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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 71 to 95 of 183. Go back in thread:
Posted by ed_uk on May 6, 2005, at 5:28:39
In reply to Re: Survector expired, posted by sukarno on May 5, 2005, at 8:51:58
Hi Paul!
>Is there some mode of action that Nardil and Tofranil (imipramine) have that is separate from their effects on 5-HT and to a lesser extent NE that causes them to have much higher efficacy than the SSRIs?
Nardil raises levels of 5-HT, NE, dopamine and GABA in the brain. Parnate raises 5-HT, NE and dopamine but not GABA. Also, it is important to bear in mind that MAOIs affect 5-HT via a completely different mechanism to the SSRIs.
In addition to 5-HT reuptake inhibition, the noradrenergic properties of imipramine may help to suppress panic attacks.... SSRIs do not share this effect.
>Survector is still being produced in Uruguay according to an online pharmacy, but I'd bet that they are wrong about it after doing more searching on Google.
Can you find out who the manufacturer is, call them, and find out whether they're still making it??
Kind regards,
Ed.
Posted by pro_social_soon on May 6, 2005, at 5:40:31
In reply to Re: Survector » sukarno, posted by ed_uk on May 6, 2005, at 5:28:39
> Hi Paul!
>
> >Is there some mode of action that Nardil and Tofranil (imipramine) have that is separate from their effects on 5-HT and to a lesser extent NE that causes them to have much higher efficacy than the SSRIs?
Dr.Liebowitz observed in comparison studies between the TCA "imipramine" (Tofranil) and the MAOI "phenelzine" (Nardil) that while phenelzine was extremely effective in treating Social Anxiety, imipramine showed no efficacy - with the primary difference in the two drugs being the marked pro-DA effect of Nardil. Recent studies also show low levels of sex steroid "pregnenolone sulphate" in those with generalized Social Phobia and GAD (generalized anxiety disorder). Low PS levels are linked with abnormal dopamine function and passivity.
Posted by sukarno on May 6, 2005, at 12:16:21
In reply to Nardil,Imipramine » ed_uk, posted by pro_social_soon on May 6, 2005, at 5:40:31
Hi Ed! :-) I sent off an email a few days ago to Uruguay but have not received a reply. I even wrote it in Spanish. Oh well. *sigh* I guess it's gone for good!
" Dr.Liebowitz observed in comparison studies between the TCA "imipramine" (Tofranil) and the MAOI "phenelzine" (Nardil) that while phenelzine was extremely effective in treating Social Anxiety, imipramine showed no efficacy - with the primary difference in the two drugs being the marked pro-DA effect of Nardil. Recent studies also show low levels of sex steroid "pregnenolone sulphate" in those with generalized Social Phobia and GAD (generalized anxiety disorder). Low PS levels are linked with abnormal dopamine function and passivity."
Would this explain low libido in some folks with GAD?
I'm also interested to see if l-deprenyl (selegiline, trade name "Eldepryl" and in Indonesia "Jumex") since it is an MAO-b inhibitor in doses <10mg, could have the same effects as Nardil on panic disorder. I'm assuming it doesn't affect GABA...perhaps it is more like Parnate?
Also, DA agonists tend to lower prolactin levels which can increase libido and motivation.
I wonder if l-deprenyl is a better idea for me than Nardil. I'm afraid also of what dose I should take since all of these drugs are metabolised by CYP2D6.
I highly suspect that I'm a "poor metaboliser".
I've also considered amphetamine but it too is metabolised by 2D6.
The rule of thumb I went by with Prozac and Effexor was to take 1/20 the standard dose and that worked, except I couldn't find an Effexor elixir to take, so I took 1/4 of 25mg dose and it gave me hypertension and severe headache.
Posted by sukarno on May 6, 2005, at 14:57:57
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Atypical antidepressants
Enclosed in 16/02/2005Until it appears a better term, the antidepressants that do not characterize as Tricíclicos, as Inhibiting Selective of the Recaptação of the Serotonina and nor as Inhibiting of the MonoAminaOxidase are atypical.
