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Norepinephrine - what does it do?


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I'm not sure how it helps alleviate anxiety but I know a little about noradrenaline (norepinephrine for you yanks). Basically it's a stress hormone and a neurotransmitter which gets increase during our fight or flight response. From that it sounds counterintuitive to give more noradrenaline to someone who is prone to anxiety attacks. If I had to guess it raises the level in the brain for the body to get used to it over time, therefore stressful triggers don't seem as bad. That's my guess anyway, I don't know if that's true. 

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https://en.wikipedia.org/wiki/Norepinephrine

Norepinephrine is one of the fight or flight hormones of the sympathetic nervous system. It helps respond to novel stimuli, and if they are dangerous, mobilizes the body to take action--raises heart rate, raises blood pressure, increases glucose production and glucose uptake, decreases digestive action, etc..

The way it helps anxiety alone, is that it generally doesn't. If anything, people with anxiety usually are told not to use norepinephrine-activating drugs because it can make anxiety worse. The exception appears to be with depression + anxiety, where the norepinephrine qualities can help decrease depression, usually in combination with serotonin or as an adjunct when response to SSRIs alone is somewhat helpful but not helpful enough.

I'm curious if there was a particular reason behind your question.

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On 5/28/2016 at 3:28 PM, Wooster said:

https://en.wikipedia.org/wiki/Norepinephrine

Norepinephrine is one of the fight or flight hormones of the sympathetic nervous system. It helps respond to novel stimuli, and if they are dangerous, mobilizes the body to take action--raises heart rate, raises blood pressure, increases glucose production and glucose uptake, decreases digestive action, etc..

The way it helps anxiety alone, is that it generally doesn't. If anything, people with anxiety usually are told not to use norepinephrine-activating drugs because it can make anxiety worse. The exception appears to be with depression + anxiety, where the norepinephrine qualities can help decrease depression, usually in combination with serotonin or as an adjunct when response to SSRIs alone is somewhat helpful but not helpful enough.

I'm curious if there was a particular reason behind your question.

Because my psych wants to switch me to lofepramine which is basically a NRI and I have severe GAD

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1 hour ago, cryinginmoscow said:

Because my psych wants to switch me to lofepramine which is basically a NRI and I have severe GAD

Have you asked your psych why s/he thinks lofepramine would be a good fit for you?

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4 minutes ago, jt07 said:

Have you asked your psych why s/he thinks lofepramine would be a good fit for you?

I know it's because I'm very depressed and don't get out of bed for weeks but I think they're forgetting some other things I suffer from like anxiety. Lofepramine is metabolised as Desipramine.

Desipramine binding profile is

179 SERT

2.27 NET

5-HT2a 114

5-HT2c 496 

5-HT7 1000

a1 130

a2a 1380 

D2 1560

H1 45.6

M1 110

M3 210

 

 

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Well, from my experience with the tricyclics including desipramine, they all were sedating for me. Even the ones that work on norepinephrine. Lofepramine is not a pure NRI. It might be more of an NRI than, say, imipramine but the tricyclics are all "dirty" meds, meaning they have significant activity at multiple receptor sites.

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1 hour ago, jt07 said:

Well, from my experience with the tricyclics including desipramine, they all were sedating for me. Even the ones that work on norepinephrine. Lofepramine is not a pure NRI. It might be more of an NRI than, say, imipramine but the tricyclics are all "dirty" meds, meaning they have significant activity at multiple receptor sites.

Lofepramine is 1.7-2.5 hours (dose-dependent; parent drug); 12-24 hours (active metabolites) and the binding profile for Lofepramine is 70 SERT and 5.4 NET so from my understanding this means Lofepramine is metabolised first for 1.7-2.5 hours and then it is converted into desipramine and metabolised for 12-24 hours 

and it says  It is partially converted to its active metabolite desipramine in vivo. However, it is unlikely this property plays a substantial role in its overall effects as lofepramine exhibits lower toxicity and anticholinergic side effects relative to desipramine while retaining equivalent antidepressant efficacy. on Wiki

Edited by cryinginmoscow
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You know, you can study it forever or you can just try it and see how you react to it. Nothing is permanent. If it doesn't work for you or gives you intolerable anxiety you can just tell your psych that you don't want to take it anymore and ask for something else. But I think you have to go along with what the psych prescribed because otherwise you might be viewed as a non-compliant patient and then have trouble getting anything prescribed. Just give it a chance.

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2 hours ago, jt07 said:

You know, you can study it forever or you can just try it and see how you react to it. Nothing is permanent. If it doesn't work for you or gives you intolerable anxiety you can just tell your psych that you don't want to take it anymore and ask for something else. But I think you have to go along with what the psych prescribed because otherwise you might be viewed as a non-compliant patient and then have trouble getting anything prescribed. Just give it a chance.

I'd ditto that.  I know it sucks when a drug is prescribed and your thought is "but what about (fill in the blank symptom or side effect)" or "I thought it could make (fill in the blank) worse."  It's an awful feeling because you know that at the end of the day you are the one that has to agree (or not) and take the medication (or not).

in general, unless you know definitively that it would be a really bad thing (for example, you've taken it before and it landed you in the hospital for suicidal ideation), I've found it's generally better to give it a go.  Sometimes your concerns remain and you describe them and (hopefully) things get changed if you e given it enough of a trail period.  Sometimes though, you can be surprised and things will work better than expected.  

For example, I have a friend with both depression and anxiety and for her, treating the depression really hard makes the anxiety go away.  So although the current drug might not be the most logical choice if you were solely dealing with depression, it can make more sense if it's designed to knock out the underlying cause.

again, no promises that it will go smoothly and no suggestion that your concerns aren't valid.  But realistically the time to raise your concerns about something being prescribed and to debate whether it make sense or try to get something else is during the appointment itself.  Coming home and then having your anxiety spin you in a million directions, though understandable, still doesn't mean it's a good idea to completely avoid it unless you know it's done awful things for you already.

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