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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by alexcanada on March 26, 2013, at 12:25:31
I started Anafranil/Clomipramine 10mg yesterday evening. I also take 2mg valium total per day, and 1.25mg ritalin 2-3 times a day.Yesterday night i was extremely tired and slept soon after my dose. When i woke up about 5 hours later my mind would be wandering in bed a bit. Some bit of small imagination but it would feel very dark and negative. People's faces for instance in my mind would feel a bit fearsome.
Recently I've been having insomnia but Anafranil may be making it worse as during the morning was extremely difficult to sleep.
Lot of anxiety has emerged, feel very bothered, heart rate is up, head feels a bit warm, and sometimes heavy breathing especially if I allow my mind to wander while in bed. Earlier this morning I just could not stand to stay in bed, it just felt frightening to be there. I ended up watching a bit of TV to attempt to distract myself. While watching tv it felt bit different than usual. As if I am more able to somewhat feel emotions associated with anxiety such as tension. Easier to feel startled. Less emotionally numb but this anxiety and whatever else is severe and I just want these extremely umcomfortable and troublesome feelings to pass.
Additionally I have developed a massive toothache. it's monsterous. I had to take a bit of gabapentin to try and subside it. Pain has gone down from a 9 to a 6. I only had a very mild toothache before Anafranil.
Is this overall a bit frightening and I want to know if I should bother with continueing? I heard of someone having a very bad experience with 10mg Anafranil but they did better on 20. Might this be dose related? Or is this simply a sign of what I should expect? Does this med release norepinephrine early or is it something else? Because I feel very off. Something is very wrong today and I am scared to take another dose.
Also should ritalin be avoided completely with Anafranil?
It was very difficult to make this posting. I don't know how to wrap my head around this. Anxiety is harsh.
Posted by SLS on March 26, 2013, at 13:06:58
In reply to Anafranil Day 1 is frightening!, posted by alexcanada on March 26, 2013, at 12:25:31
Hi.
Anafranil is a potent:
1. Serotonin reuptake inhibitor (SRI)
2. Norepinephrine reuptake inhibitor (NRI)
3. Anticholinergic (ACh M1 receptor antagonist)Numbers #2 and #3 act synergistically to increase "fight or flight" tone. Many of the things you describe are the direct result of these drug effects. Ritalin also acts as #2. I would experiment with discontinuing the Ritalin, as this might be making the Anafranil startup side effects worse. As these effects ease with continued treatment, you might be able to add back the Ritalin if you find it necessary. If you need the Ritalin for ADD/ADHD, and Ritalin is problematic, you can try switching to Dexedrine, Vyvanse, or Adderall. These drugs are less potent NRIs and more potent NE releasers. Focalin might be smoother than Ritalin if methylphenidate is preferred. It is likely that your heart rate will decrease somewhat, but will remain elevated relative to baseline. This is not dangerous unless your HR exceeds 120 BPM.
- Scott
Posted by tensor on March 26, 2013, at 14:48:40
In reply to Anafranil Day 1 is frightening!, posted by alexcanada on March 26, 2013, at 12:25:31
>
> I started Anafranil/Clomipramine 10mg yesterday evening. I also take 2mg valium total per day, and 1.25mg ritalin 2-3 times a day.
>
> Yesterday night i was extremely tired and slept soon after my dose. When i woke up about 5 hours later my mind would be wandering in bed a bit. Some bit of small imagination but it would feel very dark and negative. People's faces for instance in my mind would feel a bit fearsome.
>
> Recently I've been having insomnia but Anafranil may be making it worse as during the morning was extremely difficult to sleep.
>
> Lot of anxiety has emerged, feel very bothered, heart rate is up, head feels a bit warm, and sometimes heavy breathing especially if I allow my mind to wander while in bed. Earlier this morning I just could not stand to stay in bed, it just felt frightening to be there. I ended up watching a bit of TV to attempt to distract myself. While watching tv it felt bit different than usual. As if I am more able to somewhat feel emotions associated with anxiety such as tension. Easier to feel startled. Less emotionally numb but this anxiety and whatever else is severe and I just want these extremely umcomfortable and troublesome feelings to pass.
