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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by deniseuk190466 on January 30, 2008, at 16:00:45
Scott,
I hope you haven't done a runner again.
I just wanted to ask you how you responded to a tricyclic on it's own, if you ever actually took noratryptaline on it's own that is.
The reason I ask is I wonder if my American friend who suffers from Bipolar (mainly depression now) would respond too the same combination as you.
As he said that tricyclics made him "punch walls" he is reluctant to try one again. Did they affect you that way when or if you took Noratryptaline on it's own.
I'm just thinking your response to Nortryptaline (alone) would be an indication of his response to a tryciclic/MAOI combination.
Thanks.....Denise
Posted by linkadge on January 30, 2008, at 22:02:24
In reply to To Scott (SLS), posted by deniseuk190466 on January 30, 2008, at 16:00:45
The effects of the TCA's as a class are very diverse. From what I understand, clomipramine is more SSRI like whereas desipramine can be very activating.
I even noticed a difference between clomipramine and doxapin. The former made me docile wherase the latter seems to make me a bit more edgy.
I think doxapin is more ballanced SNRI wheras clomipramine is more like an SSRI.
Linkadge
Posted by SLS on January 31, 2008, at 6:20:31
In reply to To Scott (SLS), posted by deniseuk190466 on January 30, 2008, at 16:00:45
> Scott, > > I hope you haven't done a runner again.
Still here for now.I was away for a few days setting up a new computer.
> I just wanted to ask you how you responded to a tricyclic on it's own,
My "virgin" (drug-naive) response to imipramine was robust, but short-
lived. It was the first drug I tried.> if you ever actually took noratryptaline on it's own that is.
No. I did try amitriptyline, the parent compound of nortriptyline. I experienced the same sort of transient robust effect from it.
> The reason I ask is I wonder if my American friend who suffers fro Bipolar (mainly depression now) would respond too the same combination as you.
Ah, if only a crystal ball...To answer your question, how could we really know for sure. You do know that Lamictal is particularly effective as an augmentor of antidepressants. It has a pronounced antidepressant effect in addition to its mood stabization properties (especially when combined with lithium). Here is my current regime:
Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mgIf you throw enough crap against the wall, some of it is bound to stick. You can try to remove one drug at a time to strip away useless agents.
I discontinued Deplin because I wanted to experiment and determine if it remained a contributor to my treatment with chronic use. It seems to have pooped-out. I remain without it. It has only been a few days since I discontinued it, though. Damned uncertainty.
> As he said that tricyclics made him "punch walls" he is reluctant to try
one again.Which TCA?
> Did they affect you that way when or if you took Noratryptaline on it's own. > > I'm just thinking your response to Nortryptaline (alone) would be an indication of his response to a tryciclic/MAOI combination. > > >
I find that if you keep a record of which drugs had a positive effect, even if only transiently, you can use it to combine the ones that had been of some benefit previously. I would say to give Nardil monotherapy a shot if there is no reason not to. If a partial, although inadequate, improvement is the result, I would add things to it rather than switch. I wish I had some evidence that my treatment was universally effective for bipolar depression. Damned uncertainty.Things that can be added to Nardil:
TCA: Nortriptyline, desipramine, and perhaps trimipramine. Clomipramine and imipramine are to be avoided because of they are more likely to precipitate serotonin syndrome.
Wellbutrin.
lithium
Anticonvulsant mood stabilizers
Lamictal
Dextroamphetamine
Ritalin
Thyroid hormone
DA receptor agonists - Mirapex, Requip, piribedil
Atypical antipsychotics - Abilify, Geodon, Zyprexa, Seroquel, Risperdal (5-HT2a antagonists)
Remeron?
NO SSRIs - Prozac, Zoloft, Paxil, Celexa, Lexapro, Luvox
NO SNRIs - Effexor, Cymbalta
I'm sure I am forgetting something.
Please ask more questions.
> Thanks.....DeniseYou are very receptive to new ideas, and process information effectively. You might have to think "outside the box" in order to get well.
Good luck - always.
