![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Greg on July 24, 2000, at 20:33:56
Cam,
Was put on Tegretol and Despiramine today by my doc. After reading info on them at mentalhealth.com, it appears that there may be some potentially dangerous interactions between the two. Can you clear this up for me? I'm a little concerned. I was also told to continue the Prozac in tapering off mode for the next two weeks. Any danger there? You help would be greatly appreciated.
Greg
Posted by Janice on July 24, 2000, at 23:03:05
In reply to CAM, need some info desperately, posted by Greg on July 24, 2000, at 20:33:56
Hi Greg,
I'm sorry to hear you're feeling so bad. I was reading your thread above. Personally, I wouldn't make that medication change without at least a second opinion. Just the simple fact you would be changing 3 medications within a 2 week period sounds very unsettling. I hope Cam comes on soon. Maybe you could try emailing him at home or try another doctor in the area where you live. As you know, I'm no doctor, I've just swallowed alot of those pills. Let us know how you're doing Greg.
Please take care, Janice
Posted by Cam W. on July 24, 2000, at 23:57:29
In reply to CAM, need some info desperately, posted by Greg on July 24, 2000, at 20:33:56
Greg - Nah, not really a potentially serious interaction, but you do need a doc who will monitor your dosing. A couple of studies have shown desipramine may increase Tegretol blood levels, but some other studies haven't been able to replicate this.
Also, by the same token, Tegretol could theoretically decrease desipramine levels by inducing (increasing) the drug metabolizing cytochrome system (CYP-3A3/4) by which both drugs are metabolized. This decrease of desipramine levels is ulikely because desipramine is also metabolized by other cytochrome enzymes (CYP-2D6 & CYP-1A2) which are not induced by Tegretol. Thus this should negate Tegretol's effect on desipramine's metabolism.
Just because these two drugs interact doesn't mean you can't use them together. You just have to modify the dose of Tegretol. Your doc will probably start you on a low dose and, by taking Tegretol blood levels, he/she will adjust the dosage according to you side effects (an indication of appropriate dose. Docs will raise your dose slowly until you have resolution of your symptoms or the side effects (nausea, lethargy, confusion, etc.) become a nuisance (then back off the dose a bit).
In the end you may probably be on a normal to low-normal dose of Tegretol and a normal dose of desipramine. •But this is only a guess•
I hope this makes some sense. If not I can try to clarify it a little better. Please ask questions. - Cam
Posted by Sunnely on July 25, 2000, at 1:00:50
In reply to CAM, need some info desperately, posted by Greg on July 24, 2000, at 20:33:56
> Was put on Tegretol and Despiramine today by my doc. After reading info on them at mentalhealth.com, it appears that there may be some potentially dangerous interactions between the two. Can you clear this up for me? I'm a little concerned. I was also told to continue the Prozac in tapering off mode for the next two weeks. Any danger there? You help would be greatly appreciated.
>
> GregPardon me for intruding. I hope you don't mind that I share my 2-cent opinion with you.
Tegretol, Desipramine, and Prozac can cause clinically significant drug-drug interactions. There are 2 kinds of drug-drug interactions which can happen: "pharmacodynamic" and "pharmacokinetic." Based on the "pharmacodynamic" interaction, Tegretol and desipramine taken together may cause increased emergent side effects such as drowsiness, dizziness, unsteadiness, confusion, and visual disturbances. Based on "pharmacokinetic" interaction, Tegretol can induce the liver metabolism of desipramine leading to decrease in desipramine's blood level and possibility of losing its therapeutic effect. However, inducing the metabolism via liver enzymes usually takes effect much longer (than inhibition of liver enzymes); the onset of decline in the desipramine's blood level may not take effect until after several days later. It may be necessary to increase the dose of desipramine (or other tricyclic antidepressant) if Tegretol is added. Checking the blood level of desipramine is also necessary to guide with the effective antidepressant dosing.
