![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 42. Go back in thread:
Posted by Elizabeth on October 31, 2001, at 22:26:49
In reply to Re: Which benzo is *least* sedating? +other stuff » Thrud, posted by Mitch on October 30, 2001, at 23:02:04
> I have found that cheap old generic chlordiazepoxide (Librium) was the least sedating benzo that I have ever taken.
I didn't experience any sedation on Librium. I've been interested in finding out whether I could take a high dose of it for panic disorder (I had already been taking quite a bit -- 50 mg q.i.d. -- when I gave up on it, but I probably could have gone higher without any problems). But there's little evidence supporting the use of low-potency benzos in PD.
> I also have IBS/d and I never have heard of "celiac disease" before. I know what you mean by "hellish AD's"!! I get the most benefit from SSri's, but they DO rip my guts to shreds. I have tried adding nortriptyline (20-30mg/day) to the SSRi and it did help a lot, BUT I didn't like the sfx from the NT!
What side effects did NT have that bothered you?
(BTW, what did you mean by "IBS/d?")
-elizabeth
Posted by Mitch on October 31, 2001, at 23:28:28
In reply to Re: Which benzo is *least* sedating? +other stuff » Mitch, posted by Elizabeth on October 31, 2001, at 22:26:49
> > I have found that cheap old generic chlordiazepoxide (Librium) was the least sedating benzo that I have ever taken.
>
> I didn't experience any sedation on Librium. I've been interested in finding out whether I could take a high dose of it for panic disorder (I had already been taking quite a bit -- 50 mg q.i.d. -- when I gave up on it, but I probably could have gone higher without any problems). But there's little evidence supporting the use of low-potency benzos in PD.Wow! I used to get by OK on 10mg tid! Of course, I am med sensitive and it generally takes about 1/6 to 1/3 of anything to do the same thing for me that it takes for other folks. It is true that the low-potency benzos work better for GAD symptoms. The Klonopin I take will prevent a panic attack, but at the cost of amblyopia, cognitive dysfunction, etc. ChlorD. would prevent a panic attack for me *most* of the time-but it wasn't *reliably* effective. The ChlorD. was also a lot less depressogenic (?) than Valium.
>
> > I also have IBS/d and I never have heard of "celiac disease" before. I know what you mean by "hellish AD's"!! I get the most benefit from SSri's, but they DO rip my guts to shreds. I have tried adding nortriptyline (20-30mg/day) to the SSRi and it did help a lot, BUT I didn't like the sfx from the NT!
>
> What side effects did NT have that bothered you?Mainly cold extremities (cold nose/hands, ie.), also got some facial numbness on the front of my face and forehead (that was like high-dose Gabitril in some ways). Also, my arms and legs would go to sleep easily and get numb and tingle. A little bit of tachycardia as well.
>
> (BTW, what did you mean by "IBS/d?")Diarrhea predominant IBS. If I add the NT to an SSRi it tends to dampen that problem (anticholinergic effects). Remeron worked even better for that (IBS/d)-I believe because of the 5-HT3 antagonism. But it hits far more receptors than the NT did! Definitely the NT was less antihistaminic and I didn't get irritable on it (no alpha-2 antagonism).
BTW, I am thinking about starting a thread regarding Odansentron (ZOFRAN). It is a selective 5-HT3 antagonist which is used for chemotherapy/radiotherapy/postsurgical nausea and vomiting from the chemo drugs or from anesthetics/opioids. I heard somewhere that it decreased alcohol cravings in some people dramatically-also if my theory is correct it should be able to reduce nausea/diarrhea from SSRI's as well. I haven't brought it up to my pdoc just yet. I was given Odansentron immediately after my thyroid surgery and I was sitting up in bed shortly after +morphine and eating a big tray of food with no nausea!
>
> -elizabeth
Posted by Gracie2 on November 1, 2001, at 9:07:40
In reply to Which benzo is *least* sedating? +other stuff, posted by Thrud on October 25, 2001, at 1:11:40
I am not sure how celiac disease is diagnosed but if it requires a barium enema or a colonoscopy, I would insist on a sedative before the procedure.
I would insist on it.
-Gracie the X-Ray Tech
Posted by Elizabeth on November 1, 2001, at 14:43:29
In reply to Re: Which benzo is *least* sedating? +other stuff » Elizabeth, posted by Mitch on October 31, 2001, at 23:28:28
> Wow! I used to get by OK on 10mg tid! Of course, I am med sensitive and it generally takes about 1/6 to 1/3 of anything to do the same thing for me that it takes for other folks.
I've heard many people say they are generally sensitive to meds. I wonder how that could come about (other than something major like liver disease).
> It is true that the low-potency benzos work better for GAD symptoms.
I've never seen any data to suggest that. Klonopin, Ativan, and Xanax have all been found effective for GAD as well as PD.
[re nortriptyline side effects]
> Mainly cold extremities (cold nose/hands, ie.), also got some facial numbness on the front of my face and forehead (that was like high-dose Gabitril in some ways). Also, my arms and legs would go to sleep easily and get numb and tingle. A little bit of tachycardia as well.Huh. Those are pretty weird, except for the tachycardia. I wonder what was going on there.
> BTW, I am thinking about starting a thread regarding Odansentron (ZOFRAN). It is a selective 5-HT3 antagonist which is used for chemotherapy/radiotherapy/postsurgical nausea and vomiting from the chemo drugs or from anesthetics/opioids.
It's bloody expensive, too.
> I heard somewhere that it decreased alcohol cravings in some people dramatically-also if my theory is correct it should be able to reduce nausea/diarrhea from SSRI's as well.
Sure -- so would augmenting with Remeron. I think Zofran was being studied as a possible anxiolytic, too, but I don't think anything came of it.
> I haven't brought it up to my pdoc just yet. I was given Odansentron immediately after my thyroid surgery and I was sitting up in bed shortly after +morphine and eating a big tray of food with no nausea!
Except for one time when I tried to start on too high a dose of buprenorphine (I need to start at 1/2 mL and then increase to 1 mL), I've never gotten nausea from opioids. How much morphine were you on?
-elizabeth
Posted by Mitch on November 1, 2001, at 23:37:38
In reply to Re: Which benzo is *least* sedating? +other stuff » Mitch, posted by Elizabeth on November 1, 2001, at 14:43:29
> > Wow! I used to get by OK on 10mg tid! Of course, I am med sensitive and it generally takes about 1/6 to 1/3 of anything to do the same thing for me that it takes for other folks.
