![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Maxime on April 7, 2005, at 13:35:56
I can't f*cking believe it. What is wrong with my body. This morning I showed signs of lactating. I knew it was going to happen, but I wanted to wait to see if I actually would. I haven't taken ANY Thorazine so I know it has to be the Desipramine.
How could Desipramine make me lactate? Does it do anything to prolactin levels? I never look at possible side effects before I start a new med so I don't know if it is listed as one. I will check though.
I am in tears right now. What is wrong with me? I had my prolactin levels tested and they are on the high side but not abnormally high.
I am becoming more convinced that my mood problems are related to my endocrine system. I just don't know how to get anyone to listen.
I need a hug ... but be gentle because my breasts are killing me!
Where do I go from here?
Maxime
Posted by MidnightBlue on April 7, 2005, at 14:13:27
In reply to Got Milk? Lactating on Desipramine - SLS?? ED??, posted by Maxime on April 7, 2005, at 13:35:56
Oh Maxime,
PLEASE accept a gentle hug from me! I really don't think desipramine could be causing you to lactate. I hate to mention this, but is there any possibility you could have a small tumor on the pituitary gland? Not wanting to put ideas in your head, but you are such a smart person I'm sure you already thought of this.
Posted by Maxime on April 7, 2005, at 14:23:18
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED?? » Maxime, posted by MidnightBlue on April 7, 2005, at 14:13:27
> Oh Maxime,
>
> PLEASE accept a gentle hug from me! I really don't think desipramine could be causing you to lactate. I hate to mention this, but is there any possibility you could have a small tumor on the pituitary gland? Not wanting to put ideas in your head, but you are such a smart person I'm sure you already thought of this.Hi MidnightBlue (I love that name!)
Yes, I thought of it a long time ago when I had trouble with antipsychotics. That is when I had my prolactin level measured. My doctor told me (not that she is right) that is was on the high side but not abnormally high and so she ruled out the possibility of a tumor based on that. I know that benign (usually) tumors can occur on that gland. Do you think I should ask for further investigation?
Maxime
Posted by MidnightBlue on April 7, 2005, at 15:06:17
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED? » MidnightBlue, posted by Maxime on April 7, 2005, at 14:23:18
Maxime,
Honestly, I do think you should check. There is SOMETHING wrong and if it isn't a med (and the only way to really know that is to stop all of them) then it must be something wrong inside of you like hormones. Don't you think?
I had a high prolactin level a few years ago and it was just because the way they drew the blood. It was a false positive. But it is my understanding it is an easy test to mess up.
I was on 325 mg of desipramine about 10 years ago, and didn't have a problem with lactation, but I was dizzy, had blood pressure problems, my hands were cold and bluish, it was no fun. I was really sick. I couldn't get to the right theraputic level even taking more than the recommended dose.
That was when they put me on Wellbutrin and the combo of the two almost did me in. They switched too fast and I didn't sleep well for a couple of days. I was very suicidal. I had been for months, but switching made it worse. Eventually, the crisis passed and I got better on just Wellbutrin. Now it doesn't work.
My niece (who is adopted) is bipolar and has all sorts of endo problems. She has some sort of benign cyst on or near the pituitary they are watching. It has been hard for her to get good treatment, too, because she has not had a complete medical history. She is stable now for the first time. I can't remember exactly what she is on--I'm sorry.
I mention that only because I read in one of your other posts that you were adopted. I hope you don't mind, but I have been praying for you. Both my children are adopted, too.
Hugs,
MidnightBlue
Posted by ed_uk on April 7, 2005, at 15:35:19
In reply to Got Milk? Lactating on Desipramine - SLS?? ED??, posted by Maxime on April 7, 2005, at 13:35:56
Hi Maxime,
>How could Desipramine make me lactate? Does it do anything to prolactin levels?
Tricyclic ADs have been known to induce lactation, it is thought that they can occasionally cause hyperprolactinemia in susceptible individuals. You are clearly susceptible to drug-induced hyperprolactinemia. The question is: why are you susceptible? It could be because your hypothyroidism is not being adequately treated.
>I am in tears right now....
Oh Maxime, please accept a gentle hug from me.
((((Maxime))))
>Where do I go from here?
I think it would be useful to have your high prolactin investigated further. A prolactinoma is possible but very unlikely.
I have read that hypothyroidism can raise prolactin levels, perhaps you could encourage your doc to increase your thyroxine. Hypothyroidism can apparantly cause a condition called pituitary hyperplasia, which is associated excessive prolactin secretion. An adequate dose of thyroxine can treat the pituitary hyperplasia and decrease the prolactin level. Perhaps you would be able to take desipramine without lactating if your thyroxine dose was increased.