On the other hand, at least one case report documented Tegretol toxicity resulting from a doubling of the drug's blood level after the addition of desipramine to the patient's therapy. Desipramine does this by antagonizing or inhibiting the action of the liver enzymes that Tegretol depend on for metabolism. Symptoms of Tegretol toxicity may include dizziness, unsteadiness, nausea, vomiting, tremor, agitation, nystagmus (rapid eye movement). Heart rhythm irregularity and heart block have also been reported even at mildly elevated Tegretol blood levels. Therefore, it is clinically important to monitor both the Tegretol and desipramine blood levels when combined when these 2 drugs are used in combination. Whereas liver enzyme induction during drug-drug interaction occurs much later (several days to weeks), liver enzyme inhibition occurs much earlier (hours to a few days).
Prozac + Tegretol + Desipramine may spell trouble if not monitored closely. FYI, Prozac inhibits the action of several liver enzymes involved in the metabolism of drugs including the ones responsible for Tegretol and Desipramine. Prozac markedly inhibits the action of liver enzyme called CYP2D6; moderately inhibits CYP3A4, CYP2C9, and CYP2C19. Desipramine mainly depends on the liver enzyme CYP2D6 for its metabolism. Therefore, the combination of Prozac and desipramine will lead to increased in desipramine's blood level causing increased desipramine side effects. Heart rhythm irregularity and heart block has been reported with toxic level of desipramine (and other tricyclic antidepressants). On the same token, Prozac + Tegretol may lead to decreased (moderately) metabolism of Tegretol causing an increase in its blood level leading to potential Tegretol toxicity. In effect, both desipramine and Prozac are capable of raising the blood level of Tegretol.
Although your dose of Prozac is being tapered down, its inhibiting effect on the liver enzymes will continue until after about 5 weeks from the time it is stopped. This is due to its very long half-life (3 days for the parent compound and 5-15 days for its active metabolite). The pharmacokinetic interaction between Prozac + desipramine should be taken seriously. Toxic levels of desipramine (and other tricyclic antidepressants) can lead to a electrocardiogram abnormality called prolonged QTc which has the potential to generate an even more serious ECG abnormality called "torsades de pointes." "Torsades" usually is self-limiting and the only symptoms could be fainting and loss of consciousness and subsequently, the heart rhythm returns to normal. However, in some cases, it can generate into a serious arrhythmia called ventricular fibrillation and sudden cardiac death. Several sudden deaths attributed to serious heart rhythm irregularity (possibly "torsades") have been reported with the use of Seldane, Hismanal, and Propulsid. Aside from the tricyclic antidepressants, prolonged QTc, with potential for "torsades," have also been reported with thioridazine (Mellaril) and pimozide (Orap). Sertindole (Serlect), a promising atypical antipsychotic drug failed to make the US shores due to prolonged QTc. Ziprasidone (Zeldox) was on a holding pattern for FDA approval for awhile due to the same reason. (Zeldox, just recently received FDA approval.)
The bottom line here is, your ECG and blood levels of Tegretol and desipramine should be monitored periodically while you remain on this combination, especially if Prozac is to continue as part of the drug regimen. In fact, if you are over 40 or have pre-existing heart condition, you should have an ECG prior to the start of a tricyclic antidepressant therapy.
Posted by Cam W. on July 25, 2000, at 7:13:19
In reply to Re: CAM, need some info desperately, posted by Sunnely on July 25, 2000, at 1:00:50
Sunnely - A slow taper on of Tegretol and desipramine with a slow taper off of Prozac should be no problem in a compliant person. You are correct that the Prozac and Tegretol can alter each other's metabolism; sometimes in unpredictable ways, but I have also seen both used together several times, with no ill effects. Though these drugs interact, it shouldn't preclude one from using them together; with a caveat. Like you said, this combination (Prozac + desipramine + Tegretol) should be monitored for adverse effects and blood levels should also be monitored for Tegretol and desipramine. This close monitoring (in this case) should be done in 2 stages. Initially for 5 weeks until the Prozac clears the system significantly and then in about 8-10 weeks, when Tegretol seems to begin to induce it's own metabolism (and it's dose usually needs to be raised). Serotonin syndrome should not be a problem, as desipramine is mainly noradrenergic in action.
