10:15
In reply to reboxetine, posted by kribensis on August 3, 2014, at 13:10:41
> I know that this is not supposed to be that effective of an AD, but I keep coming up with not only was it ineffective in trials but it might actually cause more harm than good. But I can't find what harm it causes, if any. Does anyone know? Anyone using this?
When some researchers concluded that Reboxetine "did more harm than good," this was based on the retrospective review of the original clinical trial data. Many of the negative result trials were originally unpublished. After this data was later made available, a few meta-analysis studies demonstrated that Reboxetine often times did not outperform placebo or compare to a gold-standard treatment (e.g., SSRI). In some trials, Reboxetine performed worse than placebo, so this is why it was concluded that it can sometimes "do more harm than good." This is the reason that Pfizer finally gave up on the US approval process of Reboxetine several years ago.
http://www.bmj.com/content/341/bmj.c4737.full
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC161714/
Personally speaking, Reboxetine worsened my depression. Many here on the board have unfortunately not fared well on it either. But there does seem to be a minority of sufferers that find it helpful, particularly as an augmentor.
This is the end of the thread.
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