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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by circusboy on April 30, 2006, at 12:08:27
In January of this year, my psychiatrist started to wean me off Prozac and add in desipramine.
At 50mg, the results were dramatic. And...disconcerting. My noisy, buzzing head quieted down. My anxeity -- and along with it most of my nervous, self-depricating humor -- was gone. I was afraid I wouldn't think Woody Allen was funny anymore. My friends liked being around me more, even though I felt like I was kinda boring. At work, I was more confident, direct, organized. My sinuses even cleared up! I felt what I suspected "normal" might be like. I wasn't sure I liked it, but it was so much better than before.
Unfortunately, I was exhausted all the time. I think the desipramine was disturbing my sleep by raising my heart rate and perhaps blood pressure. I tried dividing the dose, backing down to 37.5, 25mg... Nothing helped. We had my blood levels checked. I metabolize the stuff normally.
My pdoc and I thought we were on to something, though, so we switched to nortriptyline. I was sleeping again & my mood was good, but nortriptyline was causing serious cognitive dysfunction. I felt like a saturated sponge -- I couldn't absorb new ideas, listen to the radio and work at the same time, etc. Still, my doctor wanted me to stay on it at 25mg for a month.
A week later, evidence of cognitive decline mounting, I quit. I've been off nortriptyline for about a week now and feel so much better. Considering my history of lifelong low-level depression punctuated by major episodes (at least 4, each lasting 6-9 months), I'm probably going to have to take meds again someday.
I still take Ritalin (20-30mg), fish oil (500mg) and a multivitamin.
I'm writing this long post -- for comment, yes, but also because I haven't given back in so long (I used to post as "pellmell" but my password seems unrecoverable), and other peoples' detailed stories on this board have helped me so much in the past.
I'd also like to bounce these ideas:
1. My primary depressive symptoms have always been cognitive (and come on fast and strong): poor concentration, pseudodementia, etc. Of all the SSRIs I've tried, perhaps Prozac worked the best because of its noradrenergic activity?
2. My anxeity has not returned. I'm starting to think that Prozac was CAUSING it, perhaps through its actions as a 5HT2C agonist.
3. I felt all of the classic anticholinergic effects on desipramine: dry mouth, constipation, blurry vision, etc. They were virtually nonexistent on nortriptyline. Is it possible that nortriptyline is "stickier" at central cholinergic receptors (at least in my brain)?
4. The next logical antidepressant choice would seem to be imipramine. From the posts on this board, I'm suspicous of Cymbalta. Maybe Strattera is worth a try?
I could say so much more -- especially on the long-term effects of SSRIs, especially Prozac ('cause it's the one I know best)... but I'll save it.
Thanks for reading... I hope this has been more interesting than tedious. :)
-cb
Posted by Racer on April 30, 2006, at 12:48:29
In reply to Tricyclics Revisited (desipramine, nortriptyline), posted by circusboy on April 30, 2006, at 12:08:27
Much more interesting than tedious, and welcome back.
I've tried both desipramine and nortriptyline, and also Prozac, Strattera, Ritalin, and Cymbalta --did you mention any others? -- so I'll make a few notes of my own experience with them...
Nortriptyline was great for my depression, first one I'd ever taken, truly a miracle drug for me. At the cost of decent sleep, a 70 pound weight gain (the doctor said I was just eating too much), chronic constipation that didn't clear up for years after I stopped taking it, and living in a fog the entire time I was on it. Which is why I wouldn't take it again, but it was truly, hands down, a necessary and life saving AD for me. I tried desipramine, but had a hypotensive reaction to it -- which it's not supposed to do, but I seem to be an outlier on sensitivity to blood pressure effects from TCAs. The other TCAs I've tried were all much worse -- 25mg of Sinequan had me holding on to furniture in order to walk.
Cymbalta? Meh.
(What? You don't think that covers it? I was on it nearly a year and a half. Trust me -- it says all I need to say on the subject ;-D )
I quite liked Strattera, actually. It didn't cause any of the difficulties I have had in the past, and I felt cognitively alert. The adverse effects I had on it were mostly mentrual -- which were VERY disconcerting, let me tell you! -- so I doubt they'd be much of an issue for you... I was on it with Prozac, though, and was very fidgetty, and anxious, which I think now was probably the Prozac. Dunno, though, since I haven't tried ti again. For what it's worth, though, I would try it again without a qualm, and probably will once we get past the whole baby-making thing. (It's something weird like Category C.75 -- not quite Category D, but it wants to be.)