The CYP-3A4 inducing effects of Tegretol really do not affect desipramine, but it can affect the hydroxylation of imipramine to desipramine. CYP-2D6 is still the major enzyme system in both the metabolism of imipramine and desipramine, which does not metabolize Prozac. Since desipramine is being used (and not imipramine) the Tegretol/desipramine should really not interact.
Desipramine can be a problem in slow metabolizers of CYP-2D6, but this can occur in the absence of other drugs. Therefore, the side effects of desipramine (and TCAs in general) that you mention, must be closely watched in the first couple of weeks especially.
After rereading my last post, I do realize I was a little complacent in the way I shrugged off the interactions. I just see many drugs that interact in a potentially serious manner used in combination by some aggressive pdocs (even Prozac and TCAs, quite commonly) in treatment refractory patients.
I cannot believe that Greg's doc would start him on desipramine and Tegretol without considering the taper of Prozac. Both doses of desipramine and Tregretol should be started at normally sub-therapeutic doses and increased gradually as the Prozac is eliminated from the body. Done correctly, there should really be no antidepressant off-time with this method.
Thanks Sunnely, I appreciate your imput and caution against my blaise attitude. Sometimes I do get jaded with some of the combinations that I see.
Keep me honest - Cam
Posted by tina on July 25, 2000, at 7:38:37
In reply to Re: CAM, need some info desperately, posted by Cam W. on July 25, 2000, at 7:13:19
I've read that desipramine is a "heterocyclic AD. What the heck does that mean anyway?
> Sunnely - A slow taper on of Tegretol and desipramine with a slow taper off of Prozac should be no problem in a compliant person. You are correct that the Prozac and Tegretol can alter each other's metabolism; sometimes in unpredictable ways, but I have also seen both used together several times, with no ill effects. Though these drugs interact, it shouldn't preclude one from using them together; with a caveat. Like you said, this combination (Prozac + desipramine + Tegretol) should be monitored for adverse effects and blood levels should also be monitored for Tegretol and desipramine. This close monitoring (in this case) should be done in 2 stages. Initially for 5 weeks until the Prozac clears the system significantly and then in about 8-10 weeks, when Tegretol seems to begin to induce it's own metabolism (and it's dose usually needs to be raised). Serotonin syndrome should not be a problem, as desipramine is mainly noradrenergic in action.
>
> The CYP-3A4 inducing effects of Tegretol really do not affect desipramine, but it can affect the hydroxylation of imipramine to desipramine. CYP-2D6 is still the major enzyme system in both the metabolism of imipramine and desipramine, which does not metabolize Prozac. Since desipramine is being used (and not imipramine) the Tegretol/desipramine should really not interact.
>
> Desipramine can be a problem in slow metabolizers of CYP-2D6, but this can occur in the absence of other drugs. Therefore, the side effects of desipramine (and TCAs in general) that you mention, must be closely watched in the first couple of weeks especially.
>
> After rereading my last post, I do realize I was a little complacent in the way I shrugged off the interactions. I just see many drugs that interact in a potentially serious manner used in combination by some aggressive pdocs (even Prozac and TCAs, quite commonly) in treatment refractory patients.
>
> I cannot believe that Greg's doc would start him on desipramine and Tegretol without considering the taper of Prozac. Both doses of desipramine and Tregretol should be started at normally sub-therapeutic doses and increased gradually as the Prozac is eliminated from the body. Done correctly, there should really be no antidepressant off-time with this method.
>
> Thanks Sunnely, I appreciate your imput and caution against my blaise attitude. Sometimes I do get jaded with some of the combinations that I see.
>
> Keep me honest - Cam
Posted by Greg on July 25, 2000, at 12:40:34
In reply to CAM, need some info desperately, posted by Greg on July 24, 2000, at 20:33:56
All,
First of all, thanks to everyone for their input, advise and support. As usual you were there for me.
