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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 75. Go back in thread:
Posted by Bob on May 17, 2010, at 17:33:29
In reply to Re: Imipramine really that good? » med-amorphosis, posted by SLS on May 17, 2010, at 14:57:24
>
> When combined with an MAOI, imipramine might have a greater potential to produce serotonin toxicity when compared to lofepramine. I think lofepramine is a prodrug that is converted to desipramine in the body. Desipramine is selective enough for NE that it be safer with an MAOI. I experience a degree of serotonin syndrome when I combine imipramine with Nardil.
>>
> Thanks.
>
>
> - Scott
Scott -What exactly do you feel when you experience "a degree of serotonin syndrome"? I'm not sure I would know what that feels like.
Bob
Posted by Bob on May 17, 2010, at 17:43:07
In reply to Re: Imipramine really that good?, posted by SLS on May 17, 2010, at 15:30:02
>
> The potencies of imipramine to inhibit the reuptake of serotonin and norepinephrine are about the same.
>
>
> - ScottSo would it be reasonable to say that imipramine is sort of like a tricyclic version of milnacipran, or vice versa? Not that there exactly the same, but both of them are similar in their approximately even reuptake of serotonin and norepinephrine.
I'm trying to create such a balance with nortriptyline and citalopram, but am not sure what dose combination might do that.
Posted by med-amorphosis on May 17, 2010, at 17:56:23
In reply to Re: Imipramine really that good?, posted by SLS on May 17, 2010, at 15:30:02
> > So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI,
>
> Perhaps he has experience with it. However, if he is relying on "theoretical" safety, I must reiterate that I have had a SS reaction to imipramine in combination with Nardil on two occassions.He leads a whole team of psychopharms. And I'm not on Nardil. Im on Marplan- a VERY different drug. I've used both long term.
> I experienced severe hypotension, hyperreflexia, and rigidity.
Sounds more like fits/convulsions to me...Lots of drugs can cause them- even wellbutrin on its own.
> The potencies of imipramine to inhibit the reuptake of serotonin and norepinephrine are about the same.Thanks. Sounds about right, but I need to find some hard fact about this drug i think.
> - Scott
p.s. no disrespect intended
Posted by med-amorphosis on May 17, 2010, at 17:58:21
In reply to Re: Imipramine really that good?, posted by Phillipa on May 17, 2010, at 15:36:58
> Best to be careful not something to take chances with. Phillipa
So your saying I shouldn't trust my pdoc? Then who do I trust?
Posted by med-amorphosis on May 17, 2010, at 18:05:23
In reply to Re: Imipramine really that good?, posted by ed_uk2010 on May 17, 2010, at 15:38:39
> >So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI, as well as amitriptyline?
>
> I must say that I am very surprised.
>
> >Anyway, imipramine is greatly more potent as an NRI than SRI, esp as its broken down to desipramine anyway. No?
>
> Imipramine itself acts as a moderate SRI and a NRI. Desipramine is an NRI. I would be very concerned about combining imipramine with any of the MAOIs. Fatalaties have been reported.
>
> eg. Imipramine added to the MAOI tranylcypromine (Parnate)...
>
> http://www.ncbi.nlm.nih.gov/pubmed/12927331
>
>
>
>
>
>But im taking Marplan not Parnate. Very different drug. Thats the problem with MAOIs- they are now looked upon as one group of similar drugs, like SSRIs. BUT, MAOIs are totally unique to each other. None are the same, or even similar. Trust me. I've found I can get away with allmost anything with Marplan, unlike Nardil. Pizza? YES! Cheese strait from the block? YES! Could I do this on Nardil? NO!
Posted by SLS on May 17, 2010, at 18:30:27
In reply to Re: Imipramine really that good? » SLS, posted by med-amorphosis on May 17, 2010, at 17:56:23
> > > So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI,
> > Perhaps he has experience with it. However, if he is relying on "theoretical" safety, I must reiterate that I have had a SS reaction to imipramine in combination with Nardil on two occassions.
> He leads a whole team of psychopharms.
