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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Chairman_MAO on January 30, 2004, at 22:28:32
I wish I'd tried this stuff two years ago; I would have probably aborted a fruitless quest of self-medication. I wish doctors hand't shoved serotonergic drug after serotonergic drug in my face! Even Strattera did not make me feel this lively, and it is purportedly a more "selective" NE reuptake inhibitor. This confirms my suspicion that "selective", despite the many studies to the contrary", is more a marketing tool than an indicator of clinical utility. I enjoy exercising for the first time in my life (I suffer from a lifetime of dysthymia/cyclothymia)! (I am 23) Even amphetamine did not have this outstanding, sustained effect on my mood, and I have no idea why desipramine is working so well where so many other drugs have failed.
I do, however, have some disconcerting side effects, and I'm wondering if anyone could give me some insight on:
1) Impotence. One could call this "shrinkage" or the "cold water effect". I have a feeling that it's due to NE overactivity in the bladder/genital tissue. I'm wondering if anyone's had this go away over time. I have used trazodone, which has alpha-1 adrenergic blocking activity, to remedy this. Unfortunately, the dose of trazodone needed to produce this effect is not compatible with, umm, walking or thinking. I've heard of Flomax or Cardura being used to combat urinary hesitancy of reboxetine; think this could be used here? It's driving me crazy to have my libido finally restored and non-working equipment!
2) Tachycardia. My normal resting heart rate is 70-80, and now it's about 90-110. I exercised this morning and felt a subtle pain in my upper chest, by the heart, after 20 minutes on an elliptical trainer, and my heart rate was probably about 150bpm. I experienced a "runner's high" for the first time! I will be insanely frustrated if I have to stop taking the first drug that feels like it will produce "remission" because of cardiotoxicity. Did anyone build a tolerance to this effect, or should I just give up on the drug now (after only day 5 at 75mg!)
Perhaps I'll just have to advocate for Parnate after all. :(
Thanks for any help,
--cm
Posted by Keith Talent on January 31, 2004, at 0:07:17
In reply to Desipramine's the thing that makes me swing!, posted by Chairman_MAO on January 30, 2004, at 22:28:32
> I wish I'd tried this stuff two years ago; I would have probably aborted a fruitless quest of self-medication. I wish doctors hand't shoved serotonergic drug after serotonergic drug in my face! Even Strattera did not make me feel this lively, and it is purportedly a more "selective" NE reuptake inhibitor. This confirms my suspicion that "selective", despite the many studies to the contrary", is more a marketing tool than an indicator of clinical utility. I enjoy exercising for the first time in my life (I suffer from a lifetime of dysthymia/cyclothymia)! (I am 23) Even amphetamine did not have this outstanding, sustained effect on my mood, and I have no idea why desipramine is working so well where so many other drugs have failed.
>
> I do, however, have some disconcerting side effects, and I'm wondering if anyone could give me some insight on:
>
> 1) Impotence. One could call this "shrinkage" or the "cold water effect". I have a feeling that it's due to NE overactivity in the bladder/genital tissue. I'm wondering if anyone's had this go away over time. I have used trazodone, which has alpha-1 adrenergic blocking activity, to remedy this. Unfortunately, the dose of trazodone needed to produce this effect is not compatible with, umm, walking or thinking. I've heard of Flomax or Cardura being used to combat urinary hesitancy of reboxetine; think this could be used here? It's driving me crazy to have my libido finally restored and non-working equipment!
>
> 2) Tachycardia. My normal resting heart rate is 70-80, and now it's about 90-110. I exercised this morning and felt a subtle pain in my upper chest, by the heart, after 20 minutes on an elliptical trainer, and my heart rate was probably about 150bpm. I experienced a "runner's high" for the first time! I will be insanely frustrated if I have to stop taking the first drug that feels like it will produce "remission" because of cardiotoxicity. Did anyone build a tolerance to this effect, or should I just give up on the drug now (after only day 5 at 75mg!)
>
> Perhaps I'll just have to advocate for Parnate after all. :(
>
> Thanks for any help,
>
> --cm
>
>
I remember watching a web presentation by Elliot Richelson, MD, where he said that desipramine was twelve times more potent than reboxetine at blocking noradrenaline reuptake. Don't know about atomoxetine, but this could explain your experiences. By the way, if you later miss the serotonergic feelings, you can get the same noradrenergic oomph from clomipramine (its metabolite desmethylclomipramine is about as potent as desipramine at blocking noradrenaline reuptake - see Sheldon Preskorn's (MD) website preskorn.com).The impotence seems to be related to alpha-1 antagonism. The same problem happens with alpha-1 blockers that can be used for hypertension (not used so much now). Not sure what to recommend.
