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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by KaraS on July 14, 2004, at 17:38:25
I'm considering going back on a TCA but am concerned about tachycardia. I tried both nortriptyline and desipramine many years ago - both for only a short while but gave them up because of (what I considered to be) a racing heart beat. It was at about 100 bpm. That felt really uncomfortable to me and I was always aware of it.
I've since read on this board that your heart rate can adjust on these and eventually go back down a bit though it's standard to have a faster heart rate while on these meds than you'd normally have. I was wondering what other people's experiences have been like with TCAs. For instance, what was your heart rate at? Did it ever go down? Was it uncomfortable? Were you able to exercise? Did it give you insomnia? If so, what did you take with it?
Thanks,
Kara
Posted by RetiredYoung on July 14, 2004, at 17:43:38
In reply to TCAs and Tachycardia - experiences?, posted by KaraS on July 14, 2004, at 17:38:25
I took Pamelor (nortriptyline) for over a year and developed Tachycardia, which was defined for me as a resting heart rate of 100 or higher. I was sent to a heart specialist who confirmed that the TCA was the culprit and advised my psychiatrist to move me to an SSRI immediately.
What is most unfortunate for me is that I have yet to find a medication that treats my depression and chronic headaches better than the Pamelor. :(
Posted by KaraS on July 14, 2004, at 17:59:15
In reply to Re: TCAs and Tachycardia - experiences?, posted by RetiredYoung on July 14, 2004, at 17:43:38
> I took Pamelor (nortriptyline) for over a year and developed Tachycardia, which was defined for me as a resting heart rate of 100 or higher. I was sent to a heart specialist who confirmed that the TCA was the culprit and advised my psychiatrist to move me to an SSRI immediately.
>
> What is most unfortunate for me is that I have yet to find a medication that treats my depression and chronic headaches better than the Pamelor. :(
It was the only thing for me so far that gave me energy and motivation but I have several other things I want to try for that still. Did your doctor or the heart specialist consider putting you on a beta blocker? Have you tried stimulants, selegiline or Parnate? (Actually I've assumed that you were taking it for anergic depression when that may not have been the case at all.)
Posted by RetiredYoung on July 14, 2004, at 18:31:08
In reply to Re: TCAs and Tachycardia - experiences?, posted by KaraS on July 14, 2004, at 17:59:15
No, I was not offered a beta blocker and have not tried any MAOIs or Selegiline. I am taking Adderal right now with Lexapro and a small dose of Surmonti (TCA-trimipramine). I rate my response to all these as "sometimes good", but I'm no where near as well as I'd like to be.
I have dysthymia, but also seem to have atypical and anergic (as in, fatigue, low energy?) depression, as well. Headaches, too, which I'm beginning to learn more and more seem to be a part of my condition and not a separate neurological problem.
Posted by RetiredYoung on July 14, 2004, at 18:48:03
In reply to Re: TCAs and Tachycardia - experiences?, posted by RetiredYoung on July 14, 2004, at 18:31:08
Kara - I meant to ask you if you had experience with MAOIs (is Selegiline a type of MAOI??)? I've come to a point where I think they may be of benefit to me, but am very wary of their side effects.
Jim
Posted by linkadge on July 14, 2004, at 19:02:20
In reply to Re: TCAs and Tachycardia - experiences ...KaraS, posted by RetiredYoung on July 14, 2004, at 18:48:03
something like clomipramine, or amitryptaline might produce less tachycardia.
Linkadge
Posted by KaraS on July 14, 2004, at 20:26:32
In reply to Re: TCAs and Tachycardia - experiences?, posted by RetiredYoung on July 14, 2004, at 18:31:08
> No, I was not offered a beta blocker and have not tried any MAOIs or Selegiline. I am taking Adderal right now with Lexapro and a small dose of Surmonti (TCA-trimipramine). I rate my response to all these as "sometimes good", but I'm no where near as well as I'd like to be.
I asked for a beta blocker at the time but my doctor didn't think it was a good idea.
>
> I have dysthymia, but also seem to have atypical and anergic (as in, fatigue, low energy?) depression, as well. Headaches, too, which I'm beginning to learn more and more seem to be a part of my condition and not a separate neurological problem.My situation is similar but without the headaches.
Posted by KaraS on July 15, 2004, at 0:20:30
In reply to Re: TCAs and Tachycardia - experiences ...KaraS, posted by linkadge on July 14, 2004, at 19:02:20
> something like clomipramine, or amitryptaline might produce less tachycardia.
>
> LinkadgeLinkadge,
Amitryptaline was too sedating for me. I haven't tried clomipramine. What's its side effect profile? I know that it's used for something else besides depression but I can't remember what. Lately I can't remember much and don't have the motivation to look things up the way I used to.
I really need something stimulating that will also help me to focus. What do you think of the idea of adding Pindolol to Nortriptyline to keep the heart rate down?
Thanks,
K
Posted by SLS on July 15, 2004, at 1:40:00
In reply to Re: TCAs and Tachycardia - experiences ...KaraS, posted by KaraS on July 15, 2004, at 0:20:30
I don't think that any one tricyclic is markedly better than another with regard to accelerating heart rate. Perhaps Sad Panda or King Vultan can comment on that. I guess the ones with the lower anticholinergic load would be preferable - desipramine and nortriptyline. Surely, clomipramine is no bargain when it comes to side effects, although it does score high on efficacy for depression and OCD.
