Psycho-Babble Medication Thread 532192

Shown: posts 12 to 36 of 49. Go back in thread:

 

Re: Can stopping a TCA cause palpitations? KaraS

Posted by ed_uk on July 24, 2005, at 8:41:56

In reply to Re: Can stopping a TCA cause palpitations? ed_uk, posted by KaraS on July 23, 2005, at 20:14:38

Hi Kara,

Perhaps it would be useful to have an ECG when you're having palpitations.

I can see why doxepin + dex is worrying, especially given your previous experience with tachy on nortriptyline and your current palpitations. On the other hand, low doses of doxepin probably don't have much effect on the reuptake of norepinephrine. AFAIK, your pulse is normal on doxepin whereas it was elevated on nortriptyline. Nortriptyline is a potent norepi reuptake inhibitor whereas doxepin is not.

If you did decide to combine doxepin with dex, it would be wise to initiate dex at a very low dose and to increase the dose in small steps every few days. You could take 1.25mg as a test dose.

Ed x

 

Re: Can stopping a TCA cause palpitations?

Posted by med_empowered on July 24, 2005, at 12:31:54

In reply to Re: Can stopping a TCA cause palpitations? KaraS, posted by ed_uk on July 24, 2005, at 8:41:56

hey! In response to Ed_UK's question about librium vs. valium....they're really similar, but Librium is nice for nite time anxiety. I always took it in 25mgs tablets, whereas I've taken valium in a range of 5 to 10mgs at a time. Anyway. for me the Librium had a more sedating effect and a bigger effect on tension headaches (thank god) which made it awesome for nite time use.

 

Re: Can stopping a TCA cause palpitations? med_empowered

Posted by KaraS on July 24, 2005, at 14:52:46

In reply to Re: Can stopping a TCA cause palpitations?, posted by med_empowered on July 24, 2005, at 1:48:10

> hey! Yeah, TCA's + stimulants= trouble. In some cases, its good short term; they tend to play off one another, so in cases of depression accompanied by extreme fatigue and what not, the combo can be kinda of beneficial, but its really only helpful b/c the combo kicks in so fast. Benzos+stimulants CAN be tricky; you run the risk of overstimulating, oversedating, or generally overmedicating. But, if you look back historically, one of the first "antidepressants" was Dexamyl, a one-pill combo of Dexedrine and Amobarbital. The idea was that the two meds, when combined, would last about the same amount of time in the system, and that the the two seemingly contradictory meds ("upper" and "downer") would play off one another, compelementing one another. It sounds ridiculous today, but Dexamyl hit the market in the 40s, I believe, and stuck around until the 70s. It appears that some people managed to get very impressive, fast relief without becoming addicted (the addictive potential of barbiturates, and later benzodiazpenes, was way overhyped). ANYWAY, my point is you can balance it out. Personally, I wouldn't do Klonpin with a stimulant; the chances of over-sedation and worsening the mood are a little too high. I think Tranxene would be a good idea; Librium and Valium could work well, also. As for Xanax...its an odd drug. On the one hand, its amazing for panic attacks, and it can be really helpful in some cases of depression. On the other hand..there are more psychotic reactions to xanax reported than for the other BZDs, even when you account for the relative popularity of the meds and the patient populations to whom they are prescribed (i.e, Klonopin and Ativan are commonly RX'd to those with bipolar, schizophrenia, and schizoaffective, so there will be more psychotic episodes in that group than in some others). Based on my own experiences, I prefer something that works a little more "in the background" than xanax, which seems to kind of take over my whole brain somehow. To that end, I prefer Ativan for short-acting BZDs, and Tranxene or Librium for longer-acting ones. When I need a BZD for sleep, I like to either use Ativan or Restoril.