It is good that you trust your doctor.
> And I'm not on Nardil. Im on Marplan- a VERY different drug.
Well, I would still consider the possibility that there is some overlap between MAO inhibitors regarding biological effects. That being said, I did not have the problem with Parnate that I had with Nardil when I added imipramine to it.
> > I experienced severe hypotension, hyperreflexia, and rigidity.
> Sounds more like fits/convulsions to meWhy do you say this? How is what I described similar to "fits/convulsions"?
> > The potencies of imipramine to inhibit the reuptake of serotonin and norepinephrine are about the same.
> Thanks. Sounds about right, but I need to find some hard fact about this
drug i think.I think this site will prove useful to you:
http://pdsp.med.unc.edu/indexR.html
- Scott
Posted by SLS on May 17, 2010, at 18:51:15
In reply to Re: Imipramine really that good? » SLS, posted by Bob on May 17, 2010, at 17:33:29
> What exactly do you feel when you experience "a degree of serotonin syndrome"? I'm not sure I would know what that feels like.
The symptoms of serotonin syndrome vary greatly between individuals and the drugs being used. I experienced severe hypotension, mild hyperreflexia, and moderate muscle rigidity when I combined Nardil with imipramine. However, when I combined Parnate with Effexor, in addition to muscle rigidity and ataxia, I became incoherent (altered mental status) and spoke complete gibberish. However, my body temperature was not elevated during any episode, and I did not experience anxiety.
http://uuhsc.utah.edu/poison/healthpros/utox/vol4_no4.pdf
- Scott
Posted by linkadge on May 17, 2010, at 19:34:18
In reply to Re: Imipramine really that good? » Bob, posted by SLS on May 17, 2010, at 18:51:15
Amitriptyline has been combined with MAOI's supposedly without consequence. You will want to watch with the tryptophan though, thats a tripple whammy serotonin boost.
In some studies, long term amitriptyline administration upregulates the serotonin transporter and reduces serotonin levels (hence its antimigrane effect)?
The TCA's inhibit monoamine oxidase themselves (to some extent). Vise versa, parnate inhibits monoamine reuptake. Some degree of overlap is probably ok.
Linkadge
Posted by SLS on May 17, 2010, at 19:46:10
In reply to Re: Imipramine really that good?, posted by linkadge on May 17, 2010, at 19:34:18
> Amitriptyline has been combined with MAOI's supposedly without consequence.
I was treated at Columbia Presbyterian with a combination of Nardil 45mg and amitriptyline 150mg without sequalae. I do wonder, though, if this dosage of Nardil was too low to produce sufficient MAO inhibition to produce a reaction. 45mg is usually too low for me to respond to. These same doctors refused to combine imipramine with Nardil. I am not sure what their concern was.
- Scott
Posted by gman22 on May 17, 2010, at 19:49:23
In reply to Imipramine really that good?, posted by med-amorphosis on May 17, 2010, at 14:11:37
Imipramine was discovered by accident. One can infer that there was no experimental bias in evaluating it's effectiveness, as opposed to the way that drugs are developed today. They were giving the drug to psych patients and found out it made psychotic patients worse, but depressed patients much better. It does hit a lot of receptors and have some side effects, but it is very effective when given at proper dosages. It is considered very safe and doesn't lose effectiveness like SSRI's can over the years.
It helped me immensely.
Posted by med-amorphosis on May 18, 2010, at 5:40:33
In reply to Re: Imipramine really that good? » med-amorphosis, posted by SLS on May 17, 2010, at 18:30:27
> > > > So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI,
>
> > > Perhaps he has experience with it. However, if he is relying on "theoretical" safety, I must reiterate that I have had a SS reaction to imipramine in combination with Nardil on two occassions.
>
> > He leads a whole team of psychopharms.
>
> It is good that you trust your doctor.
>
> > And I'm not on Nardil. Im on Marplan- a VERY different drug.
>
> Well, I would still consider the possibility that there is some overlap between MAO inhibitors regarding biological effects. That being said, I did not have the problem with Parnate that I had with Nardil when I added imipramine to it.