Some of these Atypical Antidepressants increase the noradrenérgica transmission, through the antagonism of receivers a2 (daily pay-sinápticos) in the central nervous system, at the same time where they modulate the central function of the serotonina for interaction with the receivers 5-ht2 and 5-ht3, as it is the case of the Mirtazapina.
The antagonistic activity in the histaminérgicos receivers H1 of the Mirtazapina is the responsible one for its sedative effect, even so is practically unprovided of anticolinérgica activity.
Other atypical ones are inhibiting of the recaptação of Serotonina and Norepinefrina, some also inhibiting, the recaptação of dopamina. It is the case of the Venlafaxina, the Mirtazapina. Some of these drugs also costumam to reduce the sensitivity of the receivers beta adrenergics, also after acute administration, what it can suggest a beginning of faster clinical effect.
Also they are here the inhibitors of the recaptação of the Norepinefrina (Noradrenalina), as it is the case of the Riboxetina. Some atypical ones, as it is the case of the Tianeptina, even so are serotoninérgicos, do not inhibit the recaptação of the Serotonina in the neuron daily pay-sináptico but, induce its recaptação for the neurons of the cortex, hipocampo and the límbico system.
The Amineptina, another atypical one, is a molecule derived from the tricíclicos but its mechanism of action is essentially dopaminérgico, while that the other tricíclicos antidepressants are essentially noradrenérgicos and serotoninérgicos. Unhappyly its production in Brazil was discontinued in 2005.
http://translate.google.com/translate?hl=en&sl=pt&u=http://virtualpsy.locaweb.com.br/index.php%3Fsec%3D61%26art%3D273&prev=/search%3Fq%3Dbrasil%2Bamineptina%26hl%3Den%26lr%3D%26sa%3DG
Posted by ed_uk on May 7, 2005, at 8:57:08
In reply to Re: Nardil,Imipramine, posted by sukarno on May 6, 2005, at 12:16:21
Hi Paul!
I'm sorry to hear about amineptine being discontinued in Brazil :-(
>selegiline.....
Selegiline can sometimes cause considerable anxiety as a side effect. I haven't heard of anyone benefitting from it as a treatment for anxiety.
Kind regards,
Ed.>
Posted by Chairman_MAO on May 7, 2005, at 12:00:08
In reply to Nardil,Imipramine » ed_uk, posted by pro_social_soon on May 6, 2005, at 5:40:31
ARe you sure the neurosteroid in question was not allopregNANolone? Pregnenolone is a negative GABA-A modulator, while allopregnanolone is a positive GABA-A modulator, acting at a binding site on the GABA-A receptor distinct from benzodiazepines and barbiturates. Interestingly enough, allopregnaolone builds cross tolerance to diazepam, but not to itself. It is also more potent than benzos. The investigational drug ganaxolone is a methylated synthetic derivative of allopregnanolone that is being studied for epilepsy, but I predict will have profound value in treating PTSD, mood disorders related to the menstrual cycle, as well as SAD, GAD, etc.
Posted by Chairman_MAO on May 7, 2005, at 12:11:17
In reply to Re: Nardil,Imipramine, posted by sukarno on May 6, 2005, at 12:16:21
Unfortunately, selegiline does not have the same magical effect (at least for me) on social anxiety that Nardil does. Perhaps somewhat motivating, but anxiety was increased. I took up to 15mg/day on top of Celexa and then Lexapro years ago. I wish I knew then what I know now, because I Would've asked my shrink then--who was extremely accomodating to my needs--to try an irreversible MAOI. I brought it up in passing, but he told me he'd rather not deal with it because of the diet unless we had to. In retrospect, if I pushed the issue, I'm sure he would've gone for it. Oh well,gotta look to the future now. :)
I have to say, now that the adjustment "brain shocks" have subsided (after only about 5 days), Nardil (75mg/day) is slightly superior to tranylcypromine (200mg/day) for social phobia. Parnate would be better for someone with absolutely no other anxiety complaints except social phobia, I think, because it has such a great dopaminergic "push" to it. At around 120mg/day and above, it is really like no other medication; I feel for anyone (like SLS) whose depression is so recalcitrant that it doesn't respond to that because it is so damn effective. However, phenelzine has somewhat of an effect like that for me, although it's more subtle. The main difference is that phenelzine is so effective for the physiological manifestations of anxiety, general anxiety, etc. that it's superior--again, for me--in social phobia. It is better than a benzo for me, because it gives me motivation instead of takes it away. I'm noticing that it makes me want to go up to people I don't know and just talk to them. I have never felt that before. Is that what it's like to be an "outgoing" person? Wow, there's a whole world out there ...
