![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 56 to 80 of 150. Go back in thread:
Posted by ed_uk2010 on August 23, 2010, at 17:17:18
In reply to Re: I feel horrible, posted by Dima on August 23, 2010, at 15:41:52
>The Adderall barely does anything for me, even at 30 mg, so I'm not too hopeful about that.
In that case, it might be best to stop taking it. There's no point risking dependence on a medication which isn't helping.
>She thinks I'm taking Celexa, Remeron, Lithium, and Seroquel, but I'm only taking Lithium. Should I suggest switching out the Celexa and Remeron for the TCA you were talking about?
You could do. It's just a suggestion. Here is some information from Dr. Gillman. He mentions the DUAG studies (Danish University Antidepressant Group). These studies suggested that clomipramine is more effective than citalopram, and also more effective than other tricyclics.
http://www.psychotropical.com/Antidepressants_Clomipramine.shtml
>Maybe Parnate would help more?
Maybe, maybe not. It is usual to try a couple of tricyclics before considering MAOIs. This is mainly due to the dietary restrictions and drug interactions associated with MAOIs.
Posted by Phillipa on August 23, 2010, at 20:36:59
In reply to Re: I feel horrible » Phillipa, posted by ed_uk2010 on August 23, 2010, at 13:41:57
Ed now why could that possibly be bad? It's perfectly fine to me. Love PJxxx
Posted by Dima on August 24, 2010, at 10:54:34
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on August 23, 2010, at 17:17:18
I tried Effexor for eight weeks with no effect and that page says they're pretty similar. Is it worth a try?
> >The Adderall barely does anything for me, even at 30 mg, so I'm not too hopeful about that.
>
> In that case, it might be best to stop taking it. There's no point risking dependence on a medication which isn't helping.
>
> >She thinks I'm taking Celexa, Remeron, Lithium, and Seroquel, but I'm only taking Lithium. Should I suggest switching out the Celexa and Remeron for the TCA you were talking about?
>
> You could do. It's just a suggestion. Here is some information from Dr. Gillman. He mentions the DUAG studies (Danish University Antidepressant Group). These studies suggested that clomipramine is more effective than citalopram, and also more effective than other tricyclics.
>
> http://www.psychotropical.com/Antidepressants_Clomipramine.shtml
>
> >Maybe Parnate would help more?
>
> Maybe, maybe not. It is usual to try a couple of tricyclics before considering MAOIs. This is mainly due to the dietary restrictions and drug interactions associated with MAOIs.
>
>
Posted by ed_uk2010 on August 24, 2010, at 15:24:48
In reply to Re: I feel horrible, posted by Dima on August 24, 2010, at 10:54:34
> I tried Effexor for eight weeks with no effect and that page says they're pretty similar.
I don't think it does. If you look at his website, Dr. Gillman does not believe that Effexor is comparable to clomipramine. He believes that clomipramine is superior for severe depression. He indicates that Effexor is more similar to an SSRI.
So yes, I think it's worth a try. You must start at a fairly low dose (eg. 25mg at night) and increase in steps of 25mg. Dosage requirements vary considerably. Initiating treatment at a high dose is likely to cause a lot of side effects.
In the US, clomipramine (Anafranil) is approved as a treatment for OCD, not depression. This is entirely due to the fact that the manufacturer wanted to promote it as an anti-obsessional drug when it was first launched. In reality, it is effective both for depression and for OCD. In the UK and in most countries, it is approved for both conditions. It is at least as effective as other tricylic antidepressants for depression (and probably more effective than most).
What happened to the dopamine agonist that you started? Are you still taking it?
Posted by Dima on August 24, 2010, at 16:16:57
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on August 24, 2010, at 15:24:48
> > I tried Effexor for eight weeks with no effect and that page says they're pretty similar.
>
> I don't think it does. If you look at his website, Dr. Gillman does not believe that Effexor is comparable to clomipramine. He believes that clomipramine is superior for severe depression. He indicates that Effexor is more similar to an SSRI.
>
> So yes, I think it's worth a try. You must start at a fairly low dose (eg. 25mg at night) and increase in steps of 25mg. Dosage requirements vary considerably. Initiating treatment at a high dose is likely to cause a lot of side effects.