>
> Additionally I have developed a massive toothache. it's monsterous. I had to take a bit of gabapentin to try and subside it. Pain has gone down from a 9 to a 6. I only had a very mild toothache before Anafranil.
>
> Is this overall a bit frightening and I want to know if I should bother with continueing? I heard of someone having a very bad experience with 10mg Anafranil but they did better on 20. Might this be dose related? Or is this simply a sign of what I should expect? Does this med release norepinephrine early or is it something else? Because I feel very off. Something is very wrong today and I am scared to take another dose.
>
> Also should ritalin be avoided completely with Anafranil?
>
> It was very difficult to make this posting. I don't know how to wrap my head around this. Anxiety is harsh.Clomipramine is the best anxiolytic med I have been taking. Don't be scared, your anxiety will diminish as the dose goes up. 10mg is just a startup dose, don't expect much until you hit 75-100mg. I really felt great at 150mg. It's a really good antidepressant.
I don't know your history, but if your anxiety is severe, stay away from stims until it's under control. You could talk to your pdoc about titrating faster, like 25mg every third day./tensor
Posted by jono_in_adelaide on March 26, 2013, at 17:47:46
In reply to Anafranil Day 1 is frightening!, posted by alexcanada on March 26, 2013, at 12:25:31
Drop the Ritalin, increase the Valium, and slwoly increase the clomipramine to a therapttic dose level.
Dont juste it on how you feel on day one, give it a chance to bed down.
Posted by alexcanada on March 26, 2013, at 18:50:45
In reply to Re: Anafranil Day 1 is frightening!, posted by jono_in_adelaide on March 26, 2013, at 17:47:46
Thanks guys. I will give it a try and I took my 10mg dose an hour ago.I continued it because it has been several hours since that strong intense frightening anxiety. It was still present on some smaller level in early afternoon but it began to subside. It might have all been a ritalin interaction! Since the timing is pretty spot on. My last ritalin dose was at 1am.
I had to take some gabapentin 9am today to try and deal with the intense toothache and as an additional measure against the anxiety.
Now it is 7:40pm and even after the anafranil my anxiety is not shooting up. So unless it has something to do with peak plasma levels hopefully it was just an interaction. Since it would be very odd for such a low dose to effect me so strongly (despite me being med sensitive) to the point where my thoughts were becoming dark and frightening.
At least this will get me off the ritalin. I been trying to withdrawal and was down to 1.25mg twice a day so now it's done with. Each day was just so extremely bland and dull. Ritalin used to help me a lot long ago. It was a miracle but tolerance develops and likely seratonin downregulation would occur on top of that. Therefor it doesn't seem to be a realistic long term med for me. It would still give me a small boost these days but when it wears off it's a lousy feeling.
Some background: melancholic depression + some on and off general anxiety (sometimes med induced). No ADD, no psychotic symptoms.
Posted by baseball55 on March 26, 2013, at 19:11:17
In reply to It might have been ritalin interaction, posted by alexcanada on March 26, 2013, at 18:50:45
I doubt your toothache has anything at all to do with meds. You should see a dentist. Mild toothaches turn nasty when an inflamed tooth gets abcessed.
Posted by Phillipa on March 26, 2013, at 23:08:30
In reply to Re: It might have been ritalin interaction, posted by baseball55 on March 26, 2013, at 19:11:17
Definitely see the dentist. Don't want infection. Phillipa
Posted by jono_in_adelaide on March 26, 2013, at 23:28:30
In reply to Re: It might have been ritalin interaction, posted by baseball55 on March 26, 2013, at 19:11:17
Agree - toothache is unlikely to be med related.
Ibuprofen (400mg) is likely to be more effective as an analgesic than gabapentin
Posted by alexcanada on March 27, 2013, at 7:47:57
In reply to Re: It might have been ritalin interaction, posted by baseball55 on March 26, 2013, at 19:11:17
Yesterday evening it wasn't too bad but this morning has felt dreadful again. Though not as bad as the previous morning. I did not take any ritalin since I don't want to make it any worse.Middle of the night I woke and could not sleep further. Laying in bed felt very uncomfortable and troublesome and wanted to get up to distract myself. Breathing is still heavy at times.
