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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Cindylou on May 2, 2001, at 11:50:42
Another tread for me, thanks for your patience...
Desipramine --
- what is the lowest effective dose?
- What are side effects?
- What is it best for treating (e.g. depression, anxiety, social anxiety, etc.)I was on this drug way-back-when (before SSRIs hit the scene) but only on 40 mg. Still, I thought it helped, but a doc I saw later said that that was too low of a dose to make a difference.
Thanks for feedback, advice, etc.!
- cindy
Posted by Mr.Scott on May 2, 2001, at 14:57:48
In reply to Desipramine, posted by Cindylou on May 2, 2001, at 11:50:42
Depends what your taking it for. Some people with ADHD take only 10-20mg a day. Plus people have different metabolic activity levels in the liver. 40 mgs may be fine for you and too much or little for someone else. Sounds like you have some concerns though.. Is it working for you?
Posted by SalArmy4me on May 2, 2001, at 17:46:33
In reply to Desipramine, posted by Cindylou on May 2, 2001, at 11:50:42
I think you may find this movie from the University of Nebraska Psychiatry useful: http://hog.unmc.edu:8080/ramgen/psychiatry/psych02282001.rm
Posted by Cindylou on May 2, 2001, at 18:23:36
In reply to Re: Desipramine, posted by Mr.Scott on May 2, 2001, at 14:57:48
Hi Scott,
I haven't taken Desipramine for 12 years now; when the SSRIs came out, my new doctors kept trying me on those (Prozac, Zoloft, Effexor)plus Wellbutrin -- but these all made me feel exhausted and mentally fogged. I stopped Effexor about a month ago, and unfortunately the depression is coming back, along with agitation and irritation.SO... my doc and I are toying with some different options, Desipramine again, or maybe Manerix. I haven't started either yet; still on Wellbutrin which isn't doing much at this point.
That's it in a nutshell -- Thanks so much for your response; it was very helpful knowing that I may have actually benefitted from a low dose, even though my doc said I wouldn't have had any benefits at that level. I am VERY sensitive to medications, so it makes sense that I would react to a lower dose; I guess my doc just goes by the book as far as therapeutic doses go!
Thanks again!
cindy> Depends what your taking it for. Some people with ADHD take only 10-20mg a day. Plus people have different metabolic activity levels in the liver. 40 mgs may be fine for you and too much or little for someone else. Sounds like you have some concerns though.. Is it working for you?
Posted by SLS on May 4, 2001, at 21:21:48
In reply to Desipramine, posted by Cindylou on May 2, 2001, at 11:50:42
Hi Cindy.
> Desipramine --
> - what is the lowest effective dose?The lowest effective dose is always the minimum dosage that gets the results you are looking for and maintains them.
I am not trying to be a wise guy (it comes naturally). Each individual must find this dosage by clinical (observation) adjustment of dosage. I think it is safe to say that 40mg was too low to expect much. You might have felt some sort of energy boost temporarily, but larger dosages are usually needed in cases of moderate to severe depression. Just as a general guideline, I would consider dosages between 100mg - 200mg to be average for most moderate depressions in an outpatient setting. Dosages up to 300mg are often needed for more severe depressions. However, the rate at which people metabolize (break-down) and excrete desipramine is highly variable. That is why one must methodically discover which dosage is ideal for them. Blood tests can help with this. Depending on your tolerance of side effects, I would think 150mg to be a good target.
> - What are side effects?
This again is variable for each individual, but some of the more common side effects are: dry mouth, blurred vision, constipation, difficulty initiating urination, dizziness (especially when standing from a seated or lying position), drowsiness, increased perspiration, mild tremors, anxiety, and insomnia. You may experience only a few of these. The side effects of desipramine diminish and are generally mild once one has been taking it for awhile.
> - What is it best for treating (e.g. depression, anxiety, social anxiety, etc.)
Desipramine can effectively treat all of these. It depends upon exactly what is going on within the three pound organ located between your ears. Often, anxiety and social inhibition are features of the depression itself, and improve when the depression improves. For instances in which true social phobia is prominent or in cases of generalized anxiety disorder, the SSRIs and MAO-inhibitors, particularly Nardil (phenelzine), are usually better choices. From the standpoint of statistics, there is a small tendency for males to respond to tricyclics and females to respond to SSRIs.
So, what do you do now?
I don't know.