>
> In the US, clomipramine (Anafranil) is approved as a treatment for OCD, not depression. This is entirely due to the fact that the manufacturer wanted to promote it as an anti-obsessional drug when it was first launched. In reality, it is effective both for depression and for OCD. In the UK and in most countries, it is approved for both conditions. It is at least as effective as other tricylic antidepressants for depression (and probably more effective than most).
>
> What happened to the dopamine agonist that you started? Are you still taking it?
>
>
>
>No, I took it for about a week. It seemed to make me even more tired the entire day, and I saw no other effects. If it helped the RLS, I didn't care enough to notice.
I'll bring the page you showed me to my therapist's appointment, and maybe I can get a chance to talk to the doctor on that day as well.
I've cried three times in the past two days, which is very rare for me. It's a horrible feeling in my chest that keeps getting worse and worse until I cry, and I feel slightly better, but I don't even have the energy to cry for very long.
Posted by ed_uk2010 on August 25, 2010, at 14:32:34
In reply to Re: I feel horrible, posted by Dima on August 24, 2010, at 16:16:57
>I'll bring the page you showed me to my therapist's appointment, and maybe I can get a chance to talk to the doctor on that day as well.
That might help. I expect your doctor will say 'Oh, it's an old drug, we don't prescribe THAT anymore'..... here, have some samples of Seroquel XR.............but I could be wrong. Anafranil is indeed an old drug. You will never see an advert for it. No one is out there promoting it and giving doctors pens and mugs which say 'Anafranil'.
> I've cried three times in the past two days, which is very rare for me.If I feel really bad, I actually find it helpful to cry a little. It releases the tension somehow - all the tension that's built up.
Take care.
Posted by Dima on August 25, 2010, at 16:26:01
In reply to Re: I feel horrible, posted by ed_uk2010 on August 25, 2010, at 14:32:34
I went to the hospital last night for extremely bad depression and nonstop suicidal thoughts. They didn't really do anything and I went home at four in the morning. I saw a pdoc today and she prescribed Anafranil. So I'll be taking:
Morning: Lithium 300, Celexa 40
Evening: Seroquel 50, Anafranil 25, Lithium 300
She prescribed 50 mg of the Anafranil, but you think I should start at 25?
Posted by ed_uk2010 on August 25, 2010, at 17:41:08
In reply to Re: I feel horrible, posted by Dima on August 25, 2010, at 16:26:01
> Morning: Lithium 300, Celexa 40
>
> Evening: Seroquel 50, Anafranil 25, Lithium 300
>
> She prescribed 50 mg of the Anafranil, but you think I should start at 25?Hi Dima,
Taking Anafranil in combination with SSRIs such as citalopram is not normally recommended. Anafranil is a very potent serotonin reuptake inhibitor in its own right. Once you have started Anafranil, you will probably be able to taper off citalopram very quickly. Personally, I would reduce citalopram to 20mg immediately after starting Anafranil. After a few days, I would then reduce to 10mg........and then stop after a few more days. Please bear in mind that this is what I would do myself. I am not a doctor and this should not be taken as medical advice.
Anafranil often causes drowsiness, especially during the early stages of treatment. You may be able to stop Seroquel - ask your doctor. Taking all these meds together could make you feel very tired and 'out of it'! I think it would be best to simplify your regimen as much as possible.
I think you should start Anafranil at the lowest possible dose and increase gradually. You should expect some dry mouth, drowsiness, dizziness, tremor and sweating - clomipramine is a powerful medication. If the starting dose is too high, side effects are more likely. You need to give your body time to get used to the medication before you increase up to a therapeutic dose.
Listen to your body! If you experience strong side effects after starting clomipramine, this suggests that your blood level might already be high despite the low dose - in this case you should not increase until you have consulted your doctor. If you experience mild side effects, wait a few days and then increase in small steps. If you experience no side effects at all, you should be able to increase more rapidly.
Take care, and let us know how you get on. Best of luck.