Posted by sukarno on May 20, 2005, at 3:40:04
In reply to Re: Nardil,Imipramine » sukarno, posted by Chairman_MAO on May 7, 2005, at 12:11:17
Hi everyone! :-)
Well, I've figured out that 2 tablets a day doesn't quite cut it for my depression, but 3 tablets gives me a headache and some slight jitters, so I'm going to have to "fine tune" the dose some more.
I'm guessing that 2 1/2 tablets per day is optimal dose for me.
This is good stuff...much more tolerable than an SSRI and I definitely don't worry like I used to.
:-)
I did have a major panic attack, but that was a few days after I moved to a new house, so all the moving, etc, could have caused that.My Xanax dose is 1mg at 9am, 1mg at 3pm, 1.5mg at 9pm and another 1.5mg at 3am/5am (depending on when I wake up).
5mg seems to stop the nighttime panic attacks. I'm getting more used to the weird dreams I guess. hehheh.
Posted by ed_uk on May 20, 2005, at 5:09:53
In reply to Stablon (tianeptine) update, posted by sukarno on May 20, 2005, at 3:40:04
Hi Paul!
I hope you're not having any side effects from the increased Xanax :-)
Ed.
Posted by Declan on May 20, 2005, at 7:33:11
In reply to Re: Stablon (tianeptine) update » sukarno, posted by ed_uk on May 20, 2005, at 5:09:53
Hi there, so its worth taking, you reckon? Like it's one I can actually get . Does it help you get organized and motivated at all?
Declan
Posted by sukarno on May 20, 2005, at 8:09:17
In reply to Re: Stablon (tianeptine) update, posted by Declan on May 20, 2005, at 7:33:11
Hi Declan. :-)
I find it helps me concentrate better or think clearer. I don't really feel more motivated unfortunately.
I was thinking of trying dopamine agonists like Survector *grin* or some of those Parkinson's drugs since they seem to really boost motivation from what I've read.
Other than that, I've read that amphetamines like Adderall are good for lack of motivation, but they have quite a few side effects and would probably worsen my anxiety. Not sure if the benzos would cover for the anxiety caused by amphetamines.
The price of Stablon is quite high I think, especially since you have to take it 2 to 3 times a day. Here in Jakarta it is about 40 to 60 cents per tablet...so multiply that by 2 or 3 and the cost is substantial, but to me it is worth it...and I don't have insurance so I pay the full price.
Maybe in a larger dose it will motivate you. I like the good feeling it gives me in the higher doses, but I'll end up with a headache later on. Gives me some jitters but not as bad as caffeine or anything of that sort. Feels like adrenaline and my breathing improves.
It has been investigated in treatment of asthma and the few studies I've read are promising, so if you have asthma you might want to give it a try.
I took 3 yesterday and feel pretty good now...not depressed at all.
No side effects from increasing the Xanax to 5mg/day. My doctor said it was ok to do that.
One thing about Stablon I've noticed is that it has reversed some of the cognitive deficits caused by Xanax and/or anxiety. I feel "smarter" than I used to.