Toothache has subsided. I did see a dentist yesterday and told me to give it a day or two.
My anxiety normally is NEVER this bad under normal circumstances. Anafranil clearly having a negative impact so far. Also my general mood is quite negative, darker, bit dysphoric perhaps. The passage of time feels very slow. I feel I just want the day to pass and be over with. I feel I just want relief. It is painful like this. I don't feel tired or low energy the way I normally did prior to Anafranil. I feel more awake but I think it's likely much due to all the anxiety. There is a great deal of discomfort within me that is difficult to describe. Very low appetite too.
It's bad enough that I keep considering giving up. The more peaceful SSRI type effect might be more ideal. I don't know. It's hard to think right now. I may give 20mg a try tonight but it's difficult to tolerate this. I might resort to taking Gabapentin to take the edge off or possibly magnesium. Perhaps I will just resort to taking gabapentin every day in order to give Anafranil a proper trial. I hope this is just a case of feeling worse before feeling better.
> I doubt your toothache has anything at all to do with meds. You should see a dentist. Mild toothaches turn nasty when an inflamed tooth gets abcessed.
Posted by tensor on March 27, 2013, at 8:21:37
In reply to Day 2. Pretty bad anxiety, posted by alexcanada on March 27, 2013, at 7:47:57
>
> Yesterday evening it wasn't too bad but this morning has felt dreadful again. Though not as bad as the previous morning. I did not take any ritalin since I don't want to make it any worse.
>
> Middle of the night I woke and could not sleep further. Laying in bed felt very uncomfortable and troublesome and wanted to get up to distract myself. Breathing is still heavy at times.
>
> Toothache has subsided. I did see a dentist yesterday and told me to give it a day or two.
>
> My anxiety normally is NEVER this bad under normal circumstances. Anafranil clearly having a negative impact so far. Also my general mood is quite negative, darker, bit dysphoric perhaps. The passage of time feels very slow. I feel I just want the day to pass and be over with. I feel I just want relief. It is painful like this. I don't feel tired or low energy the way I normally did prior to Anafranil. I feel more awake but I think it's likely much due to all the anxiety. There is a great deal of discomfort within me that is difficult to describe. Very low appetite too.
>
> It's bad enough that I keep considering giving up. The more peaceful SSRI type effect might be more ideal. I don't know. It's hard to think right now. I may give 20mg a try tonight but it's difficult to tolerate this. I might resort to taking Gabapentin to take the edge off or possibly magnesium. Perhaps I will just resort to taking gabapentin every day in order to give Anafranil a proper trial. I hope this is just a case of feeling worse before feeling better.What is your target dose and how fast are you planning to get there?
/tensor
Posted by alexcanada on March 27, 2013, at 13:30:54
In reply to Re: Day 2. Pretty bad anxiety » alexcanada, posted by tensor on March 27, 2013, at 8:21:37
30mg or possibly more would be my target dose. Low doses usually work best for me since I'm very med sensitive. Paxil 9mg for instance was about the ideal dose for me.I am considering starting 20mg tonight and perhaps staying there for a while before trying 30mg. Though if there is some noticable improvement or reduction in anxiety symptoms then I may move up quicker. It's hard to tell because I don't know how I will feel tomorrow.
I am hoping that the medication behaves differently at higher doses. Kind of like how Remeron was very sedating for me at 10mg but more activating at 40mg. Except in this case I'd prefer some anxiety relief because it's really difficult right now.
Gabapentin is allowing me to tolerate it more thankfully.
Valium does help too. More than usual. Of course my anxiety is much much much stronger than usual. I wonder if Anafranil is thus effecting my valium in any way? Because this dysphoric feeling is a bit similar to when I tried withdrawing from valium and everything became really dark. But the thing is 2 weeks ago I was at 2.5mg and then been on 2mg ever since. It's been a bad few weeks but not horrendous. It did not become this bad until Anafranil. Anxiety this morning was absolutely fierce.
>
> What is your target dose and how fast are you planning to get there?