'A 21-year-old woman complaining of 8-month amenorrhea associated to weight gain, galactorrhea and frequent headaches, presented for clinical evaluation; her laboratory tests were: TSH: 1192 mUI/ml (0.27-4.2); TT4: 1.0 microg/dl (4.4-11.4 l); TT3: 0.41 ng/ml (0.7-2.1); prolactin: 69.2 ng/ml (3-20) and a diagnosis of myxedema associated to galactorrhea was made. A hypothalamic-pituitary magnetic resonance imaging (MRI) showed a suprasellar and intrasellar mass lesion of 1.9 x 1.4 x 1.9 cm, determining compression and deviation of the optic chiasm. Due to the possibility of hyperplasia of the TSH-producing cells, treatment of hypothyroidism was initiated with levothyroxine. Two months later, upon normalization of thyroid hormones and TSH levels, a second MRI showed an anatomically normal pituitary gland. Regression of the pituitary mass after treatment with levothyroxine confirmed the hypothesis of pituitary hyperplasia secondary to primary hypothyroidism. Our findings support the importance of determining thyroid function tests during the investigation of pituitary masses and thus avoiding an unnecessary surgery.''This study investigated the effect of levothyroxine treatment on serum prolactin (PRL) levels in women with subclinical hypothyroidism. Sixty-six women (mean age, 58.5 +/- 1.3 years) with confirmed subclinical hypothyroidism (mean thyrotropin [TSH], 11.7 +/- 0.8 mIU/L) were randomly assigned to receive levothyroxine or placebo for 48 weeks. Based on blinded TSH monitoring, physiologic levothyroxine replacement (85.5 +/- 4.3 microg/d; TSH, 3.1 +/- 0.3 mIU/L) was ascertained throughout the study. PRL levels were measured before and after administration of thyrotropin-releasing hormone (TRH) at baseline, after 24 and 48 weeks. Sixty-three of the 66 women completed the study. At baseline, basal PRL levels were elevated in 19% of the patients. None of the patients reported menstrual disturbances, infertility, or galactorrhea. In the levothyroxine group (n = 31) basal and peak PRL levels were significantly reduced after 24 and 48 weeks (p = 0.03 and p = 0.001). Mean changes in PRL levels differed significantly between the two treatment groups after 24 weeks (p = 0.03 and p = 0.01). The treatment effect was more pronounced in patients with PRL and TSH levels above the median at baseline (i.e., PRL > 16 ng/mL; TSH > 11 mIU/L). Based on this double-blinded, placebo-controlled study we demonstrate that in subclinical hypothyroidism PRL regulation is altered with elevated basal and stimulated PRL levels, and that physiologic levothyroxine treatment restores PRL concentrations.'
Some hypothyroid patients with galactorrea (lactation) may need high doses of T4..............
Galactorrhea was found in 5 patients with subclinical hypothyroidism. The galactorrhea consisted of the discharge of a few drops of milk only under pressure. Serum T4 was in the lower level of the normal range, but serum T3 was normal (T4: 6.3 +/- 1.2 micrograms/dl, T3: 113 +/- 7 ng/dl). Basal serum TSH and PRL were slightly increased only in 2 and 1 cases, respectively. The PRL (prolactin) responses to TRH stimulation were exaggerated in all cases, although the basal levels were normal. An enlarged pituitary gland was observed in 1 patient by means of CT scanning. All patients were treated by T4 replacement. ***In serial TRH tests during the T4 replacement therapy, the PRL response was still increased even when the TSH response was normalized. Galactorrhea disappeared when the patients were treated with an increased dose of T4 (150-200 micrograms/day).*** Recurrence of galactorrhea was not observed even though replacement dose of T4 was later decreased to 100 micrograms/day in 4 cases. In patients with galactorrhea of unknown origin, subclinical hypothyroidism should NOT be ruled out EVEN WHEN THEIR T4, T3, TSH and PRL are in the normal range. The TRH stimulation test IS NECESSARY to detect an exaggerated PRL response as the cause of the galactorrhea. To differentiate this from pituitary microadenoma, observation of the effects of T4 replacement therapy on galactorrhea is essential.
Have you ever had a TRH stimulation test Maxi??????????
Administration of thyroid hormones may produce *transient increases* in prolactin..........
Following the administration of gradually increasing doses of thyroid hormones, plasma PRL showed paradoxical and transient increases, while plasma TSH decreased steadily. The elevated basal PRL level and the enhanced response to sulpiride turned to be within the normal range when the patients became euthyroid by treatment.'
If increasing your thyroxine dose was not effective in normalising your prolactin level, treatment with a dopamine agonist could be helpful. A precise diagnosis is important. A CT or MRI of the pituitary gland might be useful.Bromocriptine, quinagolide and cabergoline are dopamine agonists which are used to lower prolactin, they are used to treat prolactinomas.
Pramipexole is a dopamine agonist which is most commonly used to treat Parkinson's disease. It is also used to treat depression, including bipolar depression. It might be effective in reducing your prolactin level. Treatment with pramipexole might also allow you to tolerate desipramine if pramipexole was not an effective treatment for your depression on its own. I would be a bit concerned that pramipexole might induce hypomanic symptoms, it does seem to be useful in bipolar II disorder though.........
Pramipexole for bipolar II depression: a placebo-controlled proof of concept study.