But, have you tried Wellbutrin? I know that it's said to increase anxiety if that's an issue, and I will say that it does increase my *energy* in a bad way -- not the kind of energy that gets things done, just the energy that gets anxiety kicked up. If I can focus the energy into something physical, I'm fine, and feel better than the average bear. It's just that that isn't always my first response to that feeling... {heheheh...} What I've found on it, though, is that it relieves my depression enough that the nasty parts of anxiety aren't a problem. And honestly? The high level of background anxiety I live with is basically a personality thing. There's no official "Anxious Personality Disorder," and I'm not sure I think it's solely a personality disorder thing, I just think it's the way I'm wired. And the background stuff I can tune out. The Wellbutrin pretty well stops the ruminations, the thoughts racing in circles, etc, that get me to the point of giving up.
Oh, and Dexedrine helps me, too, with a lot of that... (Ritalin produced three adverse effects: headaches, feeling high, and increased appetite. I could have stuck out the headache and feeling high, since I kinda figured those would probably fade after the adjustment phase. But the increased appetite, combined with the decreased inhibitions from feeling high -- that I couldn't handle. I was too freaked out about that, panicking because I felt so out of control. Sadly, Ritalin was MUCH more effective than any of the other stimulants I tried for mood brightening and calming the cognitive firestorm.)
Too much information, huh? HOpe something in there helped.
Posted by Phillipa on April 30, 2006, at 13:48:29
In reply to Re: Tricyclics Revisited (desipramine, nortriptyli » circusboy, posted by Racer on April 30, 2006, at 12:48:29
Sorry what's your diagnosis? Love Phillipa
Posted by blueberry on April 30, 2006, at 17:47:17
In reply to Tricyclics Revisited (desipramine, nortriptyline), posted by circusboy on April 30, 2006, at 12:08:27
You mentioned long term effects of prozac. I am interested in that. Your detailed post was interesting to read.
Please fill me in on the prozac...
Posted by Colleen D. on April 30, 2006, at 18:47:02
In reply to Tricyclics Revisited (desipramine, nortriptyline), posted by circusboy on April 30, 2006, at 12:08:27
>In January of this year, my psychiatrist started to wean me off Prozac and add in desipramine.
At 50mg, the results were dramatic. And...disconcerting. My noisy, buzzing head quieted down. My anxeity -- and along with it most of my nervous, self-depricating humor -- was gone. I was afraid I wouldn't think Woody Allen was funny anymore. My friends liked being around me more, even though I felt like I was kinda boring. At work, I was more confident, direct, organized. My sinuses even cleared up! I felt what I suspected "normal" might be like. I wasn't sure I liked it, but it was so much better than before.<
Hi! I haven't taken many TCAs, but the one I'm taking, doxepin, along with Lexapro and Klonopin, has helped me quite alot with my anxiety. I could relate so well with your comments above, and I feel so thankful that I've found a good combo (for now, anyway) that allows me to feel good about myself at work and in other social situations. Without these meds I don't think I could function well enough to do much outside my home! I, too, have been blessed with that Anxious Personality Disorder!
At this point I feel that I will forever have to be medicated for my "wiring" uniqueness in order to keep gaining confidence and well, to basically, keep living.
I wish you luck in the days ahead. Thanks for sharing your experience!
Colleen
Posted by circusboy on April 30, 2006, at 19:24:34
In reply to Re: Tricyclics Revisited (desipramine, nortriptyli » circusboy, posted by Racer on April 30, 2006, at 12:48:29
Racer,
Thank you for a warm, smart response. It was the best sort of welcome (back) I could've hoped for. It did make me a little neurotic-nervous, though: it reminded me that I'm among people who care about what I have to say... which means I have to care about what I say, too. (Yes, I have some issues with expectations. :) )
I think high-dose Zoloft+Li was my nortriptyline. I mean, my life was never in danger. Suicide never occurred to me -- I thought I deserved to suffer for being so stupid and useless. (Which means that, as depressions go, I've been lucky.) Anyway. Three days after my pdoc added lithium to the 200mg Zoloft, the world, like, blossomed in front of me. My thoughts and words came fluently, I was interested in people and ideas again, etc.
On the other hand, the whole impotent college sophomore scene was a serious downer. Let the empirical trial games begin! Eight years and a dozen drugs later...
And no, say no more about Cymbalta. I'd already started unpacking that one syllable into many more before I got to your next line.
I *have* tried Wellbutrin. Yes oh yes. When I wasn't busy errupting geyser-like with hostile impatience, I would pass the time doing things like rototilling the garden...without a rototiller. To relax I'd curl up in a ball of unrelenting anxeity. After that I went on a drug-switching spree that landed me on Effexor... Meh. :)
What you said about Strattera (and Ritalin, actually) is very encouraging... since, as you guessed, I'm underequipped for childbearing and all. I'll bring it up next time I see my pdoc (if we get passed the me unilaterally dropping nortriptyline thing). I haven't brought it up before, though, 'cause I'm embarrassed to mention heavily advertised drugs...even if the ads have nothing to do with why I'm asking.
