![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 47. This is the beginning of the thread.
Posted by borderliner21 on January 19, 2002, at 19:00:25
I need an anti-depressant badly. Although the ssris are very effective, I am intolerant to them now.(akatesia, dystonia, rash)
Does anafranil sound like the next choice for me?
Posted by TSA West on January 19, 2002, at 22:23:11
In reply to Are tricylics safer than ssris?, posted by borderliner21 on January 19, 2002, at 19:00:25
I think that venlafaxine or mirtazapine would be next, according to the Harvard Depression Algorithm (http://www.mhc.com/Algorithms/Depression). They have a more benign side-effect profile than Anafranil does. If all you can afford is a tricyclic, then definitely choose desipramine (Norpramin, others).
Have a wonderful night,
TSA West
Posted by nightlight on January 20, 2002, at 11:18:35
In reply to Are tricylics safer than ssris?, posted by borderliner21 on January 19, 2002, at 19:00:25
> I need an anti-depressant badly. Although the ssris are very effective, I am intolerant to them now.(akatesia, dystonia, rash)
> Does anafranil sound like the next choice for me?BL~
No, I believe they carry more health risks (possible cardiac complications)HAVE SOME MISERABLE SIDE-EFFECTS (sorry-caps) and are potentially lethal in overdose. It is quite difficult to OD on SSRI's & that is a big motivator for the docs to prescribe them (understandably).When I used Desipramine for sev'l months, I developed the dryest mouth possibe-constantly felt like i had hang-over cotton-mouth, no matter how much water I drank. It also gave me an intense craving for sweets, s/t I have never had before. I thought ice cream bingers and chocoholics were a little loopy-they needed that fix! My girlfriends always needed desert after our dinners out, while I preferred a low-cal white wine. *That* was before A-D's.
Now, I'm the ice cream addict-and it must be vanilla with hot fudge sauce-and I want it everyday!
The sweets, combined with the dry mouth, led me to major dental woes, a work still in progress. & the tricyc's did nada for my depression.But, that's just me. I've yet to find the exact combo for me. I'm on Effexor right now, only a couple of months, titrating slowly. I'm at 112.5 mgs daily and no insufferable side-effects, as yet.
Remeron was a pleasant experience for me-worked great on sleep-& relieved anxiety symptoms I wasn't even aware should be addressed! I thought that raw-nerved sensitivity was just a nasty personality trait. HA! I took 30 mgs. an hr. b/f sleep (I like to read a bit in bed before lights out). Then off to beautiful dreamland, & I suffered no daytime grogginess. But, it did nada for my depression and i have never been so hungry in my entire life. I was already 20 lbs. overweight & cd. not afford to gain more on a med that didn't address my core symptoms.Good luck-don't mean to sway you-just my personal experiences-You might consider Wellbutrin, as well.It treated me kindly, but was a quick burn-out.
Do some research, consult ur doc...
nightlight
Posted by jimmygold70 on January 20, 2002, at 12:52:05
In reply to Are tricylics safer than ssris?, posted by borderliner21 on January 19, 2002, at 19:00:25
Why not ?
Posted by Mr. Scott on January 20, 2002, at 13:30:31
In reply to Are tricylics safer than ssris?, posted by borderliner21 on January 19, 2002, at 19:00:25
Safer? Hell no! Have you tried all the SSRI's?
Prozac
Zoloft
Celexa
Paxil
Luvox
Effexor
Posted by borderliner21 on January 20, 2002, at 14:58:42
In reply to Re: Are tricylics safer than ssris? » borderliner21, posted by Mr. Scott on January 20, 2002, at 13:30:31
Just paxil and prozac. I heard celexa and very selective(no action on dopamine). DOes this mean it is less likely to cause akathesia and dystonia than paxil?(paxil blocks some dopamine, correct me if I'm wrong)
Posted by spike4848 on January 20, 2002, at 16:13:29
In reply to Re: Are tricylics safer than ssris? » borderliner21, posted by Mr. Scott on January 20, 2002, at 13:30:31
> Safer? Hell no! Have you tried all the SSRI's?
