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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by JohnL on October 17, 1999, at 5:27:53
In Sept 99 issue of Clinical Psychiatry News (at the Medscape site) the FDA has just deemed Reboxetine "approvable" and should be available by year's end. It tested superior to Prozac in severe depression and was also superior in symptoms of interest, energy, motivation. It's side effects--including sexual-- were less than SSRIs. Should be an interesting development. Just thought I'd pass this along to anyone interested.
Also of interest was anecdotal reports of St Johswort inducing mania in bipolars. Also evidence that serotonin inhibition by St Johns is not achievable in clinical practice to cause serotonin sydrome with an SSRI. Doctors discourage the combo because of lawsuit risk. Also the MAOI characteristics of St Johns seem to be negligible. It's true mechanisms seems controversial and not well known based on conflicting things I've read.
And one more tidbit, the novel anticonvulsant Lamictal is showing great promise in bipolar illness, being effective for both mania and depression.
Just some various tidbits of interest. I thought the Reboxetine issue would be of particular interest to a lot of us out there.
Posted by Bob on October 17, 1999, at 17:41:40
In reply to Reboxetine "Approvable", posted by JohnL on October 17, 1999, at 5:27:53
Hey JohnL!
For me, dj, and the rest of us who get buried under all these medical-sounding names, can you do a recap on Reboxetine -- how it relates to other SSRIs, oh, I dunno ... you're good at this medicine stuff, you decide what to say.
Thanks in advance,
Bob
Posted by Elizabeth on October 17, 1999, at 20:56:47
In reply to Re: Reboxetine "Approvable", posted by Bob on October 17, 1999, at 17:41:40
> For me, dj, and the rest of us who get buried under all these medical-sounding names, can you do a recap on Reboxetine -- how it relates to other SSRIs, oh, I dunno ... you're good at this medicine stuff, you decide what to say.
It's not an SSRI; I'd hope that the drug development types had gotten bored of those by now. It could be called an SNRI (selective noradrenaline reuptake inhibitor). It does to norepinephrine [another name for noradrenaline] what Prozac & co. do to serotonin (and what Congress has been doing to the country?).
An older drug with a similar profile is the tricyclic desipramine. Reboxetine is liable to have fewer side effects than desipramine, though, due to minimal interaction with various receptors besides the NE transporter.
Posted by dj on October 18, 1999, at 0:06:49
In reply to Re: Reboxetine "Approvable", posted by Elizabeth on October 17, 1999, at 20:56:47
Eliz, kindly responded to Bob's request however the jargon is still a bit thick for those of us who flunked chemistry, didn't study pharmacy and prefer english to scientific semi-mystic babble...
So perhaps one of you would be so kind as to explain in basic English the following. For instance what the heck is norepinephrine aka
noradrenaline I understand the words that nor is accompanying but not sure what it is doing to them...And perhaps while you are at it you can clearly explain what exactly a "reuptake inhibitor" is and does, as I don't know enough about your politics to determine what Congress is doing to the country, though generally one hears that politicians of all types are screwing their counties, however I can't quite see the chemical interaction there (the seminal one, perhaps but I digress...;8^! )
And is it possible that the recprtors affected are the same one's andrewb refers to in our earlier thread about the effects of various meds. on dopamine or does norepinephrine interact with completely different pathways, which I suspect is the case but I can't ig-nor-e the possibilty that they are companion reactions in re-uptaking...& brain shaking...nuff said, so please help clear my head of jargon overload as it is fuzzy enough already...
>>... SNRI (selective noradrenaline reuptake inhibitor). It does to norepinephrine [another name for noradrenaline] what Prozac & co. do to serotonin (and what Congress has been doing to the country?).
>
>... minimal interaction with various receptors besides the NE transporter.
Posted by Anon on October 18, 1999, at 10:56:58
In reply to Reboxetine "Approvable", posted by JohnL on October 17, 1999, at 5:27:53
Reboxetine appears to be an antidepressant with great potential. It has indeed received an 'Approvable' letter.
That does _ NOT_ mean Pharmacia & Upjohn will actually sell it to the public anytime soon.
Why? Well, the FDA is concerned enough about one of its side effects to ask for physician monitoring of this side effect while the patient is taking Reboxetine. No general physician or family practicioner in his/her right mind will prescribe Reboxetine if they have to monitor the patient. Better to give the patient Prozac or whatever and not be concerned with monitoring this certain vital sign. Thus, the business potential of Reboxetine is greatly reduced. Pharmacia & Upjohn is now squabbling with the FDA to get this restriction removed (it appears to be a statistical fluke).