Thanks. I intend to be very careful. I think the Klonopin was chosen because I probably have a soft bipolar condition.

k


 

Re: Can stopping a TCA cause palpitations? ed_uk

Posted by KaraS on July 24, 2005, at 15:15:35

In reply to Re: Can stopping a TCA cause palpitations? KaraS, posted by ed_uk on July 24, 2005, at 5:31:24

> Hi Kara,
>
> >TCAs are contraindicated with stimulants aren't they?
>
> Hmm, well......... Here's what I'd want to do if I were you, which I'm not LOL, but anyway.......
>
> 1. Find the minimum dose of doxepin which is effective for your anxiety eg. 20mg/day or whatever.
>
> 2. Monitor your pulse and blood pressure to obtain a baseline.
>
> 3. Start Dexedrine at a very low dose. Monitor your pulse and BP regularly to monitor for changes.
>
> 3. Increase the Dexedrine dose in small steps until relief is obtained.
>
> 4. Carefully monitor pulse and BP after each dose increase. Keep a record. Agree a maximum acceptable BP. If your BP exceeds the maximum, consult your doctor.
>
> >It's fairly dirty, as we know.
>
> I thought it was excellent in treating your anxiety with minimum side effects?
>
> >I have mixed feelings about getting on the clonazepam. I am worried that it might add to my depression and that even a short trial could result in a long tapering period.
>
> Clonazepam also concerns me. I find it a little odd that your doc is so keen to abandon the doxepin when it's working for your anxiety.
>
> >I think he feels that the clonazepam will also add some mood stabilization that might be good for me.
>
> Hmmm
>
> Ed xxx
>
> >


Hi Ed,

I've already stopped the doxepin. I do know that I can function on 12.5 mg. but 25 mg. is a more complete fix for the anxiety problem. I think that Dr. E. thinks I may need to go up a ways on the dexedrine and so doesn't want me on doxepin. Also, I think that he is very concerned with finding the cleanest solutions that don't hit other receptors that I don't need to have involved. He always thinks in terms of how this will affect the brain scans. It's hard to describe because he works differently than other pdocs.

I think I should probably get a blood pressure monitor anyway because of the dexedrine. That way if I were to decide to add doxepin back in for any reason, then I could follow your advice above.

The doxepin does work well for me but not without side effects. I'm a little bit groggy on it and it does dumb me down a bit. It's not great for memory either. I love it because it enables me to function and I can go on it and off of it so quickly without a problem but I think a better solution might exist.

I was going to start on the Klonopin last night but chickened out. I'm worried that it won't be good for me - that it will make me too groggy and add to the depression. I develop dependence quickly so I'm thinking that a short trial of even a week or two could leave me with 9 months of tapering and increased anxiety and depression because of that. I was hoping that if this didn't work out that he could switch me to Xanax. At least with that one I could have more of an antidepressant effect but Dr. E. doesn't like Xanax. He says it's too stimulating. I'm sure that has to do with how he sees it's effects on the brain scans.

I wish I weren't so neurotic and could just easily follow the doctor's orders!! Why do I have to agonize so much over new medications????

K
xxxx

 

Re: Can stopping a TCA cause palpitations? KaraS

Posted by ed_uk on July 24, 2005, at 16:20:06

In reply to Re: Can stopping a TCA cause palpitations? ed_uk, posted by KaraS on July 24, 2005, at 15:15:35

Hi K :-)

> I'm a little bit groggy on it and it does dumb me down a bit. It's not great for memory either.

Even at 12.5mg? I was thinking you could try a few different doses eg. 20mg etc. You could divide the 10mg capsules to adjust the dose. Dexedrine might reduce the groggyness (sp). Perhaps you could try a less anticholinergic TCA - less memory problems.

>I love it because it enables me to function and I can go on it and off of it so quickly without a problem.......

But that's great! Clonazepam can be difficult to d/c. Although clonazepam can be very effective for anxiety, you're already taking a drug which is very effective for your anxiety. I suppose I'm just concerned that clonazepam might not be necessary. Clonazepam affects memory - just like doxepin. Clonazepam might make you groggy - just like doxepin. In addition, you haven't developed tolerance to the doxepin :-)

>I think that Dr. E. thinks I may need to go up a ways on the dexedrine and so doesn't want me on doxepin.

Say you were on 20mg doxepin..... I doubt it would interact with Dexedrine at all. It is possible though, so you'd need to be cautious.

>At least with that one I could have more of an antidepressant effect but Dr. E. doesn't like Xanax. He says it's too stimulating. I'm sure that has to do with how he sees it's effects on the brain scans.

It certainly didn't stimulate me, it put me to sleep!

>I develop dependence quickly so I'm thinking that a short trial of even a week or two could leave me with 9 months of tapering and increased anxiety and depression because of that.