>
> Prozac
> Zoloft
> Celexa
> Paxil
> Luvox
> EffexorHey There,
That is a pretty resounding no. For me, I felt the tricyclics were much easier to tolerate than the SSRIs. On desipramine or pamelor I had:
Dry mouth ..... so I chewed gum and this stopped after a month or two
Sedation .... great-finally sleeping for the first time in years
Weight gain ..... I needed an extra 5 lbs anywayWith SSRIs I experienced .....
Insomnia .... pure torture and thus I needed second med for sleep
Sexual Dysfunction .... that made me depressed more .... it alway took a toll on my relationships
Persistant Nausea .... pure torture again, can't enjoy food or nice night out at a restaurant
As far as long term side effects, we have use tricyclic for years with no known long term adverse effects. And there studies to show TCA are safe on the heart. With SSRIs .... who knows? We do know that similar drugs that raise serotonin levels may cause primary pulmonary hypertension and cardiac valve defects.Unfornuately .... companies pushing SSRI downplay the fact that many people on ssri's are suffer from nausea, impotency, insomnia!
So my vote is for tertiary TCA!
Spike
Posted by Mr. Scott on January 20, 2002, at 16:33:40
In reply to Re: Are tricylics safer than ssris? » Mr. Scott, posted by spike4848 on January 20, 2002, at 16:13:29
Point taken Spike!
Posted by Mr. Scott on January 20, 2002, at 16:36:54
In reply to Re: Are tricylics safer than ssris?, posted by borderliner21 on January 20, 2002, at 14:58:42
Zoloft actually has the greatest effect on increasing Dopamine.. I had dystonia from it REAL BAD. Prozac gave me akathesia at doses above 20mg.
I think it's worth trying Celexa and certainly Effexor, before moving on to Anafranil.
Scott
Posted by OldSchool on January 20, 2002, at 17:38:04
In reply to Are tricylics safer than ssris?, posted by borderliner21 on January 19, 2002, at 19:00:25
> I need an anti-depressant badly. Although the ssris are very effective, I am intolerant to them now.(akatesia, dystonia, rash)
> Does anafranil sound like the next choice for me?You shouldnt be getting dystonia from SSRIs. Akathesia is rather common on SSRIs though and I find that this is just an early adjustment side effect of SSRIs that goes away after a few weeks. If you are getting dystonia from SSRIs, you need to tell your doctors this. Thats not normal. Rash isnt normal for SSRIs either. Somethings not right here. Tell your doctor this stuff.
Tricyclics are more sedating and are less likely to cause akathesia. Also tricyclics have anti-cholinergic side effects and that can help combat akathesia and dystonia.
Old School
Posted by Chloe on January 20, 2002, at 20:03:42
In reply to Re: Are tricylics safer than ssris?, posted by borderliner21 on January 20, 2002, at 14:58:42
Borderliner,
I am very med sensitive. So, I use a little SSRI and a little TCA. I can only tolerate 2 mgs of Celexa or I feel anxious, irritable and have insomnia. But without Celexa, I don't have that "spark" that helps me feel (some what!) positive.Then at night, I take 10-20 mgs of amytriptyline, a rather sedating TCA. I love it! The low dose doesn't really give me any off the typical problems with dry mouth, daytime sedation etc. It reduces anxiety and I finally can sleep at night.
So, IMHO, I think one can get benefit from a subtherapuetic dose of both classes of AD's
Good luck
Chloe
Posted by Elizabeth on January 23, 2002, at 13:53:44
In reply to Are tricylics safer than ssris?, posted by borderliner21 on January 19, 2002, at 19:00:25
> I need an anti-depressant badly. Although the ssris are very effective, I am intolerant to them now.(akatesia, dystonia, rash)
> Does anafranil sound like the next choice for me?Anafranil has some pretty bad side effects -- I'd avoid it if you can. Also, although this may not apply to Anafranil, there's evidence that at least some of the TCAs can make BPD symptoms worse. I think that Effexor or Wellbutrin is a better choice. Anticonvulsants might be helpful for you, too.
Can you describe your reaction to the SSRIs that made you stop taking them? Did it happen with both Paxil and Prozac? I think it might be worthwhile for you to try a different SSRI (or Effexor, which acts mostly like an SSRI at lower doses), since they worked so well -- or an SSRI in combination with other medication (e.g., benztropine (Cogentin), propranolol, Klonopin) to relieve the extrapyramidal side effects (if that's what they were).