Posted by sukarno on May 25, 2005, at 6:56:53
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
I ran out of Stablon a few days ago and had to resort to taking an expired batch (exp. 1/2004) which I got as a free sample from a pdoc in 2002.
This stuff appears to be made in France by the "real" Servier, hehheh.
Seems to be stronger...I feel a bit "hypomanic" and irritable.
Can Stablon become more potent with age? Does anyone know?
Of course, I also just recently moved (on 8 May) so I've felt quite stressed out...maybe it's just the stress.
Posted by sukarno on May 25, 2005, at 7:00:46
In reply to Re: Nardil,Imipramine » sukarno, posted by Chairman_MAO on May 7, 2005, at 12:11:17
Chairman MAO said:
> I have to say, now that the adjustment "brain shocks" have subsided (after only about 5 days)I've been wanting to ask you about that but kept putting it off. Sorry.
Can you describe those "brain shocks"? Is it anything like the "zaps" you get during SSRI withdrawal?I wonder if zaps are a result of SSRI neurotoxicity or because of serotonin fluctuations.
Posted by sukarno on June 24, 2005, at 5:16:10
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
I'm curious if anyone else here has taken Stablon (tianeptine, an atypical tricyclic antidepressant...supposedly with no anticholinergic action).
Have you ever felt thirsty on it? I never have until recently. I had raised the dose from 25mg to 37.5mg (2 to 3 tablets respectively) and noticed some thirst, sometimes intense. I now drink double (3 litres) the amount of water than I used to.
Is this something I should be concerned about? I thought Stablon doesn't have anticholinergic or antihistaminic effects.
Ed, are you still around? You know a lot about psychopharmacology. :)
I also have been steadily raising my Pepcid (famotidine) dose to quite a high level. I'm on 20mg 6 to 8 times a day since I'm developing a tolerance to it and the acid was coming back (I have GERD).
I'm not sure which drug is responsible...or maybe both are.
Can Pepcid, since it is an H2 receptor antagonist become *nonselective* and target H1 histamine receptors too?
Thanks in advance! I drink a lot of water but it doesn't seem to help, but if I lower the Pepcid, the acid will come back with a vengeance and if I cut the Stablon down I'll get some headaches as a withdrawal reaction.
Thanks again. :)
Paul
Posted by ed_uk on June 24, 2005, at 10:26:25
In reply to Dry mouth.... Stablon (tianeptine) side-effect?, posted by sukarno on June 24, 2005, at 5:16:10
Hi Paul!
Apparantly, 20% of patients treated with tianeptine get a dry mouth. I expect the true figure is higher though because this study seems to underestimate side effects! Only 17% got drowsy on amitriptyline - I think not LOL!
The incidence of dry mouth (38 vs 20%), constipation (19 vs 15%), dizziness/syncope (23 vs 13%), drowsiness (17 vs 10%) and postural hypotension (8 vs 3%) are greater with amitriptyline than with tianeptine. Insomnia and nightmares occur in more tianeptine than amitriptyline recipients (20 vs 7%).
>thirst, sometimes intense.......
>Is this something I should be concerned about?Probably not ...but I think it would be worth seeing your doctor and getting a few tests done eg. blood glucose for diabetes etc.
>I also have been steadily raising my Pepcid (famotidine) dose to quite a high level.
Dry mouth is listed as a side effect of Pepcid but I don't think it's common.
> I'm on 20mg 6 to 8 times a day since I'm developing a tolerance to it and the acid was coming back (I have GERD).
I hope the high dose is helping :-) Perhaps you should see a gastro-enterologist. Have you tried a proton pump inhibitor eg. lansoprazole? They can be more effective than H2 antagonists for some people.
Kind regards
~Ed
Posted by sukarno on July 9, 2005, at 11:31:28
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Hi everyone! :-)
I was taking 12,5mg Stablon 3 times a day and about two weeks ago it began to "poop out". It was horrible. I admit I was under a lot of extra stress, but even after a good night's sleep I would wake up feeling hopeless with the depression returning full force. My life quickly became doom & gloom..plus some anxiety.