That's very unlikely. One week *on an adequate dose* should be long enough to find out whether it helps. Some benefit is likely after the first dose. If a given dose hasn't helped after two weeks, it never will. If clonazepam is not effective or tolerable, the trial should be limited to 4 weeks, including tapering, this will minimise the risk of w/d symptoms.

>I was going to start on the Klonopin last night but chickened out.

Don't be scared :-) You won't get dependent after a few doses. If it affects you badly during the first few days, you can decide where to go from there. You could continue clonazepam to see whether the side effects subside or you could return to doxepin. If the side effects haven't subsided after a couple of weeks it might be best to return to doxepin - continuing clonazepam for longer might make w/d difficult, which certainly isn't what you want if you're having side effects!

Kind regards

Ed xxx

 

Re: Can stopping a TCA cause palpitations? KaraS

Posted by ed_uk on July 24, 2005, at 16:59:39

In reply to Re: Can stopping a TCA cause palpitations? ed_uk, posted by KaraS on July 24, 2005, at 15:15:35

>I develop dependence quickly.......

Withdrawal symptoms are definitely the major concern, all other side effects can be dealt with by d/cing the Klonopin.......which can be difficult due to withdrawal symptoms........

Although long term benzodiazepine treatment can be effective for some patients with chronic severe anxiety, you've already found a treatment which is very effective for your anxiety :-) Doxepin is causing you some side effects..... but clonazepam can cause side effects too. I don't doubt that clonazepam is likely to be effective :-)

I wouldn't be concerned about taking the first few doses of clonazepam........ the difficult decisions arise after you've been on clonazepam for a couple of weeks. Do you continue?

If I was in your position, I'd probably try taking 3/4 of a 25mg doxepin pill. Buying a BP monitor before starting Dexedrine is an excellent idea.

Kind regards

Ed xoxo

 

Re: Can stopping a TCA cause palpitations? med_empowered

Posted by Phillipa on July 24, 2005, at 19:21:05

In reply to Re: Can stopping a TCA cause palpitations?, posted by med_empowered on July 24, 2005, at 1:48:10

Med_empowered PLEASE I beg answer me. In the 70's, when I had my first panic attack a pdoc[who later lost his license as he had meds in his desk drawer and used to hand them out]prescribed a med for me that he referred to as an upper-downer. I always thought it would have been a TCA. I never knew the name as the first time I took it I was up all night crying walking around the block with my then husband. I never took it again. But do you think it could have been Dexamyl? I was so young 22 at the time and didn't know anything about medications. It's really important for me to know as I've always stayed away from TCA's thinking it was one of them. But when you said upper-downer that's exactly what that doc called the med. Please I beg of you help me solve this mystery as it's kept me from taking TCA's again. Thanks, Phillipa

 

Re: Can stopping a TCA cause palpitations? ed_uk

Posted by Phillipa on July 24, 2005, at 19:36:24

In reply to Re: Can stopping a TCA cause palpitations? KaraS, posted by ed_uk on July 24, 2005, at 16:20:06

Ed, so xanax made you tired like it did to me in the end? Wow I guess my anxiety was really high when it didn't do this. Fondly, PJ O

 

Re: Can stopping a TCA cause palpitations? KaraS

Posted by 4WD on July 24, 2005, at 22:54:43

In reply to Can stopping a TCA cause palpitations?, posted by KaraS on July 23, 2005, at 14:49:47

> I have posted a few messages here over the past couple of months about my having heart palpitations. I may have mentioned that when I'm on a small amount of doxepin, I don't have or notice the palpitations. I thought that maybe the doxepin ironically provided some kind of buffer against them. Ed said that it was entirely possible. Now, however, I found out that a friend of mine has just gone off of a TCA and she started having palpitations as well. I am wondering if our bodies don't adjust to the TCA and then are thrown out of balance when we stop the TCA, therefore causing the palpitations. It just seems too coincidental that another person, who normally does not have any palpitations or history of heart problems, should also experience these palpitations upon discontinuing a tricyclic.
> Does this make sense to anyone else?
>
>
> K
>


Kara,

I found that when I started meds (among them were Prozac, Celexa and imipramine) or increased or reduced dosage, I was prone to palpitations. They subsided as I adjusted to the drug or the different dosage.

