Posted by zeugma on October 31, 2004, at 14:53:38
In reply to Re: dirty drugs and filth » zeugma, posted by karaS on October 30, 2004, at 0:04:48
> >You are not a big fan of anything SSRI related, are you?
> > >
> > Well, some of my comments were more driven by some of your worries concerning the indirect anti-dopaminergic effects of powerful SRI's. I was also reacting to your comments that, simply, Zoloft and Effexor did nothing for your depression despite their cleanness. I read at Preskorn's web site (not the pdf I linked to) that 375 mg Effexor was equivalent in its noradrenergic effect to 150 mg maprotiline. I don't know if going from 225 to 300 mg Effexor would have helped you. But clearly Effexor at 75 mg + is an SRI equivalent to zoloft etc. Since the SRI component did nothing for you, why not try the NRI by itself?
>
> I did know what you were reacting to in my situation but I've also read other posts where I thought you made rather contemptuous remarks about SSRIs. Could have been my misinterpretation. Nothing wrong with having that opinion though. I think I'm starting to feel that way about them. Actually, based on the title of this message, it sounds like your contempt is more for that gutter-dwelling doxepin. :-)
>No, you weren't misinterpreting. But I need to qualify my attitudes towards them. A lot of my negative attitude comes from two sources: 1) observation of friends whose conditions actually worsened on SSRI's, in particular in terms of demotivation and apathy over the long term; and 2) the well-documented disruptive effects of SSRI's on sleep. These are obviously far from a comprehensive overview of the pluses and minuses of SSRI use. But they do bias me against them, yes.
> > > > > I'm curious why you suggested maprotiline. I used to take a small amount of it for years for sleep. I tolerated it well but I gained too much weight from it.
> > > >
> > > > I suggested maprotiline because it is the most NE-selective (relative to serotonin) reuptake inhibitor on the market that I'm aware of. It is also has less anticholinergic effects than desipramine, the least anticholinergic of the TCA's, according to the chart I am going by:
>
> Therapeutically, it is an excellent suggestion. I guess the only thing worrying me is the weight gain issue. It might be less of a problem at higher doses but I'd hate to put on a lot of weight trying to find out. I'm finally thin after years of carrying around extra weight. I don't want to go back there ever again! I'll have to do more thinking and researching on this.
>
> I wonder if taking extra choline or DMAE would offset the anticholinergic effects of TCAs. Do you know?
>
I don't know. I suggest asking on Alternative about the supplements. But they're good ideas :)
>
> > http://www.primarypsychiatry.com/pdf/art_453.pdf
> > > >
> > > > (If you scroll down past the dull text you get to the useful info.) I seem to remember that you had tachycardia from desipramine and nortriptyline. That sounds like an anticholinergic s/e.
> > >
> > >There's charts for various AP's and AD's that list potencies for specific sites, you will find MAP listed among secondary amine TCA's. Of note, maprotiline and nortriptyline share a common property: they are the only two AD's whose highest affinities are for the NE reuptake protein and the H1 receptor, although nortriptyline is more selective for the NE reuptake mechanism and MAP is more selective for H1 (which is why you were able to use it as a sleep aid). But maprotiline is cleaner in general than nortriptyline, so there is a chance you might be able to tolerate an AD dose of it. If nortriptyline is dirty, then doxepin is pure filth, as you can see from the chart.
> > > > As for weight gain, that's because of MAP's potent H1 blockade
>
> H1 blockade does have some benefit. It would be nice to be able to exercise without the urticaria... I liked the energy I felt on Nortriptyline. What about Nort with Pindolol for the tachycardia? They don't seem to use Pindolol anymore to potentiate ADs, do they?
>
> I don't know the answer to that either. I would guess that pindolol is an obscure drug to most pdocs when considered as a psychotropic. I have a long list of contraindicated meds to nortriptyline that came with my last refill, and pindolol was not one of them.
> > See comment above on doxepin's filthiness. I don't know if maprotiline would be any different, either. Well, it would be different, but it might not work. But what do you think is more worth trying?
>
> MAP probably would be better than Effexor. I took doxepin. It is "filthy" - I can attest to that but I will always be grateful that it "cured" me of my horrible anxiety, panic attacks and agoraphobia many years ago (way before all of these other options). It allowed me to sleep and made me functional again.
>
Associating with gutter elements can have benefits :) Who would have guessed?> > > > > Caffeine isn't an AD for me but it's sure the best drug I've ever taken for energy!
> > > > >
> > > > The Ritalin LA at 50 mg requires supplementation from caffeine. I can tell you that it seems much less stimulating than Provigil, and provides none of the 'jolting' effects of Strattera. It is doing something, though. Ask me in a week about it.
> > >
> > > OK, I will. Thank goodness for coffee! I've been lost without it on the Cymbalta. Hoping that the 50 Ritalin LA ends up working sufficiently for you.
> > >
>
> Thanks. I am more 'there' at work. This is both good and bad, but I cannot say more here.
>
> Ok, but if you want to talk more, you know where to find me.
>
>
> > > I've toyed with the idea of using the Ritalin I have here for a sleeping pill. I doubt there's any harm in using it periodically (assuming it isn't contrainidicated with anything else I'm taking) but I wonder if there would be any harm in usuing it frequently. I don't need it now but when I get stressed out and can't sleep, it could come in very handy.
>
> It's so ironic. I aways thought that I could fall back on stimulants if nothing else worked for my anergia and problems concentrating. I did a lot of reading on preventing tolerance. Lots of wasted time!!! I never dreamed that stimulants would put me to sleep.
>
>
> > Other than the bizarreness of using a stimulant as a sleeping pill, I don't see what the harm is in using it frequently- people use it frequently to wake themselves up! Of course, there could be something weird in the chemistry of the paradoxical reaction. I would be wary.
>
> Yes, you're probalby right. But, on the otherhand, maybe flooding the synapses with dopamine would eventually force downregulation? It's too risky. I wouldn't try it but I do wonder.
>
>
I wonder also. If you do need a sleeping pill, though, doxepin would seem more reasonable.> > > Well, I know you're really busy and you must be very tired so I won't ask you any more questions for now.
> > >
> > Well, I've answered a little, and asked a question or two of you. We're probably both too tired now to solve all of our problems. Those will have to wait :)
>
> Yes, both physically and emotionally tired. I'm sick to death of this process.
>
> > > Take care of yourself and try not to let all of the stress get to you.
> >
> >
> > I'm trying, I'm trying. But trying not to stress is like trying not to think of a purple elephant. It is dancing now in my head :)
>
> Maybe that's the answer. Keep thinking about the dancing purple elephant and your mind won't be worrying about anything else.
>
> Thanks for all of your help! (really)
>
> Later,
> KYou're welcome. Your questions are also helpful to me. Has the Cymbalta done anything at all for you yet?
-z
poster:zeugma
thread:406397
URL: http://www.dr-bob.org/babble/20041029/msgs/409639.html