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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on November 22, 2007, at 11:54:40
In reply to Re: TCA's, the best one for you ?/ Nortriptylline, posted by stargazer2 on November 21, 2007, at 22:46:18
I think that SLS (an longtime member of this board who doesn't post so much anymore), found relief with a nardil + nortryptaline combination.
He was very TRD, but did well with this combination.
Posted by stargazer2 on November 22, 2007, at 12:23:04
In reply to Re: TCA's, the best one for you ?/ Nortriptylline » stargazer2, posted by linkadge on November 22, 2007, at 11:54:40
Link, actually I knew this and grabbed onto his formula since I had heard it was helping him and he has a reputation as a med wizard. No 2 of us are alike though, but at least we can try when another has a success. So I'm only on Nardil and deplin right now, feels pretty good to know what is doing what.
Thanks...Stargazer
Posted by sdb on November 22, 2007, at 12:55:00
In reply to Re: TCA's, the best one for you ? » sdb, posted by tecknohed on November 21, 2007, at 21:07:17
thanks for your replies everybody.
according to its pharmacokinetic profile someone could take tca's once daily at the evening (correct me, if am wrong). There are also long lasting versions of tofranil (tofranil pm), imipramine
http://www.tofranil-pm.com/ (egg and sweet bird)
and anafranil (clomipramine) available. Not sure about its therapeutic advantages.
of course if someone know of cardiac arrhythmias naturally or after bad events it must be very carefully used if used. Toxicity at high dosages (torsade, widened QRS complexes and marked S-T shifts). But thats only my paper knowledge
warm regards
sdb
Posted by Quilter on November 23, 2007, at 0:49:22
In reply to Re: TCA's, the best one for you ?, posted by sdb on November 22, 2007, at 12:55:00
I did well on a combination of Surmontil (trimiprimine) and Cytomel for several years.
Quilter
Posted by brooke484 on November 23, 2007, at 10:19:47
In reply to Re: TCA's, the best one for you ?/ Nortriptylline, posted by stargazer2 on November 21, 2007, at 22:46:18
Stargazer,
When did you really notice that Nardil was helping you? I know you've been on it awhile. I was hoping to stick with it but could never go above 45 mgs without feeling 10 times worse than I already did. Just curious.
I'm on week 9 of Marplan (5th week on 30 mgs) but it isn't doing anything yet.
Thanks,
Brooke
Posted by stargazer2 on November 23, 2007, at 15:33:51
In reply to Re: TCA's, the best one for you ? - stargazer2, posted by brooke484 on November 23, 2007, at 10:19:47
Hi Brooke...
I started Nardil in May of this year. I had an immediate response after about 5 days at 30 mg but I was also on Abilify 2.5. This initial response was only for a week or so. Nardil was increased to 45 in June, ankles became swollen and resolved in 3-4 weeks. I was still on Abilify at 10 mg and then mid June, Wellbutrin 150 SR was added. On July 6, Abilify was d/c'ed per my request. The Wellbutrin was increased to 300 but was the Budeprion brand and I was very unsure of this brand. The end of July I was very depressed again.
In July I pondered the addition of a few other meds to give me energy and focus, such as Strattera, Adderall or a TCA (Nortriptylline of Desipramine). I initially tried generic adderall since I had some lying around. I tried 5 mg initially, but had extremes lows in my BP, recorded at 75/45, next day normal BP, but a pulse of 44. And then I did a dumb thing by increasing my amphetamine to 10 mg, which preceipitated a hypertensive reaction, so all
amphetamines were stopped. They are contra indicated anyway but did something at 5 mg to increase my energy.In mid August I added Nortriptylline 75mg at bedtime to the Nardil to see if this would decrease the depression. I also began Synthroid 50 mcg after seeing an endocrinologist to evaluate my TRD.
Mid September, had some improvement in my depression and felt good enough to start looking for a job (hadn't been able to do this since previous July). But by Mid October the depression
flared up again. I increased the Nardil to 60 mg along with taking Synthyroid 50 mcg and Nortriptylline 75 mg.This increase in Nardil was the key to boost my mood where it has been since then, so it hasn't really been that long so there's no telling what can happen next. I do feel much better though and again have been job seeking and although my self-esteem is shaky, I believe once I get a job I will feel much better.