If you are that concerned with TCAs and their producing a resting HR of 100 at the beginning of treatment, you should consult with a physician who has lots of experience using them. What alternatives have you explored without success?
Wellbutrin
Adderall
Ritalin
Thyroid
Prozac
LamictalIf nothing exists more palatable than a TCA, I don't think 100 bpm is too much of an issue. It is more important to screen for ECG irregularities and heart disease than for accelerated HR per se. Consult with a cardiologist. I don't feel qualified to tell you anything more than my own personal experience and relate to you the level of concern that the doctors who have treated me have shown over the last 22 years regarding my elevated heart rate on tricyclics. I would be surprised if your HR didn't eventually settle down to something closer to 80 bpm, but I am unwilling to sign and contracts.
I guess I've said this stuff already. I'm such a bore. :-)
- Scott
Posted by KaraS on July 15, 2004, at 18:29:31
In reply to Re: TCAs and Tachycardia - experiences ...KaraS » KaraS, posted by SLS on July 15, 2004, at 1:40:00
> I don't think that any one tricyclic is markedly better than another with regard to accelerating heart rate. Perhaps Sad Panda or King Vultan can comment on that. I guess the ones with the lower anticholinergic load would be preferable - desipramine and nortriptyline. Surely, clomipramine is no bargain when it comes to side effects, although it does score high on efficacy for depression and OCD.
>
> If you are that concerned with TCAs and their producing a resting HR of 100 at the beginning of treatment, you should consult with a physician who has lots of experience using them. What alternatives have you explored without success?
>
> Wellbutrin
> Adderall
> Ritalin
> Thyroid
> Prozac
> Lamictal>
> If nothing exists more palatable than a TCA, I don't think 100 bpm is too much of an issue. It is more important to screen for ECG irregularities and heart disease than for accelerated HR per se. Consult with a cardiologist. I don't feel qualified to tell you anything more than my own personal experience and relate to you the level of concern that the doctors who have treated me have shown over the last 22 years regarding my elevated heart rate on tricyclics. I would be surprised if your HR didn't eventually settle down to something closer to 80 bpm, but I am unwilling to sign and contracts.
>
> I guess I've said this stuff already. I'm such a bore. :-)
>
>
> - ScottHere's my history:
Wellbutrin - I tried a small amount but felt like I couldn't breathe on it.
Adderall - I haven't tried it yet but it's on my list. I would have to see a doctor often for that one so it's at the bottom of the list for now. (I have no health insurance.)
Ritalin - I took 5 mg. of a generic which made me so tired. I was afraid of going any higher on the Ritalin for fear it would completely (and unsafely?) knock me out. I still have the pills here and really should muster some courage and try a larger dose. I'm particularly interested in Concerta should I get past my fear.
Thryoid - I'm on Armour now for Hashimoto's. I may try straight T3 in the form of Cytomel or patch at some time in future as well.
Prozac - I had a really good, but short, response to it. (Also some things in my life really improved around that time so it's hard to know how much was attributable to the Prozac.) It pooped out quickly though. Also I had tremors from it which people interpreted as my being afraid of them. I wasn't aware of the tremors yet and people were asking me if they were scaring me. Very strange.
Lamictal - haven't tried it. Just read about BarbarCat's experience with it though and it doesn't make me want to try it.
Scott, you are opinionated but never boring!!!-Kara
Posted by Sad Panda on July 15, 2004, at 18:43:07
In reply to Re: TCAs and Tachycardia - experiences ...KaraS, posted by KaraS on July 15, 2004, at 0:20:30
Hi All,
Clomipramine was the first drug used successfully for OCD.
>
>What do you think of the idea of adding Pindolol to Nortriptyline to keep the heart rate down?
>That sounds like a great idea, BUT, I would get electrocardiograms taken. TCA's mess with your heart in so many ways. They are cardiotoxic which can cause arrhythmias & sinus tachycardia, they increase NE which naturally causes higher heart rate & they are Alpha-1 NE blockers which cause orthostatic hypotension & reflex tachycardia. If a heart doctor took you off Nort, it might be due to sinus tachycardia which is deadly.
Cheers,
Panda.
Posted by ravenstorm on July 16, 2004, at 17:09:46
In reply to Re: TCAs and Tachycardia - experiences ...KaraS, posted by Sad Panda on July 15, 2004, at 18:43:07
My heart raced on a very low dose of nortrip. (felt like it would pound right out of my chest)
My pdoc wasn't concerned, but I freaked out and stopped the trial. (Husband was also contributing to anxiety about meds)
I am trying to decide if it is worth trying again.
I feel for you Kara. It is just such a crap shoot with these drugs.
Someday, they will look back at this trial and error approach and consider it as barbaric as we consider the way the used to "bleed" psychiatric patients in the past. I envy those who can go off and on these meds with little to no side effects.
Posted by crazychickuk on July 18, 2004, at 18:35:33
In reply to Re: TCAs and Tachycardia - experiences ...KaraS, posted by ravenstorm on July 16, 2004, at 17:09:46
I had the fast hrt rate on ssri's .... i am scared i will end up with this on dothiepin.. :-S o my i dont wann think about it.. i am just scared... someone plse reasure me..
This is the end of the thread.
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