BACKGROUND: The original serotonergic and noradrenergic hypotheses do not fully account for the neurobiology of depression or mechanism of action of effective antidepressants. Research implicates a potential role of the dopaminergic system in the pathophysiology of bipolar disorder. The current study was undertaken as a proof of the concept that dopamine agonists will be effective in patients with bipolar II depression. METHODS: In a double-blind, placebo-controlled study, 21 patients with DSM-IV bipolar II disorder, depressive phase on therapeutic levels of lithium or valproate were randomly assigned to treatment with pramipexole (n = 10) or placebo (n = 11) for 6 weeks. Primary efficacy was assessed by the Montgomery-Asberg Depression Rating Scale. RESULTS: All subjects except for one in each group completed the study. The analysis of variance for total Montgomery-Asberg Depression Rating Scale scores showed a significant treatment effect. A therapeutic response (>50% decrease in Montgomery-Asberg Depression Rating Scale from baseline) occurred in 60% of patients taking pramipexole and 9% taking placebo (p =.02). One subject on pramipexole and two on placebo developed hypomanic symptoms. CONCLUSIONS: The dopamine agonist pramipexole was found to have significant antidepressant effects in patients with bipolar II depression.
I don't know whether pramipexole is available in Canada, I would expect that it is. Other dopamine agonist will be available. Ropinirole is quite similar to pramipexole. It would be great if you could encourage your doc to increase your thyroxine dose.Ed xxxxxxxxxxxxx
PS. I know very LITTLE about endocrinology. Everything I have said may be a load of rubbish. I just did a bit of research and came up with this!
Posted by Spriggy on April 7, 2005, at 16:12:25
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED?? » Maxime, posted by ed_uk on April 7, 2005, at 15:35:19
I know it's not funny, but OH My word... that just tickled my funny bone.
Got milk?? LOL
I'msorry, it's not nice to laugh at such a thing but I can't help myself.
If it makes you feel any better, I am PMS'n right now and my breasts feel like they might fall off into the floor at any moment (like concrete bricks!).
I told my husband today, " if you find them on the floor, bring them back to me."
LOL Aleve becomes my good friend during this time of the month.
Posted by Maxime on April 7, 2005, at 16:44:42
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED?? » Maxime, posted by ed_uk on April 7, 2005, at 15:35:19
Hi Ed. I appreciate your research. My doctor lowered my Synthroid on my last visit. I see him on Monday. You see he WON'T do the proper test. He just tests my TSH and free T4. I want him to test my Free T3. I also want the test that will show if I have a conversion problem. I still feel like have hypothroid symptoms (which present as psych symptoms) and Synthroid is T4 and need to be converted to T3 for my body to use it. Well some people can't convert it. So it would be better if I was taking something like Cytomel which is T3. He won't prescribe the Cytomel. Synthroid is so much easier to dose.
I can't force him to do these tests. I'm so f*cking frustrated. I think I will have my pdoc call him again or something.
I want to get to the bottom of this but no one will listen. And since so many of the symptoms of hypothyroidism mimic depression, my endo is no doubt assuming that "Ms. Psych Patient" problems are all in her head.
I saw my GP yesterday, and she said my endo had to look after these problems. Her nose is out of joint because last year I started to see an endo because she wasn't managing my thyroid problem. I was taking Dilantin and I told her it made the Synthroid less effective and she didn't believe me. I had read it on www.rxlist.com That's when my TSH went up to 25.
So that's my soap opera. Stay tuned.
xxxxxxx
Maxi> Hi Maxime,
>
> >How could Desipramine make me lactate? Does it do anything to prolactin levels?
>
> Tricyclic ADs have been known to induce lactation, it is thought that they can occasionally cause hyperprolactinemia in susceptible individuals. You are clearly susceptible to drug-induced hyperprolactinemia. The question is: why are you susceptible? It could be because your hypothyroidism is not being adequately treated.
>
> >I am in tears right now....
>
> Oh Maxime, please accept a gentle hug from me.
>
> ((((Maxime))))
>
> >Where do I go from here?
>
> I think it would be useful to have your high prolactin investigated further. A prolactinoma is possible but very unlikely.
>
> I have read that hypothyroidism can raise prolactin levels, perhaps you could encourage your doc to increase your thyroxine. Hypothyroidism can apparantly cause a condition called pituitary hyperplasia, which is associated excessive prolactin secretion. An adequate dose of thyroxine can treat the pituitary hyperplasia and decrease the prolactin level. Perhaps you would be able to take desipramine without lactating if your thyroxine dose was increased.
>
>
> 'A 21-year-old woman complaining of 8-month amenorrhea associated to weight gain, galactorrhea and frequent headaches, presented for clinical evaluation; her laboratory tests were: TSH: 1192 mUI/ml (0.27-4.2); TT4: 1.0 microg/dl (4.4-11.4 l); TT3: 0.41 ng/ml (0.7-2.1); prolactin: 69.2 ng/ml (3-20) and a diagnosis of myxedema associated to galactorrhea was made. A hypothalamic-pituitary magnetic resonance imaging (MRI) showed a suprasellar and intrasellar mass lesion of 1.9 x 1.4 x 1.9 cm, determining compression and deviation of the optic chiasm. Due to the possibility of hyperplasia of the TSH-producing cells, treatment of hypothyroidism was initiated with levothyroxine. Two months later, upon normalization of thyroid hormones and TSH levels, a second MRI showed an anatomically normal pituitary gland. Regression of the pituitary mass after treatment with levothyroxine confirmed the hypothesis of pituitary hyperplasia secondary to primary hypothyroidism. Our findings support the importance of determining thyroid function tests during the investigation of pituitary masses and thus avoiding an unnecessary surgery.'
