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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 Chairman_MAO on June 2, 2004, at 6:24:05
I have begun my second trial of desipramine, starting at 75mg/day. In addition to the coarse, virtually instantaneous coarse mood lift and partial remission of ADD, I am experiencing impotence and tachycardia. The impotence is even worse than the last trial, because I am already on 75mg of Effexor. Man, my girlfriend is going to be really bummed about this!
Thus, my question is, has anyone here ever developed a significant tolerance to one or both of these side effects?
Posted by King Vultan on June 2, 2004, at 8:07:02
In reply to tolerance to desipramine impotence and tachycardia, posted by Chairman_MAO on June 2, 2004, at 6:24:05
> I have begun my second trial of desipramine, starting at 75mg/day. In addition to the coarse, virtually instantaneous coarse mood lift and partial remission of ADD, I am experiencing impotence and tachycardia. The impotence is even worse than the last trial, because I am already on 75mg of Effexor. Man, my girlfriend is going to be really bummed about this!
>
> Thus, my question is, has anyone here ever developed a significant tolerance to one or both of these side effects?
>
I did experience a fair amount of tachycardia when I was on desipramine last year. Looking back on my notes, it looks like there was some decrease as time went on, but my resting heart rate would still occasionally go up into the 90's. I'm not sure how high your resting heart rate is, but I would not start to be concerned until it was over 100, or possibly even 110, but I am not a cardiologist. Incidentally, I'm finding the heart rate and BP decrease on Nardil to be a much bigger pain in the neck, as I've come close to blacking out on several occasions. I experienced a BP decrease combined with noticeable orthostatic hypotension on desipramine also, but the reflex tachycardia induced by that drug helped compensate much better. I had my blood plasma level checked a couple times while on desipramine, and I did make it into the therapeutic range of 125-300 ng/ml--my level was 207 at one point.As far as the impotence/erectile dysfunction, I experienced this on the somewhat similar but far more anticholinergic Vivactil but not on desipramine. Ultimately, this was the reason I dumped Vivactil, as this is one of the few side effects I find intolerable, and I am not about to start messing around with Viagra or something in order to combat it.
Todd
Posted by Chairman_MAO on June 2, 2004, at 9:26:07
In reply to Re: tolerance to desipramine impotence and tachycardia, posted by King Vultan on June 2, 2004, at 8:07:02
Thanks for the thorough response. I am now encouraged to persevere with the desipramine for a month to see what happens. Just out of curiosity, what was the dose of desipramine needed to get you into the therapeutic range, and why did you leave desipramine behind? How effective was it for you?
Regarding your BP problem on Nardil: I've heard that high-dose Parnate is less likely to have this problem because of its intrinsic sympathomimetic effects. Whether this is mediated by Parnate itself or its metabolites I do not know. Could adding Ritalin or an amphetamine compensate for the BP decrease?
Posted by King Vultan on June 2, 2004, at 13:15:16
In reply to Re: tolerance to desipramine impotence and tachycardia » King Vultan, posted by Chairman_MAO on June 2, 2004, at 9:26:07
> Thanks for the thorough response. I am now encouraged to persevere with the desipramine for a month to see what happens. Just out of curiosity, what was the dose of desipramine needed to get you into the therapeutic range, and why did you leave desipramine behind? How effective was it for you?
>
It gets a little complicated because I was actually on both Wellbutrin and desipramine when I had the 207 ng/ml reading and was taking a lower dosage of desipramine than I would have been taking by itself because of Wellbutrin's powerful CYP-450 2D6 inhibition. In this case, I was taking 150 mg/day of Wellbutrin SR and 100 mg/day of desipramine.A few months earlier, I had taken the desipramine by itself at 150 mg/day. We checked the blood plasma level, and it was 89 ng/ml. We figured that adding another 50 mg/day would probably get me into the therapeutic range of 125-300 ng/ml, and while I did go up to 200 mg/day for a few weeks, we did not actually check the blood plasma level at that dosage, as by that time, I had decided to go on to the Vivactil.
As for why I left it behind, I found it very beneficial and constructive, but it was not quite the silver bullet I was looking for. In retrospect, it's probably the 2nd best antidepressant I've taken and reminds me in several ways of the Nardil I'm currently taking.