Marsha

 

Re: Can stopping a TCA cause palpitations? 4WD

Posted by KaraS on July 25, 2005, at 0:41:23

In reply to Re: Can stopping a TCA cause palpitations? KaraS, posted by 4WD on July 24, 2005, at 22:54:43


> Kara,
>
> I found that when I started meds (among them were Prozac, Celexa and imipramine) or increased or reduced dosage, I was prone to palpitations. They subsided as I adjusted to the drug or the different dosage.
>
> Marsha


Now that you and my other friend have had similar experiences as me, I'm not at all concerned about the palpitations. They definitely subside when I adjust to a drug or adjust to being off of it.
Thanks!

K


 

Re: Can stopping a TCA cause palpitations? ed_uk

Posted by KaraS on July 25, 2005, at 2:01:15

In reply to Re: Can stopping a TCA cause palpitations? KaraS, posted by ed_uk on July 24, 2005, at 16:20:06

Hi Ed,

> > I'm a little bit groggy on it and it does dumb me down a bit. It's not great for memory either.
>
> Even at 12.5mg? I was thinking you could try a few different doses eg. 20mg etc. You could divide the 10mg capsules to adjust the dose. Dexedrine might reduce the groggyness (sp). Perhaps you could try a less anticholinergic TCA - less memory problems.

I don't know if groggy is the right word as I'm not tired from it just a little slowed down. I could try to find out what the perfect dose of doxepin is for me for the anxiety. I could try two 10 mg. capsules. (My mood also goes up as dose increases which is something to take into account.) The other TCAs that aren't as anticholinergic, give me tachycardia. I used to be able to take 25 mg. of maprotiline. It also helped immensely with less grogginess or slowness. Now, however, it gives me tachycardia also. It's possible that I'll try one of the other TCAs with a beta blocker in the future - probably desipramine as that's on Dr. E's list for me.



> >I love it because it enables me to function and I can go on it and off of it so quickly without a problem.......
>
> But that's great! Clonazepam can be difficult to d/c. Although clonazepam can be very effective for anxiety, you're already taking a drug which is very effective for your anxiety. I suppose I'm just concerned that clonazepam might not be necessary. Clonazepam affects memory - just like doxepin. Clonazepam might make you groggy - just like doxepin. In addition, you haven't developed tolerance to the doxepin :-)


I understand and I share your concerns. Partly I think that Dr. E. just doesn't like doxepin. Also I think he feels that I could benefit from the mood stabilization effects of the Klonopin. I'm really torn about starting on it when my anxiety is already under control. It's been a wonderful medication for many people here but it's also caused more depression for others.


> >I think that Dr. E. thinks I may need to go up a ways on the dexedrine and so doesn't want me on doxepin.
>
> Say you were on 20mg doxepin..... I doubt it would interact with Dexedrine at all. It is possible though, so you'd need to be cautious.


My pulse rate shoots up very quickly and stays there a while at the slightest provocation - either from something emotional or from medications so I think the combination may be more dangerous for me than for most. Also, I think he's hoping that the Klonopin will bring down the pusle rate from the dex.


> >At least with that one I could have more of an antidepressant effect but Dr. E. doesn't like Xanax. He says it's too stimulating. I'm sure that has to do with how he sees it's effects on the brain scans.
>
> It certainly didn't stimulate me, it put me to sleep!


I suppose he thinks of it like he does the SSRIs. He sees them as creating high voltage in the frontal lobe (but I could be wrong about the location in the brain). The way he thinks about things is quite different. He supposedly has good success rates with TRDs so maybe there's some validity to the way he looks at things. I feel that I've gained some valuable insights into my condition already from seeing him. I have been impressed by how quickly he diagnosed an attention deficit problem with me. So I want to go along with him here ... but I still have many doubts about the Klonopin for me.

> >I develop dependence quickly so I'm thinking that a short trial of even a week or two could leave me with 9 months of tapering and increased anxiety and depression because of that.
>
> That's very unlikely. One week *on an adequate dose* should be long enough to find out whether it helps. Some benefit is likely after the first dose. If a given dose hasn't helped after two weeks, it never will. If clonazepam is not effective or tolerable, the trial should be limited to 4 weeks, including tapering, this will minimise the risk of w/d symptoms.


I read in the archives about a couple of people who said that the apathy/depression set in on the K for them around the 4 week mark. If that were to happen to me, then I'd already be on it long enough to have a sustained tapering, don't you think?


