Posted by SLS on July 11, 2004, at 10:12:25
In reply to Re: tachycardia vs. bradycardia, posted by KaraS on July 11, 2004, at 2:19:28
Hi Kara
> > > Those were the two reasons - the 100 bpm heart rate and the insomnia.
> > Your "tachycardia" is absolutely the norm for these drugs. I would love to hold your hand through your first few weeks with them - really. :-)
> RE: My "tachycardia" being the norm for these TCAs... REALLY? My doctor was quite concerned about it at the time.Your concern is not a silly one to be sure. It would not be a bad idea to get a baseline ECG before beginning the TCA and then one after, especially since you have a family history of heart disease.
I think it might be worthwhile starting a new thread asking people taking TCAs what were their initial experiences with HR and if they changed over time.
> You really get used to that feeling of your heart racing?
Yes. I was very aware of it in the beginning. After a few months, I didn't notice it at all. Although the heart is beating more often, it is not beating as hard. It does not have as much of a pressure load to overcome because the TCA antagonizes NE alpha-1 receptors and dilates blood vessels.
> Two really good points you made - that the rate of heart beats isn't dosage dependent and that the pindolol isn't a depressant.
There are still those who will debate whether any of them produce depression. I'm all but sure that propranolol does, though. It passes through the blood-brain barrier more easily than any of the others.
> I don't know that this would definitely be a dream med for me but I think it is worth revisiting. I still have plenty of others that I want to try as well including imipramine. Hard to believe after several years of trying medications that I've never tried the gold standard.
Yeah. The old drugs are just sitting on the sidelines sulking because of their underutilization.
> How are you doing on that BTW?
Not too well, but I've been worse. The combination of Lamictal 300mg + imipramine 300mg gives me about a 15% improvement over my unmedicated baseline, allowing me to function well enough to take care of my basic needs and participate on Psycho-Babble. Otherwise, well, I don't like thinking about how sick I can get. My previous doctor, a professor at NYU, described my condition as being horrendous. Nice.
> > As far as benzodiazepines are concerned, being physiologically dependant on them is not the same as being addicted to them. Too much fuss is made of all of this.
> I'm also concerned with needing to take more and more of the benzo in order to get the effect of getting me to sleep.
During my Parnate + desipramine treatment, I reached a point where I no longer needed to increase the dosages of the benzos to be able to sleep. I'm not sure how common this is, though. I was taking twice the amount of Halcion than is currently recommended. (The recommended dosage of Halcion was cut in half when there was an uproar in the media regarding iatrogenic amnesia. Ambien is no less offensive in this regard). Again, who cares? What difference does it make? You take as much as you need to get the job done. These are clean drugs that are perfectly safe at high dosages. Sometimes, I think the dosage recommendations of benzodiazepines are almost arbitrary. I think these are important tools that are grossly underutilized.
> I remember with the Ativan that I would start getting nauseous in the evening a couple of hours before it was time to take it. I don't want to live with that kind of side effect.
Hmmm. That is quite a nuissance. What about using Remeron? If anxiety were a feature of your depression, you could rationalize taking more Ativan either at night or in divided doses. What other drugs have you tried for insomnia? It might not be a bad idea to try a few different ones for a few nights at a time to see which ones work best for you. Restoril is pretty smooth. Ambien might not cause the nausea. There's also the option of riding it out and allowing your system to adjust, using a sleep aid perhaps every third night if necessary. I don't know, but I think you can effectively treat the insomnia such that it doesn't preclude you from using a potentially effective antidepressant.
> I have learned how to go off of things very slowly to minimize withdrawal so I'm less concerned with that aspect of it. Perhaps a longer lasting benzo like Klonopin would work better - but don't the benzos increase depression?
Generally speaking, I would say no. However, Klonopin is the one that I would point at as being the exception.
- Scott
poster:SLS
thread:13117
URL: http://www.dr-bob.org/babble/20040710/msgs/364986.html