>
> 'This study investigated the effect of levothyroxine treatment on serum prolactin (PRL) levels in women with subclinical hypothyroidism. Sixty-six women (mean age, 58.5 +/- 1.3 years) with confirmed subclinical hypothyroidism (mean thyrotropin [TSH], 11.7 +/- 0.8 mIU/L) were randomly assigned to receive levothyroxine or placebo for 48 weeks. Based on blinded TSH monitoring, physiologic levothyroxine replacement (85.5 +/- 4.3 microg/d; TSH, 3.1 +/- 0.3 mIU/L) was ascertained throughout the study. PRL levels were measured before and after administration of thyrotropin-releasing hormone (TRH) at baseline, after 24 and 48 weeks. Sixty-three of the 66 women completed the study. At baseline, basal PRL levels were elevated in 19% of the patients. None of the patients reported menstrual disturbances, infertility, or galactorrhea. In the levothyroxine group (n = 31) basal and peak PRL levels were significantly reduced after 24 and 48 weeks (p = 0.03 and p = 0.001). Mean changes in PRL levels differed significantly between the two treatment groups after 24 weeks (p = 0.03 and p = 0.01). The treatment effect was more pronounced in patients with PRL and TSH levels above the median at baseline (i.e., PRL > 16 ng/mL; TSH > 11 mIU/L). Based on this double-blinded, placebo-controlled study we demonstrate that in subclinical hypothyroidism PRL regulation is altered with elevated basal and stimulated PRL levels, and that physiologic levothyroxine treatment restores PRL concentrations.'
>
> Some hypothyroid patients with galactorrea (lactation) may need high doses of T4..............
>
> Galactorrhea was found in 5 patients with subclinical hypothyroidism. The galactorrhea consisted of the discharge of a few drops of milk only under pressure. Serum T4 was in the lower level of the normal range, but serum T3 was normal (T4: 6.3 +/- 1.2 micrograms/dl, T3: 113 +/- 7 ng/dl). Basal serum TSH and PRL were slightly increased only in 2 and 1 cases, respectively. The PRL (prolactin) responses to TRH stimulation were exaggerated in all cases, although the basal levels were normal. An enlarged pituitary gland was observed in 1 patient by means of CT scanning. All patients were treated by T4 replacement. ***In serial TRH tests during the T4 replacement therapy, the PRL response was still increased even when the TSH response was normalized. Galactorrhea disappeared when the patients were treated with an increased dose of T4 (150-200 micrograms/day).*** Recurrence of galactorrhea was not observed even though replacement dose of T4 was later decreased to 100 micrograms/day in 4 cases. In patients with galactorrhea of unknown origin, subclinical hypothyroidism should NOT be ruled out EVEN WHEN THEIR T4, T3, TSH and PRL are in the normal range. The TRH stimulation test IS NECESSARY to detect an exaggerated PRL response as the cause of the galactorrhea. To differentiate this from pituitary microadenoma, observation of the effects of T4 replacement therapy on galactorrhea is essential.
>
> Have you ever had a TRH stimulation test Maxi??????????
>
> Administration of thyroid hormones may produce *transient increases* in prolactin..........
>
> Following the administration of gradually increasing doses of thyroid hormones, plasma PRL showed paradoxical and transient increases, while plasma TSH decreased steadily. The elevated basal PRL level and the enhanced response to sulpiride turned to be within the normal range when the patients became euthyroid by treatment.'
>
>
> If increasing your thyroxine dose was not effective in normalising your prolactin level, treatment with a dopamine agonist could be helpful. A precise diagnosis is important. A CT or MRI of the pituitary gland might be useful.
>
> Bromocriptine, quinagolide and cabergoline are dopamine agonists which are used to lower prolactin, they are used to treat prolactinomas.
>
> Pramipexole is a dopamine agonist which is most commonly used to treat Parkinson's disease. It is also used to treat depression, including bipolar depression. It might be effective in reducing your prolactin level. Treatment with pramipexole might also allow you to tolerate desipramine if pramipexole was not an effective treatment for your depression on its own. I would be a bit concerned that pramipexole might induce hypomanic symptoms, it does seem to be useful in bipolar II disorder though.........
>
> Pramipexole for bipolar II depression: a placebo-controlled proof of concept study.