I was unable to get the Despiramine Rx filled as the pharmacy was out of the dosage I needed, I get that today. I did start the Tegretol yesterday and WOW!!! About 45 minutes after taking it (the prescribed dose is 200mgs am, 200mgspm) I got really loaded. And by loaded, I mean smoked a joint of really good weed loaded. I started to laugh, get really stupid, head rushes when I stood, etc. Then came the munchies... After dinner, I ate 3 pcs of Pizza, a quarter gallon of ice cream, and my personal favorite Peanut Butter (just the jar and a spoon, thank you). Sure I gained at least 5 lbs last night. Needless to say I woke at 1am with some pretty intense stomach cramps. After eating, I just pretty much just passed out on the couch. I hope this is a normal side-effect of the med and will pass. I certainly can't take this at work, I couldn't focus to do my job. I'm feeling pretty much like a zombie this am, and to top things off, I have to meet with the big boss at 1pm to try to convince him to purchase a quarter million dollar software package. I think I'll just hide under my desk instead.....
I've read the info you all have given me and quite frankly am a little concerned. Looks like some real potential for problems. I'm going to print your inputs on the meds and fax them to my doc today. I need some more reassurance that we are taking the right course of action here. Better safe than sorry, right? Why do they give an anti-seizure med for mood stabilization?
Thanks again to everyone for the help and support. A special thanks to Tina who spent an hour on the Internet with me last night tracking down info on these meds. Thank you for being such a good friend, I'm very lucky to have you.
I will let everyone know how it goes. If anyone has any direct experience with either or both of these meds together, I'd like to hear about it.
Have a peaceful day all,
Greg
Posted by stjames on July 25, 2000, at 17:31:14
In reply to Re: CAM, need some info desperately, posted by Cam W. on July 25, 2000, at 7:13:19
> Sunnely - A slow taper on of Tegretol and desipramine with a slow taper off of Prozac should be no problem in a compliant person. You are correct that the Prozac and Tegretol can alter each other's metabolism; sometimes in unpredictable ways, but I have also seen both used together several times, with no ill effects. Though these drugs interact, it shouldn't preclude one from using them together; with a caveat. Like you said, this combination (Prozac + desipramine + Tegretol) should be monitored for adverse effects and blood levels should also be monitored for Tegretol and desipramine
James here....
It is also important to remember that some of us
count of interactions of this nature to better treat depression, ect. I am speaking of one med
effecting he way another is processed, by enzymes
and other liver products. The net effect (I take Effexor + Remeron) usually means higher blood levels with less meds to take. Herein is a corner
stone of why polypharm works; ther are other factors, too, but this is a biggie. Generally most
psyco meds have the potential to effect other psyco meds.james
Posted by Cam W. on July 25, 2000, at 19:00:20
In reply to Update on meds and thank yous, posted by Greg on July 25, 2000, at 12:40:34
Greg
> First of all, thanks to everyone for their input, advise and support. As usual you were there for me.
As you are there for us.
> I was unable to get the Despiramine Rx filled as the pharmacy was out of the dosage I needed, I get that today.
What was the dose? (just curious)
>I did start the Tegretol yesterday and WOW!!! About 45 minutes after taking it (the prescribed dose is 200mgs am, 200mgspm) I got really loaded.
This may be an indication that the dose may be too high and you may need to increase the dose slowly, at a lower dosage (eg. 100mg twice daily for 4-7 days, then increase) to avoid this feeling. Your body should adjust to the Tegretol within a month.
>I have to meet with the big boss at 1pm to try to convince him to purchase a quarter million dollar software package.
I hope it went okay.
> I've read the info you all have given me and quite frankly am a little concerned. Looks like some real potential for problems.
Yes, there are potential problems, but they can be minimized by you and your doc working together on a game plan to find an effective balance of dosages.. Once the Prozac clears your system enough to not inhibit the cytochrome system, a dosage balance will be reached between the desipramine and Tegretol. It should be fairly stable, with maybe the occational minor tweaking of dose.