> Regarding your BP problem on Nardil: I've heard that high-dose Parnate is less likely to have this problem because of its intrinsic sympathomimetic effects. Whether this is mediated by Parnate itself or its metabolites I do not know. Could adding Ritalin or an amphetamine compensate for the BP decrease?
Yes, I have read that Parnate has less of a hypotensive effect, probably due to the stimulant-like effects you allude to. I have seen amphetamine recommended to help mitigate these types of effects with MAOIs, but I have never actually taken a stimulant and would prefer not to go down that road if possible. I am trialing a different alpha blocker that I take for a minor prostate condition because my feeling is that the doxazosin I've been on has been exacerbating the orthostatic hypotension problems. Beyond all this, I would consider trying Parnate if the Nardil winds up proving inadequate, but the Nardil has been so beneficial so far, particularly with my social phobia, that I want to see what more I can accomplish while on it.Todd
Posted by Sad Panda on June 2, 2004, at 14:33:58
In reply to tolerance to desipramine impotence and tachycardia, posted by Chairman_MAO on June 2, 2004, at 6:24:05
Trazodone might fix the erection problems: http://www.bjui.org/85/7/article/bju601.asp but it would make your blood pressure & tachycardia worse.
Cheers,
Panda.
Posted by Chairman_MAO on June 2, 2004, at 14:52:11
In reply to Re: tolerance to desipramine impotence and tachycardia » Chairman_MAO, posted by Sad Panda on June 2, 2004, at 14:33:58
I actually take trazodone 50-200mg qhs for sleep. It did ameliorate the problem completely at 200mg the last time I took desipramine, but this time it only enables "relaxation". Arousal, on the other hand, doesn't happen, presumably because I have 75mg Effexor on board. I'm going to wait two weeks or so, and if there is no change, dump the Effexor. That brings me to another question: could being on the desipramine help Effexor withdrawl? I remember I once took Dexedrine during Effexor withdrawl and it eliminated all of the symptoms. I do not expect anyone to have an answer to this question. :)
Posted by stjames on June 2, 2004, at 16:40:10
In reply to Re: tolerance to desipramine impotence and tachycardia » Chairman_MAO, posted by Sad Panda on June 2, 2004, at 14:33:58
> Trazodone might fix the erection problems: http://www.bjui.org/85/7/article/bju601.asp but it would make your blood pressure & tachycardia worse.
>
> Cheers,
> Panda.Whoa...very wrong here. Trazo is well known for
Priapism, a sustained erection that causes damage
and often requires surgical intervention. Tends to leave one unable to get an erection.Abber JC, Lue TF, Luo J–A, Juenemann K–P, Tanagho EA. Priapism induced by chlorpromazine and trazodone: mechanism of action. J Urol 1987; 137: 1039–42
Posted by King Vultan on June 2, 2004, at 17:11:54
In reply to Re: tolerance to desipramine impotence and tachycardia, posted by stjames on June 2, 2004, at 16:40:10
> > Trazodone might fix the erection problems: http://www.bjui.org/85/7/article/bju601.asp but it would make your blood pressure & tachycardia worse.
> >
> > Cheers,
> > Panda.
>
> Whoa...very wrong here. Trazo is well known for
> Priapism, a sustained erection that causes damage
> and often requires surgical intervention. Tends to leave one unable to get an erection.
>
> Abber JC, Lue TF, Luo J–A, Juenemann K–P, Tanagho EA. Priapism induced by chlorpromazine and trazodone: mechanism of action. J Urol 1987; 137: 1039–42
>
>I think what Panda is implying is that trazodone has a pro-erectile effect, that is, it tends to encourage erections. I'm assuming this is because of its alpha-1 and alpha-2 adrenergic blockades. Yes, priapism has been noted as occurring with trazodone, but this is relatively rare (1 out of 6000-7000 chance). My own observation taking various drugs with alpha-1 blockades is that they do tend to promote erections. The BPH drug Flomax, which is an alpha-1 blocker selective for the 1a receptors in the prostate, also has a chance of causing priapism, but it is only about 1 in 50,000.
Todd
This is the end of the thread.
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