>
> BACKGROUND: The original serotonergic and noradrenergic hypotheses do not fully account for the neurobiology of depression or mechanism of action of effective antidepressants. Research implicates a potential role of the dopaminergic system in the pathophysiology of bipolar disorder. The current study was undertaken as a proof of the concept that dopamine agonists will be effective in patients with bipolar II depression. METHODS: In a double-blind, placebo-controlled study, 21 patients with DSM-IV bipolar II disorder, depressive phase on therapeutic levels of lithium or valproate were randomly assigned to treatment with pramipexole (n = 10) or placebo (n = 11) for 6 weeks. Primary efficacy was assessed by the Montgomery-Asberg Depression Rating Scale. RESULTS: All subjects except for one in each group completed the study. The analysis of variance for total Montgomery-Asberg Depression Rating Scale scores showed a significant treatment effect. A therapeutic response (>50% decrease in Montgomery-Asberg Depression Rating Scale from baseline) occurred in 60% of patients taking pramipexole and 9% taking placebo (p =.02). One subject on pramipexole and two on placebo developed hypomanic symptoms. CONCLUSIONS: The dopamine agonist pramipexole was found to have significant antidepressant effects in patients with bipolar II depression.
>
>
> I don't know whether pramipexole is available in Canada, I would expect that it is. Other dopamine agonist will be available. Ropinirole is quite similar to pramipexole. It would be great if you could encourage your doc to increase your thyroxine dose.
>
> Ed xxxxxxxxxxxxx
>
> PS. I know very LITTLE about endocrinology. Everything I have said may be a load of rubbish. I just did a bit of research and came up with this!
>
>
>
>
Posted by Maxime on April 7, 2005, at 16:49:37
In reply to OH MAXIME..., posted by Spriggy on April 7, 2005, at 16:12:25
Well at least I made someone laugh which counts for something. "Got Milk" is part of a campaign to drink more milk and that's how the commercial ends "Got Milk?"
Aleve doesn't help with PMS though, does it? It helps cramps though. It's the only thing that helps mine. I get the prescription version of Aleve.
Maxime
> I know it's not funny, but OH My word... that just tickled my funny bone.
>
> Got milk?? LOL
>
> I'msorry, it's not nice to laugh at such a thing but I can't help myself.
>
> If it makes you feel any better, I am PMS'n right now and my breasts feel like they might fall off into the floor at any moment (like concrete bricks!).
>
> I told my husband today, " if you find them on the floor, bring them back to me."
>
> LOL Aleve becomes my good friend during this time of the month.
Posted by Maxime on April 7, 2005, at 16:55:51
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED?, posted by MidnightBlue on April 7, 2005, at 15:06:17
I appreciate your prayers.
Sometimes I think that bipolar illness is really an endocrine problem gone undiagnosed.
You know I am trying to get into that DBS study in Toronto? I am willing to have someone put a drill to my skull. I am going to mention this to my endo and tell that I would really like to know if it is my endocrine system gone haywire before I have my head drilled. I am going to be VERY pushy on Monday. I will try not to be a smart *ss but it will be hard. I know the blood tests I just had done will show that my "thyroid is under control" when all the tests are really showing is that I have been taking my Synthroid as prescribed.
Thanks again for your input. Everyone is so helpful!
Hugs,
Maxi> Maxime,
>
> Honestly, I do think you should check. There is SOMETHING wrong and if it isn't a med (and the only way to really know that is to stop all of them) then it must be something wrong inside of you like hormones. Don't you think?
>
> I had a high prolactin level a few years ago and it was just because the way they drew the blood. It was a false positive. But it is my understanding it is an easy test to mess up.
>
> I was on 325 mg of desipramine about 10 years ago, and didn't have a problem with lactation, but I was dizzy, had blood pressure problems, my hands were cold and bluish, it was no fun. I was really sick. I couldn't get to the right theraputic level even taking more than the recommended dose.
>
> That was when they put me on Wellbutrin and the combo of the two almost did me in. They switched too fast and I didn't sleep well for a couple of days. I was very suicidal. I had been for months, but switching made it worse. Eventually, the crisis passed and I got better on just Wellbutrin. Now it doesn't work.
>
> My niece (who is adopted) is bipolar and has all sorts of endo problems. She has some sort of benign cyst on or near the pituitary they are watching. It has been hard for her to get good treatment, too, because she has not had a complete medical history. She is stable now for the first time. I can't remember exactly what she is on--I'm sorry.
>
> I mention that only because I read in one of your other posts that you were adopted. I hope you don't mind, but I have been praying for you. Both my children are adopted, too.
>
> Hugs,
>
> MidnightBlue
>
>
>
Posted by ed_uk on April 7, 2005, at 17:16:06
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED?? » Maxime, posted by ed_uk on April 7, 2005, at 15:35:19
Hi Maxime,
What are you going to do about the desipramine? If you do decide to stop it please taper it over a few days if at all possible.
I think you need to get your endo to measure your prolactin level again when you are off desipramine. Stress that it was borderline/high when it was measured before and that you are concerned because you always lactate on psych meds. If your prolactin is high when you're off desipramine he will have to consider that this could be due to inadequately treated hypothyroidism. If you are on desipramine he will probably tell you that the desipramine is to blame and that your prolactin would be normal if you stopped it. Stress can also raise prolactin!
If your endo will not listen, you could always ask your pdoc what he thinks about pramipexole at your next appointment. I must admit that I am a bit concerned about how you'd react to pramipexole since it's a dopamine agonist. Chlorpromazine (a dopamine antagonist) relieves some of your symptoms. Anyway, psych meds can work in strange ways so it could be really helpful. Even if the pramipexole didn't help your depression (which it might!) it would probably allow you to tolerate other drugs such as desipramine. What do you think?