>I'm going to print your inputs on the meds and fax them to my doc today. I need some more reassurance that we are taking the right course of action here. Better safe than sorry, right?
Absolutely, always err on the side of caution. Become as informed as you can on this.
>Why do they give an anti-seizure med for mood stabilization?
Because it works.
I don't know if an exact antimanic/antidepressive mechanism has been proven, but I think both epilepsy and bipolar disorder involve temporal lobe structures (I could be wrong).Greg, call your doc about the side effects you experienced. He may lower the dose or have you ride it out for a day or two.
Good luck - Cam
Posted by Cam W. on July 25, 2000, at 19:27:02
In reply to Re: Heterocyclic AD's, posted by tina on July 25, 2000, at 7:38:37
> I've read that desipramine is a "heterocyclic AD. What the heck does that mean anyway?
It is a description of desipramine's chemical structure and is used as a way to classify the molecule as being different from other antidepressants.
Desipramine has 3 rings in it's structure: 2 benzene rings (a six carbon atom structure joined together with double-bonds) connected by a five sided pentagram with a nitrogen atoms replacing one of the carbon atoms.
In other words, desipramine has a 3 ring chemical structure, with one of the rings different from the others.
Hence, heterocyclic: having or pertaining to a closed chain or ring formation that includes atoms of different elements (a nitrogen atom instead of a carbon atom in the center ring, in this case).
I know that this is not too clear, but hopefully you get the gist. - Cam
Posted by tina on July 26, 2000, at 7:27:35
In reply to Re: Heterocyclic AD's » tina, posted by Cam W. on July 25, 2000, at 19:27:02
> > I've read that desipramine is a "heterocyclic AD. What the heck does that mean anyway?
>
> It is a description of desipramine's chemical structure and is used as a way to classify the molecule as being different from other antidepressants.
>
> Desipramine has 3 rings in it's structure: 2 benzene rings (a six carbon atom structure joined together with double-bonds) connected by a five sided pentagram with a nitrogen atoms replacing one of the carbon atoms.
>
> In other words, desipramine has a 3 ring chemical structure, with one of the rings different from the others.
>
> Hence, heterocyclic: having or pertaining to a closed chain or ring formation that includes atoms of different elements (a nitrogen atom instead of a carbon atom in the center ring, in this case).
>
> I know that this is not too clear, but hopefully you get the gist. - Cam
Posted by tina on July 26, 2000, at 7:31:49
In reply to Update on meds and thank yous, posted by Greg on July 25, 2000, at 12:40:34
Greg: My distinct pleasure. You'd do the same for me. Just a comment: I take Rivotril 3X a day. It is an anti-convulsant/anti-seizure med and it apparently stabilizes my moods too. That's why the doc gave it to me when it was determined I had Bipolar II tendencies. Don't know why they work, they just do!
Very glad you are getting more info on your meds. Definitly better to be safe than sorry.
Have a great day
luv ya
Tina> All,
>
> First of all, thanks to everyone for their input, advise and support. As usual you were there for me.
>
> I was unable to get the Despiramine Rx filled as the pharmacy was out of the dosage I needed, I get that today. I did start the Tegretol yesterday and WOW!!! About 45 minutes after taking it (the prescribed dose is 200mgs am, 200mgspm) I got really loaded. And by loaded, I mean smoked a joint of really good weed loaded. I started to laugh, get really stupid, head rushes when I stood, etc. Then came the munchies... After dinner, I ate 3 pcs of Pizza, a quarter gallon of ice cream, and my personal favorite Peanut Butter (just the jar and a spoon, thank you). Sure I gained at least 5 lbs last night. Needless to say I woke at 1am with some pretty intense stomach cramps. After eating, I just pretty much just passed out on the couch. I hope this is a normal side-effect of the med and will pass. I certainly can't take this at work, I couldn't focus to do my job. I'm feeling pretty much like a zombie this am, and to top things off, I have to meet with the big boss at 1pm to try to convince him to purchase a quarter million dollar software package. I think I'll just hide under my desk instead.....