- Scott
Posted by ny2bk on January 31, 2008, at 8:05:41
In reply to Re: To Scott (SLS) » deniseuk190466, posted by SLS on January 31, 2008, at 6:20:31
Scott ill be doing a parnate/nortrip/benzo combo shortly,my question is do you dose the notrip with the Maoi,i.e concomintly,or do you dose both apart at seperate times.
Im assuming on my part that both be taken togther as a single dosing combo?
Posted by Phillipa on January 31, 2008, at 10:14:46
In reply to Re: To Scott (SLS)/sorry meaning to ask, posted by ny2bk on January 31, 2008, at 8:05:41
So no more Deplin nothing here either I feel it's a joke. Nothing but money no wonder they offer a continuous discount. Phillipa
Posted by SLS on January 31, 2008, at 16:58:18
In reply to Re: To Scott (SLS)/sorry meaning to ask, posted by ny2bk on January 31, 2008, at 8:05:41
> Scott ill be doing a parnate/nortrip/benzo combo shortly,my question is do you dose the notrip with the Maoi,i.e concomintly,or do you dose both apart at seperate times.
>
> Im assuming on my part that both be taken togther as a single dosing combo?Yes. I take both Nardil and nortriptyline at the same time. Traditionally, it is recommended to start both medications at the same time or add the MAOI while already taking nortriptyline. I've done it all three ways, and I have no reason to believe that it matters too much how the two are initiated together. Low and slow.
Do not combine a MAOI with imipramine, clomipramine, SSRIs or SNRIs. All of these drugs substantially inhibit the reuptake of serotonin, which almost always leads to serotonin syndrome, a potentially fatal reaction.
- Scott
Posted by ny2bk on February 3, 2008, at 18:59:06
In reply to Re: To Scott (SLS)/sorry meaning to ask » ny2bk, posted by SLS on January 31, 2008, at 16:58:18
> > Scott ill be doing a parnate/nortrip/benzo combo shortly,my question is do you dose the notrip with the Maoi,i.e concomintly,or do you dose both apart at seperate times.
> >
> > Im assuming on my part that both be taken togther as a single dosing combo?
>
> Yes. I take both Nardil and nortriptyline at the same time. Traditionally, it is recommended to start both medications at the same time or add the MAOI while already taking nortriptyline. I've done it all three ways, and I have no reason to believe that it matters too much how the two are initiated together. Low and slow.
>
> Do not combine a MAOI with imipramine, clomipramine, SSRIs or SNRIs. All of these drugs substantially inhibit the reuptake of serotonin, which almost always leads to serotonin syndrome, a potentially fatal reaction.
>
>
> - ScottI made that mistake scott of using it with imiprimine,WOW teeth shattering toal interaction,in fear of death that day.
Thanks for foresight
Posted by deniseuk190466 on February 5, 2008, at 15:45:13
In reply to Re: To Scott (SLS), posted by linkadge on January 30, 2008, at 22:02:24
Thanks for the comparison Linkadge although again it just proves that we all respond very differently to meds.
My belief is that if you respond to one tricyclic then you will respond to another and that it is just the side affects that vary.
From reading your note you didn't really respond to any of the tricyclics, you just had different side affects?
Denise
Posted by deniseuk190466 on February 5, 2008, at 15:49:34
In reply to Re: To Scott (SLS) » deniseuk190466, posted by SLS on January 31, 2008, at 6:20:31
Thanks Scott,
He has been on Lamictal and experienced no benefits.
I don't think he has had a transient robust response to anything (unlike you) so you are obviously not similiar in your responses to drugs.
The best so far have been Nardil and Parnate but with Nardil the sweating was really bad and he kept needing to go to sleep thoughout the day.
I think the tricyclic he has tried in the past is a drug (which I've never heard of) called Vivactyl.
Abilify is good at controlling his irritability.
I guess you have suggested everything there is to suggest so thanks for that.
Thanks also for the compliment on my information processing abilities (that's a first) :-)
Denise
This is the end of the thread.
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