>> I've heard many people say they are generally sensitive to meds. I wonder how that could come about (other than something major like liver disease).
Nah, it's not that. There is something else going on. I have had blood levels drawn for NT and lithium, i.e., and they show low or sub-therapeutic levels and I am experiencing all sorts of weird sfx. One thing my pdoc mentioned is the possibility that my receptor densities tend to be high in general for unknown reasons, which might explain the "knee-jerk" reaction to meds. I also think that it is related to neuronal firing instability as in epilepsy (I have family history of inheritable epilepsy). A neurologist I saw once told me I had an "atypical bipolar syndrome" or "possible frontal lobe dysfunction". The trick is to get me ATTENTIVE *and* CALM. I can get one or the other fairly easily, but BOTH is *THE* problem!
>
> > It is true that the low-potency benzos work better for GAD symptoms.
>
> I've never seen any data to suggest that. Klonopin, Ativan, and Xanax have all been found effective for GAD as well as PD.From personal experience, yes, Klonopin/Ativan/Xanax does the trick for panic, BUT, just ordinary anticipatory GAD-like angst- chlordiazepoxide or diazepam seemed to work much better-I think you are onto something there.
>
> [re nortriptyline side effects]
> > Mainly cold extremities (cold nose/hands, ie.), also got some facial numbness on the front of my face and forehead (that was like high-dose Gabitril in some ways). Also, my arms and legs would go to sleep easily and get numb and tingle. A little bit of tachycardia as well.
>
> Huh. Those are pretty weird, except for the tachycardia. I wonder what was going on there.I am guessing it has something to do with vasoconstriction that is experienced with drinking a lot of coffee or taking pseudo-ephedrine for example. The increased noradrenaline levels I think account for that.
>
> > BTW, I am thinking about starting a thread regarding Odansentron (ZOFRAN). It is a selective 5-HT3 antagonist which is used for chemotherapy/radiotherapy/postsurgical nausea and vomiting from the chemo drugs or from anesthetics/opioids.
>
> It's bloody expensive, too.
Yes, I am aware of that, unfortunately.>
> > I heard somewhere that it decreased alcohol cravings in some people dramatically-also if my theory is correct it should be able to reduce nausea/diarrhea from SSRI's as well.
>
> Sure -- so would augmenting with Remeron. I think Zofran was being studied as a possible anxiolytic, too, but I don't think anything came of it.No Remeron for this dude again! For some reason anything that is an alpha-2 adrenoreceptor antagonist makes me VERY hostile and irritable. I can't trust myself-it's that bad..really.
Remeron just hits way too many receptors for someone like me.>
> > I haven't brought it up to my pdoc just yet. I was given Odansentron immediately after my thyroid surgery and I was sitting up in bed shortly after +morphine and eating a big tray of food with no nausea!
>
> Except for one time when I tried to start on too high a dose of buprenorphine (I need to start at 1/2 mL and then increase to 1 mL), I've never gotten nausea from opioids. How much morphine were you on?Oh, I have no idea! They started to give me a Vicodan when I got back to the observation room, and hey my throat is sore you know??, so they gave me a morphine shot in the but. I just got back from surgery and my mouth was practically glued shut from all the anticholinergics they use, and I was asked if I wanted to eat some soft food, have some juice, etc. I really *did* feel hungry! No nausea at all! I didn't know about the Odansentron until I got the statement from the insurance a couple of weeks later.
Mitch
Posted by Thrud on November 3, 2001, at 7:24:37
In reply to Celiac disease - Thrud, posted by Gracie2 on November 1, 2001, at 9:07:40
>
> I am not sure how celiac disease is diagnosed but if it requires a barium enema or a colonoscopy, I would insist on a sedative before the procedure.
> I would insist on it.
> -Gracie the X-Ray Tech
It is first screened by testing the levels of certain antibodies in the blood; no big deal, just the usual, 'you might feel a little prick...'These blood tests indicated positive results for Celiac Disease in my case. The final step will be a small intestine biopsy which I will be sedated for. I hope they're not thinking of using some benzo...I think I would prove somewhat resistant to the sedative effect!
Thrud
Posted by Thrud on November 3, 2001, at 7:30:24
In reply to Re: Which benzo is *least* sedating? +other stuff » Thrud, posted by judy1 on October 25, 2001, at 18:59:00
> I'm interested in your doctor's choice of lamictal for panic disorder- or are you treating bipolar disorder also?
No. PD+unipolar depression. It was a choice made out of desperation because other medications give me such strong sexual dysfunction. Benzos by themselves will not relieve my chronic fatigue; it seems that I need some sort of stimulating med as well.
>I hope you get the correct diagnosis and treatment- Judy
Thanks. I hope you receive the same.
Thrud
Posted by Thrud on November 3, 2001, at 7:34:41
In reply to Re: Which benzo is least sedating? » Thrud, posted by Elizabeth on October 25, 2001, at 12:48:20
> It's really not possible to predict -- it's different for everybody. I would try Klonopin first, since it has the additional advantage of being long-acting. (A disadvantage of Klonopin is that it doesn't start working as fast as Xanax, but that shouldn't be an issue since you're taking it around-the-clock.)
>
> Ativan is less potent than Klonopin and Xanax, so you should expect to need a higher dose of that if you decide to try it. You may find that you need a slightly higher total daily dose of Klonopin than of Xanax, too.
Some people rave on about 'Tranxene' (its supposed to be a 'clean burner'). I guess this is not a triazolam and therefore not as potent as Xanax etc? Unfortunately I do need a potent benzo.Thrud
Posted by Thrud on November 3, 2001, at 7:37:54
In reply to Re: Which benzo is *least* sedating? +other stuff » Thrud, posted by Mitch on October 30, 2001, at 23:02:04
> I have found that cheap old generic chlordiazepoxide (Librium) was the least sedating benzo that I have ever taken.
From what I've heard it is not a very potent benzo, at least compared to Xanax and the like. How did you find it?
