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Re: Ed, you must have been referring to this post. ed_uk

Posted by KaraS on July 28, 2005, at 23:55:47

In reply to Re: Can stopping a TCA cause palpitations? KaraS, posted by ed_uk on July 26, 2005, at 14:08:33

> Hi Ed!

I did read this one but I forgot to respond. Sorry.

> >It might not be very good for my ADD ... but if it isn't that anticholinergic (as you say below), then maybe it wouldn't be that bad.
> Doxepin actually is quite anticholinergic. I was just saying that it's unlikely to cause as much tachycardia as nortriptyline because it's only a 'weak' NE reuptake inhibitor.

Ok. I understand.

> >I probably have this wrong but I thought that desipramine wasn't supposed to be very anticholinergic... yet it's most likely of all of the TCAs to cause tachycardia?
> Norepinephrine reuptake inhibition is probably the major cause of TCA-induced tachycardia. Although desipramine is only weakly anticholinergic, it's a very potent NE reuptake inhibitor.

Yes, I thought the NE reuptake was responsible for the tachycardia. I got confused above when I thought you were saying that the anticholinergic effects were causing the tachycardia.

> >It behaves more like an AP doesn't it?
> It's a very 'weak' dopamine antagonist. 'Weaker' than any of the antipsychotics AFAIK.

I wonder if it would be an ok med to take for someone who is very low dopamine to begin with.
Maybe it's too weak to make any kind of a difference. OTOH, if it's that weak why would it be used as an AP?

> >I can't say for sure but I think he's thinking that it might help my depression because of it's mild mood stabilization properties.
> Japanese psychiatrists believe that clonazepam can be used to augment an antidepressant. I'm not convinced though. IMO, it's just an anxiolytic.

Besides, fish oil has mild mood stabilizing properties too. I could take that instead.

> >Yet, how would he explain that doxepin lifts my mood as well as Effexor at only 75-150 mg. (with minimal NE in that range)?
> Perhaps a little bit of NE reuptake inhibition is all you need to lift you depression? Desipramine or nortriptyline might be helpful at a very low dose. I guess you could take doxepin 20mg + a little bit of desipramine.

I was on that combo many years ago. It wasn't enough unfortunately. The scary part was that when I took that first desipramine pill, my heart felt like it was going to leap out of my chest. I thought for sure I was having a heart attack. The following days when I would take the desipramine I didn't have that happen. I still had tachycardia but not that initial horrible feeling. Isn't that weird?

> >Actually he mentioned Lamictal or Topomax.
> I'd be inclined to try Lamictal first - due to it's known antidepressant properties.

I'll have to see if he just mentioned those two as an example of meds that could provide mood stabilization or if he only meant those two. I'd prefer to try lithium orotate or even small amounts of lithium carbonate. Lamictal and trileptal are so expensive here if you don't have health insurance plus if I did get SJ, then I'd probably need to be hospitalized. That would end up putting me in so much debt. I'd never be able to recover from it.

> >It is usually in the 70's.
> Normal :-)


> >It can easily go up into the 80s though.
> Still normal :-)

High side of normal perhaps. Dr. E. wanted to put me on a beta blocker because he thought that was my normal rate. He claims he has had success using them to stop some people's anxiety and that is has stopped their depression as well.

> >BTW, I know that Dex can cause increased blood pressure. Does it (and other meds) do this directly or do they do it by increasing the pulse rate?
> It's partly because it's a vasoconstrictor. When the blood vessels are narrower (due to muscle contraction of the blood vessel wall) the pressure increases.

Makes sense. Thanks. Beta blockers are vasoconstrictors too, right?

> You could increase the dose every 7 days or so - just a suggestion.

Right now I've only taken that one quarter of a .5 mg. pill of Klonopin one time. It grogged me out for 3-4 days. I'm only now starting to feel not drugged. I did take it with 6 mg. of doxepin though, but still. I'll try it again tonight without the doxepin. I've taken Valium, Xanax and Ativan before without a problem. I expected that this might make me a little bit groggy, but not this much. It's tough because I live alone and there's no one to take care of me. I have to do my own grocery shopping and drive myself to take care of other things. I can't be grogged out for weeks while I build up on this stuff.

> >Does that make sense to you or am I being much too cautious and wasting time that could get me feeling better sooner?
> Well....... you definitely need to start clonazepam and doxepin several weeks apart. You need to be able to fully evaluate the effect of each medication. If you start them at the same time you won't know what's doing what! Too confusing :-S

Agreed. (I'm assuming you meant Dex instead of doxepin above.)

> >Does it not have the electrical conduction issues the other TCAs have?
> Same as doxepin.

Then the point of switching to trimipramine would be because of less NE reuptake?

> >Does it have the risks of akathisia?
> Perhaps a very low risk.....
> >In fact, it might be a good substitute for the Klonopin to begin with - although maybe the DA antagonism would be counterproductive?
> To help you withdraw from clonazepam while still taking Dex?

So you're saying that it's not a good substitute for the Klonopin now but rather just something to keep in mind if I'm on the Dex and wanting to withdraw from the Klonopin?





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