>
> I've read the info you all have given me and quite frankly am a little concerned. Looks like some real potential for problems. I'm going to print your inputs on the meds and fax them to my doc today. I need some more reassurance that we are taking the right course of action here. Better safe than sorry, right? Why do they give an anti-seizure med for mood stabilization?
>
> Thanks again to everyone for the help and support. A special thanks to Tina who spent an hour on the Internet with me last night tracking down info on these meds. Thank you for being such a good friend, I'm very lucky to have you.
>
> I will let everyone know how it goes. If anyone has any direct experience with either or both of these meds together, I'd like to hear about it.
>
> Have a peaceful day all,
> Greg
Posted by Greg on July 26, 2000, at 12:48:56
In reply to Re: Update on meds and thank yous, posted by Cam W. on July 25, 2000, at 19:00:20
Cam,
At your suggestion and with my docs OK, I went to a lower dose of the Teg, 100mgs am and 100mgs pm. I experienced no loaded feeling, ate only my dinner (thank God, visions of writing Goodyear across my stomach dancing in my head) and I slept pretty well. Still couldn't get the Desipramine though, they won't have it until today, but I will let you know about the dose when I do. I hear that the maximum dose per day is 300mgs, does that sound about right to you?
Thank you again my friend for all your support. I hope you know how needed and appreciated you are here!
Peace,
Greg
Posted by Greg on July 26, 2000, at 13:25:53
In reply to Re: Update on meds » Cam W., posted by Greg on July 26, 2000, at 12:48:56
Cam,
Just an added note, the meeting with my boss went suprisingly well considering.....
And yes I did sell him on the software package, WOO HOO!!! Can I cook or can't I?
Greg
Posted by dove on July 26, 2000, at 15:57:20
In reply to Re: Update on meds - P.S. - CAM, posted by Greg on July 26, 2000, at 13:25:53
Hello again Greg :-)
Affirming St. James' input about drug interactions, I too count on the meds interacting with each other in order to take smaller dosages, have less side-effects, and to obtain better and wider results. I was on Amitriptyline, Adderall, Wellbutrin, and Prozac all at the same time. If you run this combo through a drug interaction checker I think you'll find some "serious" interactions. Unfortunately, it didn't do a whole lot of good for me, as I degenerated into a suicidal mess, unable to even look at myself in the mirror. I don't know enough about Desipramine to say definitively whether or not it is as dangerous as combining Amitriptyline w/ Prozac.
Tegretol... I hate this med with a passion, as it brought me out of my dream world into the darkest pits of depression. I was a depressed, detached zombie. I dropped out of college, got pregnant, and sat in the dark for days on end. I never laughed, never felt any joy, and was scared to death that I was actually going to die due to sitting on the floor, in a corner, with no lights, with no food, for days and days at a time. So... I'm happily surprised by your significantly more positive reaction to the med :-) I should also note that I was prescribed Tegretol for migraine black-outs (black-out as in fainting and hitting the floor really hard and possibly epileptic in nature.). At that time I was taking no ther meds and my initial dosage was some where between 450mgs and 600mgs. All I did was sleep and sleep at first, and when I woke up, all I did was behave like a vampiric zombie.
I'm not being very positive with regard to the mood-stabilizer Tegretol, but on a more positive note I just started an anti-seizure med Neurontin (Gabapentin) for my own extreme mood-swings. Initial dosage was 600mgs, taken all at once before bed (with my all-in-one dose of Amitriptyline and Serzone, and I'm *still* struggling to fall asleep at night. Yikes!!!). I've been super-duper surprised by my reaction to the mood-stabilizer, I was *so* afraid that I would turn into zombie woman again (like with the Tegretol) but instead I feel truly tinged with mania for the second time in ten years.