Thrud
Posted by Thrud on November 3, 2001, at 7:39:17
In reply to Re: Which benzo is *least* sedating? +other stuff, posted by Thrud on November 3, 2001, at 7:37:54
Posted by Mitch on November 3, 2001, at 9:53:02
In reply to Re: Which benzo is *least* sedating? +other stuff, posted by Thrud on November 3, 2001, at 7:37:54
> > I have found that cheap old generic chlordiazepoxide (Librium) was the least sedating benzo that I have ever taken.
>
> From what I've heard it is not a very potent benzo, at least compared to Xanax and the like. How did you find it?
>
> Thrud
It worked really well for GAD-type symptoms. High-potency BZD's tend to produce a "drunk" like feeling (Xanax), memory problems (Ativan), or fatigue (Klonopin-I am taking low-dose of now). Diazepam worked the best for GAD (in my case), but it clearly worsened my depressive symptoms. So, for a year or two I kind of bounced back and forth between Chlord. and diazepam. The Chlord. definitely provoked less depression. Hmm.. maybe that is why they included it in Limbitrol tabs (amitriptyline+chlordiazepoxide)??? That that was the first med that contained an BZD that I was ever prescribed (back in 1979).Mitch
Posted by Elizabeth on November 3, 2001, at 10:54:26
In reply to Re: Which benzo is *least* sedating? +other stuff » Elizabeth, posted by Mitch on November 1, 2001, at 23:37:38
> > I've heard many people say they are generally sensitive to meds. I wonder how that could come about (other than something major like liver disease).
>
> Nah, it's not that. There is something else going on.I know that; I'm sure if all these people had liver disease, at least *some* of them would have found out by now.
> I have had blood levels drawn for NT and lithium, i.e., and they show low or sub-therapeutic levels and I am experiencing all sorts of weird sfx. One thing my pdoc mentioned is the possibility that my receptor densities tend to be high in general for unknown reasons, which might explain the "knee-jerk" reaction to meds. I also think that it is related to neuronal firing instability as in epilepsy (I have family history of inheritable epilepsy). A neurologist I saw once told me I had an "atypical bipolar syndrome" or "possible frontal lobe dysfunction".
Hand-waving. You can come up with all sorts of theories, but the fact is, we don't know what causes any of this. I hope we will one day, though.
> The trick is to get me ATTENTIVE *and* CALM. I can get one or the other fairly easily, but BOTH is *THE* problem!
ADD + anxiety/agitation is really tough to treat, but I think MAOIs might be effective.
> From personal experience, yes, Klonopin/Ativan/Xanax does the trick for panic, BUT, just ordinary anticipatory GAD-like angst- chlordiazepoxide or diazepam seemed to work much better-I think you are onto something there.
"Onto something?" I was disagreeing with you! :-) I *don't* think there is any evidence to support the idea that low-potency benzos work better in general for GAD than high-potency benzos do, although this may be true for you personally (and with regard to the benzos that are marketed and that you've tried). Different people have different reactions to benzos, just like SSRIs or any other class of drug for that matter -- some people find Klonopin more sedating than Xanax (at theoretically "equivalent" doses), others find Xanax more sedating, etc.
Librium has a reputation for having low abuse potential, so it's still used to help alcoholics detox sometimes.
> I am guessing it has something to do with vasoconstriction that is experienced with drinking a lot of coffee or taking pseudo-ephedrine for example. The increased noradrenaline levels I think account for that.
I don't know. If you were experiencing that, I would expect your blood pressure to be quite high. I've experienced actual hypertensive crisis (due to MAOI-food interaction) and what you're describing doesn't sound much like it at all.
Did the side effects last long (more than a few weeks, say), or were you unable to tolerate the nortriptyline long enough to find out?
> No Remeron for this dude again! For some reason anything that is an alpha-2 adrenoreceptor antagonist makes me VERY hostile and irritable.
Alpha2 blockade leads to increased NE firing. But again, this is just speculative. What other drugs have caused that problem for you?
> > How much morphine were you on?
>
> Oh, I have no idea! They started to give me a Vicodan when I got back to the observation room, and hey my throat is sore you know??, so they gave me a morphine shot in the but.Oh, it was IM. Injected morphine can hit pretty hard -- its bioavailability is a lot better when it's given parenterally than orally. And you were basically opioid-naive, right? (Never taken them long-term or anything like that?) Had you had nausea from opioids before?
> I just got back from surgery and my mouth was practically glued shut from all the anticholinergics they use,
Morphine won't make *that* any better! I get horrible dry mouth from buprenorphine (morphine and hydrocodone caused it too).
> and I was asked if I wanted to eat some soft food, have some juice, etc. I really *did* feel hungry! No nausea at all! I didn't know about the Odansentron until I got the statement from the insurance a couple of weeks later.
Weird that the specific drugs you were given were listed on your insurance statement.
I find that opioids make me hungry, although that might just be due to relief of depression.
-elizabeth
Posted by Mitch on November 3, 2001, at 12:46:20
In reply to Re: Which benzo is *least* sedating? +other stuff » Mitch, posted by Elizabeth on November 3, 2001, at 10:54:26
> > The trick is to get me ATTENTIVE *and* CALM. I can get one or the other fairly easily, but BOTH is *THE* problem!
>
> ADD + anxiety/agitation is really tough to treat, but I think MAOIs might be effective.Elizabeth, I would definitely agree but my current pdoc won't touch them-nyet, no, nada (and perhaps for good reasons)! I even mentioned selegiline and NOPE to that one as well. Is SJW really much of an MAOI inhibitor or is most of that just BS? I was told it would be ok to experiment with that somewhat.
>
> > From personal experience, yes, Klonopin/Ativan/Xanax does the trick for panic, BUT, just ordinary anticipatory GAD-like angst- chlordiazepoxide or diazepam seemed to work much better-I think you are onto something there.
>
> "Onto something?" I was disagreeing with you!OOPs! There's my ADHD sneaking in again.
> I don't know. If you were experiencing that, I would expect your blood pressure to be quite high. I've experienced actual hypertensive crisis (due to MAOI-food interaction) and what you're describing doesn't sound much like it at all.
Well, my BP *is* much higher while taking NT or Zoloft or Effexor (not a hypertensive crisis by any means-and different sfx)! It is normal if I am not taking those meds. It is borderline high when I am taking them. (118/70 > 145/80)
All I know is that the "cold nose", clammy hands, etc. were just like when I take pseudoephedrine for a cold. Also, when I was taking Adderall (just 5mg AM)-I coud jump on a stairmaster and I would get really nasty headaches in the back of my head.