It really isn't easy to predict what side effects a particular person will have from a particular drug, and maybe Anafranil would be right for you. Then again, maybe a different SSRI (Zoloft, Luvox, Celexa) would help you without causing intolerable side effects. I'd probably wait on trying Anafranil, if I were in your situation.
-elizabeth
Posted by Elizabeth on January 23, 2002, at 14:11:50
In reply to Re: Are tricylics safer than ssris? » Mr. Scott, posted by spike4848 on January 20, 2002, at 16:13:29
> As far as long term side effects, we have use tricyclic for years with no known long term adverse effects. And there studies to show TCA are safe on the heart.
Depends what you mean. They can cause cardiac arrhythmias (this is well known), especially in overdose. For a person who's seriously suicidal, this can be an important issue. There are also plenty of people who don't metabolize TCAs normally. For these people, taking a normal therapeutic dose of a TCA will result in abnormally high serum levels. This can have serious consequences. (I had a seizure on desipramine, and my serum level turned out to be high, probably due to inadequate metabolism. Lowering of the seizure threshold is another serious side effect of the TCAs, BTW.)
> With SSRIs .... who knows? We do know that similar drugs that raise serotonin levels may cause primary pulmonary hypertension and cardiac valve defects.
You mean fenfluramine, I guess. I wouldn't call that a "similar drug" to the SSRIs. Fenfluramine enhances serotonin release rather than blocking reuptake. It has been pretty well established, that SSRIs don't cause the problems that fenfluramine can cause. (These problems occur rapidly enough that we would know by now if SSRIs caused them. Fenfluramine had been around since the '70s, but it wasn't until dexfenfluramine (Redux) was approved in the mid-1990s (1995 or 1997, I think) that the serious side effects were discovered. Prozac has been around since late 1987, much longer than Redux had been available before it got pulled from the market.)
Also, of course, Anafranil (the TCA that borderliner21 was considering) blocks serotonin reuptake to a clinically significant degree at prescribed doses, just as the SSRIs do. (Most of the tertiary-amine TCAs are mixed serotonin-norepinephrine reuptake inhibitors, while the secondary-amine TCAs mainly affect norepinephrine.)
> Unfornuately .... companies pushing SSRI downplay the fact that many people on ssri's are suffer from nausea, impotency, insomnia!
I think Remeron is a good addition for people who benefit from SSRIs but suffer from these side effects, FWIW.
> So my vote is for tertiary TCA!
I prefer the secondary-amine TCAs, myself (such as the ones you tried) -- they have milder side effects, in general.
-elizabeth
Posted by spike4848 on January 23, 2002, at 16:56:26
In reply to Re: Are tricylics safer than ssris? » spike4848, posted by Elizabeth on January 23, 2002, at 14:11:50
>They can cause cardiac arrhythmias (this is well known), especially in overdose. For a person who's seriously suicidal, this can be an important issue
Yes, I believe in normal doses though, the only cardiac contraindication to a TCA is Left Bundle Branch or 2 degree heart block. In overdose, I understand SSRIs can cause serontonin syndrome ... also potential lethal.
>There are also plenty of people who don't metabolize TCAs normally. For these people, taking a normal therapeutic dose of a TCA will result in abnormally high serum levels. This can have serious consequences. (I had a seizure on desipramine, and my serum level turned out to be high, probably due to inadequate metabolism. Lowering of the seizure threshold is another serious side effect of the TCAs, BTW.)
I am sorry you had to go through that horrible experience. I have heard of slow metabolizers and the risk of elevated serum TCAs .... more often elevated TCAs levels with combination with SSRIs. I think a blood level is always wise during a course of TCA therapy.
>It has been pretty well established, that SSRIs don't cause the problems that fenfluramine can cause. (These problems occur rapidly enough that we would know by now if SSRIs caused them. Fenfluramine had been around since the '70s, but it wasn't until dexfenfluramine (Redux) was approved in the mid-1990s (1995 or 1997, I think) that the serious side effects were discovered. Prozac has been around since late ?1987, much longer than Redux had been available before it got pulled from the market.)