I had this feeling momentarily when I increased my Wellbutrin I believe, but it only lasted 24 hours. Whereas, this Neurontin induced manic feeling has lasted since last Thursday, and I can definitely tell the difference between this aggravated-agressive-hot-tempered, but optimistic and in love with people and the world "high" versus the really mellow subdued "UP" that I experienced with Verapamil (Oh how I miss it). I've been dxed w/ bipolar for a while now and my p-doc was totally centered on ridding me of my depression before starting a mood-stabilizer. My p-doc move to sunny Cali last month and it was my new p-doc (although temporary because he's going to retire in a few months) who said I really need the mood-stabilizer in order to beat the depression.
I am having some short-term memory difficulties, can't keep track of all the loose ends I need to attend to, lose track of time in hours not minutes, and am experiencing big angry downs when the Neurontin has worn off, so-to-speak. I really want to split the dosage in half, in order to cover the daylight hours better, but my doc wants me to take it all at once. I do metabolize meds at double the normal speed, this being part of the problem with my negative response to Prozac (nausea and the shakes in late afternoon and evening and super adrenalin-filled *rushes* for the first three hours after I took it in the morning.). I've even had blood tests done, especially when I was taking Tegretol, that would convince my doc that I wasn't taking the med at all, and she would up the dosage, telling me that I was either lying or I needed more to actually do the job.
We're all so unique and yet, fundamentally the same under our thick and thin skin. Best wishes and thoughts are keeping vigil for you Greg!!!
dove
Posted by dove on July 26, 2000, at 16:15:32
In reply to Re: Update on meds and thoughts, posted by dove on July 26, 2000, at 15:57:20
Yes, I'm writing again, I think maybe my mood-swings are actually getting worse. Anyway, in regard to the people intolerance rage thing, I too am experiencing these extreme fluctuations. Could it be season related, is this what they call a mixed episode? Bad combo of Serzone, Neurontin, and other CNS Stimulants? Have you ever thought about trying something along the lines of a Calcium-channel blocker (as in Verapamil)? Would a Beta-blocker be similar?
I really find the mood-swinging agitated rage-fests a tad too heavy to keep up with, they hit so suddenly and seemingly out of no-where! And my anger fluctuations seem to thrive on anxiety, pain, helplessness, and vulnerability reminders, triggers, and/or memories.
Just some more thoughts...
dove
Posted by Greg on July 26, 2000, at 19:50:31
In reply to Re: Update on meds and thoughts, posted by dove on July 26, 2000, at 15:57:20
Hi Dove!
My God, with the dosage you were taking it's no wonder you were a zombie all the time! The reaction I described was to 200mgs, 600 would have put me into a coma, after eating all of the food in the house first of course. I can't even fathom it! The thing that is concerning me the most about the Teg/Despiramine combo is the sleep effects. My doc was very clear about about the Desp making me very drowsy and to make sure I took it just before going to bed. But he said nothing about the Teg doing that. The first night I slept horribly, waking with the stomach cramps, but last night after halving the dose to 100 (and not stuffing myself all night) I slept really well and was able to shake off the morning fog with little effort. No mood swings or anger today either, although I have trouble believing that the med could have worked that quick. I remain cautiously optimistic. Tonight will tell the tale I guess.
Your experience with the Teg sounds like a total nightmare! Did your doc insist that you continue taking it even though it was having this reaction on you? I'd a had to been killin' somebody! I think that your not wanting to eat surprises me the most. I absolutely gorged myself, couldn't get enough food. I'm glad the Teg isn't a part of your life anymore.
I think the thing that upsets me most about this whole deal is that I was really feeling good for months, and now suddenly the bottom drops out! It really pisses me off! I don't want to feel this way, dancing thru the house one minute, biting someone's head off the next. I talked to a good friend of several years at work today and told her what I was going thru. When I was done, she looked at me and smiled and said "Sounds just like PMS to me". I couldn't help but laugh. Life teaches me lessons everyday, whether I want to learn them or not....
I hope things continue to improve for you. You are always in my thoughts and knowing that I'm in yours makes me feel better already!