Ed xxxxxxxxxx
Posted by Minnie-Haha on April 7, 2005, at 17:25:14
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED? » MidnightBlue, posted by Maxime on April 7, 2005, at 16:55:51
> Sometimes I think that bipolar illness is really an endocrine problem gone undiagnosed...
Yes! I think that too!!
Posted by Minnie-Haha on April 7, 2005, at 17:31:06
In reply to Re: You got that right, girlfriend » Maxime, posted by Minnie-Haha on April 7, 2005, at 17:25:14
> Sometimes I think that bipolar illness is really an endocrine problem gone undiagnosed...
In fact, I think someday (I hope not in the too distant future) people will be saying something like: Oh, that's XYZ Syndrome! In the "dark ages," they called it bipolar disorder and people suffered terribly because there wasn't effective treatment. Now they just use ABC Therapy and they lead happy, productive, normal lives.
Posted by Phillipa on April 7, 2005, at 18:22:21
In reply to Re: You got that right, girlfriend, posted by Minnie-Haha on April 7, 2005, at 17:31:06
Maxime, it seems as if women are prone to every bizarre illness. Especially in re to the endocrine system. So I'm leaking from my neck, and you're leaking from your breasts. What's the deal? Fondly, Phillipa
Posted by Maxime on April 7, 2005, at 20:19:40
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED?? » ed_uk, posted by ed_uk on April 7, 2005, at 17:16:06
Hi Ed.
I'm stopping the Desipramine right away. I have been on 75 mg for 10 days or so and I was on 25 mg for one week. I really don't think I will suffer any withdrawal symptoms.
Other than that I don't know what to do. I don't feel like I have a voice anymore.
Maxime
> Hi Maxime,
>
> What are you going to do about the desipramine? If you do decide to stop it please taper it over a few days if at all possible.
>
> I think you need to get your endo to measure your prolactin level again when you are off desipramine. Stress that it was borderline/high when it was measured before and that you are concerned because you always lactate on psych meds. If your prolactin is high when you're off desipramine he will have to consider that this could be due to inadequately treated hypothyroidism. If you are on desipramine he will probably tell you that the desipramine is to blame and that your prolactin would be normal if you stopped it. Stress can also raise prolactin!
>
> If your endo will not listen, you could always ask your pdoc what he thinks about pramipexole at your next appointment. I must admit that I am a bit concerned about how you'd react to pramipexole since it's a dopamine agonist. Chlorpromazine (a dopamine antagonist) relieves some of your symptoms. Anyway, psych meds can work in strange ways so it could be really helpful. Even if the pramipexole didn't help your depression (which it might!) it would probably allow you to tolerate other drugs such as desipramine. What do you think?
>
> Ed xxxxxxxxxx
Posted by zeugma on April 7, 2005, at 22:43:23
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED? » ed_uk, posted by Maxime on April 7, 2005, at 20:19:40
Hi Maxime,
Desipramine elevates prolactin levels, but nortriptyline apparently doesn't. Nortriptyline is very similar in effect to desipramine otherwise. It got me out of a terrible depression, where I was literally wasting away.
-z
Posted by SLS on April 8, 2005, at 1:52:44
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED?? » ed_uk, posted by ed_uk on April 7, 2005, at 17:16:06
Hi Maxime.
I like Ed's idea.
I think you should call your doctor's office. Inform them that you are lactating, and that you are stopping the desipramine temporarily until you can get a full endocrinological work-up. Ask who he would recommend. That way, he still feels that he is a participant in your care, even if you have no intention of seeing who he recommends. You won't be doing things behind his back.
- Scott> Hi Maxime,
>
> What are you going to do about the desipramine? If you do decide to stop it please taper it over a few days if at all possible.
>
> I think you need to get your endo to measure your prolactin level again when you are off desipramine. Stress that it was borderline/high when it was measured before and that you are concerned because you always lactate on psych meds. If your prolactin is high when you're off desipramine he will have to consider that this could be due to inadequately treated hypothyroidism. If you are on desipramine he will probably tell you that the desipramine is to blame and that your prolactin would be normal if you stopped it. Stress can also raise prolactin!
>
> If your endo will not listen, you could always ask your pdoc what he thinks about pramipexole at your next appointment. I must admit that I am a bit concerned about how you'd react to pramipexole since it's a dopamine agonist. Chlorpromazine (a dopamine antagonist) relieves some of your symptoms. Anyway, psych meds can work in strange ways so it could be really helpful. Even if the pramipexole didn't help your depression (which it might!) it would probably allow you to tolerate other drugs such as desipramine. What do you think?
>
> Ed xxxxxxxxxx
Posted by ed_uk on April 8, 2005, at 7:31:24
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED? » Maxime, posted by zeugma on April 7, 2005, at 22:43:23
>'Desipramine, acutely, had no effect on any of the above paradigms but after chronic administration, potentiated the effect of low dose 5-HTP on prolactin secretion. Nortriptyline had no effect on prolactin secretion after acute or chronic treatment.'