>
> Did the side effects last long (more than a few weeks, say), or were you unable to tolerate the nortriptyline long enough to find out?They were tolerable but very annoying. The Zoloft+Nortriptyline combo works fairly well for attentiveness. *If* the antihistaminic effect of the NT wasn't there it would probably be nearly ideal.
>
> > No Remeron for this dude again! For some reason anything that is an alpha-2 adrenoreceptor antagonist makes me VERY hostile and irritable.
>
> Alpha2 blockade leads to increased NE firing. But again, this is just speculative. What other drugs have caused that problem for you?Buspar(even worse than Remeron). I was told (I think by JohnX2) that its primary metabolite is also an alpha-2 antagonist.
>
> > > How much morphine were you on?
> >
> > Oh, I have no idea! They started to give me a Vicodan when I got back to the observation room, and hey my throat is sore you know??, so they gave me a morphine shot in the but.
>
> Oh, it was IM. Injected morphine can hit pretty hard -- its bioavailability is a lot better when it's given parenterally than orally. And you were basically opioid-naive, right? (Never taken them long-term or anything like that?) Had you had nausea from opioids before?No, I never had to take any opioids long term. Yes, the Vicodans they sent me home with *did* make me a little nauseous, but it was tolerable.
>
> > I just got back from surgery and my mouth was practically glued shut from all the anticholinergics they use,
>
> Morphine won't make *that* any better! I get horrible dry mouth from buprenorphine (morphine and hydrocodone caused it too).
>
> > and I was asked if I wanted to eat some soft food, have some juice, etc. I really *did* feel hungry! No nausea at all! I didn't know about the Odansentron until I got the statement from the insurance a couple of weeks later.
>
> Weird that the specific drugs you were given were listed on your insurance statement.Ooops again, it wasn't the insurance statement it was the itemized statement from the *hospital*.
>
> I find that opioids make me hungry, although that might just be due to relief of depression.Yes, I would agree with that.
Mitch>
> -elizabeth
Posted by Gracie2 on November 3, 2001, at 17:57:00
In reply to Re: Celiac disease - Thrud, posted by Thrud on November 3, 2001, at 7:24:37
Posted by Elizabeth on November 6, 2001, at 14:49:18
In reply to Re: Which benzo is *least* sedating? +other stuff » Elizabeth, posted by Mitch on November 3, 2001, at 12:46:20
> > ADD + anxiety/agitation is really tough to treat, but I think MAOIs might be effective.
>
> Elizabeth, I would definitely agree but my current pdoc won't touch them-nyet, no, nada (and perhaps for good reasons)!Probably not for good reasons, IMO. A lot of doctors are afraid of MAOIs because they haven't kept up with research on food-drug interactions involving MAOIs that shows that most of the foods that were thought to be dangerous (based on some hysteria in the '60s/'70s) really aren't.
> Is SJW really much of an MAOI inhibitor or is most of that just BS?
I think it's probably BS, but it's always good to be careful when you don't know what something does (especially when it's a plant produt that probably contains multiple active drugs). If SJW is a MAOI at all, it's probably a reversible one, I think.
> I was told it would be ok to experiment with that somewhat.
If you do, I'd suggest caution.
> > "Onto something?" I was disagreeing with you!
>
> OOPs! There's my ADHD sneaking in again.You have my sympathies. :-)
> Well, my BP *is* much higher while taking NT or Zoloft or Effexor (not a hypertensive crisis by any means-and different sfx)! It is normal if I am not taking those meds. It is borderline high when I am taking them. (118/70 > 145/80)
How many measurements did you do? Effexor and TCAs can elevate blood pressure moderately, but I'd be surprised if Zoloft did it. Anyway, while you might be symptomatic at 145/80-ish, I wouldn't expect the symptoms to be major (maybe mild headache, skin tingling, that kind of thing). Also if the high BP was sustained (rather than, say, going up within an hour after you took the med and then going back down to normal shortly thereafter) I'd expect the symptoms to be less noticeable.
> All I know is that the "cold nose", clammy hands, etc. were just like when I take pseudoephedrine for a cold.
FWIW, I often had problems that seemed to be related to circulation (cold hands & feet even when wearing thick gloves and boots) when I was on Parnate (typically, my BP would be running a bit low). Weird that Sudafed would cause that.
> Also, when I was taking Adderall (just 5mg AM)-I coud jump on a stairmaster and I would get really nasty headaches in the back of my head.
Did you ever have a chance to take your BP when this happened?
> > Did the side effects last long (more than a few weeks, say), or were you unable to tolerate the nortriptyline long enough to find out?
>
> They were tolerable but very annoying. The Zoloft+Nortriptyline combo works fairly well for attentiveness.Lucky! I never found any SSRI that I tried (Prozac, Paxil, Zoloft) useful for attention problems.
> *If* the antihistaminic effect of the NT wasn't there it would probably be nearly ideal.
In what way was the H1-blockade a problem? Did you ever try desipramine?
> > Alpha2 blockade leads to increased NE firing. But again, this is just speculative. What other drugs have caused that problem for you?
>
> Buspar(even worse than Remeron).Buspar does have a metabolite that is an alpha2 blocker, but it doesn't do it to any significant degree at prescribed doses as far as anyone can tell. It definitely would have less effect in that respect than Remeron would.
> No, I never had to take any opioids long term. Yes, the Vicodans they sent me home with *did* make me a little nauseous, but it was tolerable.
I use promethazine for nausea, usually. Benadryl can help too. The nausea has mostly gone away with time, tho'.
> > I find that opioids make me hungry, although that might just be due to relief of depression.
>
> Yes, I would agree with that.Well, I never had to watch what I ate before taking ADs, but on buprenorphine I do have to be careful about overeating (especially sweets). I think hydrocodone and morphine were the same way.
