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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by saturn on November 18, 2006, at 11:49:28
to try another SSRI after having a horrible reaction to Zoloft (8/10 chest pain, heart rate around 150 after a single 50 mg dose)? I think I probably would.
I'm completely gun-shy to try anything else and do not want to use a beta blocker. I mean if I can't tolerate an SSRI from a cardiovascular perspective what *could* I possibly tolerate? Any suggestions? Thanks.
Peace...Saturn
Posted by Racer on November 18, 2006, at 12:58:37
In reply to Would I be crazy, posted by saturn on November 18, 2006, at 11:49:28
No, I don't think you'd be crazy. Another SSRI may not have the same effect on you, or another sort of medication altogether might make a difference. I'd suggest trying Lexapro, if Zoloft was a problem, but that's just a guess on my part. Or maybe another class of AD, like TCAs? Desipramine is supposed to be a good option.
What does your doctor say about it? Could you have been taking something else that created an interaction with the Zoloft? Another medication? A supplement?
Good luck, whatever you decide to do.
Posted by blueberry on November 18, 2006, at 14:14:44
In reply to Would I be crazy, posted by saturn on November 18, 2006, at 11:49:28
> to try another SSRI after having a horrible reaction to Zoloft (8/10 chest pain, heart rate around 150 after a single 50 mg dose)? I think I probably would.
>
> I'm completely gun-shy to try anything else and do not want to use a beta blocker. I mean if I can't tolerate an SSRI from a cardiovascular perspective what *could* I possibly tolerate? Any suggestions? Thanks.
>
> Peace...Saturn
>I sure understand the gunshy thing. That has happened to me so many times. 50mg can actually be a pretty hefty dose to start with for many people. 25mg is a common starting dose. Here are just some opinions of what you could do.
The bad effects you felt are common start-up effects with all ssris and usually go away in 1 to 3 weeks. I've been with prozac for years though and it never tamed down completely. Paxil to me felt like zoloft to you, but in a month it was calm peace. Lexapro to me was not nearly as uncomfortable at the start. Nevertheless, they all did it to varying degrees.
If you really want to give zoloft a trial, I would suggest cutting the tablet so that you get 12.5mg. After 4 days, go to 25mg. As soon as you can go to 37.5mg. And so on. You will find that the first step will be the hardest, the others will get easier, and eventually the steps will be very tame.
Other options would be to try different antidepressants altogether. But in any case, keep in mind you can reduce that first day's dose to whatever you want by either cutting the pill or by mixing capsuled powder into juice and drinking a custom amount.
Posted by saturn on November 18, 2006, at 16:11:26
In reply to Re: Would I be crazy, posted by Racer on November 18, 2006, at 12:58:37
> No, I don't think you'd be crazy. Another SSRI may not have the same effect on you, or another sort of medication altogether might make a difference. I'd suggest trying Lexapro, if Zoloft was a problem, but that's just a guess on my part. Or maybe another class of AD, like TCAs? Desipramine is supposed to be a good option.
My biggest concern w/ TCA's is tachycardia due to anticholinergic effects, but I may talk it over with my doc (when I find a good one hopefully soon)since it's also the TCA most alleged to help with ADHD--for which I can't tolerate stimulants. Thanks for the suggestion.
>
> What does your doctor say about it?I'm in a transient state right now, so I don't have a pdoc. When I did I don't think he appreciated the significance of my reaction to the zoloft. Chest pain frightens me to no end (as it should!). He rx'd remeron which was way too sedating. I've had similiar symptoms with ritalin & amphetamine--but cardiovascular side effects are not too unexpected with them.
I'd always assumed TCA's would have more cardio side effects than SSRI's, but perhaps this isn't true at the therapeutic level.
>>Could you have been taking something else that created an interaction with the Zoloft? Another medication? A supplement?
Not at all. I'm baffled. Elderly people with heart failure etc take Zoloft all the time and I'm young and healthy and cannot tolerate it. *Maybe* lexapro would be worth a shot. Again, I really appreciate your input.
>
> Good luck, whatever you decide to do.Thank you Racer
Peace...Saturn
Posted by saturn on November 18, 2006, at 16:22:01
In reply to Re: Would I be crazy, posted by blueberry on November 18, 2006, at 14:14:44
>
>>>Other options would be to try different antidepressants altogether. But in any case, keep in mind you can reduce that first day's dose to whatever you want by either cutting the pill or by mixing capsuled powder into juice and drinking a custom amount.I am an *expert* at cutting pills, so this I could certainly handle :)
Thank you so much for sharing this info, blueberry. Hearing experience such as yours is invaluable to me. If I do decide to give it another go, I will certainly remember this...and let you know.