Until next time,
-cb
Posted by circusboy on April 30, 2006, at 19:33:11
In reply to Re: Tricyclics Revisited (desipramine, nortriptyli, posted by Phillipa on April 30, 2006, at 13:48:29
> Sorry what's your diagnosis? Love Phillipa
The only doc impolite enough to give me a diagnosis without asking had just mis-diagnosed me as BP-II, which he subsequently mis-coded as BP-I. All because I said I had one day in the past month when I felt "really good." Ugh. Which means I have some...sympathy with real BP's who have to take things like Depakote... But that's another story for another time.
My diagnosis is/was major depression + dysthymia, as far as I can tell.
Posted by Racer on April 30, 2006, at 23:49:13
In reply to Re: Tricyclics Revisited » Racer, posted by circusboy on April 30, 2006, at 19:24:34
>
> I *have* tried Wellbutrin. Yes oh yes. When I wasn't busy errupting geyser-like with hostile impatience, I would pass the time doing things like rototilling the garden...without a rototiller. To relax I'd curl up in a ball of unrelenting anxeity.That nearly choked me, too funny. I read it to my husband who said, "Someone who can write like that really should do it professionally." Highest praise from him.
As for the Strattera, I had the same trepidation when I asked about it. What I liked about it was that I felt LIKE ME. I did not feel drugged, I did not feel foggy, I did not feel dazed and stupid. I felt clear, and that felt so very, very good.
The down side, maybe, is that feeling like me kinda does mean feeling a little hyper, a little irritable -- no doc, I'm not BP, just bitchy -- and generally erupting geyser-like with hostile impatience. And don't keep saying that like it's a bad thing, 'K? (I told my therapist once that my goal was to become a bitch. She got it, too.)
But it's certainly worth a try, good luck with it.
Posted by jedi on May 1, 2006, at 0:47:07
In reply to Tricyclics Revisited (desipramine, nortriptyline), posted by circusboy on April 30, 2006, at 12:08:27
Hi,
I'm on a revisit of the tricyclics also. Currently I'm taking 150mg of nortriptyline with no anticholinergic side effects. I believe I'm a rapid metabolizer because I was never able to get a blood level above 30ng/ml while on 100mg. So far the nortrip seems to be holding off the major depression. Just at a low level dysthymia at this time. In the past when my major depression hit the only med that worked was Nardil. I've even mixed 100mg Nortrip with 90mg of Nardil with no problems. But it did not seem to help with the depression more than the Nardil alone. As far as the tricyclics go, I believe that nortriptyline is a fairly clean med. Now if I can just get up to the therapeutic level of between 50 & 150ng/ml maybe the stuff will do some good. I'll have it tested again in a couple of weeks.
Take care,
Jedi> In January of this year, my psychiatrist started to wean me off Prozac and add in desipramine.
>
> At 50mg, the results were dramatic. And...disconcerting. My noisy, buzzing head quieted down. My anxeity -- and along with it most of my nervous, self-depricating humor -- was gone. I was afraid I wouldn't think Woody Allen was funny anymore. My friends liked being around me more, even though I felt like I was kinda boring. At work, I was more confident, direct, organized. My sinuses even cleared up! I felt what I suspected "normal" might be like. I wasn't sure I liked it, but it was so much better than before.
>
> Unfortunately, I was exhausted all the time. I think the desipramine was disturbing my sleep by raising my heart rate and perhaps blood pressure. I tried dividing the dose, backing down to 37.5, 25mg... Nothing helped. We had my blood levels checked. I metabolize the stuff normally.
>
> My pdoc and I thought we were on to something, though, so we switched to nortriptyline. I was sleeping again & my mood was good, but nortriptyline was causing serious cognitive dysfunction. I felt like a saturated sponge -- I couldn't absorb new ideas, listen to the radio and work at the same time, etc. Still, my doctor wanted me to stay on it at 25mg for a month.
>
> A week later, evidence of cognitive decline mounting, I quit. I've been off nortriptyline for about a week now and feel so much better. Considering my history of lifelong low-level depression punctuated by major episodes (at least 4, each lasting 6-9 months), I'm probably going to have to take meds again someday.
>
> I still take Ritalin (20-30mg), fish oil (500mg) and a multivitamin.
>
> I'm writing this long post -- for comment, yes, but also because I haven't given back in so long (I used to post as "pellmell" but my password seems unrecoverable), and other peoples' detailed stories on this board have helped me so much in the past.
