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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by kizzie2 on May 27, 2010, at 4:42:14
Hello - i would really appreciate some advice re. this medication.
I have been on Ad's for 10 years since post natal depression/anxiety. Initially on seroxat/paxil. Worked well for me but despite slow withdrawal attempts I relapsed each time.
Switched to prozac to try and withdraw but same thing happened.
In 2006 ended up on anafranil/clomip 75mg. Eventually settled on 50mg and after very very difficult initial side effects was very well on 50mg and below. 2007 50mg -30mg 2008 25mg 2009 20mg fo 6 months. 15mgs for 6 months (very well all year).In Jan 2010 I dropped to 10mg from 15mg and a couple of weeks later started having severe panic attacks and depression. Obsessive suicidal thoughts. had to take sick leave etc etc.
I am now back up to 75mg and after a number of months am hopefully starting to stabilise again.
My questions are:
- can anyone think of any explanation as to whay I am very well (fully functioning, successful career, happy family life) on very low doses but then suddenly go rapidly down hill. Mr psychiatrist says he doesnt really understand it.- Can anyone please explain exactly what anafranil is doing to me brain. (my dr tells me not to get too interested in the detail but I would like to know.) Is anafranil really a TCA or is it more like an SSRI? And does it work on 3 neuro transmittors ? I am hoping that more knwledge may help me to manage my condition - whatever it is more effectively.
Thank you for any help.
Kizzie
Posted by Laney on May 27, 2010, at 10:21:09
In reply to Advice please re. clomipramine/anafranil, posted by kizzie2 on May 27, 2010, at 4:42:14
Welcome Kizzie!
I'm somewhat of a newbie myself so I can't really help you there. Just wanted to say hi and that hopefully someone will chime in soon.
Laney
Posted by Phillipa on May 27, 2010, at 12:37:26
In reply to Re: Advice please re. clomipramine/anafranil, posted by Laney on May 27, 2010, at 10:21:09
I just know that Anafranil is a TCA used for mostly OCD. Phillipa
Posted by hopefullynow on May 27, 2010, at 13:58:34
In reply to Advice please re. clomipramine/anafranil, posted by kizzie2 on May 27, 2010, at 4:42:14
Hello,
Anafranil is a very potent AD, even in small doses.I am currently on Anafranil 100mg/day and in the very beginning i started with 10 mg pills.I felt an robust improvement even at this small dose.What I felt when i increased to 100 mg/day, was that the major improvement were at relative small doses 50-75 mg, when i reached 150 mg/day the side effects couteracted the feelin good sensation and the diffenece in efficacity was minimal.
Anafranil is a very potent AD which targets serotonin in the first place and norepinephrine in the second.Thru his 5-HT2a antagonism it should target dopamine, but i don't think it does too much as long as I encounter elevated prolactine levels.
For me Anafranil is the foundation of the treatment but I had to introduce in my regimen an norephrinergic agent to reach remission.First was maprotiline, but being too sedating, now i'm experiencing with low dose Wellbutrin with nice results.
Best regards!
Posted by Phillipa on May 27, 2010, at 20:17:12
In reply to Re: Advice please re. clomipramine/anafranil, posted by hopefullynow on May 27, 2010, at 13:58:34
Thanks for the great post. Is it for depression or Ocd? Phillipa
Posted by Deneb on May 27, 2010, at 21:44:12
In reply to Advice please re. clomipramine/anafranil, posted by kizzie2 on May 27, 2010, at 4:42:14
Hello kizzie2!
Welcome to Psycho-Babble! I don't think anyone really understands why we can suddenly go downhill. I hope you figure it out though, so you can prevent it. It could be anything I think, lack of sleep, too much sleep, change in habits, etc.