> >I was going to start on the Klonopin last night but chickened out.
>
> Don't be scared :-) You won't get dependent after a few doses. If it affects you badly during the first few days, you can decide where to go from there. You could continue clonazepam to see whether the side effects subside or you could return to doxepin. If the side effects haven't subsided after a couple of weeks it might be best to return to doxepin - continuing clonazepam for longer might make w/d difficult, which certainly isn't what you want if you're having side effects!

I took Ativan for three weeks at night to sleep many years ago. Then I stopped it abruptly and all hell broke loose. I didn't think I had taken it long enough to have a problem. Since then I've been a benzophobe. Fortunately then I was able to start on doxepin and taper off of the Ativan very slowly.

Here's the scenario that I'm most concerned about. I need to stop the K and I'm already on the dex. I may not be able to take doxepin in order to stop the K (because of the dex), then how would I cope with the anxiety????? I could stop the dex and start on doxepin but imagine the depression from stopping both of them. I can't even fathom it.

You're very kind to take the time to listen to me and answer all of my questions.

Big hug,
Kara

xxx

 

Re: Can stopping a TCA cause palpitations? Phillipa

Posted by ed_uk on July 25, 2005, at 16:08:09

In reply to Re: Can stopping a TCA cause palpitations? med_empowered, posted by Phillipa on July 24, 2005, at 19:21:05

Hi PJ,

If it made you very restless it might have contained an antipsychotic. It might have been amitriptyline/perphenazine.

~Ed xxx

 

Re: Can stopping a TCA cause palpitations? KaraS

Posted by ed_uk on July 25, 2005, at 16:29:43

In reply to Re: Can stopping a TCA cause palpitations? ed_uk, posted by KaraS on July 25, 2005, at 2:01:15

Hi K!

>I could try to find out what the perfect dose of doxepin is for me for the anxiety.

:-)

>My mood also goes up as dose increases which is something to take into account.......

What's the highest dose you've tried? How did it affect you?

>The other TCAs that aren't as anticholinergic, give me tachycardia.

Anticholinergic drugs *cause* tachycardia. The reason low-dose doxepin doesn't cause much tachycardia is because it's only a 'weak' norepinephrine reuptake inhibitor. It's also quite sedating.

Btw, trimipramine (Surmontil) is a strange TCA which doesn't inhibit the reuptake of anything! Larry Hoover takes it.

>Also I think he feels that I could benefit from the mood stabilization effects of the Klonopin.

What does he mean by 'mood stabilization'? If it helped your depression that would be fantastic! Very high doses of clonazepam can be useful as an adjunct to other meds in the treatment of acute mania. I wouldn't really call clonazepam a mood stabiliser though.

Does your doc believe that Dex will improve your depression or just your ADD?

Am I right in thinking that he suggested Lamictal as an AD?

>My pulse rate shoots up very quickly and stays there a while at the slightest provocation - either from something emotional or from medications so I think the combination may be more dangerous for me than for most.

Perhaps........ but isn't your pulse actually quite low on doxepin?

>I read in the archives about a couple of people who said that the apathy/depression set in on the K for them around the 4 week mark.

Perhaps they increased the dose over the first few weeks?

>If that were to happen to me, then I'd already be on it long enough to have a sustained tapering, don't you think?

If you'd been on clonazepam for 4 weeks, I expect you'd need to taper over a few weeks or so. It might be quite unpleasant but I expect you'd make it!

>I took Ativan for three weeks at night to sleep many years ago. Then I stopped it abruptly and all hell broke loose.

Clonazepam's withdrawal symptoms are almost identical to those of Ativan. They should be somewhat less intense though, due to clonazepam's longer half-life.

>Fortunately then I was able to start on doxepin and taper off of the Ativan very slowly.

Doxepin could help you get off clonazepam too.

>I may not be able to take doxepin in order to stop the K (because of the dex), then how would I cope with the anxiety?????

You could always try Surmontil. It's anxiolytic like doxepin but it's not at all noradrenergic.

Ed xx

 

Re: Can stopping a TCA cause palpitations? Phillipa

Posted by Phillipa on July 25, 2005, at 18:22:54

In reply to Re: Can stopping a TCA cause palpitations? med_empowered, posted by Phillipa on July 24, 2005, at 19:21:05

Ed, I knew it! I thought it had to be a TCA. Amiltriptaline was popular then. Was the other drug/ the European version? Fondly, PJ O

 

hey Philiipa!