There are lots of things that you might take into consideration. How many drugs have you tried without success, and at what dosages? What combinations of medications have you tried? Are you, or is anyone in your family bipolar? Should any of your immediate family members suffer from a mood or anxiety disorder, which drugs have been effective for them? Have you had your thyroid function checked? Does your depression include constant melancholic, morbid thoughts and feelings of doom? Do you have trouble sleeping, especially in the early morning? Does you depression have any psychotic features? Do you sleep to little or too much? Do you eat too little or too much? Do you feel agitated and have trouble sitting still? Do you have too little energy to get out of a chair?
These questions and more are relevant in making a best *guess* as to which medication or combinations of medication have the best chance of working for you. A good psychiatrist would take all of these things into consideration.
So, what do you do now?
I think desipramine is a reasonable choice. If you are comfortable with trying it first, and your doctor feels that it is a good first choice for you in particular, I can't think of any reason to hesitate other than the presence of preexisting abnormal heart function.
I have probably made things more complicated for you. Sorry.
- Scott
Posted by Cindylou on May 6, 2001, at 12:43:44
In reply to Re: Desipramine, posted by SLS on May 4, 2001, at 21:21:48
Dear Scott,
WOW! Thanks for the excellent information. No, you didn't make things too complicated for me. I didn't explain in my original post that I have been dealing with this depression thing for 12 years now -- have tried many meds (almost ALL of the SSRIs which made me extremely fatigued and foggy-headed; even when combined with Wellbutrin.) I recently came off of Effexor, the last SSRI I tried. (That's a whole other story...)Have also tried Prozac, Zoloft and Paxil.That's why my doc and I are going back to Square One - Desipramine. It was the first med I was on, before Prozac even came out. And it did seem to help with no side effects, but most people seem to agree that 40 mg was too low of a dose to have a true effect.
I think you're right that my "social anxiety" is more a function of my depression than actual social phobia. I am fine in front of a group of people I don't know; it's only when I'm with people who could potentially become friends that I get hit with a surge of insecurity and inferiority.
So...I guess we'll see what happens.
The other option my doc and I discussed was the reversible MAOI called Manerix, available in Canada. Do you know anything about that drug?
Thanks again for your support,
cindy> Hi Cindy.
>
> > Desipramine --
> > - what is the lowest effective dose?
>
> The lowest effective dose is always the minimum dosage that gets the results you are looking for and maintains them.
>
> I am not trying to be a wise guy (it comes naturally). Each individual must find this dosage by clinical (observation) adjustment of dosage. I think it is safe to say that 40mg was too low to expect much. You might have felt some sort of energy boost temporarily, but larger dosages are usually needed in cases of moderate to severe depression. Just as a general guideline, I would consider dosages between 100mg - 200mg to be average for most moderate depressions in an outpatient setting. Dosages up to 300mg are often needed for more severe depressions. However, the rate at which people metabolize (break-down) and excrete desipramine is highly variable. That is why one must methodically discover which dosage is ideal for them. Blood tests can help with this. Depending on your tolerance of side effects, I would think 150mg to be a good target.
>
> > - What are side effects?
>
> This again is variable for each individual, but some of the more common side effects are: dry mouth, blurred vision, constipation, difficulty initiating urination, dizziness (especially when standing from a seated or lying position), drowsiness, increased perspiration, mild tremors, anxiety, and insomnia. You may experience only a few of these. The side effects of desipramine diminish and are generally mild once one has been taking it for awhile.
>
> > - What is it best for treating (e.g. depression, anxiety, social anxiety, etc.)
>
> Desipramine can effectively treat all of these. It depends upon exactly what is going on within the three pound organ located between your ears. Often, anxiety and social inhibition are features of the depression itself, and improve when the depression improves. For instances in which true social phobia is prominent or in cases of generalized anxiety disorder, the SSRIs and MAO-inhibitors, particularly Nardil (phenelzine), are usually better choices. From the standpoint of statistics, there is a small tendency for males to respond to tricyclics and females to respond to SSRIs.
>
> So, what do you do now?
>
> I don't know.
>
> There are lots of things that you might take into consideration. How many drugs have you tried without success, and at what dosages? What combinations of medications have you tried? Are you, or is anyone in your family bipolar? Should any of your immediate family members suffer from a mood or anxiety disorder, which drugs have been effective for them? Have you had your thyroid function checked? Does your depression include constant melancholic, morbid thoughts and feelings of doom? Do you have trouble sleeping, especially in the early morning? Does you depression have any psychotic features? Do you sleep to little or too much? Do you eat too little or too much? Do you feel agitated and have trouble sitting still? Do you have too little energy to get out of a chair?
