Posted by silvercoin on July 31, 2006, at 12:47:24
In reply to Re: What would you do? EMSAM » silvercoin, posted by mayzee on July 31, 2006, at 11:02:54
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> I think laima also recommended Ritalin. Racer suggested Florinef. Have you used either of these yourself to increase blood pressure? (neither of my docs want to give me a drug to deal with the blood pressure, so I'd have to go to a different doc)
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> The 2 times I had my bp measured this week it was 80/60 & 80/42; not positive but I think my pulse was in the 80s.
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> I'm I right in thinking that all the MAOIs lower bp too? I didn't know that MAOIs usually lower heart rate. My pdoc told me that due to the low bp, my heart rate would be increased.
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> Todd, thanks so much for your input!!!
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> mayzee
I guess I would tend to question your doctors' unwillingness to help you with the low BP given that the EMSAM is helping with your depression, which is the whole point of this exercise. My impression is that they seem to be taking a dim view of MAOIs in general compared to tricyclics, which doesn't really make a lot of sense to me. There is a lot of hysteria over MAOI dietary restrictions, but the dietary restrictions in the prescribing directions at the EMSAM site are accurately spelled out and are also applicable to the other MAOIs. There are just not that many foods that are of any real concern.I've taken three different tricyclics and three different MAOIs, and my own experience is that tricyclics have much worse side effects than do MAOIs, particularly, constipation and dry mouth. Nortriptyline and desipramine are the two with the fewest side effects, but nortriptyline is a relatively sedating drug, while constipation, dry mouth, urinary hesitation, and tachycardia are all relatively common with desipramine; although, these effects are less severe than seen with most of the other tricyclics.
I have never taken anything to boost low BP while on either tricyclics or MAOIs, but it might have been wise in some instances, as I have come perilously close to fainting, particularly, the first time I was on Nardil. All of the MAOIs tend to lower both BP and heart rate, but this can vary. I'm not experiencing low BP on 50 mg Marplan, but my heart rate has declined from 60 to below 50, which occasionally causes problems. Tricyclics can either raise or lower BP, but it is probably more common to see a lowering, especially at higher dosages. I've experienced hypertension of 160/100 on a low dose of desipramine but then seen BP decline with escalating dosage and the passage of time down to perhaps 95/65. However, tricyclics do typically increase heart rate, and mine was very commonly 90-110 on both desipramine and Vivactil; although, I cannot say that this caused me any ill effects personally.
My own opinion is that MAOIs are superior antidepressants to tricyclics, and with the exception of hypotension and insomnia, they also have fewer side effects. I would suggest seeing if you cannot exert some pressure on your doctors to help you make a go of it on the EMSAM.
Todd
poster:silvercoin
thread:672050
URL: http://www.dr-bob.org/babble/20060724/msgs/672300.html