Posted by med_empowered on July 25, 2005, at 19:55:43

In reply to Re: Can stopping a TCA cause palpitations? Phillipa, posted by Phillipa on July 25, 2005, at 18:22:54

It certainly is quite possible that it was Triavil, the perphenazine+Elavil combo ed_uk wrote about. The other "combo" antidepressant was Limbitrol, librium+Elavil. The Triavil "idea" was to calm people down with the antipsychotic while treating the depression...I think the aim was to make people placid and happy. It was also used for psychotic depression, schizophrenia, and "agitated depression," which is now usually understood to be a bipolar mixed-state. It is possible that you were given Dexamyl...amphetamines were still really popular in the 1970s, and barbiturates were still being used a good bit. I dont think Dexamyl was taken off the market until the very late 70s, maybe sometime into the 1980s, so thats a possibility.

 

Re: hey Philiipa! med_empowered

Posted by Phillipa on July 25, 2005, at 21:47:03

In reply to hey Philiipa!, posted by med_empowered on July 25, 2005, at 19:55:43

Med, getting confused again! I always thought elavil sounded like an upper downer by it's name. So maybe TCA's are no no's for me? He finally gave me valium and meprobomate 450mg. He also was a believer of placidyl for sleep along with a good red, expensive wine. And he didn't have a problem with this when I was pregnant! I put myself into the hospital when my baby was sent to Yale University for failure to thrive and severe hyperactivity. I left the same day with dire threats by the nurses that I would develop seizures with abrupt withdrawal of meds. Well after thinking I was walking on a ship for two weeks, and lying on the couch all day. I allowed myself 5mg of valium and felt okay. The pdoc called and said I didn't need to see him anymore. I had an openended Rx for valium for years until one day they told me he had lost his license. I just don't have luck with picking good pdocs. Fondly, Phillipa

 

Re: hey Philiipa! Phillipa

Posted by KaraS on July 25, 2005, at 23:42:20

In reply to Re: hey Philiipa! med_empowered, posted by Phillipa on July 25, 2005, at 21:47:03

> Med, getting confused again! I always thought elavil sounded like an upper downer by it's name. So maybe TCA's are no no's for me? He finally gave me valium and meprobomate 450mg. He also was a believer of placidyl for sleep along with a good red, expensive wine. And he didn't have a problem with this when I was pregnant! I put myself into the hospital when my baby was sent to Yale University for failure to thrive and severe hyperactivity. I left the same day with dire threats by the nurses that I would develop seizures with abrupt withdrawal of meds. Well after thinking I was walking on a ship for two weeks, and lying on the couch all day. I allowed myself 5mg of valium and felt okay. The pdoc called and said I didn't need to see him anymore. I had an openended Rx for valium for years until one day they told me he had lost his license. I just don't have luck with picking good pdocs. Fondly, Phillipa


Phillipa,

It's hard to imagine Elavil (amitriptyline) causing anxiety. It's one of them most sedating drugs ever. My guess is that the offending agent was the other medication, perphenazine. Some of the other TCAs might cause some anxiety but amitriptyline and doxepin work incredibly well to prevent anxiety.

K

 

Re: Can stopping a TCA cause palpitations? ed_uk

Posted by KaraS on July 26, 2005, at 1:33:58

In reply to Re: Can stopping a TCA cause palpitations? KaraS, posted by ed_uk on July 25, 2005, at 16:29:43

Hi Ed!

>>My mood also goes up as dose increases which is something to take into account.......

>What's the highest dose you've tried? How did it affect you?

It was over 20 years ago so I don't remember all that well. I think the highest dose I took was 75 mg. It got me back on my feet and functioning again. I had the usual TCA side effects but nothing I couldn't manage at the time. I have no doubt that if I increased up to 75 mg. or more of the doxepin now that my mood wood lift. 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. It does seem like it slows me down a bit physically and mentally though.

>>The other TCAs that aren't as anticholinergic, give me tachycardia.

>Anticholinergic drugs *cause* tachycardia. The reason low-dose doxepin doesn't cause much tachycardia is because it's only a 'weak' norepinephrine reuptake inhibitor. It's also quite sedating.