-elizabeth
Posted by Mitch on November 6, 2001, at 23:29:49
In reply to Re: other stuff » Mitch, posted by Elizabeth on November 6, 2001, at 14:49:18
> > Well, my BP *is* much higher while taking NT or Zoloft or Effexor (not a hypertensive crisis by any means-and different sfx)! It is normal if I am not taking those meds. It is borderline high when I am taking them. (118/70 > 145/80)
>
> How many measurements did you do? Effexor and TCAs can elevate blood pressure moderately, but I'd be surprised if Zoloft did it. Anyway, while you might be symptomatic at 145/80-ish, I wouldn't expect the symptoms to be major (maybe mild headache, skin tingling, that kind of thing). Also if the high BP was sustained (rather than, say, going up within an hour after you took the med and then going back down to normal shortly thereafter) I'd expect the symptoms to be less noticeable.I took the same measurements at the same times doing the same tasks with the same machine... at Wal-Mart. :)
Also, there were measurements at my GP's that confirmed the changes as well. So, no doubt about different meds affecting BP. I know about controls and variables and stuff :)
Oh, the BP changes were more chronic, not right after taking a dose kind of thing. I always took NT in divided doses anyways.
As far as *symptoms* go I cannot directly correlate the "cold/numb hands-nose" sfx with the BP changes-they may likely be separate events that are independent of the BP changes.
Also, Zoloft had the least BP effect of the meds I mentioned.
> > Also, when I was taking Adderall (just 5mg AM)-I coud jump on a stairmaster and I would get really nasty headaches in the back of my head.
>
> Did you ever have a chance to take your BP when this happened?
Unfortunately not, but I did question the pharmacist about this and he told me it was probably increased blood pressure and that I should probably do my CV workout immediately after awakening and *then* take my Adderall.
>
> > > Did the side effects last long (more than a few weeks, say), or were you unable to tolerate the nortriptyline long enough to find out?
> >
> > They were tolerable but very annoying. The Zoloft+Nortriptyline combo works fairly well for attentiveness.
>
> Lucky! I never found any SSRI that I tried (Prozac, Paxil, Zoloft) useful for attention problems.Well, Prozac clearly did help the most of the SSRi's, and Zoloft clearly does help (but much less so and not so great by itself). The reason I am still "hanging-around" SSRI's basically is that I have not just an attentional *deficit*, it is an attentional syndrome of sorts. I can have trouble switching attenton (OCPD-"like" hyperfocused stuff), and also have great trouble maintaining attention as well (more classic ADHD symptoms).
>
> > *If* the antihistaminic effect of the NT wasn't there it would probably be nearly ideal.
>
> In what way was the H1-blockade a problem? Did you ever try desipramine?Elizabeth, ANY antihistamine *wrecks* my attentional capacities. Remeron whacked it, so does nearly all the sedative TCA's, OTC antihistamines, etc.
Yes, I did try desipramine and had a *dramatic* improvement in attention (almost as good as Adderall!). However, I was too anxious on it and had much worse tachychardia and dizziness than with NT. NT, in summary is the only TCA I have tried that doesn't make me *profoundly* dizzy, confused, or anxious. I would like to retry low-dose Wellbutrin, however, in combo with low-dose activating SSRI. From my two experiences (during seasonal depressions with WB), I *didn't* get any irritability and I actually worked my way up to 150mg/day for a while. That's very unusal for me to be able to even approach "standard" doses of AD's.
>
> > > Alpha2 blockade leads to increased NE firing. But again, this is just speculative. What other drugs have caused that problem for you?
> >
> > Buspar(even worse than Remeron).
>
> Buspar does have a metabolite that is an alpha2 blocker, but it doesn't do it to any significant degree at prescribed doses as far as anyone can tell. It definitely would have less effect in that respect than Remeron would.I just read a post yesterday or today about 1-PP, which mentions that it was quite a *potent* alpha-2 antagonist. Also, I think the serotonin 5-HT1a *agonist* activity of Buspar may have contributed just as much to the irritability. Also possibly I may have simply had a classic paradoxical hostility reaction to an anxiolytic which is not uncommon with people that have ADHD.
Mitch
Posted by Elizabeth on November 7, 2001, at 10:45:02
In reply to Re: other stuff » Elizabeth, posted by Mitch on November 6, 2001, at 23:29:49
> I took the same measurements at the same times doing the same tasks with the same machine... at Wal-Mart. :)
Did you take several measurements while you were on each drug?
> As far as *symptoms* go I cannot directly correlate the "cold/numb hands-nose" sfx with the BP changes-they may likely be separate events that are independent of the BP changes.
Both changes might relate to changes in your circulation. Serotonin does have some vasoconstricting effect, but SSRIs don't usually cause much change in BP.
> Also, Zoloft had the least BP effect of the meds I mentioned.
That, at least, fits. :-)
> Unfortunately not, but I did question the pharmacist about this and he told me it was probably increased blood pressure and that I should probably do my CV workout immediately after awakening and *then* take my Adderall.
That makes more sense, yes. I always tried to avoid heavy exercise right after taking Parnate, which tended to raise my BP for a short time about a half hour after taking it. (This was a little tricky when I was taking the Parnate six times a day!)
> Well, Prozac clearly did help the most of the SSRi's, and Zoloft clearly does help (but much less so and not so great by itself). The reason I am still "hanging-around" SSRI's basically is that I have not just an attentional *deficit*, it is an attentional syndrome of sorts. I can have trouble switching attenton (OCPD-"like" hyperfocused stuff), and also have great trouble maintaining attention as well (more classic ADHD symptoms).
I understand. I'm like that too, in a lot of ways: I have trouble shifting, I hyperfocus (this is something that's definitely been going on since I was *very* young -- like, my mother and I both can remember it happening when I was 3), I have a hard time getting started on a project or a task, and I have trouble sticking to a project or task when it becomes frustrating or I get bored of it. But I find that serotonin-selective ADs don't help a bit, with that or the depression either.
> Elizabeth, ANY antihistamine *wrecks* my attentional capacities. Remeron whacked it, so does nearly all the sedative TCA's, OTC antihistamines, etc.
Like Benadryl, ChlorTrimeton, etc.? What about the non-drowsy ones (just curious)?
> Yes, I did try desipramine and had a *dramatic* improvement in attention (almost as good as Adderall!). However, I was too anxious on it and had much worse tachychardia and dizziness than with NT.
Yeah, that's a problem with DMI. Beta blockers can help (IME). Incidentally, I'm noticing that the DMI seems to help a little with the attention stuff although buprenorphine is definitely responsible for most of the improvement.
> NT, in summary is the only TCA I have tried that doesn't make me *profoundly* dizzy, confused, or anxious.
Which others have you tried? Ever think about getting your hands on some reboxetine? Also...did you get a serum level on the nortriptyline?