I didn't mean to infer that SSRIs will have the same effects as fenfluramine/phentermine, just that we simply haven't had them as long as the TCAs, and really don't know the long term side effect profile. I wasn't aware that there were studies ongoing concerning the long term safety of SSRIs .... can you give me those citations. Thanks.
>I think Remeron is a good addition for people >who benefit from SSRIs but suffer from these >side effects, FWIW.I think I would prefer just to take one medication ... I need to take ambien with nardil currently for sleep. It is very inconvenant .... if I am invited to stay over a friends apartment and I don't have ambien .... no sleep. An also the extra cost as well. If one has a good response to an SSRI .... remeron at low dose is a great option for side effects.
> > So my vote is for tertiary TCA!
>
> I prefer the secondary-amine TCAs, myself (such as the ones you tried) -- they have milder side effects, in general.Oops ... I mean't secondary TCA .... sorry.
Thanks for the information Elizabeth!
Spike
Posted by Chloe on January 23, 2002, at 18:33:04
In reply to Re: Are tricylics safer than ssris? » borderliner21, posted by Elizabeth on January 23, 2002, at 13:53:44
"there's evidence that at least some of the TCAs can make BPD symptoms worse."
Elizabeth,
Could you explain in what way TCA's can make BPD worse? I had never heard of this.
Thanks in advance.
Chloe
Posted by finelinebob on January 24, 2002, at 21:18:52
In reply to Re: TCA's and BPD » Elizabeth, posted by Chloe on January 23, 2002, at 18:33:04
YMMV, as always...
SSRIs always gave me worse side effects than therapeutic effects (which, for a few, were nil anyway). Within a month of being on nortriptyline, I knew TCAs were for me. Over two years now, and no noticable side effects.
cheers,
flb
Posted by Elizabeth on January 25, 2002, at 0:57:13
In reply to Re: TCA's and BPD » Elizabeth, posted by Chloe on January 23, 2002, at 18:33:04
> Could you explain in what way TCA's can make BPD worse? I had never heard of this.
I should have been more specific. The TCAs are definitely not a treatment of choice for BPD, simply because it's been pretty well established that they don't work very well. There have also been some studies and case reports suggesting that TCAs (amitriptyline in particular) can have "paradoxical" effects in depression associated with BPD, making patients feel worse rather than better. I'm out of town and don't have my books around, but I believe that TCAs can worsen symptoms such as self-destructiveness, paranoia, and hostility. Again, I think this may not apply to clomipramine.
There may be a relationship between BPD symptoms and mixed mania or hypomania in bipolar disorder. Tricyclics are thought to be more likely to trigger or exacerbate dysphoric (mixed) manic states than other ADs, and this may be why they make some borderline patients worse: because dysphoric mania is part of the problem.
Of course, people with BPD are a heterogeneous group, so it's hard to make general statements about them.
-elizabeth
Posted by Chloe on January 25, 2002, at 17:15:47
In reply to Re: TCA's and BPD » Chloe, posted by Elizabeth on January 25, 2002, at 0:57:13
> >There have also been some studies and case reports suggesting that TCAs (amitriptyline in particular) can have "paradoxical" effects in depression associated with BPD, making patients feel worse rather than better. I believe that TCAs can worsen symptoms such as self-destructiveness, paranoia, and hostility.
>
> There may be a relationship between BPD symptoms and mixed mania or hypomania in bipolar disorder. Tricyclics are thought to be more likely to trigger or exacerbate dysphoric (mixed) manic states than other ADs, and this may be why they make some borderline patients worse: because dysphoric mania is part of the problem.
Elizabeth,I just added 20 mgs of Amitriptyline to my cocktail for neuropathic scalp pain. I also take less than 2 mgs of celexa, plus a low dose of neurontin and lithium.
After two weeks on amitriptyline, I am having increased cycling and horrific aggitated mixed states. I have not lost my temper in such abrupt and abusive ways in so long. I am sure it's the amitrip. and asked my pdoc to switch to doxepin. She refused. Saying that all TCA;s are alike. Changing won't make a difference. So she said to decrease the celexa more and see if the cycling stops. But I think it's the Ami...Celexa can make me irritable, but not explosive, hostile and rageful, like I feel on ami...
Anyway, I was hoping you had a link that I could give to her that says Ami is "particularly" bad for the rapid cycling bipolar (ex-BPD, since I have not been self destructive in over a decade..), like me. Any info would be greatly appreciated.
