Posted by svevo1922 on November 19, 2001, at 15:37:04
In reply to Re: anafranil....oh lord » elizashae, posted by Mitch on October 31, 2001, at 11:45:42
Oh Lord is right.. .,or perhaps more appropriately, to borrow a line from remake of "The Fly":
"Be Afraid. Be Very Afraid."
Anafranil may provide relief for certain individuals with OCD, but the improvement comes at a very high price, at least in my view.
It was with extreme, agonized reluctance that I agreed a couple of weeks ago to try Anafranil (clomipramine) for the second time in about 16 months. I stopped taking it a year ago after reaching a therapeutic dose of 200 milligrams a day and having taken the drug for three or four months. I apparently have an extremely treatment-refractory combination of OCD (pure obsessional variety), major depression, dysthymia and some variant of anxiety disorder. I have been treated by traditional and cognitive/behavioral therapists, including at present, but without much success. I have also been in the care of an experienced psychopharmacologist. Whenever I read an article or book on drugs for mood and anxiety disorders, e.g., Andrew Solomon's Noonday Demon, it is difficult not to burst out laughing because I have taken virtually every Tricyclic, SSRI, and benzodiazepam listed, not to mention the drugs that defy neat categorization. It's also quite ironic because in my youth I did not go in for recreational drugs. Unlike my friends, I believed all those cautionary filmstrips shown in jr. high school. The only class of drug I have not taken, notwithstanding my doctor's urging, are the MAOIs, because adherence to the diet would have added a whole new level of obsession and anxiety that I was not prepared to contend with. As a compromise, I ordered, legally, from another country, a much more expensive, reversible MAOI that did not require the special diet. Unfortunately, it was not effective.
After roughly 10 years of taking psychotropic medications, only two have caused a dramatic improvement: Prozac and Anafranil. Prozac, which I tried several years ago, caused a noticeable elevation of mood (noticeable even to others, who did not know I was taking it), but from the start the Restless Leg Syndrome (RLS) side effects were difficult to tolerate. When the drug's effect began to level off after about three months, the increased dosage (I believe I went up to 60 milligrams, which is within the normal range) caused my hair to fall out. A book I read said to carefully inspect one's comb in the morning for additional hairs to confirm that one really was losing more hair than usual. I had no need; my hair was coming out in huge gobs on the bottom of the bathroom tub. The dosage was reduced and the alopecia problem went away, but ultimately the RLS and related side effects (at night, I found myself moving my thighs in and out like a bellows and thinking incessantly about running to the window and jumping out) became unbearable and I had to go off it.
Several years followed of trial and error with various medications. Among other side effects, I often experienced the RLS, but nothing to the degree caused by Prozac. Which is not to say I haven't invoked the Han Christian Anderson fairy tale "The Red Shoes" to my doctors, explaining that at times I wish I could come across a friendly woodcutter to hack off my feet, as in the story. As noted above, I often feel like a human lab rat for the drug industry. Most of the medications have been ineffective with unpleasant but tolerable side effects. The exception was Paxil, which I had a lot of trouble getting off. (Actually, another was Lamictal, but I will try to post my extremely bad experience with that drug separately). Although I was weaning myself with very small doses, I'd have to increase them to counteract the side effects and then start all over again. I wondered if Paxil withdrawal was anything like the symptoms caused by withdrawal from the hard illegal drugs. For the first time, I became truly sympathetic to street addicts.
Just before taking Anafranil last year, I tried Remeron. It made my feet swell so much I couldn't put my shoes on, bloated my face and caused an all-over sticky, warm sensation on my skin. When I followed the Remeron with Anafranil after two or three weeks, I began to feel much better. For a second time, as with the Prozac, I realized that were I ever to find a genuinely successful drug or therapy I would not be in any doubt as to whether it worked. This understanding brought me great relief. It also proved to me that I actually did have an ailment with a substantial physiological component. Although like others, I should have gotten it out of my head a long time ago that my problem was caused by a willingness to stew in a bad mood, or a failure of willpower, that guilt often comes back to roost. With the Anafranil, I didn't have to do anything; one day, instead of constantly feeling frustrated and tormented by idiotic minutiae, everything seemed easier. The cloud of obsessions lifted, if it did disappear entirely.
Now why with such a result after so many years of searching would I stop this blessed drug?
The weight gain and other side effects. I had been resistant to going on any drug that would cause me to gain a lot of weight and feel a stranger in my own body. I have never been overweight and have always looked exceptionally young for my age; on Anafranil, I quickly gained about 15% of my normal weight. I don't recall overeating. My doctor advised me to exercise and watch my diet, but I did not have sufficient energy to exercise: just walking up a flight of stairs was winding me. I felt like an 80-year-old.