Some people who have serious anxiety just need to take a little Klonopin (or whatever) if they need an AD. ADs, especially SSRIs, can be very hard on people with panic disorder, in particular.
As for the dizziness, my experience has been that it subsides after a little while. The start low/go slow approach might help with something like this (although it can be frustratingly slow for those of us who aren't very patient < g >).
> I would like to retry low-dose Wellbutrin, however, in combo with low-dose activating SSRI. From my two experiences (during seasonal depressions with WB), I *didn't* get any irritability and I actually worked my way up to 150mg/day for a while.
That's cool. I wonder if bupropion would help me. I tried it before WB SR was available and I got *really* anxious, plus my insomnia and appetite problems got worse (and at the time they were really bad already).
> I just read a post yesterday or today about 1-PP, which mentions that it was quite a *potent* alpha-2 antagonist.
Potent means that low doses have an effect, that's all. But there are other factors, such as the extent to which buspirone is metabolized to 1-PP, volume of distribution, etc. Last time I read up on it, the findings were that buspirone didn't cause much significant alpha2-blockade in vivo.
> Also, I think the serotonin 5-HT1a *agonist* activity of Buspar may have contributed just as much to the irritability.
Maybe. Don't get yourself too wrecked trying to pin down the cause. :-) Did SSRIs or other serotonergic drugs ever make you peevish or hostile?
> Also possibly I may have simply had a classic paradoxical hostility reaction to an anxiolytic which is not uncommon with people that have ADHD.
Buspar is more like an antidepressant than like most drugs that are considered anxiolytics. Which other drugs have been known to cause hostility or irritability in people with ADD, though? I don't think I ever heard of that.
-elizabeth
Posted by Mitch on November 7, 2001, at 13:30:08
In reply to Re: other stuff » Mitch, posted by Elizabeth on November 7, 2001, at 10:45:02
> Did you take several measurements while you were on each drug?
Oh yes-there was a clear correlation and not only that but it was also accompanied by increased resting heart rate, too. My resting HR (not on the meds mentioned)is normally around 60bpm. When I was on Effex. or NT or any TCA for that matter it tends to get elevated up to around 75-80.
> > Elizabeth, ANY antihistamine *wrecks* my attentional capacities. Remeron whacked it, so does nearly all the sedative TCA's, OTC antihistamines, etc.
>
> Like Benadryl, ChlorTrimeton, etc.? What about the non-drowsy ones (just curious)?Yes, Benadryl, etc. Well, Claritin didn't, but that is a selective peripheral antagonist. Let me think...Well I tried Seldane and it made me "wired", restless, and fogged up, yuck.
>
> > NT, in summary is the only TCA I have tried that doesn't make me *profoundly* dizzy, confused, or anxious.> Which others have you tried? Ever think about getting your hands on some reboxetine? Also...did you get a serum level on the nortriptyline?
TCA's: doxepin, amitriptyline, nortripytline, desipramine. Also, see my post in the TCA survey thread.
Yes, done serum level on NT once and it was subtherapeutic-BUT I wasn't taking an SSRI with it at the time (cyp2d6), and I waited too long after the last dose.
Reboxetine-I think that might be a perfect low-dose augment to my low-dose Zoloft. Not available here in U.S., though. I think it's cousin-tamoxetine is soon to be approved for ADHD though and I will definitely bring that one up to my pdoc if they get it approved.
> As for the dizziness, my experience has been that it subsides after a little while. The start low/go slow approach might help with something like this (although it can be frustratingly slow for those of us who aren't very patient < g >).I was on doxepin for about four years, amitriptyline for about two-never seemed to shake the tachycardia and orthostatic hypotension. NT is the only one that seems to have minimal OH (even less than Remeron-which I tried for a few months the first time around).
I just thought of it, but I had some very intense "dizzy spells" on Prozac (just a few). They were so bad I had to stay on the floor for a few minutes and I wasn't sure I could drive and almost called in to work-but it passed.whew!
>Did SSRIs or other serotonergic drugs ever make >you peevish or hostile?No, in general they (SSRI's) tend to make me smiley and cheerful, but often can cause akathisia and heighten "startle" type reactions. When I was taking Buspar it was to reduce some of the restlessness caused by Celexa and improve GAD-type symptoms. Well, as I brought the Buspar dose up from 5mg > 10mg I became very very dysphoric and hateful, talking to myself a lot, and nearly became physically violent on several occasions. Don't know if it was from serotonin agonism, whatever. All I know is that the only thing that I can find in common with Remeron is the alpha-2 antagonist activity. And I got very very nasty and hateful on Remeron as well. Interestingly on Remeron I also developed a mild stutter or vocal tic at times.
Mitch
Posted by Elizabeth on November 8, 2001, at 17:09:43
In reply to Re: other stuff » Elizabeth, posted by Mitch on November 7, 2001, at 13:30:08
> My resting HR (not on the meds mentioned)is normally around 60bpm. When I was on Effex. or NT or any TCA for that matter it tends to get elevated up to around 75-80.
That's more common -- it's at least in part due to anticholinergic activity.
> Yes, Benadryl, etc. Well, Claritin didn't, but that is a selective peripheral antagonist. Let me think...Well I tried Seldane and it made me "wired", restless, and fogged up, yuck.
Seldane isn't supposed to cross the BBB either, but probably that's different for different people. (I've encountered a few people who get drowsy on Zyrtec, in particular.)
> Yes, done serum level on NT once and it was subtherapeutic-BUT I wasn't taking an SSRI with it at the time (cyp2d6), and I waited too long after the last dose.
Shouldn't consider that necessarily accurate, then.
Jeez, I need to get a desipramine serum level. I had one drawn while I was in the hospital, but of course I never hear back from those guys about blood chemistry and stuff.
> Reboxetine-I think that might be a perfect low-dose augment to my low-dose Zoloft. Not available here in U.S., though.
No. I'd be interested to try it too, if we had it here. You could probably order it from overseas -- I wonder if it's expensive.
> I was on doxepin for about four years, amitriptyline for about two-never seemed to shake the tachycardia and orthostatic hypotension.
Those are two of the worst ones, especially amitriptyline.
> NT is the only one that seems to have minimal OH (even less than Remeron-which I tried for a few months the first time around).
What about DMI?