Hugs,
Greg> Hello again Greg :-)
>
> Affirming St. James' input about drug interactions, I too count on the meds interacting with each other in order to take smaller dosages, have less side-effects, and to obtain better and wider results. I was on Amitriptyline, Adderall, Wellbutrin, and Prozac all at the same time. If you run this combo through a drug interaction checker I think you'll find some "serious" interactions. Unfortunately, it didn't do a whole lot of good for me, as I degenerated into a suicidal mess, unable to even look at myself in the mirror. I don't know enough about Desipramine to say definitively whether or not it is as dangerous as combining Amitriptyline w/ Prozac.
>
> Tegretol... I hate this med with a passion, as it brought me out of my dream world into the darkest pits of depression. I was a depressed, detached zombie. I dropped out of college, got pregnant, and sat in the dark for days on end. I never laughed, never felt any joy, and was scared to death that I was actually going to die due to sitting on the floor, in a corner, with no lights, with no food, for days and days at a time. So... I'm happily surprised by your significantly more positive reaction to the med :-) I should also note that I was prescribed Tegretol for migraine black-outs (black-out as in fainting and hitting the floor really hard and possibly epileptic in nature.). At that time I was taking no ther meds and my initial dosage was some where between 450mgs and 600mgs. All I did was sleep and sleep at first, and when I woke up, all I did was behave like a vampiric zombie.
>
> I'm not being very positive with regard to the mood-stabilizer Tegretol, but on a more positive note I just started an anti-seizure med Neurontin (Gabapentin) for my own extreme mood-swings. Initial dosage was 600mgs, taken all at once before bed (with my all-in-one dose of Amitriptyline and Serzone, and I'm *still* struggling to fall asleep at night. Yikes!!!). I've been super-duper surprised by my reaction to the mood-stabilizer, I was *so* afraid that I would turn into zombie woman again (like with the Tegretol) but instead I feel truly tinged with mania for the second time in ten years.
>
> I had this feeling momentarily when I increased my Wellbutrin I believe, but it only lasted 24 hours. Whereas, this Neurontin induced manic feeling has lasted since last Thursday, and I can definitely tell the difference between this aggravated-agressive-hot-tempered, but optimistic and in love with people and the world "high" versus the really mellow subdued "UP" that I experienced with Verapamil (Oh how I miss it). I've been dxed w/ bipolar for a while now and my p-doc was totally centered on ridding me of my depression before starting a mood-stabilizer. My p-doc move to sunny Cali last month and it was my new p-doc (although temporary because he's going to retire in a few months) who said I really need the mood-stabilizer in order to beat the depression.
>
> I am having some short-term memory difficulties, can't keep track of all the loose ends I need to attend to, lose track of time in hours not minutes, and am experiencing big angry downs when the Neurontin has worn off, so-to-speak. I really want to split the dosage in half, in order to cover the daylight hours better, but my doc wants me to take it all at once. I do metabolize meds at double the normal speed, this being part of the problem with my negative response to Prozac (nausea and the shakes in late afternoon and evening and super adrenalin-filled *rushes* for the first three hours after I took it in the morning.). I've even had blood tests done, especially when I was taking Tegretol, that would convince my doc that I wasn't taking the med at all, and she would up the dosage, telling me that I was either lying or I needed more to actually do the job.
>
> We're all so unique and yet, fundamentally the same under our thick and thin skin. Best wishes and thoughts are keeping vigil for you Greg!!!
>
> dove
Posted by Greg on July 27, 2000, at 18:08:18
In reply to Re: Update on meds » Cam W., posted by Greg on July 26, 2000, at 12:48:56
Cam,
I picked up the Desipramine today, It is 100mgs, which the Pharmacist assures me will make me very drowsy (yee haw...). I had him check the computer for possible negative interactions between the Teg/Desip/Prozac, and it came back with nothing other that the Teg intake should be monitored closely for the first little while which I already knew. Sooo, here goes nothin'. I'll let you know.
Thanks again Bud,
Greg
This is the end of the thread.
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