Reboxetine might, at best, be launched next year.
It may never be launched.
Sorry....
Posted by Jeff on October 18, 1999, at 11:14:24
In reply to I hate to burst the Reboxetine Bubble..., posted by Anon on October 18, 1999, at 10:56:58
> Reboxetine appears to be an antidepressant > Reboxetine might, at best, be launched next year.
>
> It may never be launched.
>
> Sorry....Give me a break...It will be launched...many meds are prescribed that require monitering and bloodwork.
Posted by Anon on October 18, 1999, at 15:12:25
In reply to Re: I hate to burst the Reboxetine Bubble..., posted by Jeff on October 18, 1999, at 11:14:24
> > Reboxetine appears to be an antidepressant > Reboxetine might, at best, be launched next year.
> >
> > It may never be launched.
> >
> > Sorry....
>
> Give me a break...It will be launched...many meds are prescribed that require monitering and bloodwork.
I am only going by what I hear from knowledgeable sources at Pharmacia & Upjohn. If it is launched, it will be middle of next year at best, after they have battled with FDA to change the package insert. Sure, you can launch products that require monitoring or bloodwork, but it reduces their profitability ten-fold. And THAT is what is all about.
Posted by saint james on October 18, 1999, at 17:02:50
In reply to Re: I hate to burst the Reboxetine Bubble..., posted by Anon on October 18, 1999, at 15:12:25
> > > Reboxetine appears to be an antidepressant > Reboxetine might, at best, be launched next year.
> > >
> > > It may never be launched.
> > >
> > > Sorry....
> >
> > Give me a break...It will be launched...many meds are prescribed that require monitering and bloodwork.
>
>
James here....Till it does Effexor is an excellent SNRI. I would like to try Reboxetine because I don't need to be on a SSRI. If folks want to try an SNRI right now, Effexor XR is a possibillity.
j
Posted by JohnL on October 19, 1999, at 3:10:15
In reply to Re: I hate to burst the Reboxetine Bubble..., posted by saint james on October 18, 1999, at 17:02:50
Reboxetine delayed because of some snag? I didn't know that. That is disappointing. The option is still open to anyone who wants it though thru overseas mailorder pharmacies. It's been successfull in other countries with no problems, I don't know why the FDA has to make some big deal out of it. Pity.
Posted by Elizabeth on October 19, 1999, at 12:32:27
In reply to Re: Reboxetine translation pls., Andrewb, JohnL,or, posted by dj on October 18, 1999, at 0:06:49
> Eliz, kindly responded to Bob's request however the jargon is still a bit thick for those of us who flunked chemistry, didn't study pharmacy and prefer english to scientific semi-mystic babble...
...whereas I'm just barely passing chemistry... (should spend less time online, eh?)
Sorry about that! Give me a chance to try again, at least : norepinephrine is a metabolite of epinephrine, aka adrenaline, a neurotransmitter (like serotonin). Norepinephrine is associated with alertness, in particular (though it seems to have a number of functions).
> And perhaps while you are at it you can clearly explain what exactly a "reuptake inhibitor" is and does, as I don't know enough about your politics to determine what Congress is doing to the country, though generally one hears that politicians of all types are screwing their counties, however I can't quite see the chemical interaction there (the seminal one, perhaps but I digress...;8^! )
Reuptake...well, okay, this requires some other stuff though. So the way neurons (nerve cells) talk to each other is, one of them "fires" a chemical (a neurotransmitter) and the second one, if it's in the right place at the right time, "receives" it (i.e., it binds to the appropriate receptor, a protein that is activated by the neurotransmitter, on the receiving cell). The gap in between the two cells is called a synapse (the first cell, the firing one, is sometimes called "presynaptic," while the second is the "postsynaptic" neuron.)
Not all of the neurotransmitter arrives at the receptor on the postsynaptic cell. Reuptake is the process whereby the neurotransmitter gets moved back into the cell via the transporter (a protein on the cell membrane). A reuptake inhibitor is a substance that blocks the transporter, thus increasing the amount of neurotransmitter outside the cell. Longer-term effects are more complicated, as the central nervous system will try to compensate for the increased concentration of neurotransmitter.
I hope this makes some sense.
(The thing about Congress was a paraphrase of a very old joke. It makes no sense otherwise. I must have been tired when I wrote that.)
> And is it possible that the recprtors affected are the same one's andrewb refers to in our earlier thread about the effects of various meds.
I'll have to read that thread to find out, I guess!