Deneb
Posted by hopefullynow on May 28, 2010, at 2:10:51
In reply to Re: Advice please re. clomipramine/anafranil » hopefullynow, posted by Phillipa on May 27, 2010, at 20:17:12
Hi,
I take anafranil for GAD, panic,depression and mild OCD, more a perfectionist character.> Thanks for the great post. Is it for depression or Ocd? Phillipa
Posted by Phillipa on May 28, 2010, at 20:08:54
In reply to Re: Advice please re. clomipramine/anafranil » Phillipa, posted by hopefullynow on May 28, 2010, at 2:10:51
So it helps anxiety also that is fantastic. How long did you say you've been on it? So much news about this med lately. Phillipa
Posted by hopefullynow on May 29, 2010, at 2:26:17
In reply to Re: Advice please re. clomipramine/anafranil » hopefullynow, posted by Phillipa on May 28, 2010, at 20:08:54
> So it helps anxiety also that is fantastic. How long did you say you've been on it? So much news about this med lately. Phillipa
Hello,
Yes, clomipramine helps a lot anxiety.I had done things while i'm on Anafranil that were beyond my power to handle stress and social interactions before.For example last weekend i took part of a wedding where i was the godfather and i was perfect, i mean, at the church I had a lot of things to take care, then at the party i danced, I received congratulation from a lot of unkown people, so shortening i had a looot of fun even in a situation that normal people consider a stresful situation.Anafranil is amazing!
It chaged drastically the way I am, I am no longer a freak who avoided any stressful situation or social interactions.
Sorry for rambling...:)
Posted by hopefullynow on May 29, 2010, at 11:30:10
In reply to Re: Advice please re. clomipramine/anafranil » hopefullynow, posted by Phillipa on May 28, 2010, at 20:08:54
Sorry, I didn't answer the question: i'm from a month on Anafranil and after about 10 days, things turns to be good, I felt that the effects becomes rock-solid.In the first day, definately it helped but the good sensations of confidence, lesser depression and so on came in waves.> So it helps anxiety also that is fantastic. How long did you say you've been on it? So much news about this med lately. Phillipa
Posted by Brainbeard on May 31, 2010, at 7:32:10
In reply to Advice please re. clomipramine/anafranil, posted by kizzie2 on May 27, 2010, at 4:42:14
Clomipramine - damn fine med.
Clomipramine already has very significant SRI (serotonin reuptake inhibition) at low doses, even at 10mg. It also is a strong NRI, also a noradrenergic med. It is a strong anticholnergic, which accounts for many of its side-effects but can also have an antidepressant effect. Then, like other TCA's, it may interact with the opioid system in a beneficial way. And, like mentioned above, it is a mild 5HT2A-antagonist, which may improve sleep, appetite and mood and reduce anxiety. Oh, and it is a potent inhibitor of a group of enzymes responsible for both the breakdown of melatonin and caffeine - so you could become more sleepy on clomipramine, while your cup of joe could last one heck of a lot longer.
An explanation for your experience could be that below a certain dose, serotonin receptors aren't saturated enough anymore to keep its antidepressant effects up. When I hear your story, I'd say: why not get back on a dose high enough to reap the benefits and low enough to avoid severe side-effects!!
Posted by bulldog2 on June 3, 2010, at 18:19:28
In reply to Re: Advice please re. clomipramine/anafranil, posted by hopefullynow on May 29, 2010, at 2:26:17
> > So it helps anxiety also that is fantastic. How long did you say you've been on it? So much news about this med lately. Phillipa
>
> Hello,
> Yes, clomipramine helps a lot anxiety.I had done things while i'm on Anafranil that were beyond my power to handle stress and social interactions before.
>
> For example last weekend i took part of a wedding where i was the godfather and i was perfect, i mean, at the church I had a lot of things to take care, then at the party i danced, I received congratulation from a lot of unkown people, so shortening i had a looot of fun even in a situation that normal people consider a stresful situation.Anafranil is amazing!
>
> It chaged drastically the way I am, I am no longer a freak who avoided any stressful situation or social interactions.
>
> Sorry for rambling...:)
>
>Hi Hopefully
I notice you mentioned high pro lactin on clomipramine. Any thoughts of a dopamine agonist to counter high prolactin which elevvate dopamine.
Regards
Bulldog2
Posted by hopefullynow on June 4, 2010, at 2:11:39
In reply to Re: Advice please re. clomipramine/anafranil, posted by bulldog2 on June 3, 2010, at 18:19:28
Hello Bulldog,
I'm very happy that you posted again in the clomipramine thread.How are you?Regarding prolactine, i think that we don't have much options besides DA agonists.I tried last week bromocriptine at a low dosage for a few days and it reversed somehow the AD effect of Anafranil, it made me nervous, anxious and easy startled.Im thinking of trying an less harsher DA agonist, maybe Requip or Mirapex.Tried Wellbutrin for this purpose and it did nothing.Not more alternatives, what do you think, an stimulant maybe?
