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Norepinephrine-Selective Reuptake Inhibitors (NSRIs) discussed on this site include:
We pretty much have a choice of two NSRIs, Strattera (atomoxetine HCl) in the US and Canada, and Edronax (reboxetine mesylate) most everywhere else. Viloxazine may still be available in the US, but I can’t find any information about its availability one way or the other. The only references to it on the FDA’s website and Drugs.com are on documents about other meds.
Norpramin (desipramine HCl) is a TCA, and like all TCAs is an antihistamine, anticholinergic, norepinephrine antagonistic and does some, but barely any, serotonin reuptake inhibition. Despiramine barely does much of anything in the way of serotonin reuptake inhibition and is about as close to an NSRI as you’re going to get if Strattera/reboxetine worked but the side effects where too much. Vivactil (protriptyline HCl) is also a good substitute, but obscure and expensive. At 50mg a day the generic costs over $300 a month when you have to pay full retail.
Strattera doesn’t even have FDA approval to treat depression, but it looks and acts so much like reboxetine that it may as well be an antidepressant.
NSRIs (i.e. Strattera and reboxetine, I may or may not - odds on may not - cover viloxazine) have a few things in common:
- Low side effect profile
- While the possible side effects a fewer, and generally suck less, than those associated with SSRIs, SNRIs, TCAs and MAOIs, you’re actually more likely to have the common side effects, and for those problems to stick around.
- No discontinuation syndrome like SSRIs and SNRIs
- But they’re more likely to poop-out (tachyphylaxis) than SSRIs, and you don’t have much choice in the way of other meds to try if that happens.
- At least the poop-out effect may not be totally random. Based upon anecdotal evidence only it seems like taking too much too soon, a common even with Strattera, frequently leads to Strattera’s failing. Sometimes it will work again, sometimes it won’t.
- They’re less likely to trigger mania in the bipolar than SSRIs
- But if you’re bipolar and aren’t stable, they’ll destabilize you further.
- And it might be difficult to tell if you’re manic in the first place when one side effect is a short-term euphoria.
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Page created by: Jerod Poore. Date created: 26 November 2010 Last edited by:
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