Posted by Elizabeth on October 19, 1999, at 12:53:14
In reply to I hate to burst the Reboxetine Bubble..., posted by Anon on October 18, 1999, at 10:56:58
> Why? Well, the FDA is concerned enough about one of its side effects to ask for physician monitoring of this side effect while the patient is taking Reboxetine.
Since you seem to know so much about this, what is the side effect in question?
Posted by Adam on October 19, 1999, at 14:57:57
In reply to q for Mr. or Ms. Anon, posted by Elizabeth on October 19, 1999, at 12:53:14
I also am curious. I have thought for a couple months now that a combination of an MAOI and reboxetine might be a very potent
antidepressant therapy, if such a combination proves to be safe. Especially for those with the "endogenous" or "melancholic"
type of depression, with maybe some atypical features, I have a hard time thinking of a better way to enhance the noradrenergic
response whilst minimizing adverse side effects. One favorite coctail I have dreampt up in my head is selegiline plus reboxetine.
Selegiline is activating, highly dopaminergic, probably less robust in boosting NA and 5-HT than other MAOIs, but a good mood
elevator for me, and apparently others. Combine that with the supposedly drive-enhancing effects of reboxetine, and you might
just end up with a happier, more productive person. Parnate might do well in place of selegiline in this little scheme of mine.
I know plenty of other people have thought of the same thing, and all that remains is to test it.I sure hope reboxetine is the real deal. I also wish it would get approved ASAP. I'd much rather take such a combo than, say,
an MAOI plus desipramine. I have had horrible reactions to TCAs, and have basically concluded that I can't tolerate them.
Reboxetine just sounds like a great addition to the pharmacopia.> > Why? Well, the FDA is concerned enough about one of its side effects to ask for physician monitoring of this side effect while the patient is taking Reboxetine.
>
> Since you seem to know so much about this, what is the side effect in question?
Posted by dj on October 19, 1999, at 22:23:31
In reply to Re: Reboxetine translation pls., Andrewb, JohnL,or, posted by Elizabeth on October 19, 1999, at 12:32:27
Thanks Eliz! A bit clearer now -- seems I need some more of that norepinephrine at times...I think andrewb talked about dopamine binding with D1 & D2 pathways above...
> >. Norepinephrine is associated with alertness, in particular (though it seems to have a number of functions).
>
> I hope this makes some sense.
>
> > And is it possible that the recprtors affected are the same one's andrewb refers to in our earlier thread about the effects of various meds.
>
> I'll have to read that thread to find out, I guess!
Posted by Phil on October 23, 1999, at 6:55:52
In reply to Re: Reboxetine translation pls., Andrewb, JohnL,or, posted by dj on October 19, 1999, at 22:23:31
> > I just read on Medscape that Rebox will most likely be approved by years end as mentioned above. It's a little early in the morning here but the article seemed to suggest that it was similar in action to tricyclics w/o the anticholinergic side effects...that sound right?
If true, this could be a very good drug for me. I had great results with amitryp. for years except for SE. Thanks. Phil
Posted by Judy on October 23, 1999, at 10:02:31
In reply to Question for Elizabeth, posted by Phil on October 23, 1999, at 6:55:52
After a disappointing failure with Effexor SR (and Wellbutrin a several years ago) - both caused extreme aggitation, tremors, tachycardia, etc. - should that lead me to suspect that I can probably expect the same of Reboxetine and any other SNRI's that are on the road to approval?
Posted by saint james on October 23, 1999, at 10:17:26
In reply to SNRI Question for Anyone , posted by Judy on October 23, 1999, at 10:02:31
> After a disappointing failure with Effexor SR (and Wellbutrin a several years ago) - both caused extreme aggitation, tremors, tachycardia, etc. - should that lead me to suspect that I can probably expect the same of Reboxetine and any other SNRI's that are on the road to approval?
James here....
I would say no. Effexor works with 3 neuro- transmitters while Reboxetine is only a SNRI.
Since this is not an apples to apples comparison.
You might look for euro studies on Reboxetine to see if these problems are mentioned.j
Posted by JohnL on October 23, 1999, at 13:33:41
In reply to SNRI Question for Anyone , posted by Judy on October 23, 1999, at 10:02:31
> After a disappointing failure with Effexor SR (and Wellbutrin a several years ago) - both caused extreme aggitation, tremors, tachycardia, etc. - should that lead me to suspect that I can probably expect the same of Reboxetine and any other SNRI's that are on the road to approval?
I don't think past experience on two different drugs has any predictive value at all. Even within the same class- like SSRIs -it's impossible to predict what response and what side effects will result from each. Or someone might handle one MAOI poorly but handle a similar one fine. I think all any of us can expect is that if we don't give it a fair trial we'll never know if it would have worked. And we'll never know if the side effects would have subsided or not.