All the best!
> Hi Hopefully
>
> I notice you mentioned high pro lactin on clomipramine. Any thoughts of a dopamine agonist to counter high prolactin which elevvate dopamine.
>
> Regards
> Bulldog2
Posted by Brainbeard on June 4, 2010, at 2:19:58
In reply to Re: Advice please re. clomipramine/anafranil » bulldog2, posted by hopefullynow on June 4, 2010, at 2:11:39
There are other dopamine agonists worth looking into:
There's piribedil, brand name Trivastal, Servier's D2/3-agonist, which doesn't cause sleep attacks unlike most other synthetic dopamine agonists and also has some cognitive enhancing qualities. It may not be a very strong proilactin suppressor though.
Then there's lisuride, an ergot-derived dopamine agonist that doesn't cause cardiac valve trouble like most ergot derived DA agonists can, and which is also a potent 5HT1A-agonist, which potentiates SRI. Lisuride is actually a chemical cousin of LSD, but without the hallucinogenic effects of the latter.
Finally, aripiprazole (Abilify) has also shown to be able to counter drug-induced hyperprolactinemia.
Posted by bulldog2 on June 6, 2010, at 10:44:36
In reply to Re: Advice please re. clomipramine/anafranil » bulldog2, posted by hopefullynow on June 4, 2010, at 2:11:39
> Hello Bulldog,
> I'm very happy that you posted again in the clomipramine thread.How are you?
>
> Regarding prolactine, i think that we don't have much options besides DA agonists.I tried last week bromocriptine at a low dosage for a few days and it reversed somehow the AD effect of Anafranil, it made me nervous, anxious and easy startled.Im thinking of trying an less harsher DA agonist, maybe Requip or Mirapex.Tried Wellbutrin for this purpose and it did nothing.Not more alternatives, what do you think, an stimulant maybe?
>
> All the best!
>
>
> > Hi Hopefully
> >
> > I notice you mentioned high pro lactin on clomipramine. Any thoughts of a dopamine agonist to counter high prolactin which elevvate dopamine.
> >
> > Regards
> > Bulldog2
>
>My p-doc had mentioned requip which might be gentler than the bromocriptine. I tried bromocriptine years ago and hated the way it made me feel. Also ritalin or adderall do wonders for some as an augment. Than there's another agonist miraprex which works for some.
My p-doc originally mentioned an agonist for the clomipramine and now has backed off. Wants me to wash out and try marplan an maoi.
Posted by bulldog2 on June 6, 2010, at 10:53:12
In reply to Other DA agonists: piribedil, lisuride. Abilify?, posted by Brainbeard on June 4, 2010, at 2:19:58
> There are other dopamine agonists worth looking into:
>
> There's piribedil, brand name Trivastal, Servier's D2/3-agonist, which doesn't cause sleep attacks unlike most other synthetic dopamine agonists and also has some cognitive enhancing qualities. It may not be a very strong proilactin suppressor though.
>
> Then there's lisuride, an ergot-derived dopamine agonist that doesn't cause cardiac valve trouble like most ergot derived DA agonists can, and which is also a potent 5HT1A-agonist, which potentiates SRI. Lisuride is actually a chemical cousin of LSD, but without the hallucinogenic effects of the latter.
>
> Finally, aripiprazole (Abilify) has also shown to be able to counter drug-induced hyperprolactinemia.Brainbeard some excellent advice. Now you being a genius I'm sure you can answer this. Which dopamine receptor is implicated with raising or lowering prolactin. If I knew the answer to that I could make a good choice. I tried trivetal and it had a nice feel but pooped out rather quickly.
If abilify at low doses could bring down the prolactin it would make a great choice as it is also an ad augmentor.
So tell me about this lisuride. There's a lot of talk in meds about this agonist. Does it strongly hit the prolactin receptors? What other good things does it do?
The impression I get is dostinex, miraprex and requip are good prolactin suppressors. But I would like to pick one that also has some ad properties. Sorry for the long post.
