![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by ed_uk on December 12, 2004, at 9:46:40
Hello,
Reserpine is a drug which has become notorious for inducing depression. It is an amine-depleting drug which has been used for the treatment of hypertension and psychotic disorders. It is no longer available in the UK but is still used in some parts of the world. A similar drug, tetrabenazine (Xenazine) is used in the UK as a treatment for tardive dyskinesia, it has similar central effects to reserpine but is reported to cause fewer peripheral side effects. Tetrabenazine is also capable of causing depression. Oxypertine (Integrin) is another amine-depleting drug which was formerly available in the UK for the treatment of schizophrenia.
Interestingly, combining a TCA with reserpine or tetrabenazine has sometimes been a useful therapy for treatment-resistant depression. I would be interested to hear from anyone who has experience of this combination.
From Psychopharmacologia (1967).......
14 out of 15 patients with depression resistant to imipramine responded well when 7.5 to 10mg reserpine/day for *2 days* was added to imipramine. Some patients had an initial manic response when reserpine was added. In 6 of the 14 patients improvement was maintained throughout the 6 month follow-up. (I wonder whether repeated doses of reserpine would have been useful in those patients who relapsed).
Other articles have also reported the effects of combining reserpine with imipramine or desipramine. The efficacy of such combinations has been questioned by some authors however.
Have a look at this. Reserpine is added to treatment with a TCA........
Psychiatr Clin (Basel). 1975;8(3):109-14.
Treatment with reserpine of patients resistant to tricyclic antidepressants. A double-blind trial.
Hopkinson G, Kenny F.
.........A double-blind study was conducted on 14 patients; eight were given 5 mg of reserpine i.m. and six were given 2 ml of normal saline on 2 successive days. The administration of the tricyclic antidepressants the patients had been taking, was continued. The Hamilton Depressive Rating Scale was administered on the day before treatment was commenced, and repeated on the fourth day. Statistical analysis revealed that the patients who received reserpine showed a highly significant improvement of a good quality. The mean fall in the Hamilton rating for the placebo group was 6 points, and in the reserpine group it was 18.87......
Adding tetrabenazine (Xenazine in the UK) to treatment with a TCA might be expected to have a similar effect to the addition of reserpine (since the mechanism of action of the two drugs is thought to be the same).'COMBINED ADMINISTRATION OF DESIPRAMINE AND RESERPINE OR TETRABENAZINE IN DEPRESSIVE PATIENTS.
Psychopharmacologia. 1963 May 21;65:308-10.'
Ed.
Posted by Racer on December 12, 2004, at 11:14:22
In reply to Reserpine + TCA in the treatment of depression, posted by ed_uk on December 12, 2004, at 9:46:40
I don't know anything about this first hand, but do know something about Reserpine in animals. It can cause a kinda funky type of pneumonia in some animals, when they get chilled and stressed at the same time. I hope someone will check that out.
Otherwise, anything that helps with treatment resistant depression is a good thing in my book. I'll look forward to finding out more.
Posted by linkadge on December 12, 2004, at 14:30:29
In reply to Re: Reserpine + TCA in the treatment of depression, posted by Racer on December 12, 2004, at 11:14:22
Yeah, reserpine actually causes ser/nor/dop to leak out of the synaptic terminals. The neurotransmitter is quicky metabolized as it is not really fired, but rather leaded out.
In the presence of a TCA, the neurotransmitter doesn't get recycled but rather reputake is blocked and it has more chance of reaching is destination.
Imobility time was decreased even over that of TCA alone.
Linkadge
Posted by SLS on December 12, 2004, at 15:09:24
In reply to Reserpine + TCA in the treatment of depression, posted by ed_uk on December 12, 2004, at 9:46:40
Actually, one of the treatment modalities suggested for reserpine was to use it as a pretreatment prior to the administration of a TCA. Sorry I don't remember the details.
- Scott
Posted by ed_uk on December 12, 2004, at 15:16:03
In reply to Re: Reserpine + TCA in the treatment of depression, posted by SLS on December 12, 2004, at 15:09:24
Hi Scott,
Have you ever taken reserpine + a TCA? I don't know whether reserpine is on the market where you live but I imagine you could get hold of it if you tried, if not you could always buy some tetrabenazine. I suppose it might induce mania though.