>
> > > I experienced severe hypotension, hyperreflexia, and rigidity.
>
> > Sounds more like fits/convulsions to me
>
> Why do you say this? How is what I described similar to "fits/convulsions"?Only because when my pdoc gave me Optimax the SS warnings he gave to look out for were somewhat different. I see him again today. I'll check whith him what the 1st signs are again. I've only had one SS episode when I stupidly took MDEA along with my Nardil. Feeling cold with hot sweats im sure is one symptom. I feel that mildy whenever I've started an SSRI too. But everyone different so I dont discount your claim. Just how it sounds to me thats all :)
> I think this site will prove useful to you:
>
> http://pdsp.med.unc.edu/indexR.html
>
>
> - ScottThanks Scott
Posted by med-amorphosis on May 18, 2010, at 5:48:41
In reply to Re: Imipramine really that good? » SLS, posted by med-amorphosis on May 18, 2010, at 5:40:33
> I've only had one SS episode when I stupidly took MDEA along with my Nardil.Actually my mistake. It was MDEA combined with paroxetine.
Posted by med-amorphosis on May 18, 2010, at 5:53:58
In reply to Re: Imipramine really that good?, posted by gman22 on May 17, 2010, at 19:49:23
Theres a glimmer of hope! Thanks gman22. Off to docs. I'll let you all know the outcome later.
Posted by med-amorphosis on May 18, 2010, at 11:13:10
In reply to Re: Imipramine really that good? » gman22, posted by med-amorphosis on May 18, 2010, at 5:53:58
Surprisingly, my pdoc's first suggestion was to add bupropion the the mixture, keeping the lofepramine too. But I opted for a switch in TCAs 1st. He was willing to try 3 TCAs starting with trimipramine (Surmontil). If that fails then amitryptyline and finally, imipramine. Although imipramine would be used after various other options have been tried- ie a last resort.
So im swapping 210mg/day lofepramine to 25mg trimipramine, slowly titrating to 100mg at week 3.
Any trimipramine experiences anyone would like to share? Any knowledgable babblers explain how its meant to work? Apart from re-uptake inhibition the remainder of its actions slightly baffle me in this description:
http://en.wikipedia.org/wiki/Trimipramine
maybe its not the best source. Can anyone explain its effects in plain english (or there abouts)?med
Posted by ed_uk2010 on May 18, 2010, at 15:36:15
In reply to Re: Imipramine really that good? » ed_uk2010, posted by med-amorphosis on May 17, 2010, at 18:05:23
>But im taking Marplan not Parnate. Very different drug. Thats the problem with MAOIs- they are now looked upon as one group of similar drugs, like SSRIs.
I know, but they both inhibit the break down of serotonin. Just looking out for you :)
Posted by med-amorphosis on May 19, 2010, at 13:32:53
In reply to Re: Imipramine really that good? » med-amorphosis, posted by ed_uk2010 on May 18, 2010, at 15:36:15
> >But im taking Marplan not Parnate. Very different drug. Thats the problem with MAOIs- they are now looked upon as one group of similar drugs, like SSRIs.
>
> I know, but they both inhibit the break down of serotonin. Just looking out for you :)
>
>Cool! Thanx
Posted by Dr. Bob on May 20, 2010, at 18:43:41
In reply to Gone with trimipramine, posted by med-amorphosis on May 18, 2010, at 11:13:10
> Any knowledgable babblers explain how its meant to work? Apart from re-uptake inhibition the remainder of its actions slightly baffle me in this description:
> http://en.wikipedia.org/wiki/TrimipramineSorry to interrupt, but I'd like to redirect follow-ups regarding more advanced medication-related issues to Psycho-Babble Neurotransmitters. Here's a link:
http://www.dr-bob.org/babble/neuro/20100223/msgs/948075.html
That'll be considered a new thread, so if you'd like to be notified by email of follow-ups to it, you'll need to request that there.
> Any trimipramine experiences anyone would like to share?