Oh, ok. I think I've been told that but forgot it (maybe because I think of anticholinergics in terms of slowing me down mentally?). 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?

>Btw, trimipramine (Surmontil) is a strange TCA which doesn't inhibit the reuptake of anything! Larry Hoover takes it.

Well if Larry Hoover takes it, then it must be good! :-) Actually I've been curious about that one. It behaves more like an AP doesn't it?

>>Also I think he feels that I could benefit from the mood stabilization effects of the Klonopin.

>What does he mean by 'mood stabilization'? If it helped your depression that would be fantastic! Very high doses of clonazepam can be useful as an adjunct to other meds in the treatment of acute mania. I wouldn't really call clonazepam a mood stabiliser though.

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. I think he talked about it more in those terms rather than actually calling it a mood stabilizer.

>Does your doc believe that Dex will improve your depression or just your ADD?

He definitely believes that it can help with both the depression and the ADD. He doesn't think I need any serotonin - just NE or DA. I am inclined to agree with him somewhat because of my experience on the SSRIs. 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)? I'll have to ask him about that.

>Am I right in thinking that he suggested Lamictal as an AD?

Yes, Lamictal was also one of the things he thought would be good for me. I think he might want to add it in to the mix if necessary once I'm established on the K and the Dex. Actually he mentioned Lamictal or Topomax. He didn't mention Trileptal though - not sure if that was an oversight or intentional. I will ask him about that later.

>>My pulse rate shoots up very quickly and stays there a while at the slightest provocation - either from something emotional or from medications so I think the combination may be more dangerous for me than for most.

>Perhaps........ but isn't your pulse actually quite low on doxepin?

It is usually in the 70's. It can easily go up into the 80s though. With just a little bit of stress it goes up to the upper 80's and stays there a long time. 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?

>>I read in the archives about a couple of people who said that the apathy/depression set in on the K for them around the 4 week mark.

>Perhaps they increased the dose over the first few weeks?

That's a good point but there's a good chance I would be increasing the dose along the way as well, no?

>>If that were to happen to me, then I'd already be on it long enough to have a sustained tapering, don't you think?

>If you'd been on clonazepam for 4 weeks, I expect you'd need to taper over a few weeks or so. It might be quite unpleasant but I expect you'd make it!

The tapering of the Ativan wasn't that bad because of the doxepin and because I did it very slowly. In this case it would also mean losing many weeks of time in getting well that I wouldn't have needed to experience.

>>I took Ativan for three weeks at night to sleep many years ago. Then I stopped it abruptly and all hell broke loose.

>Clonazepam's withdrawal symptoms are almost identical to those of Ativan. They should be somewhat less intense though, due to clonazepam's longer half-life.

Good to know that it's at least a little less intense so I could probably go a little faster than I did with the Ativan. OTOH, I was only on a very small amount of Ativan to begin with.

>>Fortunately then I was able to start on doxepin and taper off of the Ativan very slowly.

>Doxepin could help you get off clonazepam too.

Yes, if I'm not on Dex. Maybe it makes sense to stay on the Klonopin for a good 4 weeks at required dosage before deciding whether to keep it and before even attempting to start on the Dex. That way I won't have the possibility of having to go off of two of them at or around the same time which could cumulatively have a really horrible effect on me. I'd also be certain I could use doxepin to rid me of the K. Does that make sense to you or am I being much too cautious and wasting time that could get me feeling better sooner?

>>I may not be able to take doxepin in order to stop the K (because of the dex), then how would I cope with the anxiety?????

You could always try Surmontil. It's anxiolytic like doxepin but it's not at all noradrenergic.

That's a really good idea! Does it not have the electrical conduction issues the other TCAs have? Would the DA antagonism be a problem at all? Does it have the risks of akathisia? I'm quite certain it has a very small risk of TD. In fact, it might be a good substitute for the Klonopin to begin with - although maybe the DA antagonism would be counterproductive?

Thanks again, Ed. Anyone ever tell you you're a peach? :-)

Kara

xxx

 

Re: hey Philiipa! KaraS

Posted by MidnightBlue on July 26, 2005, at 11:33:46

In reply to Re: hey Philiipa! Phillipa, posted by KaraS on July 25, 2005, at 23:42:20

I was very anxious on elavil. It made me feel jumpy and I had terrible pins and needle feelings in my arms and legs. I was trying to take it for migraine headaches. The doc put me on Triavil which I took for a while, but I didn't feel so good on it and it did NOT help my headaches. That was many years ago........

