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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Ms Sassone on August 21, 2012, at 12:33:47
I took desipramine for the first time last night.
I fell asleep fine, but at at around 2 in the morning started having major panic attacks.The doc told me this was a good energy boosting drug.
Does anyone know of a less energizing TCA that doesn't cause weight gain? Perhaps imipramine?
I have to go back to work and I'm so desperate to get a hold on this black hole I'm in.
Thank you!
Posted by schleprock on August 21, 2012, at 18:17:39
In reply to Desperation!!, posted by Ms Sassone on August 21, 2012, at 12:33:47
> I took desipramine for the first time last night.
> I fell asleep fine, but at at around 2 in the morning started having major panic attacks.
>
> The doc told me this was a good energy boosting drug.
> Does anyone know of a less energizing TCA that doesn't cause weight gain? Perhaps imipramine?
> I have to go back to work and I'm so desperate to get a hold on this black hole I'm in.
> Thank you!I would recommend Nortriptyline. For almost 20 years it worked for me, and I certainly didn't experience any kind of that nonsense when I first took it. But personally, I think you'll need a few months before going back to work.
Posted by jono_in_adelaide on August 21, 2012, at 20:35:11
In reply to Desperation!!, posted by Ms Sassone on August 21, 2012, at 12:33:47
You could try sticking with desipramine, but using a benzo (say lorazepam 1mg twice a day) for the first week.
Other alternatives would be Welbutrin or Nortriptyline
Posted by Emily Elizabeth on August 22, 2012, at 13:51:00
In reply to Re: Desperation!!, posted by jono_in_adelaide on August 21, 2012, at 20:35:11
What about taking it in the morning? Sometimes just changing the timing of the dose is enough.
Best,
EE
Posted by Ms Sassone on August 22, 2012, at 17:31:18
In reply to Re: Desperation!!, posted by Emily Elizabeth on August 22, 2012, at 13:51:00
The Doc decided to put me on Nortryptaline (sp)
I'll start tomorrow.
unfortunately I can't take any more time off. Im going to have to fake it. I work with kids and this will be a nightmare.
Thank you for your input!
Posted by SLS on August 24, 2012, at 17:45:25
In reply to Re: Desperation!!, posted by Ms Sassone on August 22, 2012, at 17:31:18
> The Doc decided to put me on Nortryptaline (sp)
> I'll start tomorrow.
> unfortunately I can't take any more time off. Im going to have to fake it. I work with kids and this will be a nightmare.
> Thank you for your input!All of it was great advice.
Good luck with everything. If nortriptyline is the right drug for you, you might feel better by day 14. I hope so. It depends on choosing the right dosage. However, nortriptyline can cause sleepiness for the first few days. It often makes sense to begin someone at 10 mg/day. The majority of people respond to 75 mg/day. Others need 150 mg/day. It depends on one's metabolism of the drug. You can actually take blood tests to determine the right dosage.
What dosages of nortriptyline were you prescribed?
Please keep us updated.
- Scott
Posted by Ms Sassone on August 24, 2012, at 19:17:39
In reply to Re: Desperation!! » Ms Sassone, posted by SLS on August 24, 2012, at 17:45:25
Well, it wasnt the drug for me. I slept until 1 after having dreams that were horrific. Then had restless legs the rest of the night
The doc has now given me luvox, sooo, if anyone has experience with luvox that'd be way nice!
Posted by phidippus on August 27, 2012, at 23:07:18
In reply to Desperation!!, posted by Ms Sassone on August 21, 2012, at 12:33:47
It takes about a month for an antidepressant to build up and take effect in your system. Its doubtful the Desipramine caused the panic attacks-not enough of the medication has been metabolized.
Imiprramine can cause loads of weight gain.
What symptoms are you trying to treat?
Are you on any other drugs?
Eric
Posted by papillon2 on August 28, 2012, at 2:35:41
In reply to Re: Desperation!! And now Luvox?, posted by Ms Sassone on August 24, 2012, at 19:17:39
I have had no weight gain on Nortriptyline. It is activating but it hasn't made me anxious. It might depend on what type of depression you have. I have melancholic depression which involves pronounced psycho-motor retardation, so I need something activating.
I was on Luvox for one or two weeks. Probably one actually. It completely flattened me; I could barely walk or talk. This isn't a usual response to Luvox, but if suggests to me that it isn't a particularly activating anti-depressant. This could be a good thing for you.
There is another babbler who takes Luvox. Perhaps you could do a forum search.
Are you sure there isn't another reason for your panic attack? Like something particularly stressful happening at the time?
Posted by SLS on August 28, 2012, at 6:48:04
In reply to Re: Desperation!! And now Luvox?, posted by papillon2 on August 28, 2012, at 2:35:41
> I have melancholic depression which involves pronounced psycho-motor retardation, so I need something activating.