Please feel free, however, to continue to use this board to share your experiences. Thanks,
Bob
Posted by topcatclr on May 21, 2010, at 1:06:46
In reply to Re: Imipramine really that good?, posted by ed_uk2010 on May 17, 2010, at 14:50:01
Took it years ago, in 1995. Doctor combined with a blood pressure med as she new it would ramp it! My memories of it were not great. Like a very sloppy form of Cymbalta. Uneven feeling of it in my system. Sometimes sleepy, hyper, anxiety, rapid heartbeat. No thanks, i will stick with Cymbalta.
Posted by Dr. Bob on May 25, 2010, at 17:34:51
In reply to Imipramine really that good?, posted by med-amorphosis on May 17, 2010, at 14:11:37
> My current regime is...
Please don't change your posting name without following these steps:
http://www.dr-bob.org/babble/faq.html#names
Follow-ups regarding this should be redirected to Psycho-Babble Administration.
Thanks,
Bob
Posted by med-amorphosis on May 31, 2010, at 9:12:35
In reply to Re: posting name » med-amorphosis, posted by Dr. Bob on May 25, 2010, at 17:34:51
> > My current regime is...
>
> Please don't change your posting name without following these steps:
>
> http://www.dr-bob.org/babble/faq.html#names
>
> Follow-ups regarding this should be redirected to Psycho-Babble Administration.
>
> Thanks,
>
> BobSorry bob, but I've good reason to change my name, and do not want my previous i.d. known. I dont want certain people knowing who I am (again). A matter of privacy thats all. Hope thats ok.
Posted by Dr. Bob on June 1, 2010, at 15:20:49
In reply to Re: posting name » Dr. Bob, posted by med-amorphosis on May 31, 2010, at 9:12:35
> > Please don't change your posting name without following these steps:
> >
> > http://www.dr-bob.org/babble/faq.html#names
>
> Sorry bob, but I've good reason to change my name, and do not want my previous i.d. known. I dont want certain people knowing who I am (again). A matter of privacy thats all. Hope thats ok.That's fine. I just ask that you follow the above steps next time. You don't have to say what your previous name was. Thanks,
Bob
Posted by med-amorphosis on June 2, 2010, at 5:14:15
In reply to Re: posting name, posted by Dr. Bob on June 1, 2010, at 15:20:49
Posted by med-amorphosis on June 5, 2010, at 14:08:49
In reply to Gone with trimipramine, posted by med-amorphosis on May 18, 2010, at 11:13:10
Well trimipramine might zonk me out, but its a good early riser. Im awake well within 8hrs now. Great for my hypersomnia. Problem is I'm still really depressed so I stay in bed- who wants even more morbid wakefullness than they already have? lol
I hope this is one of those extra-down times you get before it 'switches on'. Otherwise...i dunno. Lost.
Posted by Brainbeard on June 7, 2010, at 3:15:33
In reply to Re: Gone with trimipramine, posted by med-amorphosis on June 5, 2010, at 14:08:49
That's a bummer, that it doesn't lift your depression.
Posted by med-amorphosis on June 7, 2010, at 6:08:01
In reply to Re: Gone with trimipramine, posted by Brainbeard on June 7, 2010, at 3:15:33
> That's a bummer, that it doesn't lift your depression.
Well im over my last blast of Concerta from last week-I dont feel so tearfull today (yes it was used abusively, free from a 'friend' whos an ADHD sufferer who hates the stuff).
Plus Im stopping nicotine, alcohol (I'm alcoholic) AND chronic weed toking all in one go. So that dont help either. But last night I had no bad dreams or terrors. I even woke up feeling more positive, I think!? Sort of forgot what positive feeling is like but im sure its this.
Oh-I wacked my trimipramine up to 100mg last night too and slept the least yet-6hrs! Ok so I went back to sleep but was still up by 10:30 which is amazing for me. Not only that but it didn't knock me out like it has been. I just went to bed and slept 2 hours after taking it. Maybe its a little like mirtazapine where the higher you go the more activating it becomes.
Still too early to tell but I 'might' be on to a winner here (PLEASE!!!)
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