>
> These questions and more are relevant in making a best *guess* as to which medication or combinations of medication have the best chance of working for you. A good psychiatrist would take all of these things into consideration.
>
> So, what do you do now?
>
> I think desipramine is a reasonable choice. If you are comfortable with trying it first, and your doctor feels that it is a good first choice for you in particular, I can't think of any reason to hesitate other than the presence of preexisting abnormal heart function.
>
> I have probably made things more complicated for you. Sorry.
>
>
> - Scott
Posted by SLS on May 6, 2001, at 18:54:10
In reply to Re: Desipramine, posted by Cindylou on May 6, 2001, at 12:43:44
Hi Cindy.
> The other option my doc and I discussed was the reversible MAOI called Manerix, available in Canada. Do you know anything about that drug?
Yes, some. However, my first question to you is whether or not you have tried Parnate, Nardil, or Marplan. Have you ever combined desipramine with any of these MAOIs?
Oh, before I ask my first question, my first first question is whether or not there is any possibility that you are bipolar. Have you tried adding lithium or any of the anticonvulsant mood-stabilizers along the way?
I am not a big fan of Manerix (moclobemide) when it comes to statistical success rate. However, it has been a miracle drug for some. It is very gentle in terms of side effects. Manerix is used to treat depression and social phobia. Antidepressant effects of Manerix occur rapidly, often producing an improvement within the first week. However, there is a tendency to require a series of dosage increases to maintain the improvement. Although the official recommended dosage range lies between 150mg and 600mg, the effective range observed clinically seems to be higher. 600mg to 900mg is most likely to produce the best results in more severe cases. Some people need as much as 1200mg.
Although the reversibility of Manerix is thought to obviate the need for a special diet, it is advisable to limit the intake of tyramine at any one meal to 50mg. There is also literature indicating that adding an SSRI to moclobemide is both safe and effective in treatment-resistant cases. With regard to both of these contentions, there are multiple anecdotal reports describing serious adverse events. However, I have no idea what the statistical rate of occurrence is.
I don't think you have anything to lose by trying Manerix.
As is the case with every other antidepressant that I am aware of, there is always the potential for it to make you feel worse or experience intolerable side effects. Of course, I'll be hoping that Manerix is your miracle drug. :-)
Good luck.
- Scott
Posted by Cindylou on May 8, 2001, at 12:59:24
In reply to Re: Desipramine, posted by SLS on May 6, 2001, at 18:54:10
Thank you Scott!
I'll keep you posted on what happens...
-cindy
> Hi Cindy.
>
> > The other option my doc and I discussed was the reversible MAOI called Manerix, available in Canada. Do you know anything about that drug?
>
> Yes, some. However, my first question to you is whether or not you have tried Parnate, Nardil, or Marplan. Have you ever combined desipramine with any of these MAOIs?
>
> Oh, before I ask my first question, my first first question is whether or not there is any possibility that you are bipolar. Have you tried adding lithium or any of the anticonvulsant mood-stabilizers along the way?
>
> I am not a big fan of Manerix (moclobemide) when it comes to statistical success rate. However, it has been a miracle drug for some. It is very gentle in terms of side effects. Manerix is used to treat depression and social phobia. Antidepressant effects of Manerix occur rapidly, often producing an improvement within the first week. However, there is a tendency to require a series of dosage increases to maintain the improvement. Although the official recommended dosage range lies between 150mg and 600mg, the effective range observed clinically seems to be higher. 600mg to 900mg is most likely to produce the best results in more severe cases. Some people need as much as 1200mg.
>
> Although the reversibility of Manerix is thought to obviate the need for a special diet, it is advisable to limit the intake of tyramine at any one meal to 50mg. There is also literature indicating that adding an SSRI to moclobemide is both safe and effective in treatment-resistant cases. With regard to both of these contentions, there are multiple anecdotal reports describing serious adverse events. However, I have no idea what the statistical rate of occurrence is.
>
> I don't think you have anything to lose by trying Manerix.
>
> As is the case with every other antidepressant that I am aware of, there is always the potential for it to make you feel worse or experience intolerable side effects. Of course, I'll be hoping that Manerix is your miracle drug. :-)
>
> Good luck.
>
>
> - Scott
This is the end of the thread.
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