> I was on Luvox for one or two weeks. Probably one actually. It completely flattened me; I could barely walk or talk.I would keep exploring tricyclics and MAOIs and look to add things like lithium and T3. This is "old school", but there was quite a bit of evidence that this strategy worked for endogenous (melanchoic) depression. It is not true that MAOIs are inferior for endogenous depression. It is true that tricyclics are inferior for atypical depression. You might consider combining Parnate with desipramine if you want to stress NE activation. This is the only treatment that brought me to full remission. I would probably still be well on it were my doctor at the time had not had me discontinue it in favor of playing with Prozac and other drugs. Psychomotor retardation is a prominent symptom of my illness.
Imipramine is the drug of choice for your kind of illness. Clomipramine might be too serotonergic for you.
Viibryd is an interesting serotonergic drug. Phiddipus has been responding to it for quite awhile now. I did not experience apathy or flat affect with it. Nor did I experience sexual side effects. Fluvoxamine is generally considered to be the least activating SSRI. It is probably better for OCD than it is for depression.
I am not a big fan of Savella, but you might want to take a look at it. Even at low dosages, it provides a balanced NE/5-HT ratio for reuptake inhibition. Otherwise, using Effexor at dosages of 300 mg/day and higher might help, particularly when combined with nortriptyline. I maintained a partial response to this combination whereas monotherapy with each drug was without therapeutic effect.
As adjunctive treatment, two antipsychotics that come to mind are Abilify and Seroquel. Geodon might be helpful, but the drug is a bit unpredictable. Some people are reporting success being treated with tramadol. Like imipramine, Geodon and tramadol both inhibit the reuptake NE and 5-HT. Of course, tramadol also modulates the opioid system (mu agonism with very little kappa and delta agonism). One needs to be wary of combining tramadol with a SRI as it can produce serotonin toxicity. Perhaps combining tramadol with a tricyclic would help. Do NOT combine tramadol with a MAOI. Serotonin syndrome has been reported with this combination.
http://www.ncbi.nlm.nih.gov/pubmed/16051647
Have you tried high-dose Remeron (45 - 90 mg/day)? It would be interesting to combine it with desipramine.
- Scott
Posted by papillon2 on August 28, 2012, at 8:16:05
In reply to Re: Desperation!! And now Luvox? » papillon2, posted by SLS on August 28, 2012, at 6:48:04
Hey Scott,
I was not looking for med suggestions as such, more responding to the original poster, but thank you for your thoughts!
My psychiatrist is looking to add/change something to my Nortriptyline/Lamictal/Melatonin combo, possibly adding Ritalin or Ketamine, to break through the rest of the depression symptoms. I might create a new thread where we can discuss this separately.
Papillon
> > I have melancholic depression which involves pronounced psycho-motor retardation, so I need something activating.
>
> > I was on Luvox for one or two weeks. Probably one actually. It completely flattened me; I could barely walk or talk.
>
> I would keep exploring tricyclics and MAOIs and look to add things like lithium and T3. This is "old school", but there was quite a bit of evidence that this strategy worked for endogenous (melanchoic) depression. It is not true that MAOIs are inferior for endogenous depression. It is true that tricyclics are inferior for atypical depression. You might consider combining Parnate with desipramine if you want to stress NE activation. This is the only treatment that brought me to full remission. I would probably still be well on it were my doctor at the time had not had me discontinue it in favor of playing with Prozac and other drugs. Psychomotor retardation is a prominent symptom of my illness.
>
> Imipramine is the drug of choice for your kind of illness. Clomipramine might be too serotonergic for you.
>
> Viibryd is an interesting serotonergic drug. Phiddipus has been responding to it for quite awhile now. I did not experience apathy or flat affect with it. Nor did I experience sexual side effects. Fluvoxamine is generally considered to be the least activating SSRI. It is probably better for OCD than it is for depression.
>
> I am not a big fan of Savella, but you might want to take a look at it. Even at low dosages, it provides a balanced NE/5-HT ratio for reuptake inhibition. Otherwise, using Effexor at dosages of 300 mg/day and higher might help, particularly when combined with nortriptyline. I maintained a partial response to this combination whereas monotherapy with each drug was without therapeutic effect.
>
> As adjunctive treatment, two antipsychotics that come to mind are Abilify and Seroquel. Geodon might be helpful, but the drug is a bit unpredictable. Some people are reporting success being treated with tramadol. Like imipramine, Geodon and tramadol both inhibit the reuptake NE and 5-HT. Of course, tramadol also modulates the opioid system (mu agonism with very little kappa and delta agonism). One needs to be wary of combining tramadol with a SRI as it can produce serotonin toxicity. Perhaps combining tramadol with a tricyclic would help. Do NOT combine tramadol with a MAOI. Serotonin syndrome has been reported with this combination.
>
> http://www.ncbi.nlm.nih.gov/pubmed/16051647
>
> Have you tried high-dose Remeron (45 - 90 mg/day)? It would be interesting to combine it with desipramine.
>
>
> - Scott
This is the end of the thread.
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