Take care,
Ed.
Posted by linkadge on December 12, 2004, at 17:32:15
In reply to Re: Reserpine + TCA in the treatment of depression » SLS, posted by ed_uk on December 12, 2004, at 15:16:03
Reserpine itself, is an antipsyhotic and antihypertensive agent. If you take reserpine by itself it could depress you.
A number of suicides were linked to the catecholamine depleating effects of reserpine used for hypertension.
Reserpine can be used as a pretreatement or as an adjunctive to TCA's.
I would imagine that the pretreatment was to kind of "reset" the neurotransmitters or something.
Linkadge
Posted by ed_uk on December 12, 2004, at 17:57:02
In reply to Re: Reserpine + TCA in the treatment of depression » SLS, posted by ed_uk on December 12, 2004, at 15:16:03
Hi,
I wasn't suggesting using reserpine on its own!
Ed.
Posted by linkadge on December 12, 2004, at 20:30:20
In reply to Re: Reserpine + TCA in the treatment of depression » ed_uk, posted by ed_uk on December 12, 2004, at 17:57:02
I know you weren't. I was merely blithering.
Linkadge
Posted by ed_uk on December 16, 2004, at 6:15:29
In reply to Re: Reserpine + TCA in the treatment of depression, posted by linkadge on December 12, 2004, at 20:30:20
Have you ever tried this combination?
Ed.
Posted by SLS on December 17, 2004, at 7:20:43
In reply to Re: To SLS.... reserpine + TCA, posted by ed_uk on December 16, 2004, at 6:15:29
> Have you ever tried this combination?
>
> Ed.Hi Ed.
No, I haven't. I guess I just assumed that it would make things worse. Do you know of any success stories?
I got somewhat bad news this morning. My pdoc expressed a concern with me combining Parnate + imipramine. I assumed he knew that I was still on imipramine when he prescribed the Parnate. I don't think he'll let me continue. He would rather that I be on amitriptyline, but that drug makes me feel like hell. The only thing that ever worked for me was Parnate + desipramine, but that combination no longer works. I do better on imipramine than I do on desipramine, so I am upset that I might not be able to use it.
Thanks for your concern. I really appreciate your input.
- Scott
Posted by ed_uk on December 17, 2004, at 7:47:08
In reply to Re: To SLS.... reserpine + TCA » ed_uk, posted by SLS on December 17, 2004, at 7:20:43
Hi Scott,
I am sorry to hear the news. I thought that you'd previously taken imipramine plus tranylcypromine without problems. SS usually develops very quickly if it is going to develop at all. I have never heard of a case of SS with delayed onset, I think you need to emphasize this to your pdoc. Have a look on pubmed, severe symptoms of SS always seem to develop very quickly. Try showing some abstracts to your pdoc. I think you'll be able to encourage him to let you take the combination if you're persistent.
I once took 50mg of amitriptyline and felt like I was about to slip into a coma! Dothiepin was a similar experience.
I've never known anyone who's taken reserpine + a TCA. Tetrabenazine (Xenazine) is apparabtly very similar to reserpine and is on the market in several countries. Xenazine is available in the UK and possibly New Zealand. The brand name Nitoman seems to be used for tetrabenazine in other countries.
Reserpine may be harder to get hold of. I guess you'd only need occasional doses though so it might not be that expensive. 'Serfinato' may still be available in Portugal, not sure.
Ed.
Posted by ed_uk on December 18, 2004, at 10:35:46
In reply to Re: Imipramine » SLS, posted by ed_uk on December 17, 2004, at 7:47:08
Perhaps your pdoc is worried that you would develop SS if you increased the dose of Parnate or imipramine. What do you think?
Ed.
Posted by SLS on December 18, 2004, at 14:27:47
In reply to Re: Imipramine.... to Scott, posted by ed_uk on December 18, 2004, at 10:35:46
> Perhaps your pdoc is worried that you would develop SS if you increased the dose of Parnate or imipramine. What do you think?