>
> I'd also like to bounce these ideas:
>
> 1. My primary depressive symptoms have always been cognitive (and come on fast and strong): poor concentration, pseudodementia, etc. Of all the SSRIs I've tried, perhaps Prozac worked the best because of its noradrenergic activity?
>
> 2. My anxeity has not returned. I'm starting to think that Prozac was CAUSING it, perhaps through its actions as a 5HT2C agonist.
>
> 3. I felt all of the classic anticholinergic effects on desipramine: dry mouth, constipation, blurry vision, etc. They were virtually nonexistent on nortriptyline. Is it possible that nortriptyline is "stickier" at central cholinergic receptors (at least in my brain)?
>
> 4. The next logical antidepressant choice would seem to be imipramine. From the posts on this board, I'm suspicous of Cymbalta. Maybe Strattera is worth a try?
>
> I could say so much more -- especially on the long-term effects of SSRIs, especially Prozac ('cause it's the one I know best)... but I'll save it.
>
> Thanks for reading... I hope this has been more interesting than tedious. :)
>
> -cb
>
>
Posted by ed_uk on May 1, 2006, at 3:46:54
In reply to Tricyclics Revisited (desipramine, nortriptyline), posted by circusboy on April 30, 2006, at 12:08:27
Hi Circusboy/Pellmell
Welcome back to p-babble.
I'm sure Dr. Bob will be able to recover your old password if you like. Still, circusboy is a good name :)
It really sounds like you were on to something with the desipramine. Perhaps you could get a prescription for the 10mg tablets and go from there. You're a low dose responder :)
Regards
Ed
Posted by Dr. Bob on May 1, 2006, at 19:19:52
In reply to Tricyclics Revisited (desipramine, nortriptyline), posted by circusboy on April 30, 2006, at 12:08:27
> I used to post as "pellmell" but my password seems unrecoverable
Ed was right, I'd be glad to email you...
Bob
Posted by circusboy on May 2, 2006, at 7:55:29
In reply to Re: Tricyclics Revisited (desipramine, nortriptyline) » circusboy, posted by ed_uk on May 1, 2006, at 3:46:54
> Welcome back to p-babble.
>
> I'm sure Dr. Bob will be able to recover your old password if you like. Still, circusboy is a good name :)
>Thanks ed! You know, I like circusboy too...think I'm going to stick with it.
> It really sounds like you were on to something with the desipramine. Perhaps you could get a prescription for the 10mg tablets and go from there. You're a low dose responder :)
>Maybe going down to 10mg would've helped, but I'm skeptical. At 25mg I felt little except dry mouth, constipation, and poor sleep...none of the mitigating positive effects that made me stick with the drug for two months before giving up.
Do you have anything to say about atomoxetine? Did Lilly ever try to get it approved for depression?
Posted by circusboy on May 2, 2006, at 7:59:02
In reply to Re: Tricyclics Revisited (desipramine, nortriptyline) » circusboy, posted by blueberry on April 30, 2006, at 17:47:17
> You mentioned long term effects of prozac. I am interested in that. Your detailed post was interesting to read.
>
> Please fill me in on the prozac...blueberry,
Pulling all of my thoughts + articles together on long-term Prozac use will be a small project. :) I'll start a new thread on the subject in a few days.
-cb
Posted by ed_uk on May 2, 2006, at 14:44:17
In reply to Re: low-dose desipramine » ed_uk, posted by circusboy on May 2, 2006, at 7:55:29
Hi CB
As far as I know, atomoxetine (Strattera) was originally developed as an antidepressant but clinical trials did not demonstrate efficacy.
>Maybe going down to 10mg would've helped, but I'm skeptical. At 25mg I felt little except dry mouth, constipation, and poor sleep...none of the mitigating positive effects that made me stick with the drug for two months before giving up.
I doubt 10mg would be enough. The 10mg tablets might be useful in helping you find the minimum effective dose though, whatever that may be eg. 40mg.
The side effects which you experienced on desipramine were probably not true anticholinergic side effects. Desipramine acts mainly as a potent NE reuptake inhibitor. It's anticholinergic properties are relatively weak. Unfortunately, NE reuptake inhibition produces very similar side effects to anticholinergic drugs eg. constipation, dry mouth etc. These symptoms are sometimes called pseudo-anticholinergic side effects.
I think you might be able to overcome the side effects of desipramine with additional medication. I know it's not a particularly attractive prospect, but it may be worthwhile. You could try zolpidem (Ambien) for insomnia and MiraLax (or another laxative) for constipation. Sugar-free chewing gum is good for a dry mouth. Various sprays and pastilles are also available.
I wonder how reboxetine would work for you. Reboxetine is a NE reuptake inhibitor which is approved as an antidepressant in most countries apart from the US. If you live in the US, you might be able to import it.
Regards
Ed
This is the end of the thread.
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