Maxime, will you try nortriptyline? Zeugma made a good point, I hadn't heard that before.
Ed xxx
Posted by Maxime on April 8, 2005, at 11:24:08
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED??, posted by SLS on April 8, 2005, at 1:52:44
Hey Scott:
Well my pdoc tried to get me in to the endo he likes his patients to see. But he wasn't accepting new ones. So I had to see this other guy. He cancelled my appointments twice at the last minute causing me to miss two half days of work. He also talked down to me the first time I saw him. So my pdoc has already done one referral and won't do another.
In the meantime I am seeing some quack who thinks that measuring my TSH and Free T4 is sufficient.
I left a message with my PDOC yesterday telling him about the lactation and that I had stopped the med. I also alluded to the fact that I thought my problem was endocrine related. I haven't heard back from him.
No one cares Scott. No one will listen. And I am too sick of trying to get people to listen. And I am just so tired and down.
I am going back to bed. I plan to spend the day there just to escape.
Maxime
> Hi Maxime.
>
> I like Ed's idea.
>
> I think you should call your doctor's office. Inform them that you are lactating, and that you are stopping the desipramine temporarily until you can get a full endocrinological work-up. Ask who he would recommend. That way, he still feels that he is a participant in your care, even if you have no intention of seeing who he recommends. You won't be doing things behind his back.
>
>
> - Scott
>
>
>
> > Hi Maxime,
> >
> > What are you going to do about the desipramine? If you do decide to stop it please taper it over a few days if at all possible.
> >
> > I think you need to get your endo to measure your prolactin level again when you are off desipramine. Stress that it was borderline/high when it was measured before and that you are concerned because you always lactate on psych meds. If your prolactin is high when you're off desipramine he will have to consider that this could be due to inadequately treated hypothyroidism. If you are on desipramine he will probably tell you that the desipramine is to blame and that your prolactin would be normal if you stopped it. Stress can also raise prolactin!
> >
> > If your endo will not listen, you could always ask your pdoc what he thinks about pramipexole at your next appointment. I must admit that I am a bit concerned about how you'd react to pramipexole since it's a dopamine agonist. Chlorpromazine (a dopamine antagonist) relieves some of your symptoms. Anyway, psych meds can work in strange ways so it could be really helpful. Even if the pramipexole didn't help your depression (which it might!) it would probably allow you to tolerate other drugs such as desipramine. What do you think?
> >
> > Ed xxxxxxxxxx
>
>
Posted by Maxime on April 8, 2005, at 11:46:22
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED? » zeugma, posted by ed_uk on April 8, 2005, at 7:31:24
I have tried it before. I am pretty sure it gave me hives.
If I had known I was going to try over 43 meds I would have logged all my various reactions to them. But I didn't. I have a decent memory. I remember amitriptyline sedated me so much I couldn't get past 10 mg. I stayed on 10 mg for 3 weeks and I couldn't move. My pdoc at the time hoped I would get up to 100 mg. I mean it was the worst sedation ever. And then there was one TCA that gave me hives and I think Pamelor was the one.
F*ck this. F*ck all meds. F*ck all pdocs and endo and stupid doctors with inflated egos who won't listen. F*ck psychopharmacologists who won't return my calls even though my pdoc faxed a referral F*ck 'em all. I am not staying on the med merry-go-round any longer. I want my endocrine problems taken care of and that's it. I'm going to taper off the Trileptal. I will stay on the clonazapam and that's all. I'm not doing this anymore. I'm done. Wasted.
> >'Desipramine, acutely, had no effect on any of the above paradigms but after chronic administration, potentiated the effect of low dose 5-HTP on prolactin secretion. Nortriptyline had no effect on prolactin secretion after acute or chronic treatment.'
>
> Maxime, will you try nortriptyline? Zeugma made a good point, I hadn't heard that before.
>
> Ed xxx
Posted by TamaraJ on April 8, 2005, at 16:10:05
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED? » ed_uk, posted by Maxime on April 8, 2005, at 11:46:22
Maxime,
I don't know if the following is relevant, but it could help explain that lactating, particularly when on ADs. Anyone FWIW and FYI, the following are some of the symptoms of Hashimotos disease (thyroiditis):
"Menstrual irregularities (typically menorrhagia, infertility, and loss of libido): Increased prolactin secondary to increased thyrotropin-releasing hormone (TRH) leads to decreased luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and to decreased response to gonadotropin-releasing hormone (GnRH). The result is anovulatory cycles with menstrual irregularities" from this site: http://www.emedicine.com/MED/topic949.htm.
I also read a post on Babble that said, among other things: " . . . Plus, stress, as well as antidepressants, can reduce the enzyme that is needed to convert T4 into T3. (I've learned today.) When people take an overdose of T4, they give them a certain stress hormone to block the T4 from converting into T3. Your body cannot use T4, it uses T3.". Here is the URL for the thread: http://www.dr-bob.org/babble/20040614/msgs/358308.html
Tamara
Posted by Maxime on April 8, 2005, at 19:22:45
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED? » Maxime, posted by TamaraJ on April 8, 2005, at 16:10:05
Thanks Tamara. It's very relevant. But my endo won't do the necessary tests. And I am already convinced that I have a conversion problem because I have all the symptoms of hypothyroidism including a low body temperature.