If I just didn't have this dumb scalp pain induced from the lithium, I could just go up on that and I think the cycling would decrease. But without a TCA, the burning is so painful, I can't tolerate the Li...
Many thanks for answering. I really enjoy reading your informative posts.
Chloe
Posted by Ritch on January 26, 2002, at 0:41:41
In reply to Re: TCA's and BPD-Link? » Elizabeth, posted by Chloe on January 25, 2002, at 17:15:47
> > >There have also been some studies and case reports suggesting that TCAs (amitriptyline in particular) can have "paradoxical" effects in depression associated with BPD, making patients feel worse rather than better. I believe that TCAs can worsen symptoms such as self-destructiveness, paranoia, and hostility.
> >
> > There may be a relationship between BPD symptoms and mixed mania or hypomania in bipolar disorder. Tricyclics are thought to be more likely to trigger or exacerbate dysphoric (mixed) manic states than other ADs, and this may be why they make some borderline patients worse: because dysphoric mania is part of the problem.
>
>
> Elizabeth,
>
> I just added 20 mgs of Amitriptyline to my cocktail for neuropathic scalp pain. I also take less than 2 mgs of celexa, plus a low dose of neurontin and lithium.
>
> After two weeks on amitriptyline, I am having increased cycling and horrific aggitated mixed states. I have not lost my temper in such abrupt and abusive ways in so long. I am sure it's the amitrip. and asked my pdoc to switch to doxepin. She refused. Saying that all TCA;s are alike. Changing won't make a difference. So she said to decrease the celexa more and see if the cycling stops. But I think it's the Ami...Celexa can make me irritable, but not explosive, hostile and rageful, like I feel on ami...
>
> Anyway, I was hoping you had a link that I could give to her that says Ami is "particularly" bad for the rapid cycling bipolar (ex-BPD, since I have not been self destructive in over a decade..), like me. Any info would be greatly appreciated.
>
> If I just didn't have this dumb scalp pain induced from the lithium, I could just go up on that and I think the cycling would decrease. But without a TCA, the burning is so painful, I can't tolerate the Li...
>
> Many thanks for answering. I really enjoy reading your informative posts.
> ChloeHi Chloe,
Just an FYI, I am taking Celexa and have taken Celexa and/or Nortripyline recently and have found that Celexa and other SSri's can and have caused just as much or worsened *cycling* than TCA's do (I am BPII as well-and have been on several TCA's in the past), the difference is that TCA's have more tendency to *not* help impulsiveness like SSri's seem to help. It is interesting that your pdoc wants you to wean off the Celexa, did she mention any reasons why she thinks that might be the culprit for your troubles?
Mitch
Posted by Chloe on January 26, 2002, at 9:32:21
In reply to Re: TCA's and BPD-Link? » Chloe, posted by Ritch on January 26, 2002, at 0:41:41
Hey Mitch,
Boy am i ever glad to see you! I was hoping I would hear from you.
I am really peeved with my pdoc (my current stage of hypo/rage doesn't help!). She is so clueless and just treating me by the seat of her pants in her spare moments. BTW, I went for a med consult, and my pdoc won't even consider his suggestions like verapamil, or clonidine.Anyway, I can't really go down on the Celexa. She had me do this once before and it was awful. I need the SSRI for my ruminating thoughts and probably some impulse control. Other AD's just don't help with the obsessons. The TCA is helping with the scalp burning, but I have had to go down on that because I keep getting into very abusive, nasty rages, hostility, mixed states. And I can't go up on the lithium (and I am only at 112 mgs right now, which is not helping the cycling at all!)if I can't take the TCA at 20 mgs or above...
So I was thinking of switching the Li(and pdoc also gave this option), for depakote which is supposed to be better for rapid cycling anyway.
My feeling is that this is probably the way to go. Then I can stay on the Celexa and low dose ami(until the scalp pain is totally gone) but not have the added AD push from the lithium. The down side of depakote for me though is hair loss! My scalp and hair just can't get a break...
Do you have any comments on my options, or other suggestions? I am still on the neurontin, 400 mgs. I think you had good result with dep and N together. Am I right?