I also started deplin about 4 days ago and can't really tell much about it but feel like it will keep the Nardil working if it starts to poop out.
That's the story of my Nardil history so hope you can find something that may help you. Perhaps another med with the Marplan might help or go a little bit higher, another user has success at 40 mg.
I'll keep in touch or if you want to babble me ever, you're welcome to...Stargazer
Posted by banga on November 25, 2007, at 7:29:32
In reply to Re: TCA's, the best one for you ?, posted by Quilter on November 23, 2007, at 0:49:22
I did fairly well on clomipramine for a while, then it pooped out.
I switched to desipramine--which has worked well, at least in combination with Abilify 5mg and Lamictal 200mg. The latter sometimes seems to not add much, but when I have tried to discontiinue it I feel a difference.
In any case, desipramine was best for me, though for some it may be too activating. I really need things to combat sluggishness when depressed.
I tried nortryptiline, I honestly dont remember what I disliked about its effects; I do remember it also caused immediate weight gain.
Posted by kaleidoscope on November 25, 2007, at 13:14:43
In reply to Re: TCA's, the best one for you ?, posted by sdb on November 22, 2007, at 12:55:00
Hi SDB
In the UK, amitriptyline is very widely prescribed to treat chronic neuropathic pain. It's also sometimes used to treat chronic insomnia and recurrent migraine. It's not much used to treat depression anymore.
Posted by brooke484 on November 25, 2007, at 14:20:18
In reply to Brooke/Nardil history, May - Nov by stargazer2, posted by stargazer2 on November 23, 2007, at 15:33:51
Thanks, stargazer. Today I went up to 35 mgs and in a week I'll go to 40. My doctor wanted me to go straight to 40 mgs, but when I did that I had major lightheadedness for about a week until I went back to 30. This time I'm taking it slow (I should know better). And he wanted me to add Lamictal but I'm not until I'm stable on Marplan. I don't want to increase two drugs at the same time and have to guess which one is causing which side effects. I'll probably stop at 40 mgs and then add Lamictal.
I've only been on Marplan 10 weeks so it's still early. I remember when I took Lexapro I was ready to give up and then after about 12 weeks it finally kicked in and I was a new person. I'll never forget walking outside that morning and the "fog" that I had had for so many years was gone.
Thanks for sharing your story. I'm glad you're feeling well enough to look for a job. That's what I should do too, but I can't right now. Too tired and too out of it. Like you I also have thyroid issues.
Take care,
Brooke
Posted by tecknohed on November 25, 2007, at 16:59:59
In reply to Re: Brooke/Nardil history, May - Nov by stargazer2, posted by brooke484 on November 25, 2007, at 14:20:18
brooke, I really hope you can get up to 40mg soon (or beyond). 40mg is really still the low end of the theraputic range, hence why I went to 40mg ASAP.
If I was you I'd hold off the lamotrigine for as long as you can. I tried it with Nardil twice & it made everything worse.
But I'm not you so you do what you feel is right. After all some people have resolved Nardil poopout with lamotrigine.
You'll get there m8!
teck
Posted by Phillipa on November 25, 2007, at 18:01:59
In reply to Re: Brooke/Nardil history, May - Nov by stargazer2, posted by brooke484 on November 25, 2007, at 14:20:18
May I interject that it seemed when I worked that the majority of patients with depression had thyroid problems? Phillipa me too.
Posted by stargazer2 on November 25, 2007, at 18:41:31
In reply to Re: Brooke/Nardil history, May - Nov by stargazer2 » brooke484, posted by Phillipa on November 25, 2007, at 18:01:59
Phillia, seems reasonable except I don't really consider myself having thyroid problems except I was put on a very low dose (50 mcg) of Synthroid for a normal TSH but many endocrinologists feel that someone with a long (mine > 20 years) history of depression may felt better when their TSH is closer to 1. Mine was 2.3 and 3.4, and the lab results consider that "normal" but I know you are aware of why they keep it closer to 1. My latest test was 1.4.
but thyroid is a very common condition especially in women, not sure why.