>
> /tensor
>
>
Posted by tensor on March 27, 2013, at 13:48:29
In reply to Does it interact w my valium?, posted by alexcanada on March 27, 2013, at 13:30:54
>
> 30mg or possibly more would be my target dose. Low doses usually work best for me since I'm very med sensitive. Paxil 9mg for instance was about the ideal dose for me.
>
> I am considering starting 20mg tonight and perhaps staying there for a while before trying 30mg. Though if there is some noticable improvement or reduction in anxiety symptoms then I may move up quicker. It's hard to tell because I don't know how I will feel tomorrow.
>
> I am hoping that the medication behaves differently at higher doses. Kind of like how Remeron was very sedating for me at 10mg but more activating at 40mg. Except in this case I'd prefer some anxiety relief because it's really difficult right now.
>
> Gabapentin is allowing me to tolerate it more thankfully.
>
> Valium does help too. More than usual. Of course my anxiety is much much much stronger than usual. I wonder if Anafranil is thus effecting my valium in any way? Because this dysphoric feeling is a bit similar to when I tried withdrawing from valium and everything became really dark. But the thing is 2 weeks ago I was at 2.5mg and then been on 2mg ever since. It's been a bad few weeks but not horrendous. It did not become this bad until Anafranil. Anxiety this morning was absolutely fierce.
>I would use the diazepam until clomipramine kicks in. Not unusual to feel worse when beginning a new med.
/tensor
Posted by jono_in_adelaide on March 27, 2013, at 19:04:52
In reply to Re: Does it interact w my valium? » alexcanada, posted by tensor on March 27, 2013, at 13:48:29
The only interaction between anafranil and valium would be increased sedation/drowsiness
30mg of Anafranil is a very low dose, i wouldnt give up on it till you have got upto 75mg for a good few weeks.
if the anxiety is bad, it might be worth asking if you can increase your valium for 1-2 weeks to get you over the start up period
Posted by alexcanada on March 28, 2013, at 18:37:43
In reply to Anafranil Day 1 is frightening!, posted by alexcanada on March 26, 2013, at 12:25:31
I raised dose to 20mg yesterday evening. Was only able to sleep for a few hours. Layed in bed for many hours afterwards and maybe was able to get a few more. Not sure. I don't recall falling asleep a 2nd time but I feel quite awake.The fierce anxiety though is the big issue. And this heavy feeling in my heart area. I'm not sure how to describe it. Also the world is darker. Very negative perspective. The anxiety is so severe that it's literally painful to be alive. This reminds me a bit of how I felt when my depression and anxiety all started.
I had to take gabapentin/neurotin to take some of the edge off. Now I am just pushing through it. The anxiety was extremely Severe prior to gaba. The valium also appears to do very little for whatever type of anxiety this is. It's just constantly there for no reason. Deep severe discomfort in my heart. Perhaps a sinking feeling? I don't know. Sounds can be bit frightening and startling.
I wonder what the Anafranil could be doing that is causing all this?
Maybe the norepinephrine is bad for me or the 3rd thing which Scott mentioned?
If I could cry I would but I can't. It just has kept getting worse and worse. Feel very dysphoric.
I didn't take my dose this evening so I assume tomorrow or soon after will be better. I'm thinking that I might be sensitive to any meds which are capable of causing anxiety so Lexapro might be a good candidate since I did respond to Paxil (lost effect). The Dep + GAD indications might make this a good choice. I am hoping at least.
The Anafranil just keeps making me worse and worse. I cannot imagine anyone living in a state like this for an extended period of time. I'll pull through though. Perhaps all TCAs are bad for me since I could not tolerate Desipramine and Nortriptiline either.
Posted by Phillipa on March 28, 2013, at 21:01:06
In reply to Day 3: Have to stop. Very painful anxiety! » alexcanada, posted by alexcanada on March 28, 2013, at 18:37:43
Can't take them either. I'd do the lexapro. Phillipa
Posted by jono_in_adelaide on April 1, 2013, at 19:31:22
In reply to Day 3: Have to stop. Very painful anxiety! » alexcanada, posted by alexcanada on March 28, 2013, at 18:37:43
Yeah, sounds like they dont suit you.
I'd go back to an SSRI or maybe Effexor, long with your Valium
This is the end of the thread.
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