Posted by Brainbeard on June 6, 2010, at 13:31:18
In reply to Re: Other DA agonists: piribedil, lisuride. Abilify? » Brainbeard, posted by bulldog2 on June 6, 2010, at 10:53:12
I really know next to nothing about the relation between dopamine receptors and prolactin. They are inversely related, for sure.
Ergot derived dopamine agonists like bromocriptine can cause cardiac valve problems. Synthetic dopamine agonists like Mirapex and Requip are infamous for causing sudden sleep attacks.
Lisuride must be a strong prolactin suppressor. It may be a mood and cognition enhancer and an anxiolytic. Some human rat should try it soon.
Abilify might be a great option, but it seems to be a rather capricious drug.
Posted by kizzie2 on June 14, 2010, at 7:25:15
In reply to Advice please re. clomipramine/anafranil, posted by kizzie2 on May 27, 2010, at 4:42:14
Thank you so much everyone for replying. Im so sorry I havent replied sooner. I got confused with the site and didnt realise that my question had been answered. Sorry!!
I am now on 60mg with the aim of going down to 50mg and staying on that for a few months then going down to 25mg and staying on that longer term. Hopefully 25mg will be a good maintenance dose for me. It seemed to work for me before.
Thanks again for your help.
Kizzie
Posted by KarenRB53 on October 7, 2010, at 9:06:30
In reply to Re: Advice please re. clomipramine/anafranil, posted by hopefullynow on May 27, 2010, at 13:58:34
> Hello,
> Anafranil is a very potent AD, even in small doses.I am currently on Anafranil 100mg/day and in the very beginning i started with 10 mg pills.
>
> I felt an robust improvement even at this small dose.What I felt when i increased to 100 mg/day, was that the major improvement were at relative small doses 50-75 mg, when i reached 150 mg/day the side effects couteracted the feelin good sensation and the diffenece in efficacity was minimal.
>
> Anafranil is a very potent AD which targets serotonin in the first place and norepinephrine in the second.Thru his 5-HT2a antagonism it should target dopamine, but i don't think it does too much as long as I encounter elevated prolactine levels.
>
> For me Anafranil is the foundation of the treatment but I had to introduce in my regimen an norephrinergic agent to reach remission.First was maprotiline, but being too sedating, now i'm experiencing with low dose Wellbutrin with nice results.
>
> Best regards!How much Wellbutrin are you using and is it immediate releae, SR or XL?
Posted by hopefullynow on October 8, 2010, at 9:06:12
In reply to Re: Advice please re. clomipramine/anafranil » hopefullynow, posted by KarenRB53 on October 7, 2010, at 9:06:30
hy, unfortunately Wellbutrin was a big disapointment, i begun to take 150 mg in XL (actually Zyban - brand) form and after about a week the energy and motivation faded out into an more pronounced lethargy and somnolence.I raised the dose to 300 mg/day and again for a few days i felt better, then the lethargy came back and that was too much, i was unable to tolerate that state.I was feeling exactly like i was on a moderate to big dose of an antypsychotic.I really dunno why i reacted so strange, apparently i'm not the only one.Now i'm back to Maprotiline and i feel fairy normal.
Regards!
Posted by kizzie2 on October 11, 2010, at 6:43:33
In reply to Re: Advice please re. clomipramine/anafranil, posted by hopefullynow on October 8, 2010, at 9:06:12
Hi
Sadly things are still not stable for me.
I am currently on 50mg a day.
I have had a couple of periods of about 2 weeks where I have felt much better. But these dont last and then the depression/anxiety return badly.As I was very well on 25mg during 2008 and 2009 I am thinking of reducing slowly to 25mg to see if there is more consistency.
For some reason I feel that at 50mg the anafranil INCREASES my obsessive anxiety. I know it is used as a treatment for OCD patients so this would seem to be impossible - but it really does seem to be the case with me.
Because I have had such a difficult year I am having lots of thoughts that there is no way i can improve from this now. But I know i have to keep telling myself that there other possibilities.
Thanks for reading.