Stargazer
Posted by stargazer2 on November 25, 2007, at 18:46:35
In reply to 40mg+! » brooke484, posted by tecknohed on November 25, 2007, at 16:59:59
Lamictal caused me to have a lack of balance walking and I had several falls before the link was made. So I will not try Lamictal again, although i was taking it with something other than Nardil, so perhaps it may not cause the same efects in you. But if you do try it, just beware that I had the balance problems which went on far longer than it should have. Sometimes the most obvious side effects are not associated with the med, in retrospect, it now seems really very obvious.
Stargazer
Posted by sdb on November 25, 2007, at 19:23:38
In reply to Re: TCA's, the best one for you ? » sdb, posted by kaleidoscope on November 25, 2007, at 13:14:43
> Hi SDB
>
> In the UK, amitriptyline is very widely prescribed to treat chronic neuropathic pain. It's also sometimes used to treat chronic insomnia and recurrent migraine. It's not much used to treat depression anymore.
>
>Hi K!
Thanks for your information. Didn't know.
But amitriptyline is not no more used because of lack of efficacy treating symptoms of depression?
warm regards
sdb
Posted by sdb on November 25, 2007, at 19:34:05
In reply to Re: TCA's, the best one for you ? }} K, posted by sdb on November 25, 2007, at 19:23:38
www.torsades.org
www.qtdrugs.orgecg + serum-potassium control
if LQTS is known <no> such drugs.
short list of drug interactions possible:
antiarrhythmics
antidepressants, antihistamines
antimycotics
antibioticsmany genetic problems:
lqts1 kcnq 11p15.5 kvlqt1 (Iks-alpha) ca. 45 %
.......-lqts8
Posted by brooke484 on November 26, 2007, at 10:52:04
In reply to 40mg+! » brooke484, posted by tecknohed on November 25, 2007, at 16:59:59
I'm trying, I'm trying. I take forever to get to where I'm supposed to be. My body just can't take too much at one time.
So far so good with 35 mgs though. No dizziness today. I'll try 40 again next week.
I'm not giving up!
brooke
Posted by brooke484 on November 26, 2007, at 10:54:09
In reply to Re: 40mg+!/Lamictal/brooke, posted by stargazer2 on November 25, 2007, at 18:46:35
I never had dizziness with lamictal. I took it years ago and for about a month last summer. I'm going against my doctor's wishes by not taking it. I need to concentrate on marplan first.
brooke
Posted by stargazer2 on November 26, 2007, at 11:49:29
In reply to Re: 40mg+!/Lamictal/brooke, posted by brooke484 on November 26, 2007, at 10:54:09
I agree, just stick with one thing at a time. more than one med can complicate things too, so your smart to take it slow and stick with just Marplan.
I took 30 mg Marplan in 1994, before it was discontinued, and it worked excellent for me. Last year in Feb, after I heard it was available again, I retried it with Lamictal and it didn't work. I think Lamictal may have complicated it's effects. I stopped Marplan in Sept and I see I only went up to 30 mg, perhaps I didn't go high enough. I hate when I find that out, since I could have responded to 40 if my pdoc had insisted I go a bit higher.
I think my effects were not good because the Lamictal caused memory and balance problems. I got scared and stopped only Marplan. Makes no sense now. I should have stopped just the Lamictal and increased the Marplan to 40.It all becomes clear in retrospect. At the time, I'm sure I was a mess so I wsn't able to think things through, but why didn't my pdoc?
I really don't think they know what their doing half the time. Alot of experimentation and guesswork. Sure, I'm the only one losing out of my life. They have all the time in the world to treat me. I get so aggravated sometimes about this, but I really like my pdoc despite my retrospective analysis of how he uses medications.
Lots of trial and error. It was at my insistence that we retry Marplan and Nardil. If I listened to him completely, I would be on Abilify or Seroquel, he loved those despite doing nothing for me. go figure...