MB

 

Re: hey Philiipa! Phillipa

Posted by ed_uk on July 26, 2005, at 13:35:50

In reply to Re: hey Philiipa! med_empowered, posted by Phillipa on July 25, 2005, at 21:47:03

Hi!

I don't think it was amitriptyline. Amitriptyline doesn't usually cause anxiety. In fact, it often reduces anxiety.

I expect you were given a combination pill containing amitriptyline *and* perphenazine. Perphenazine can cause severe restlessness. What was the nature of your reaction to the 'upper downer'?

>So maybe TCA's are no no's for me?

No, I don't think so.

>Dexamyl

I doubt it was Dexamyl. Dexamyl contains a barbiturate and an amphetamine. The barbiturate is generally quite sedating. The amphetamine is a stimulant and appetite suppressant. I know you've taken 'diet pills' in the past and not reacted badly. 'Diet pills' are stimulants.

~ed

 

Re: Can stopping a TCA cause palpitations? KaraS

Posted by ed_uk on July 26, 2005, at 14:08:33

In reply to Re: Can stopping a TCA cause palpitations? ed_uk, posted by KaraS on July 26, 2005, at 1:33:58

Hi K!

>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.

>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.

>It behaves more like an AP doesn't it?

It's a very 'weak' dopamine antagonist. 'Weaker' than any of the antipsychotics AFAIK.

>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.

>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.

>Actually he mentioned Lamictal or Topomax.

I'd be inclined to try Lamictal first - due to it's known antidepressant properties.

>It is usually in the 70's.

Normal :-)

>It can easily go up into the 80s though.

Still normal :-)

>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.

>That's a good point but there's a good chance I would be increasing the dose along the way as well, no?

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

>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

>Does it not have the electrical conduction issues the other TCAs have?

Same as doxepin.

>Would the DA antagonism be a problem at all?

I think it's very unlikely. I expect you'd be taking a very low dose.

>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?

Ed xx

 

Re: hey Philiipa! ed_uk

Posted by Phillipa on July 26, 2005, at 14:29:14

In reply to Re: hey Philiipa! Phillipa, posted by ed_uk on July 26, 2005, at 13:35:50

Ed, When I was 22 I took something OBGYN said would help me lose wt,so I guess they were diet pills. Now I know they were stimulants but at the time I didn't. I also didn't have a problem with anxiety. That came about 2 years later so I guess I was 24. But the diet pills I only took every other day and couldn't sit still. At the end of 30day rx I was starting to have trouble sleeping. Never a problem then. The other med that was an upper-downer I only took once the side effects were so horrible. I don't remember all of it it was so long ago. I've just always wanted to know what that pill was. See the valium and mephrobomate did the trick at the time. And I've lived a life so full of stress that I don't think the average person could take it. So now after all these years i wonder why I don't react to meds. I just live in fear. Fondly, PJ O

 

Re: Elavil MidnightBlue

Posted by KaraS on July 26, 2005, at 15:25:34

In reply to Re: hey Philiipa! KaraS, posted by MidnightBlue on July 26, 2005, at 11:33:46

> I was very anxious on elavil. It made me feel jumpy and I had terrible pins and needle feelings in my arms and legs. I was trying to take it for migraine headaches. The doc put me on Triavil which I took for a while, but I didn't feel so good on it and it did NOT help my headaches. That was many years ago........
>
> MB


No kidding! You're the first person I've ever heard of who was anxious on Elavil. I guess we can just never know how we're going to react!

K

 

Re: Elavil KaraS

Posted by ed_uk on July 28, 2005, at 17:30:20

In reply to Re: Elavil MidnightBlue, posted by KaraS on July 26, 2005, at 15:25:34

Hi K!

Did you see my post to you above?

Ed xxx

 

Re: Elavil ed_uk

Posted by KaraS on July 28, 2005, at 22:27:46

In reply to Re: Elavil KaraS, posted by ed_uk on July 28, 2005, at 17:30:20

> Hi K!
>
> Did you see my post to you above?
>
> Ed xxx


You mean the one where you called me a peach?

k


Go forward in thread:


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] Dr. Bob is Robert Hsiung, MD, bob@dr-bob.org

Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.