Posted by Dima on August 25, 2010, at 18:05:42
In reply to Re: I feel horrible, posted by ed_uk2010 on August 25, 2010, at 17:41:08
Thanks, that makes sense. And I have been taking the Celexa for a couple months with no effect anyway. It was actually 20 mg before and she increased it to 40 along with lowering Seroquel to 50 and prescribing Anafranil.
Is it possible to have depression as a withdrawal symptom of Adderall for days? I think there's a chance that when I take the Adderall, I feel worse for a day or two, and yesterday's depression could have been caused by not taking the Adderall for two days. Or is that too much time after?
Posted by ed_uk2010 on August 26, 2010, at 1:48:25
In reply to Re: I feel horrible, posted by Dima on August 25, 2010, at 18:05:42
>It was actually 20 mg before and she increased it to 40 along with lowering Seroquel to 50 and prescribing Anafranil.
She doesn't want you to increase citalopram at the same time as starting Anafranil, does she? If you're starting Anafranil, you need to consider decreasing citalopram.
>Is it possible to have depression as a withdrawal symptom of Adderall........?
Amphetamine withdrawal can cause depressive symptoms, yes.
Posted by ed_uk2010 on August 26, 2010, at 13:14:08
In reply to Re: I feel horrible, posted by Dima on August 25, 2010, at 18:05:42
So Dima, how are you feeling?
Posted by Dima on August 26, 2010, at 13:59:08
In reply to Re: I feel horrible, posted by ed_uk2010 on August 26, 2010, at 13:14:08
I just got the Anafranil this morning. They came in 50 mg capsules, so I don't think I'll be able to split them. Won't it work faster anyway if I start at the higher dosage? The only side effect I'm worried about is anxiety. I'm already on the edge of suicidal, and I can't afford to feel any worse. My first dose will be tonight.
On the other hand, the suicidal thoughts have calmed down. I feel better than I did for the past two days. I was very close to doing it, and if I had a foolproof, easy plan, I would have.
Posted by Dima on August 26, 2010, at 14:56:48
In reply to Re: I feel horrible, posted by Dima on August 26, 2010, at 13:59:08
Is it possible that the antidepressant can help me regain my senses as well? I have a dull sense of smell and taste. Sense of touch seems dull since touching others or massages don't feel good. Even sense of anxiety. Before, I used to feel a well defined "ball" of anxiety in my stomach, but now its more like a dull sensation throughout my body. It seems like there's a fog around my sense of anything at all, even my own thoughts.
Posted by ed_uk2010 on August 26, 2010, at 16:04:58
In reply to Re: I feel horrible, posted by Dima on August 26, 2010, at 13:59:08
> I just got the Anafranil this morning. They came in 50 mg capsules, so I don't think I'll be able to split them.
Yeah, the only way to split a capsule is to open it and divide the contents. The power will taste bitter and has a numbing effect on the tongue. Not very nice.
>Won't it work faster anyway if I start at the higher dosage?
Starting at a low dose would only delay response if you stayed on the low dose for too long. What I normally suggest is to start with a low dose and then increase at the rate which your body permits ie. rapidly if no adverse effects occur, slowly if adverse effects are a problem.
>The only side effect I'm worried about is anxiety. I'm already on the edge of suicidal, and I can't afford to feel any worse. My first dose will be tonight.
Try not to worry (easier said than done). Clomipramine doesn't usually cause anxiety, but it can do. Like most antidepressants, an initial worsening of anxiety can occur followed by an improvement after a couple of weeks. You should probably take the dose at about 10pm.
>On the other hand, the suicidal thoughts have calmed down. I feel better than I did for the past two days. I was very close to doing it, and if I had a foolproof, easy plan, I would have.
I'm sorry to hear that. Who do you have to support you when you feel so bad? What about your family?
Posted by ed_uk2010 on August 26, 2010, at 16:07:24
In reply to Re: I feel horrible, posted by Dima on August 26, 2010, at 14:56:48
>Is it possible that the antidepressant can help me regain my senses as well?
I expect that whatever treatment helps to relieve your depression will also reduce these symptoms.
Have you had physical causes of reduced smell investigated? You should ask your doctor to look into this.