Regards...Saturn
Posted by saturn on November 18, 2006, at 16:33:27
In reply to Re: Would I be crazy » blueberry, posted by saturn on November 18, 2006, at 16:22:01
http://ajpheart.physiology.org/cgi/content/abstract/290/3/H995
The title would suggest that desipramine is helpful in CHF, but it also mentions it increasing oxidative stress. Can anyone decipher this. (I do not have CHF but am looking into desipramine).
Posted by lymom3 on November 18, 2006, at 17:00:13
In reply to I can't understand this article, posted by saturn on November 18, 2006, at 16:33:27
I would echo Lexapro. That also had the least amount of side effects of any of the SSRI's that I can recall for me.
Posted by fca on November 18, 2006, at 20:08:35
In reply to Would I be crazy, posted by saturn on November 18, 2006, at 11:49:28
dramatic reactions to Zoloft--on the outer edges. Were you taking any other drugs at the time--After consulting with a physician I do not see why you could not try another drug beginning with very low dose and slowly increasing. Good Luck
Posted by saturn on November 19, 2006, at 4:01:13
In reply to Re: Would I be crazy--Those are rather, posted by fca on November 18, 2006, at 20:08:35
> dramatic reactions to Zoloft--on the outer edges. Were you taking any other drugs at the time--After consulting with a physician I do not see why you could not try another drug beginning with very low dose and slowly increasing. Good Luck
Hi fca. Yes they were dramatic reactions. I thought I was going to die, and without exaggerating I think I could have actually, given my symptoms and vital signs. It seems like it was like a serotonin syndrome or something but I was only taking claritin at the time--no other drugs, rx or otc. That's why I'm so hesitant to even try another ssri, but reconsidering. I don't know though, I'm still ambivalent as to what path I'll take but I will definitely consult a physician as you suggest. Thanks for the input--much appreciated :)
Peace...Saturn
Posted by saturn on November 19, 2006, at 8:37:15
In reply to Would I be crazy, posted by saturn on November 18, 2006, at 11:49:28
I know that conduction abnormalities are what are looked for before starting an ekg--but I've not been able to find specific recommendations.I have an incomplete right bundle branch block--which is a conduction defect--but a cardiologist told me is of no clinical significance (I have no heart problems otherwise).
I'm wondering however if I should just cross TCA's off the list totally due to this? Probably. Just want to make sure. Peace...Saturn
Posted by saturn on November 19, 2006, at 8:44:40
In reply to What are the ekg contraindications for TCA use?, posted by saturn on November 19, 2006, at 8:37:15
Is an incomplete right bundle branch block a contraindication to TCA use?
Posted by linkadge on November 19, 2006, at 8:47:16
In reply to Re: Would I be crazy » Racer, posted by saturn on November 18, 2006, at 16:11:26
Its possable that the cardiac reaction was indirect. Ie. SSRI's can cause start-up anxiety, its possable that this contributed to the tachycardia.
Never say never, but a pulse increase to 150 bpm would be a very rare reaction.
I don't think it would be crazy to try another SSRI. I would just start with a very low dose, ie split tablets and open capsules, and perhaps try one with a very short half life.
You could try a less activating ssri like perhaps celexa.
Linkadge
Posted by linkadge on November 19, 2006, at 8:52:03
In reply to I can't understand this article, posted by saturn on November 18, 2006, at 16:33:27
TCA's are no good if you've got cardiac complaints. Not only to they have strong norepinephrine reuptake like ritalin, and the amphetamines, they can also cause direct arrythmia. Despipramine is now discouraged as treatment for ADHD in some countries due to sudden cardiac death in some children.
Linkadge
Posted by linkadge on November 19, 2006, at 8:53:30
In reply to What are the ekg contraindications for TCA use?, posted by saturn on November 19, 2006, at 8:37:15
TCA's could cause further conduction defects.
Linkadge
Posted by Phillipa on November 19, 2006, at 18:22:36
In reply to What are the ekg contraindications for TCA use?, posted by saturn on November 19, 2006, at 8:37:15
I think a cardiology consult is in order in corroboration with a med for you as a bundle branch block can be serious. Meds can control them. But I think a pdoc and cardiologist should evaluate a med for you. Love Phillipa
Posted by Crazy Horse on November 19, 2006, at 19:42:44
In reply to Would I be crazy, posted by saturn on November 18, 2006, at 11:49:28
This is the end of the thread.
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