So, I raised the dose to 12,5mg 4 times a day and within one or two days my mood was right back to normal and I was once again feeling great.... positive thinking and outlook on life, looking forward to the future... began to renovate my house, etc.
I feel good now, but my concern is that Stablon might "poop out" again in the future.
I've heard of SSRIs doing that, but this isn't an SSRI.
It does have a very short half-life though... (only 3 hours). Would that have anything to do with the tolerance ("poop out")?Thanks in advance! :-)
Paul
Posted by ed_uk on July 9, 2005, at 11:42:54
In reply to Tianeptine tolerance, depression returns, posted by sukarno on July 9, 2005, at 11:31:28
Hi Paul!
>I would wake up feeling hopeless with the depression returning full force.
I'm sorry to hear that :-(
>It does have a very short half-life though... (only 3 hours). Would that have anything to do with the tolerance ("poop out")?
I don't think its short half-life is the cause of poop out ........but drugs with short half lives do seem to be associated with withdrawal symptoms between doses. Taking a small dose every few hours might be helpful.
Kind regards
~Ed
Posted by sukarno on July 17, 2005, at 23:33:39
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
I called Servier in Indonesia today and asked them what the maximum dosage is and the representative said, "We only recommend 1 tablet 3 times a day, sir."
I kept trying to ask him if there is a maximum dosage since 1 tablet 3 times a day doesn't work for me, so I take 1 tablet 4 times a day.
He acted like a robot and repeated the same thing he said before.
Does anyone here have any information about the various dosages? I do recall reading in clinical trials that Stablon was used up to 75mg/day in divided doses, so that would be 6 tablets a day.
Ed, do you know about this? All other drugs have a range of dosages, but Servier is a bit strange...seems like with any drug they produce they slap on a "one size fits all" type dosing regimen.
Thanks in advance! :-)
p.s. I did find Survector but it is expired and the Servier representative said they quit producing it at least 5 years ago. He didn't give any particular reason why they ceased production. I asked him if it was because of low demand and he said there was high demand but they just don't make it anymore. Hmm... no explanation at all why they quit (although we all know why hehheh).
I hope this isn't counterfeit Survector. It comes in strips of six 100mg tablets, still in the blister package but not in the cardboard box. Here in Indonesia, counterfeit drugs have been produced that looked so genuine almost no one noticed....even down to the blister package. Very clever counterfeiting has been accomplished here... quite scary. :-(
It is expired though, but cheaper than Stablon when I add up the cost of taking 4 Stablon per day vs. 1/2 or 1 Survector per day.
Posted by ed_uk on July 18, 2005, at 13:29:15
In reply to Maximum dosage for Stablon (tianeptine), posted by sukarno on July 17, 2005, at 23:33:39
Hi!
Some people take A LOT!
'We report on a tianeptine dependence lasting for eighteen months in a 42 year old patient............Tianeptine was prescribed for a major depressive disorder. The patient alleged a "flash sensation" like with heroin since the very first doses with a physical and psychological well-being sensation, better psychomotor performances and transient mood elation. His addiction to tianeptine was immediate and heavy. The positive reinforcement faded away after one month and a total dependance took over, with physical and psychological withdrawal symptoms when doses were not renewed. After two months of treatment, the daily consumption of tianeptine was of 90 tablets. The patient was hospitalised to treat both the addiction to tianeptine and the ongoing major depressive disorder. He was taking 240 tablets daily.'
'The authors report a case of tianeptine abuse in a 30 year-old woman. After a medical prescription of the recommended dosage of 12.5 mg 3 times daily of oral tianeptine for a depressive illness, the patient spontaneously increased the dosage which after two months reached 150 tablets per day. No severe toxic effects were observed. As adverse effects, the patient, in the beginning of this high treatment period suffered from nausea, vomiting, abdominal pain, anorexia with weight loss, constipation. These side effects progressively disappeared. The biological tolerance was excellent, and hepatic parameters were not affected. The patient experienced and seek a psychostimulant effect. After seven months of such a therapy, she was hospitalized to undergo a withdrawal. The discontinuation of the tianeptine treatment occurs in four days. A withdrawal syndrome marked by myalgia, and cold feeling was transient, and alleviated by sedative phenothiazine (cyamemazine) and myorelaxant benzodiazepine (tetrazepam).'