Kizzie x
Posted by hopefullynow on October 11, 2010, at 6:58:54
In reply to Re: Advice please re. clomipramine/anafranil, posted by kizzie2 on October 11, 2010, at 6:43:33
Hi there,
I'm sorry to hear that you're not stable at 50 mg/day.I think that clomipramine, as every AD, tends to lose its efectivness over time because it decreases noradrenergic and dopaminergic activity ( even that on paper its noradrenergic metabolite seems to be powerfull-it is not, comparing to serotonergic activity).That obsesivness/anxiety/agitation (which i know well)seems to be some form of akathisia, i dunno.All i know is that when i introduced an noradrenergic agent (nortryptiline/maprotiline/wellbutrin) my anxiety/agitation state disapeared.If i'd be in your place i'd try a tiny amount of nortryptiline...Good luck and keep us updated
Regards
> Hi
> Sadly things are still not stable for me.
> I am currently on 50mg a day.
> I have had a couple of periods of about 2 weeks where I have felt much better. But these dont last and then the depression/anxiety return badly.
>
> As I was very well on 25mg during 2008 and 2009 I am thinking of reducing slowly to 25mg to see if there is more consistency.
>
> For some reason I feel that at 50mg the anafranil INCREASES my obsessive anxiety. I know it is used as a treatment for OCD patients so this would seem to be impossible - but it really does seem to be the case with me.
>
> Because I have had such a difficult year I am having lots of thoughts that there is no way i can improve from this now. But I know i have to keep telling myself that there other possibilities.
>
> Thanks for reading.
>
> Kizzie x
Posted by kizzie2 on October 11, 2010, at 12:23:28
In reply to Re: Advice please re. clomipramine/anafranil, posted by hopefullynow on October 11, 2010, at 6:58:54
Hi - thank you for reply. Apologies for my ignorance but when you say 'decreases noradrenergic and dopaminergic activity ' - does that mean that anafranil/clomipramine can actually increase symptoms of depression (loss of enthusiasm/motivation) over time?
This definately seems to be the case with me and have wondered if it could be down to the medication.
Thanks
Kizzie
Posted by hopefullynow on October 11, 2010, at 13:38:51
In reply to Re: Advice please re. clomipramine/anafranil » hopefullynow, posted by kizzie2 on October 11, 2010, at 12:23:28
yes, decreasing noradrenergic and dopaminergic activity leads to apathy, lack of enthusiasm, drive, energy or libido.Serotonergic TCA's seems to be kinder than SSRI's in this area, but over time they appear to lead to this kind of state of numbing.Best approach would be to add to clomipramine (which hopefully abolish depresion on you)some NA/DA agent like nortryptiline, wellbutrin, desipramine...Dopamine agonists doesn't seem to do something solid on the long run.If they work, they pop up in a short time.
For me, clomipramine at 50mg/day had/have a robust response and continous efficacity in treating depression but left me somehow numb.Adding Maprotiline (NA TCA), the numbing/amotivational state was reversed.Hope it helps,
regards
> Hi - thank you for reply. Apologies for my ignorance but when you say 'decreases noradrenergic and dopaminergic activity ' - does that mean that anafranil/clomipramine can actually increase symptoms of depression (loss of enthusiasm/motivation) over time?
>
> This definately seems to be the case with me and have wondered if it could be down to the medication.
>
> Thanks
>
> Kizzie
Posted by Brainbeard on October 11, 2010, at 15:49:33
In reply to Re: Advice please re. clomipramine/anafranil, posted by hopefullynow on October 11, 2010, at 13:38:51
Adding nortriptyline to clomipramine for noradrenergic reuptake inhibition (NRI) is like adding sugar to candy, since clomipramine's metabolite, desmethylclomipramine, is a much stronger NRI than nortriptyline; it's at least ten times as strong. (See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014120/pdf/0707253a.pdf for receptor affinities in Ki; the lower the number, the stronger the affinity.)
In fact, as you go higher on clomipramine, the SRI/NRI ratio (2:1 according to Gillman (see mentioned article)) will become smaller and smaller, perhaps approaching 1:1 eventually, since the NRI metabolite has a much longer half-life than the mother drug and will therefore accumulate more in the blood over time.
Desipramine could be a little stronger than desmethylclomipramine.
I haven't seen numbers for maprotiline.
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