It doesn't matter anymore. I'm not playing this game anymore. I am dropping all my psych meds and staying on the synthroid in the hopes that my body will use some of it. And that's the best I do.
Maxime
> Maxime,
>
> I don't know if the following is relevant, but it could help explain that lactating, particularly when on ADs. Anyone FWIW and FYI, the following are some of the symptoms of Hashimotos disease (thyroiditis):
>
> "Menstrual irregularities (typically menorrhagia, infertility, and loss of libido): Increased prolactin secondary to increased thyrotropin-releasing hormone (TRH) leads to decreased luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and to decreased response to gonadotropin-releasing hormone (GnRH). The result is anovulatory cycles with menstrual irregularities" from this site: http://www.emedicine.com/MED/topic949.htm.
>
> I also read a post on Babble that said, among other things: " . . . Plus, stress, as well as antidepressants, can reduce the enzyme that is needed to convert T4 into T3. (I've learned today.) When people take an overdose of T4, they give them a certain stress hormone to block the T4 from converting into T3. Your body cannot use T4, it uses T3.". Here is the URL for the thread: http://www.dr-bob.org/babble/20040614/msgs/358308.html
>
>
> Tamara
Posted by Maxime on April 9, 2005, at 23:31:25
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED? » Maxime, posted by zeugma on April 7, 2005, at 22:43:23
Dear Zeugma:
I certainly didn't mean to ignore your suggestion. I'm sorry, I am somewhat scattered.
Did it make you gain weight? Did it increase your appetite? How bad was the sedation.
Damn I wish I could remember if this was the med that gave me hives!
Thanks Z. I hope you can tell me more about your experience with the med.
Maxi
> Hi Maxime,
>
> Desipramine elevates prolactin levels, but nortriptyline apparently doesn't. Nortriptyline is very similar in effect to desipramine otherwise. It got me out of a terrible depression, where I was literally wasting away.
> -z
Posted by zeugma on April 10, 2005, at 15:04:47
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED? » zeugma, posted by Maxime on April 9, 2005, at 23:31:25
> Dear Zeugma:
>
> I certainly didn't mean to ignore your suggestion. I'm sorry, I am somewhat scattered.>>
No apology needed, you are going through a hellish time.
>
> Did it make you gain weight? Did it increase your appetite? How bad was the sedation.>>It does cause more weight gain than desipramine. It increased my appetite slightly, but my appetite is so low that this was only a minor increase. But many report major weight gain on this med. I know that's a major concern of yours BUT it is an excellent AD and is most likely a better AD, from what I've pieced together from reading about others' experiences, than DMI.
The sedation was nonexistent at low doses, then at about 40 mg would begin to kick in. I would be more tired than usual for about two weeks each time I raised the dose from that point. I currently take 100 mg. It sedates me enough to sleep but does not give me a hangover. In fact I think the 100 mg dose is more stimulating than 75 mg, but it still helps me sleep.
I've used this med for about three years now. It helps with motivation- in fact that was its first effect when i started taking it- so you could minimize weight gain by exercising. But response to TCA's is very individual, and your doctor would have to individualize your dose regimen so you could get within its therapeutic window as quickly as possible.
Best,
z
Posted by Maxime on April 10, 2005, at 23:18:03
In reply to Re: Got Milk? Lactating on Desipramine - SLS?? ED? » Maxime, posted by zeugma on April 10, 2005, at 15:04:47
I'm glad it's working so well for you. But I can't gain weight. I can't. I am already a basket case because of the weight I have gained. I need to lose at least 30 pounds to begin with. And even more after that. I can't handle it. I can't.
Maxime
> > Dear Zeugma:
> >
> > I certainly didn't mean to ignore your suggestion. I'm sorry, I am somewhat scattered.>>
>
>
> No apology needed, you are going through a hellish time.
> >
> > Did it make you gain weight? Did it increase your appetite? How bad was the sedation.>>
>
> It does cause more weight gain than desipramine. It increased my appetite slightly, but my appetite is so low that this was only a minor increase. But many report major weight gain on this med. I know that's a major concern of yours BUT it is an excellent AD and is most likely a better AD, from what I've pieced together from reading about others' experiences, than DMI.
>
> The sedation was nonexistent at low doses, then at about 40 mg would begin to kick in. I would be more tired than usual for about two weeks each time I raised the dose from that point. I currently take 100 mg. It sedates me enough to sleep but does not give me a hangover. In fact I think the 100 mg dose is more stimulating than 75 mg, but it still helps me sleep.
>
> I've used this med for about three years now. It helps with motivation- in fact that was its first effect when i started taking it- so you could minimize weight gain by exercising. But response to TCA's is very individual, and your doctor would have to individualize your dose regimen so you could get within its therapeutic window as quickly as possible.
>
> Best,
> z
>
>
>
>
>
This is the end of the thread.
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