>
> Ed.
I really don't know what his concern is. He would prefer that I use amitriptyline. I don't think it is any less serotonergic than imipramine. I may be wrong. I did have a reaction when I tried to add Nardil to imipramine. It included severe hypotension and cramping of torso muscles. This probably was SS. The thing is, I have been on Parnate + imipramine before.This is my dilemma:
1. Amitriptyline leaves me sedated and feeling miserable, despite continued treatment.
2. With nortriptyline, there is no one dosage that provides improvement. I am one of the minority of people for whom there is no window of efficacy. 75mg is too little and 100mg too much. When I go from 75mg to 100mg, I experience a transient improvement that lasts for a portion of the day before I begin feeling worse again. When I drop from 100mg to 75mg, I experience the same thing. No window.
3. Desipramine does not help me as much as imipramine.
Besides all of this, he wrote the script for Parnate at only 30mg per day. That won't do anything for me. I can take 120mg and still sleep. I wish I would become insomniac on it. Insomnia is usually a good sign for me. The first time I tried Parnate + desipramine, I couldn't sleep for even 5 minutes a night until I was prescribed Halcion and Ativan. I didn't dream at all. I also responded to it. It was the only time I ever experienced a sustained improvement. Of course, the same combination does nothing for me now. I don't even experience REM suppression any more. There is no doubt in my mind that the medication-naive brain is altered by exposure to these drugs, and that these alterations persist.
Crap.
My doctor won't be available for over a week, I can't take the tricyclic that I know does the most for me, and I wasn't prescribed as much Parnate as I would need anyway. I wish I had looked at the prescription before I left the office. I just assumed that he would have me taking 60mg before my next visit in three weeks. 30mg is a waste of time. The only thing I can think to do is switch over to nortriptyline, finesse the dosage, and sneak an extra 10mg of Parnate. It's either that, or do nothing. I can't stand to waste another three weeks and another office visit fee. Nothing has been accomplished.
Crap.
- Scott
Posted by ed_uk on December 18, 2004, at 14:40:17
In reply to Re: Imipramine.... to Scott » ed_uk, posted by SLS on December 18, 2004, at 14:27:47
Hi Scott,
I'm sorry to hear your dilemma. I think that if you emphasize the fact that you've taken imipramine plus Parnate before without problems then your pdoc may be willing to prescribe the meds at your next appointment.
Another option could be to use the 10mg nortriptyline caps to find a better dose... perhaps 80mg or 90mg would be best. You could even get hold of the 10mg nortriptyline tablets which you can cut in half to get a more precise dose eg. 85mg. Our nortriptyline tabs are called Allegron. You could use the nortriptyline syrup 10mg/5ml for the same purpose.
Ed.
Posted by SLS on December 18, 2004, at 15:51:36
In reply to Re: Imipramine.... to Scott » SLS, posted by ed_uk on December 18, 2004, at 14:40:17
Thanks Ed. I appreciate your advice.
:-)
I am leaning in the direction of starting the nortriptyline tonight and move on up to 40mg on the Parnate tomorrow.
- Scott
> Hi Scott,
>
> I'm sorry to hear your dilemma. I think that if you emphasize the fact that you've taken imipramine plus Parnate before without problems then your pdoc may be willing to prescribe the meds at your next appointment.
>
> Another option could be to use the 10mg nortriptyline caps to find a better dose... perhaps 80mg or 90mg would be best. You could even get hold of the 10mg nortriptyline tablets which you can cut in half to get a more precise dose eg. 85mg. Our nortriptyline tabs are called Allegron. You could use the nortriptyline syrup 10mg/5ml for the same purpose.
>
> Ed.
Posted by zeugma on December 18, 2004, at 17:53:22
In reply to Re: Imipramine.... to Scott » ed_uk, posted by SLS on December 18, 2004, at 15:51:36
Ed gave the advice that I was going to give. Nortriptyline is peculiar is in its dose-proprtional effects. At 75 mg, I find it somewhat sedating, but at 100 mg, it seems to either have a stimulant effect on its own, or it potentiates the effect of Ritalin. I asked my pdoc about a pharmacokinetic reaction between the two drugs, and he said there wasn't a major one.