Previous posts to Psychopharmacology Tips by two doctors, and a book by one of the physicians, Dr. Valerie Davis Raskin, When Words Are Not Enough, confirmed my impression that there was little the patient could do to control this, because the medications appear to affect the metabolism. (Although I believe Dr. Davis commented that people who have always been thin often remain so while individuals who have struggled with their weight or always been heavy frequently tend to become heavier.) I also found support in Dr. Davis's discussion of why people, and especially women, living in this thinness-oriented culture, should not feel guilty about wanting to avoid a drug with side effects of this kind. It's an individual decision. An earlier post discussing the weight gain caused by Anafranil suggested that one consider the alternative. I can understand that point of view, but it should be understood that for all kinds of reasons not everyone can accept that alternative. And some patients apparently have not been able to lose the 60-70 pounds they gained on certain antidepressants. Each individual's experience is unique, of course. I simply wasnt willing to take a trial-and-error approach to this side effect. There are too many examples of overweight middle-aged people around me, who, without the burden of clinical depression, find it nearly impossible to lose weight. One weekend when my doctor was away, I had to call one of his colleagues about another side effect from the Anafranil. Coincidentally, I'd seen this doctor for a few months many years before but had to stop because my work schedule interfered. She said many people have trouble tolerating the Anafranil side effects.
With a strong sense of guilt, I stopped the Anafranil in July or August of last year. Since then, nothing else has worked, so my doctor suggested that I take Anafranil again. I scoured the Internet to see if there were any new theories about avoiding weight gain on this medication and found nothing convincing. I learned that Dr. Davis had written a book and ordered it in the hope that she had happened upon a solution. But the book was candid about the drugs tendency to cause weight in many people. My doctor then suggested using a smaller dose of Anafranil than I'd taken earlier to augment my other medications, which he thought might control the weight gain.
A month ago, I added 25 milligrams of Anafranil to my other medications: 100 milligrams of Zoloft, 0.5 milligrams of Ativan (lorazepam) twice a day, and 20 milligrams of Dexedrine spansules, all of which have been prescribed by my doctor. (I do not find the Ativan and Dexedrine to be in the least habit-forming; in fact, I often forget to take them.) A week ago, I went up to 50 milligrams of Anafranil a day, and although I have not put on a huge amount of weight so far, I am experiencing a lot of the same nasty side effects I associate with Anafranil: fatigue, somnolence, general grogginess, insomnia, blurry vision, constantly changing body temperature, gastrointestinal problems, and my dry mouth is worse than its ever been. I consume the contents of at least one ice cube tray a day, since sugarless gum, which has been recommended as an alternative, does not help. There is edema too, as with the Remeron. I know that I don't literally look like one of those actresses whose plastic surgeon injected too much collagen into her lips, but I certain feel like a blubber lips -- they are extremely swollen and it is a little harder to speak than usual. My upper eyelids look like I'm recovering from two spider bites.
These side effects are far more than nuisances to be tolerated: they feed into my feelings of becoming old, ugly, weak, physically disgusting, helpless, unable to read and speak, etc., etc., etc. (What do you expect, I have a strong OCD component!). Had there been ANY other drug that promised a reasonable chance of success, I would never have gone back on Anafranil. Sometimes I deliberately forget to take it at night and have to take it the following morning, so resistant am I to the idea of taking this medication.
As I am without alternatives, I am going to try to keep taking the Anafranil for several weeks or months longer, in time increasing the dosage if needed. I also will ask my doctor if substituting Prozac for the Zoloft on a short-time basis would be helpful, since Zoloft doesnt seem to help my mood. If I start to feel the full therapeutic effects of Anafranil presently, Ill make the most of them, but, as by now should be obvious, this drug is not easy to tolerate. No one should feel guilty about giving up on it. It's the antidepressant from hell.
> > I'm so scared. I was prescribed anafranil this afternoon and have yet to pick up the RX. I've been on lots of meds and I don't think I can do this one. I've already scared myself out of it by reading the side affects. I've taken Remeron, Prozac, Celexa, Effexor, Effexor XR, Buspar, Zoloft, Paxil, Wellbutrin, Serzone, Trazadone, Klonopin, Xanax.....if not more.
> > I have depression which tends to make me sleep to much and anxiety and was recently diagnosed with ADD. It's just all to much for me! I haven't been able to function at all for the past two years, although in the past I've had all of this and could function. I just don't know what to do anymore. I'm getting scared of the medicines!! They just don't work, or either the side affects are just too much.
> > Anafranil looks scary....side affect wise. Any thoughts or suggestions?
> >
> > Thanks,
> > Heather~
>
> Wow, it looks like you have made the rounds of all the SSRi meds (plus other new ones) and your pdoc is starting to consider tricyclics. I haven't tried Anafranil, but it could be helpful. I find tricyclics a lot easier on my stomach. If the Anafranil is too sedative, you might ask about Nortriptyline. It had the fewest side effects of any of the other tricyclics I have taken (especially dizziness and sedation).
poster:svevo1922
thread:82726
URL: http://www.dr-bob.org/babble/20011113/msgs/84678.html