Posted by sb417 on January 31, 2004, at 0:27:38
In reply to Desipramine's the thing that makes me swing!, posted by Chairman_MAO on January 30, 2004, at 22:28:32
Frankly, I think some of the older AD's, like desipramine, are far superior to anything that's been marketed in the last 10-15 years, but the side effects can be troubling. Please speak to your doctor about the tachycardia because that may be serious. Perhaps you can adjust the dose or add something else to ameliorate the problem. Have you ever tried nortriptyline? By the way, that's a very creative screen name!
Posted by sb417 on January 31, 2004, at 1:36:36
In reply to Desipramine's the thing that makes me swing!, posted by Chairman_MAO on January 30, 2004, at 22:28:32
I don't know what will help combat the impotence, but Bethanechol/Urecholine will help with urinary hesitancy and urinary retention.
Posted by djmmm on January 31, 2004, at 17:55:28
In reply to Desipramine's the thing that makes me swing!, posted by Chairman_MAO on January 30, 2004, at 22:28:32
> I wish I'd tried this stuff two years ago; I would have probably aborted a fruitless quest of self-medication. I wish doctors hand't shoved serotonergic drug after serotonergic drug in my face! Even Strattera did not make me feel this lively, and it is purportedly a more "selective" NE reuptake inhibitor. This confirms my suspicion that "selective", despite the many studies to the contrary", is more a marketing tool than an indicator of clinical utility. I enjoy exercising for the first time in my life (I suffer from a lifetime of dysthymia/cyclothymia)! (I am 23) Even amphetamine did not have this outstanding, sustained effect on my mood, and I have no idea why desipramine is working so well where so many other drugs have failed.
>
> I do, however, have some disconcerting side effects, and I'm wondering if anyone could give me some insight on:
>
> 1) Impotence. One could call this "shrinkage" or the "cold water effect". I have a feeling that it's due to NE overactivity in the bladder/genital tissue. I'm wondering if anyone's had this go away over time. I have used trazodone, which has alpha-1 adrenergic blocking activity, to remedy this. Unfortunately, the dose of trazodone needed to produce this effect is not compatible with, umm, walking or thinking. I've heard of Flomax or Cardura being used to combat urinary hesitancy of reboxetine; think this could be used here? It's driving me crazy to have my libido finally restored and non-working equipment!
>
> 2) Tachycardia. My normal resting heart rate is 70-80, and now it's about 90-110. I exercised this morning and felt a subtle pain in my upper chest, by the heart, after 20 minutes on an elliptical trainer, and my heart rate was probably about 150bpm. I experienced a "runner's high" for the first time! I will be insanely frustrated if I have to stop taking the first drug that feels like it will produce "remission" because of cardiotoxicity. Did anyone build a tolerance to this effect, or should I just give up on the drug now (after only day 5 at 75mg!)
>
> Perhaps I'll just have to advocate for Parnate after all. :(
>
> Thanks for any help,
>
> --cm
>
>Unfortunately, Parnate causes the same "cold water" effect, aka "speed willy" <--- I know thats crude....typically stimulating drugs (stimulants, both typical (amphetamine) and atypical (Parnate) can cause this) It is primarialy due to effects on blood pressure via norepinephrine.
Posted by billk on January 31, 2004, at 19:32:35
In reply to Re: Desipramine's the thing that makes me swing!, posted by djmmm on January 31, 2004, at 17:55:28
I too was very concerned about the tachycardia caused by the tricyclics - amitriptiline in my case. My doctor convinced me to add just a little bit of Nadolol (a beta blocker with a long half life). It immediately returned my pulse rate to near normal and made me feel much better about taking the ami.
Posted by Chairman_MAO on February 1, 2004, at 8:36:41
In reply to Re: Desipramine's the thing that makes me swing!, posted by djmmm on January 31, 2004, at 17:55:28
Thanks for your input, guys. Indeed, now that I think about it, I also often have cold and clammy extremities, which is consistent with "cold water syndrome/speed willy". It's interesting that 200mg of trazodone resolves it 100%. I'm wondering to what degree a tolerance builds to any of this (if it does at all). I'm hoping I can get my doctor to prescribe a small dose of doxazosin (a potent, generic a1 antagonist cheaper than trazodone, heh) to see if that helps. I wish I knew exactly why trazodone was so effective.
Also, does wellbutrin cause this probablem [to the same degree]?
This is the end of the thread.
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