>I kept trying to ask him if there is a maximum dosage.......
Manufacturers will only ever recommend the approved dose. They are protecting themselves from litigation in case anything goes wrong.
>I do recall reading in clinical trials that Stablon was used up to 75mg/day in divided doses, so that would be 6 tablets a day.
Get your liver function tests measured! Liver toxicity seems to be a concern.
Kind regards
~Ed
>
Posted by Declan on July 18, 2005, at 16:11:28
In reply to Maximum dosage for Stablon (tianeptine), posted by sukarno on July 17, 2005, at 23:33:39
Good luck with the Survector. I will be interested.
Declan
Posted by rod on July 19, 2005, at 3:41:53
In reply to Maximum dosage for Stablon (tianeptine), posted by sukarno on July 17, 2005, at 23:33:39
Hi Paul,
Well my former doc said if the regular dose doesnt work sufficiently, he just doubles the dose. to 6 tabs a day. Because its very unclear how this drug actualy works. In my opinion they are calling it a serotonin reuptake accelerator just because they wanted a unique label for this drug...
And in the dosage range studies it was very unclear which dose is best.
But for me 6 tabs a day was like poison. not in a physical way, but in a neurological way. One evening I suddenly became nauseaous, dizzy, and just had the feeling a am dying right now. I also became very noise sensitive during that. My guess and my doctors one, was it triggered some kind of seizure.
Well anyway, it didnt do the trick for me, neither at 2, 3 or 6 tabs, so I stopped it.
good luck
regards
Roland
Posted by sukarno on September 1, 2005, at 12:20:05
In reply to Re: Maximum dosage for Stablon (tianeptine) » sukarno, posted by rod on July 19, 2005, at 3:41:53
Hi everyone. I hope all is well with the folks on psychobabble. :-)
Well, I had tapered down the tianeptine to 1 tablet a day in late July, but the depression and anxiety came back. In fact, I experienced some "rebound" panic attacks and a fuzzy-headed sensation, but nothing major. No withdrawal symptoms to speak of.
At the suggestion of my psychiatrist I went back to 12.5mg 3x/day (TID). My depression and anxiety almost immediately responded and I felt much better. However, about 10 days later the depression began to return, so I increased the dose to 4x/day.
Here I am a few weeks later and it is beginning to "poop out" again.
What causes antidepressant "poop out"? I have read this is official termed "tachyphylaxis" (i.e. a rapid "immunity" to the effects of a drug).
I really feel hopeless right now, even though I've taken the third dose of the day. What shall I do next?
I do have some amineptine here and am seriously considering taking that despite it having been pulled from the market because numerous studies have proven its long term safety, whereas with tianeptine it seems that a lot of the claims made for this particular drug cannot be proven. I might be wrong though...but there are few studies available on tianeptine compared with amineptine.
I wonder if I can take amineptine along with tianeptine or try a cross-taper, where I would gradually decrease tianeptine whilst adding amineptine at small doses and gradually increasing it.
In other news, I quit Xanax abruptly on 31 July and substituted with Valium 10 to 20mg for every 1mg of Xanax and rapidly tapered the dosage down.
Now I am on a relatively low dose of 10mg 2x/day (BID) diazepam (Valium) and am well-controlled in terms of panic attacks and anxiety. It took a while to adjust to this dosage as the dosage of Xanax was 5mg/day (equivalent to 50 to 100mg Valium depending on which equivalency charts you read).
I feel much better in terms of anxiety. I no longer have panic attacks at night and no interdose anxiety.