> No, in general they (SSRI's) tend to make me smiley and cheerful, but often can cause akathisia and heighten "startle" type reactions.
Real akathisia, or just "jitters?" I was getting startled easily when I was on Provigil (it didn't happen with Dexedrine, Adderall, Cylert, or Ritalin, that I recall). The day I tried going up to 200 mg, I went to see the movie _Three Kings_, which has a lot of explicit violence, plus a pretty intense torture scene. Needless to say, I was jumping off the walls.
> When I was taking Buspar it was to reduce some of the restlessness caused by Celexa and improve GAD-type symptoms. Well, as I brought the Buspar dose up from 5mg > 10mg I became very very dysphoric and hateful, talking to myself a lot, and nearly became physically violent on several occasions. Don't know if it was from serotonin agonism, whatever.
Buspar is mainly a partial agonist at the 5-HT1a receptor. Unique, but not especially useful at recommended doses, IMO! (It was first tested -- as an antipsychotic -- in doses on the order of a *gram*, and it was well tolerated AFAIK, though ineffective. I think it should be used in the range of 45-120 mg.)
> All I know is that the only thing that I can find in common with Remeron is the alpha-2 antagonist activity.
Well, let me know if you can find anything on 1-PP (as a metabolite of Buspar) that suggests it contributes significantly. I wrote a paper about the strategy of selectively activating 5-HT1a receptors (i.e., Buspar and pindolol) a couple years ago and the literature that was available at the time indicated that 1-PP probably didn't contribute significantly to Buspar's effects.
> And I got very very nasty and hateful on Remeron as well. Interestingly on Remeron I also developed a mild stutter or vocal tic at times.
That is weird! I don't think I've ever gotten hostile or aggressive on any drug (although naloxone or naltrexone might do it!), but I have found that some drugs make me less aggressive. Not passive, just more friendly, better at working things through. It's very difficult for anybody to make me lose my temper when I'm in that state. Nice side benefit.
-elizabeth
Posted by Mitch on November 8, 2001, at 23:34:52
In reply to Re: other stuff » Mitch, posted by Elizabeth on November 8, 2001, at 17:09:43
> > NT is the only one that seems to have minimal OH (even less than Remeron-which I tried for a few months the first time around).
>
> What about DMI?I even noticed it on just 10mg/day of desipramine! I called my pdoc about three days after I started it telling him I didn't think I could endure this dizziness (I was told to take it at bedtime instead of in the morning-which helped). At the time I was doing a lot of maintenance work at a factory in the evenings/weekends while I was finishing college. I had a little trouble working on ladders/scaffolding without getting vertigo-I'm serious! I think I must be really hypersensitive to anticholinergic effects (CV-wise) as well.
>
> >In general they (SSRI's) tend to make me smiley and cheerful, but often can cause akathisia and heighten "startle" type reactions.
>
> Real akathisia, or just "jitters?" I was getting startled easily when I was on Provigil (it didn't happen with Dexedrine, Adderall, Cylert, or Ritalin, that I recall). The day I tried going up to 200 mg, I went to see the movie _Three Kings_, which has a lot of explicit violence, plus a pretty intense torture scene. Needless to say, I was jumping off the walls.We are talking real akathisia. All SSRI's make me pace around a lot. I get things done around the house-but that's beside the point! I have been on neuroleptics in the past and I know what akathisia is-trust me. They aren't as bad as many neuroleptics (SSRi's), but I have had the "shuffles" on AP's before and this is very similar. If it wasn't for their anxiolytic effect (especially social anxiety), I probably wouldn't touch them with a ten-foot pole. AD-wise they haven't had a good track record for me actually. They also tend to aggravate my rapid-cycling too. Wellbutrin and Adderall are the *only* two agents that I have *ever* taken during seasonal major depressions that I felt gave me complete or near-complete relief from the depressive symptoms and didn't appear to adversely affect mood-cycling.
>
> > And I got very very nasty and hateful on Remeron as well. Interestingly on Remeron I also developed a mild stutter or vocal tic at times.
>
> That is weird! I don't think I've ever gotten hostile or aggressive on any drug (although naloxone or naltrexone might do it!), but I have found that some drugs make me less aggressive. Not passive, just more friendly, better at working things through. It's very difficult for anybody to make me lose my temper when I'm in that state. Nice side benefit.
>
> -elizabethWell if you were all mixed up with bipolar/ADHD I think you would find a whole world of unexpected pharmaceutical *minefields*. I thought the Nierenberg presentation very well-considered and the studies well devised. What makes me bring that up is his discussion of a typical psychiatrist's reaction to the lack of a response from a fairly severely depressed patient to their first trial of medication. "Uh-oh, what do I do now?". And the ensuing presentation was an attempt in a way to develop a flow-chart to get people treated and responsive ASAP (which I applaud). Well...in my case and others with bipolar complications it often isn't the case of a non-response. Usually it is an *intolerant* response of one kind or another! Either the antidepressant made the patient hypomanic (not intended), hostile (not intended), dysphoric/agitated (not intended), etc. etc. I can nearly always get an *antidepressant* response to nearly any antidepressant. That isn't the problem. The problem are the other *problems* the antidepressant triggers!
Mitch
Posted by Elizabeth on November 9, 2001, at 12:33:28
In reply to Re: other stuff » Elizabeth, posted by Mitch on November 8, 2001, at 23:34:52
[re: orthostatic hypotension]
> I even noticed it on just 10mg/day of desipramine!Jeez. Well, some people are just sensitive to this stuff, I guess. Or maybe there was something else causing the dizziness.
> We are talking real akathisia. All SSRI's make me pace around a lot. I get things done around the house-but that's beside the point!
That sounds like akathisia, but it also sounds like a pretty mild case. Anyway, there are things you can take for that, like beta blockers (I think -- I could look it up if you want).
> Wellbutrin and Adderall are the *only* two agents that I have *ever* taken during seasonal major depressions that I felt gave me complete or near-complete relief from the depressive symptoms and didn't appear to adversely affect mood-cycling.
I've seen some positive studies on Wellbutrin for SAD, and I think amphetamine and MAOIs probably would help too.
> Well if you were all mixed up with bipolar/ADHD I think you would find a whole world of unexpected pharmaceutical *minefields*.
Did I ever tell you what happened after I'd been on Effexor for a few weeks?