Posted by Dima on August 26, 2010, at 16:18:38
In reply to Re: I feel horrible, posted by ed_uk2010 on August 26, 2010, at 16:07:24
I live with my older brother, who is veery understanding of the depression.
How can I neatly split a capsule and save the contents? And isn't the only worry of taking 50 mg increased side effects? I don't normally notice any side effects from antidepressants, although I think I felt more agitated and restless on Nortriptyline after a week or so.
I don't know yet whether to just take the 50 or split it.
Posted by ed_uk2010 on August 26, 2010, at 16:32:12
In reply to Re: I feel horrible, posted by Dima on August 26, 2010, at 16:18:38
>How can I neatly split a capsule and save the contents?
I'd probably just pour half the contents down the toilet and shut the capsule back up again, it doesn't have to be precise. This way, you can take 25mg for a couple of days...and then increase to 50mg (if tolerated).
>And isn't the only worry of taking 50 mg increased side effects?
Yes, that's the main issue. You can start at 50mg if you'd like to.
I'm glad that you have the understanding of your brother. That's great.
Posted by Phillipa on August 26, 2010, at 20:06:12
In reply to Re: I feel horrible, posted by ed_uk2010 on August 26, 2010, at 16:07:24
I have the same thing as you know two specialists at different hospitals said I'd had a viral infection in neurons of nose hence loss of smell and taste. Interesting as also do not feel so boy I relate to this. Supposedly two weeks of prednisone then theophylline would restore. But didn't. So quit. Anyone finds out let me know. Lymes that I had was also suggested. Phillipa
Posted by Justherself54 on August 26, 2010, at 21:39:01
In reply to Re: I feel horrible, posted by ed_uk2010 on August 26, 2010, at 16:32:12
I think you can buy empty capsules at the pharmacy. I started at 50 mg. I was amazed as I couldn't tolerate other TCA's. I slowly increased to 150 mg. and I'm doing very well. Close to remission..on a TCA..who knew!!
Side effects for me are dry mouth (this has slowly gotten better), constipation (easily remedied) and weight gain (not easily remedied).
I hope it works as well for you. I think increasing my dosage slowly did help minimize the side effects..Good luck to you.
Posted by Dima on August 27, 2010, at 14:42:42
In reply to Re: I feel horrible, posted by Dima on August 26, 2010, at 16:18:38
Took my first dose of Anafranil 50 mg last night. No side effects so far.
Posted by Phillipa on August 27, 2010, at 19:51:28
In reply to Re: I feel horrible, posted by Dima on August 27, 2010, at 14:42:42
Dima that's great. Best of luck and keep posting. Phillipa
Posted by Dima on August 28, 2010, at 11:11:06
In reply to Re: I feel horrible » Dima, posted by Phillipa on August 27, 2010, at 19:51:28
I don't usually seem to experience side effects from any antidepressants. Could it be that not enough is being absorbed for some reason? Or is that crazy?
Posted by ed_uk2010 on August 28, 2010, at 13:46:08
In reply to Re: I feel horrible, posted by Dima on August 28, 2010, at 11:11:06
>I don't usually seem to experience side effects from any antidepressants. Could it be that not enough is being absorbed for some reason? Or is that crazy?
It's great that you didn't get any side effects. Wait a few days before you increase. Did you pdoc tell you to go up to 100mg next?
I think you probably are absorbing it just fine. Metabolism of drugs is much more variable.
Posted by Dima on August 28, 2010, at 14:25:43
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on August 28, 2010, at 13:46:08
She only gave me the 50 mg dosage. Is it necessary to increase it higher to get effects?
Posted by ed_uk2010 on August 29, 2010, at 11:49:31
In reply to Re: I feel horrible, posted by Dima on August 28, 2010, at 14:25:43
>She only gave me the 50 mg dosage. Is it necessary to increase it higher to get effects?
Not always, but I suspect that it will be for you because you seem to be quite resistant to antidepressants. 125mg to 150mg per day is claimed to be optimal (on average), but higher doses are sometimes used.
Assuming that you are still experiencing no side effects, I think you should get in touch with your doctor to ask about increasing.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.