I'm just really feeling hopeless about this situation with tianeptine. I suppose I could increase the dosage to 12.5mg 5x/day or 2 tablets twice a day and one before bedtime (to avoid nightmares).
I can't take SSRIs or conventional TCAs. I won't consider MAOIs either because all of these drugs, or at least most, are metabolised by CYP2D6, which means I would have to take 1/20 the standard dose, just like I did with Prozac. Even at 1mg per day, Prozac was quite strong and mind-numbing, so I reduced it to 0.5mg per day and it worked just fine, however I am allergic to it now.
If anyone has any suggestions... or rather, what would you do if you were me? I am thinking of hospitalisation, but am not sure if that is the right thing to do.
Take care everyone,
Paul
Posted by Declan on September 1, 2005, at 15:06:56
In reply to Stablon (tianeptine) stopped working again, posted by sukarno on September 1, 2005, at 12:20:05
The CYP2D6 thing. I can't remember if you've talked about this before. Is your response to Prozac the main reason for thinking that enzyme is low in you?
Good luck, Paul
I hadn't realised you were feeling so dreadful.
Declan
Posted by sukarno on September 2, 2005, at 22:14:31
In reply to Re: Stablon (tianeptine) stopped working again » sukarno, posted by Declan on September 1, 2005, at 15:06:56
I think Ed mentioned that I should be tested to see if I am a poor metaboliser. All of the drugs I've tried in the past which were metabolised by CYP2D6 seem to have affected me so strongly even in the lowest doses. I remember venlafaxine (Effexor) at doses of 1/4 tablet (6.25mg) gave me tachycardia, high blood pressure and severe headache. Imipramine at 25mg and nortriptyline at 10 or 25mg (can't remember which) gave me irregular heartbeats and other side effects. Desipramine (Norpramin) at 10mg made me feel faint all the time.
Dextromethorphan makes me feel like I'm under the influence of something much stronger. I should get tested for that enzyme problem unless that is expensive. I remember taking codeine with my friend when I was a teenager and it didn't even affect me but my friend said he could feel it. Then I read the other day that codeine is a prodrug which is converted by CYP2D6 to morphine and if you are a poor metaboliser, it won't convert over to morphine very much, if at all.
I really wonder if I am a poor metaboliser. It could be, or it could be that I'm just very sensitive to medications.It does seem that I am tolerant of medications which aren't metabolised by that enzyme such as benzodiazepines and tianeptine, etc. I could build up quite a tolerance when I used to drink.
I took two tianeptine last night. At first I couldn't sleep and then felt quite strange. My lips and fingers felt numb and I felt a bit fuzzy headed, but that could have been anxiety.
Even now I still feel fuzzy headed and have a bit of dry mouth, but not depressed at this time.
Tianeptine feels too short-acting. I wish they could make an extended release formulation to avoid the interdose problems.
Posted by sukarno on September 16, 2005, at 4:59:16
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
I have been having increasingly frequent heart palpitations and some episodes of irregular beats.
Servier claimed initially that tianeptine is not cardiotoxic and is devoid of cardiac effects.
However, I have learned it does cause dry mouth which is an anticholinergic effect if I'm not mistaken.
The medications I am on currently besides tianeptine are:
famotidine (Pepcid) 40-60mg with every meal and at bedtime
diazepam (Valium) 10mg twice a day
I recently increased famotidine so maybe that is the culprit?
I have had heart palpitations prior to taking tianeptine, but now they are increasing in frequency and severity. I'm going to a cardiologist this evening at a clinic to have an ECG and possibly a blood count to find out what is responsible for it.
It really scares me because today I got up to get some water and I felt dizzy and faint along with shortness of breath until I sat down. I'm only 33 and had a full cardiac workup in 1993 which only turned up "premature beats" which were not serious. I hope this isn't serious this time.
I am under quite a bit of stress though. I hope it is only stress so I can try to relax. Everytime my heart pounds in my chest it makes me more worried.
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