Stargazer
Posted by brooke484 on November 26, 2007, at 20:41:17
In reply to Re: 40mg+!/Lamictal/brooke, posted by stargazer2 on November 26, 2007, at 11:49:29
I'm bad at listening to my doctor sometimes. He thinks I'm still on Lyrica even though I told him time and time again it wasn't doing anything (besides costing me $30 a month). But, he does let me try what I want to try and that's a good thing. Hopefully I'll be able to try Deplin someday.
So the balance problems started as soon as you added Lamictal? Marplan makes me feel off balance. It wasn't that, was it?
I don't like to think about all the years that I've lost. It's been almost half my life and that's depressing.
brooke
Posted by sdb on November 27, 2007, at 17:39:13
In reply to Re: TCA's, the best one for you ?, posted by banga on November 25, 2007, at 7:29:32
> I did fairly well on clomipramine for a while, then it pooped out.
> I switched to desipramine--which has worked well, at least in combination with Abilify 5mg and Lamictal 200mg. The latter sometimes seems to not add much, but when I have tried to discontiinue it I feel a difference.
> In any case, desipramine was best for me, though for some it may be too activating. I really need things to combat sluggishness when depressed.
> I tried nortryptiline, I honestly dont remember what I disliked about its effects; I do remember it also caused immediate weight gain.pity that clomipramine pooped out for you. Maybe it could work again?
it seems to me that probably every psych drug can poop out irrelevant if benzos, tca's, ssris etc.
let's name this to "poop-out syndrome"warm regards
sdb
Posted by Phillipa on November 27, 2007, at 18:46:15
In reply to Re: TCA's, the best one for you ? }} banga, posted by sdb on November 27, 2007, at 17:39:13
sdb great idea poop-out syndrome it shall be. Phillipa
Posted by banga on November 28, 2007, at 7:26:45
In reply to Re: TCA's, the best one for you ? }} banga, posted by sdb on November 27, 2007, at 17:39:13
Yes, so many meds can stop having their positive effects...for me it usually happens when I stop, then restart a med. With my current combination, I discontinued all meds but the desipramine when I got pregnant.....dropped into horrible depression and had to restart all the other meds pronto. It helped, but the combo did not work as well as it had before....
Posted by sdb on November 28, 2007, at 16:56:40
In reply to Re: TCA's, the best one for you ? » sdb, posted by banga on November 28, 2007, at 7:26:45
> sdb great idea poop-out syndrome it shall be. Phillipa
> Yes, so many meds can stop having their positive effects...for me it usually happens when I stop, then restart a med. With my current combination, I discontinued all meds but the desipramine when I got pregnant.....dropped into horrible depression and had to restart all the other meds pronto. It helped, but the combo did not work as well as it had before....then I wish to see more "stay the course for relieve" drugs. But no "stay the course" for unpleasant side effects. Normally the benzos are blamed but for the most other psych substances I did never check if there is some more clear data. It seems to have some bad data here unfortunately.
warm regards
sdb
Posted by sdb on December 2, 2007, at 16:28:40
In reply to Re: TCA's, the best one for you ? » sdb, posted by kaleidoscope on November 25, 2007, at 13:14:43
> Hi SDB
>
> In the UK, amitriptyline is very widely prescribed to treat chronic neuropathic pain. It's also sometimes used to treat chronic insomnia and recurrent migraine. It's not much used to treat depression anymore.
>
>K,
does amitriptyline work for OCD/anxiety as well as citalopram?
warm regards
sdb
Posted by sdb on December 6, 2007, at 15:05:17
In reply to Re: TCA's, the best one for you ? }} Kaleidoskope, posted by sdb on December 2, 2007, at 16:28:40
I am wondering how controversial this is...
retrograde ejaculation on desipramine (with a smooth muscle relaxer of the inner sphincter like tamsulosine it can be possible but with desipramine too, desipramine for prostate hyperplasia BPH ?)
http://www.dr-bob.org/babble/19990726/msgs/9549.html
better sex on clomipramine... but more OCD
This is the end of the thread.
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