Posted by Taryn on October 24, 1999, at 18:41:07
In reply to Re: SNRI Question for Anyone , posted by JohnL on October 23, 1999, at 13:33:41
It is my understanding that Wellbutrin mainly affects norepinephrine. Does that mean it's similar to Reboxetine? I currently take Zoloft, Ritalin, Levothroid and Wellbutrin, the Wellbutrin being added only a few months ago to help my fatigue and lack of motivation. It has helped somewhat but not as well as I had hoped. When I read about Reboxetine it sounded like just what I need. I was wondering if I should suggest to my Dr. a switch from Wellbutrin to Reboxetine when it becomes available. Or maybe I should just accept feeling so-so.
Posted by Phil on October 24, 1999, at 19:22:09
In reply to Reboxetine vs. Wellbutrin?, posted by Taryn on October 24, 1999, at 18:41:07
Taryn,
Don't just accept so-so. I feel about a step below so-so lately and I don't recommend it. I sometimes think non-medicated depression is better than the numb zone. I think I'll be looking at other possibilities soon. Can't control my apathy. What to do? What to do?
Phil
Posted by Taryn on October 26, 1999, at 8:18:10
In reply to Re: Reboxetine vs. Wellbutrin?, posted by Phil on October 24, 1999, at 19:22:09
> Taryn,
>
> Don't just accept so-so. I feel about a step below so-so lately and I don't recommend it. I sometimes think non-medicated depression is better than the numb zone. I think I'll be looking at other possibilities soon. Can't control my apathy. What to do? What to do?
> PhilI know I won't give up looking for the miracle drug that works for me. That's really all we can do. At least now I can function. Just to feel like a normal person.....I wonder what it's like.
Posted by Elizabeth on October 26, 1999, at 19:26:22
In reply to Question for Elizabeth, posted by Phil on October 23, 1999, at 6:55:52
> > > I just read on Medscape that Rebox will most likely be approved by years end as mentioned above. It's a little early in the morning here but the article seemed to suggest that it was similar in action to tricyclics w/o the anticholinergic side effects...that sound right?
Yup! That's what has me psyched too. I'm just starting nortriptyline (a metabolite of amitriptyline, fewer side effects but still has some) but would like to switch to reboxetine if it becomes available.
Posted by Phil on October 27, 1999, at 7:38:16
In reply to Re: Question for me, posted by Elizabeth on October 26, 1999, at 19:26:22
>
> Yup! That's what has me psyched too. I'm just starting nortriptyline (a metabolite of amitriptyline, fewer side effects but still has some) but would like to switch to reboxetine if it becomes available.Thanks Elizabeth. I'm so sick of SSRI's. My life is in meltdown and hope is a word for other's. I'm not suicidal but I can't see past each day. I'm really getting tired of 'changing personalities' with all the trials I've been through this past year.
I know I'm depressed when I only dream about getting in my little truck and driving til I can't drive anymore. I need a rest. Phil
Posted by malletheadoctober3 on September 28, 2001, at 18:38:09
In reply to Question for Elizabeth, posted by Phil on October 23, 1999, at 6:55:52
The tricyclics have barbaric side effects for most - take them only if nothing else works.
Some get great relief from the SSRIs. If the side effects are terrible then consider moving on to another drug (with a doctors agreement).
This leaves us with a few other alternatives:
1) Serzone
2) Wellbutrin
3) Effexor
4) Remeron
5) waiting for reboxetineMy opinion:
Try the first four (with a doctor's help) before waiting forever for reboxetine. Until you've tried them all one doesn't know if they work in their situation.
As an example I tried everything and nothing worked until I tried Serzone. My life isn't perfect, but Serzone has allowed me to enjoy life a little in this difficult world.
--mallethead
Posted by PattyG on September 29, 2001, at 21:27:34
In reply to My opinion regarding SSRIs, reboxetine, etc, posted by malletheadoctober3 on September 28, 2001, at 18:38:09
So what IS the status of Reboxetine? Heck, I would have thought it would be available by now!
PattyG
Posted by galtin on October 6, 2001, at 14:55:29
In reply to Re: My opinion regarding SSRIs, reboxetine, etc, posted by PattyG on September 29, 2001, at 21:27:34
> So what IS the status of Reboxetine? Heck, I would have thought it would be available by now!
> PattyG
I think that the FDA turned Reboxetine down.If this is what happened, does anybody know why?
galtin
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