> ...in my case and others with bipolar complications it often isn't the case of a non-response. Usually it is an *intolerant* response of one kind or another! Either the antidepressant made the patient hypomanic (not intended), hostile (not intended), dysphoric/agitated (not intended), etc. etc.
I think these are all different manifestations of mania or hypomania. I had what was considered a hypomanic reaction to Paxil, and I was "high" but also irritable and impatient.
-elizabeth
Posted by Mitch on November 9, 2001, at 13:37:30
In reply to Re: other stuff » Mitch, posted by Elizabeth on November 9, 2001, at 12:33:28
> > We are talking real akathisia. All SSRI's make me pace around a lot. I get things done around the house-but that's beside the point!
>
> That sounds like akathisia, but it also sounds like a pretty mild case. Anyway, there are things you can take for that, like beta blockers (I think -- I could look it up if you want).That would be an interesting possibility to treat performance/social anxiety as well. But, since I am touchy with anything that causes orthostatic hypotension I wonder if they might cause me more trouble than they are worth, though.
> > Well if you were all mixed up with bipolar/ADHD I think you would find a whole world of unexpected pharmaceutical *minefields*.
>
> Did I ever tell you what happened after I'd been on Effexor for a few weeks?
I think I remember something about getting the "shakes" really bad. It made me hypomanic as hell! In combination with a short stint on Prednisone it was pretty much nitroglycerine.
>
> > ...in my case and others with bipolar complications it often isn't the case of a non-response. Usually it is an *intolerant* response of one kind or another! Either the antidepressant made the patient hypomanic (not intended), hostile (not intended), dysphoric/agitated (not intended), etc. etc.
>
> I think these are all different manifestations of mania or hypomania. I had what was considered a hypomanic reaction to Paxil, and I was "high" but also irritable and impatient.
>
> -elizabeth
Yes, it is true. Some would say (and myself do also think at times) that I just need *more* mood stabilizer and everything would be okeedokee. Well, I have been down that route with mixed success and I just feel like I am loaded with meds. Also, the cognitive dulling from mood stabilizers is a touchy issue with me given my attentional problems to begin with. I DO know for a fact that if I am just taking a low-dose of Wellbutrin or Adderall+mood stabilizer(s), that I don't have any depression, and more importantly my cycling fades considerably, BUT anxiety is worsened----what to do, what to do...Mitch
Posted by Elizabeth on November 9, 2001, at 21:38:38
In reply to Re: other stuff » Elizabeth, posted by Mitch on November 9, 2001, at 13:37:30
> > That sounds like akathisia, but it also sounds like a pretty mild case. Anyway, there are things you can take for that, like beta blockers (I think -- I could look it up if you want).
>
> That would be an interesting possibility to treat performance/social anxiety as well.IME they're not that good except for the sympathetic nervous system sx of performance anxiety.
> But, since I am touchy with anything that causes orthostatic hypotension I wonder if they might cause me more trouble than they are worth, though.
I think that it wouldn't be much trouble to try a small dose of propranolol (10 mg) once. I never had any problems with propranolol (up to 40 mg at a time), although I do get OH from most TCAs and MAOIs.
[re: Effexor]
> I think I remember something about getting the "shakes" really bad. It made me hypomanic as hell! In combination with a short stint on Prednisone it was pretty much nitroglycerine.I had the so-called serotonin syndrome, including a full-blown mixed mania.
> Some would say (and myself do also think at times) that I just need *more* mood stabilizer and everything would be okeedokee. Well, I have been down that route with mixed success and I just feel like I am loaded with meds. Also, the cognitive dulling from mood stabilizers is a touchy issue with me given my attentional problems to begin with.
That sucks. I tried a lot of mood stabilizing meds (lithium, Depakote, Neurontin, Lamictal, and now Trileptal) and none of them seemed to have much effect at all, except a bit of sedation from the Neurontin.
> I DO know for a fact that if I am just taking a low-dose of Wellbutrin or Adderall+mood stabilizer(s), that I don't have any depression, and more importantly my cycling fades considerably, BUT anxiety is worsened----what to do, what to do...
Benzos?
-e
Posted by Mitch on November 10, 2001, at 0:30:30
In reply to Re: other stuff » Mitch, posted by Elizabeth on November 9, 2001, at 21:38:38
> > I DO know for a fact that if I am just taking a low-dose of Wellbutrin or Adderall+mood stabilizer(s), that I don't have any depression, and more importantly my cycling fades considerably, BUT anxiety is worsened----what to do, what to do...
>
> Benzos?
>
> -eI was on Klonopin before the Adderall trial and am on it now since *then*. When the Adderall was tried I was off all benzos and AD's. It was just a simple combo: Adderall (5mg/day) + Neurontin (300mg/day). EVERYTHING was fine, no noticeable cycling, no hypomania, no depression, greatly improved attention, ability to tolerate ordinary simple activities/tasks without restlessness wanting to get away, etc., amazingly regular sleep/wake cycles with adequate sleep (7-8hrs every nite). BUT I was still edgy, uptight, and kind of socially "cool" and "distant". I am not sure if this was SSRI withdrawal or not(?). Perhaps if I was taking Klonopin (mildly serotonergic)and/or Lithium or Depakote with the Neurontin/Adderall I wouldn't have panicked and had it discontinued??
Mitch
Posted by Elizabeth on November 10, 2001, at 21:34:39
In reply to Re: other stuff » Elizabeth, posted by Mitch on November 10, 2001, at 0:30:30
> I was on Klonopin before the Adderall trial and am on it now since *then*. When the Adderall was tried I was off all benzos and AD's. It was just a simple combo: Adderall (5mg/day) + Neurontin (300mg/day). EVERYTHING was fine, no noticeable cycling, no hypomania, no depression, greatly improved attention, ability to tolerate ordinary simple activities/tasks without restlessness wanting to get away, etc., amazingly regular sleep/wake cycles with adequate sleep (7-8hrs every nite). BUT I was still edgy, uptight, and kind of socially "cool" and "distant". I am not sure if this was SSRI withdrawal or not(?). Perhaps if I was taking Klonopin (mildly serotonergic)and/or Lithium or Depakote with the Neurontin/Adderall I wouldn't have panicked and had it discontinued??
I think that's a good guess. Many people need something to offset the jitters from stimulants.
-elizabeth
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