I used the 10 mg caps to titrate up because I was in a physically debilitated state and barely functioning when I started nortriptyline and it slowly brought me back to health (relativel;y speaking).
Since there seems to be a discontinuity between my responses to 75 and 100 mg, there may be a middle ground that works for you in combination with the Parnate. I wish you the best of luck.
--z
Posted by banga on December 21, 2004, at 10:46:48
In reply to Re: Imipramine.... to Scott » SLS, posted by zeugma on December 18, 2004, at 17:53:22
What is the dosage range on nortryptiline that people typically use? I just started some last night, will be at 50mg in three days. It will be augmenting 100mg Lamictal. And a few spansules of Cymbalta (weaning off!)
Posted by SLS on December 21, 2004, at 15:40:42
In reply to Re: Imipramine and nortryptiiline, posted by banga on December 21, 2004, at 10:46:48
> What is the dosage range on nortryptiline that people typically use? I just started some last night, will be at 50mg in three days. It will be augmenting 100mg Lamictal. And a few spansules of Cymbalta (weaning off!)
Most people do well at 75mg. The range is usually between 50-100mg. Ideally, one can have their blood levels tested after 10 days to see if they fall between 50-150 ng/ml. It is actually possible to take too much nortriptyine. Once the blood levels increase beyond a certain point, the drug stops working. This is what is known as a therapeutic window.
I wish you luck with your new treatment.
- Scott
Posted by SLS on December 21, 2004, at 15:43:42
In reply to Re: To SLS.... reserpine + TCA » ed_uk, posted by SLS on December 17, 2004, at 7:20:43
> I got somewhat bad news this morning. My pdoc expressed a concern with me combining Parnate + imipramine. I assumed he knew that I was still on imipramine when he prescribed the Parnate. I don't think he'll let me continue. He would rather that I be on amitriptyline, but that drug makes me feel like hell. The only thing that ever worked for me was Parnate + desipramine, but that combination no longer works. I do better on imipramine than I do on desipramine, so I am upset that I might not be able to use it.
I got the OK from my doctor to combine Parnate with nortriptyline. I am increasing to Parnate 60mg and nortriptyline 75mg as initial target dosages.
- Scott
Posted by jujube on December 21, 2004, at 17:06:40
In reply to Re: To SLS.... reserpine + TCA, posted by SLS on December 21, 2004, at 15:43:42
> > I got somewhat bad news this morning. My pdoc expressed a concern with me combining Parnate + imipramine. I assumed he knew that I was still on imipramine when he prescribed the Parnate. I don't think he'll let me continue. He would rather that I be on amitriptyline, but that drug makes me feel like hell. The only thing that ever worked for me was Parnate + desipramine, but that combination no longer works. I do better on imipramine than I do on desipramine, so I am upset that I might not be able to use it.
>
>
> I got the OK from my doctor to combine Parnate with nortriptyline. I am increasing to Parnate 60mg and nortriptyline 75mg as initial target dosages.
>
>
> - ScottWoo Hoo! Hope the combo works for you! Good luck, and keep us posted.
Take care.
Tamara
Posted by KarenRB53 on October 15, 2008, at 8:07:06
In reply to Re: Imipramine and nortryptiiline, posted by SLS on December 21, 2004, at 15:40:42
> > What is the dosage range on nortryptiline that people typically use? I just started some last night, will be at 50mg in three days. It will be augmenting 100mg Lamictal. And a few spansules of Cymbalta (weaning off!)
>
> Most people do well at 75mg. The range is usually between 50-100mg. Ideally, one can have their blood levels tested after 10 days to see if they fall between 50-150 ng/ml. It is actually possible to take too much nortriptyine. Once the blood levels increase beyond a certain point, the drug stops working. This is what is known as a therapeutic window.
>
> I wish you luck with your new treatment.
>
>
> - Scott
What is the normal amount of imipramine taken for depression? Also, do most take it at night or in the morning?Karen
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.