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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by clubfitter on November 11, 2007, at 14:14:52
I am so doped up right now with little relief. Am considering about asking my doctor about MAOI's or Trycyclics. Has anyone had success with Tricyclics, which ones, and how fast acting are they. Thanks in advance. MDD, AVPD, SAD, etc....maybe bipolar, mostly unipolar depression
20 lexapro
400 lamictal
300 wellbutrin
160 geodon
Posted by mav27 on November 12, 2007, at 3:45:10
In reply to Anyone using Tricyclics for Depression?, posted by clubfitter on November 11, 2007, at 14:14:52
i found tricyclics worked well for me for depression, but not for anxiety. I found them a lot nicer to be on that SSRI's, the side effects are different but easier to put up with.
Although i was having quite a bit of sucess with Dothiepin for my social phobia but at the max dose and it was causing severe constipation. it was a weird one in that it didn't feel like any drug was effecting my brain yet i was rather talkative whilst on it. It may not be available in the US though from memory.Imipramine was also promising but my GP panicked when my heart rate got too high.
Posted by stargazer2 on November 12, 2007, at 10:51:52
In reply to Anyone using Tricyclics for Depression?, posted by clubfitter on November 11, 2007, at 14:14:52
I have been on Nardil since May of this year. In the beginning I was also on Abilify and wellbutrin, which weren't doing all that much. I started on Nardil 15 went to 45 then to 60. I had tried to add an amphetamine to this and had a hypertensive reaction and dropped the Nardil to 30 mg as a precautionary measure.
In August I started on Nortriptylline 25 plus Nardil 30. Then the nortriptylline was raised to 75 mg at bedtime. The nardil was raised to 45 after some mood instability at 30.
During this time, I was seen by an endocrinology APRN who started me on Synthroid for a "normal" TSH (3.4), but because of my resistent depression, it was felt a lower level of my TSH (to around 1) would be beneficial.
In October, the depression recurred and the dose of Nardil was increased to 60 and the Nortriptylline was 75 mg. I also continue on 50 mcg of synthroid.
Right now, I seem rather stable on this mix although I have lowered the nortriptylline to 50, then to 25 to see if any mood variability will result. So far, no immediate change has been noticed. I do still have dizziness from Nardil as it affects my bP which is low to begin with.
My next thought is to try deplin or another methyl folate product to see how that works for me. I had bloods drawn today for cortisol, homocysteine and blood type. The endocrinologist saw me last week and offered a few suggestions for my depression. One is a diet based on blood type, one is rechecking my cortisol level to determine if a small dose of hydrocortisone (5-20 mg) may be indicated and lastly, a homocysteine level to determine if I am deficient in folate.
That's my current story, I'm not sure what the Nortriptylline is doing, but the nardil must be working since I raised it to 60. Too bad the original Nardil no longer exists since I used to take 30 mg with very good control and no side effects. Pfizer messed with the formula and now you have to take much higher doses with more SE's.
Stargazer
Posted by Astounder on November 15, 2007, at 20:20:02
In reply to Anyone using Tricyclics for Depression?, posted by clubfitter on November 11, 2007, at 14:14:52
25 mg. Increased to 50 mg next week. My psych says it works well for obsessive symptoms (which result for me in avoidance), and that it's effects on this are immediate. I WAS able to look at my face uncritically in the mirror this morning, which IS unusually non-avoidant. I was however, terribly akathitic, tense, and chilled, similar to the feeling of taking Effexor with Selegiline. Onle problem with clomipramine is that I won't be able to augment with an MAOI.
I tried desipramine for a month, adding it onto Namenda (10 mg) high doses EmSam (21 mg) and Remeron (90 mg). When I kicked the desipramine up to 100 mg, I started getting frank visual hallucinations, and at 25 mg aural hallucinations. This was really surprising to me, as I've taken high doses of cyproheptadine, Benadryl, doxylamine, and scopolamine before, but never had anything like that--especially since desipramine is supposed to be the kindest with regard to mACh affinity. I figure it was an enzymatic issue.
Desipramine didn't really add on anything; no extra energy/anti-avoidance like I hoped, and I was continuing to have terrible REM issues.
> I am so doped up right now with little relief. Am considering about asking my doctor about MAOI's or Trycyclics. Has anyone had success with Tricyclics, which ones, and how fast acting are they. Thanks in advance. MDD, AVPD, SAD, etc....maybe bipolar, mostly unipolar depression
>
> 20 lexapro
> 400 lamictal
> 300 wellbutrin
> 160 geodonNortrip looks like a good add on, since it's heavily NAergic, which would potentiate the SSRI and DAergic effects of wellbutrin. Also might help you sleep at night. You'll develop a tolerance to that effect, though. Or instead you might take the Wellbutrin up to 600 mg if you're sleeping too much.
Posted by circusboy on November 16, 2007, at 12:38:01
In reply to Anyone using Tricyclics for Depression?, posted by clubfitter on November 11, 2007, at 14:14:52
I tried both desipramine and nortriptyline, in separate, back-to-back trials.
Desipramine was very good in terms of mood and motivation. Just what you might expect from a good noradrenergic drug. No real cognitive SEs to speak of. I did have some symptoms that could be described as anticholinergic (constipation, crazy urges to pee along with urinary retention), but I've also read on babble that those could be caused by extra norepinephrine as much as by muscarinic acetylcholine receptor antagonism. IIRC, I felt the positive effects within 2 weeks. On the other hand, it sort of flattened my creativity and sense of humor. That was not what I expected from an antidepressant, especially after nearly a decade on and off of SSRIs. Also -- and this was the kicker -- it made my heart pound irregularly, making it nearly impossible to fall asleep. I gave it a good try, even at a low dose, but never adjusted.
So. Desipramine: good if you can tolerate it.
Then I tried nortriptyline. Slept beautifully; very little constipation and urinary retention. However, I started to feel like I had early onset dementia. I could barely do my work -- I was overwhelmed by things I used to handle easily. My doctor briefly considered prescribing me a cholinergic drug to compensate. I had to ask for an emergency vacation, which was generously granted. Took me a few weeks to feel normal again after I stopped. On the other hand, once I got up to a therapeutic dose (150mg? can't remember), my mood did improve significantly. Not nearly enough to compensate for the cognitive SEs, though.
So Nortriptyline: Terrible for me! Extra-sticky to the wrong receptors in the brain. Some people here on babble seem to really like it, though... so YMMV.
Good luck,
-cb
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