Option 1
NO celexa
225-450 lithium(if tolerated)
400 neurontin
20 amitrip
10 valiumOption 2
1.75 Celexa
250? Depakote
400 Neurontin
10-20 ami(until pain is gone, or keep on to help with sleep?)
10 ValiumI really hope you are doing ok. It probably about time for a med adjustment for you too...The days are getting longer, have you noticed?
Thanks,
Chloe
> Just an FYI, I am taking Celexa and have taken Celexa and/or Nortripyline recently and have found that Celexa and other SSri's can and have caused just as much or worsened *cycling* than TCA's do (I am BPII as well-and have been on several TCA's in the past), the difference is that TCA's have more tendency to *not* help impulsiveness like SSri's seem to help. It is interesting that your pdoc wants you to wean off the Celexa, did she mention any reasons why she thinks that might be the culprit for your troubles?
>
> Mitch
Posted by Ritch on January 26, 2002, at 10:43:19
In reply to Re: TCA's and BPD-Link? » Ritch, posted by Chloe on January 26, 2002, at 9:32:21
> Anyway, I can't really go down on the Celexa. She had me do this once before and it was awful. I need the SSRI for my ruminating thoughts and probably some impulse control. Other AD's just don't help with the obsessons. The TCA is helping with the scalp burning, but I have had to go down on that because I keep getting into very abusive, nasty rages, hostility, mixed states. And I can't go up on the lithium (and I am only at 112 mgs right now, which is not helping the cycling at all!)if I can't take the TCA at 20 mgs or above...
>
> So I was thinking of switching the Li(and pdoc also gave this option), for depakote which is supposed to be better for rapid cycling anyway.
>
> My feeling is that this is probably the way to go. Then I can stay on the Celexa and low dose ami(until the scalp pain is totally gone) but not have the added AD push from the lithium. The down side of depakote for me though is hair loss! My scalp and hair just can't get a break...
>
> Do you have any comments on my options, or other suggestions? I am still on the neurontin, 400 mgs. I think you had good result with dep and N together. Am I right?
>
> Option 1
> NO celexa
> 225-450 lithium(if tolerated)
> 400 neurontin
> 20 amitrip
> 10 valium
>
> Option 2
> 1.75 Celexa
> 250? Depakote
> 400 Neurontin
> 10-20 ami(until pain is gone, or keep on to help with sleep?)
> 10 Valium
>
> I really hope you are doing ok. It probably about time for a med adjustment for you too...The days are getting longer, have you noticed?
> Thanks,
> Chloe
>
> > Just an FYI, I am taking Celexa and have taken Celexa and/or Nortripyline recently and have found that Celexa and other SSri's can and have caused just as much or worsened *cycling* than TCA's do (I am BPII as well-and have been on several TCA's in the past), the difference is that TCA's have more tendency to *not* help impulsiveness like SSri's seem to help. It is interesting that your pdoc wants you to wean off the Celexa, did she mention any reasons why she thinks that might be the culprit for your troubles?
> >
> > Mitch
Hi Chloe,I would definitely consider option#2 and stay on the Celexa. Obviously you know the Celexa helps. Your pdoc probably thinks it is aggravating your cycling and wants to pitch it-it *does* aggravate my cycling as well, but for the same reasons you list I need to take a minimal dose (not really for depression-but for anxiety probs.).
You've had trouble before with lithium at doses that are going to be helpful. I found I have to get my dose up to about 450mg/day to really notice a difference-but for me those doses make me *really* foggyheaded and cause severe cramping and diarrhea.
The Neurontin also seems to help you (I think you said it does?). So you could leave that one in-and you appear to tolerate it ok.
So, the tiny dose of amitrip. is definitely helping your neuropathic pain, right? It probably is working together with the Neurontin on that one. It does help you sleep better. I was taking nortrip. with my Celexa before (also nortrip. and Zoloft) and it worked fairly well. The NE boost *can* increase the likelihood for raging behavior. I popped off a little more often than otherwise-but I could focus a *lot* better at work and it didn't make me anxious.
So...the only thing left to try is the Depakote... I would suggest it. I have extra 125mg, 250mg, and 500mg tabs around just in case. I didn't notice any increased hairloss on it. I *did* gain some weight though. You could try adding just 125mg to your current mix (ditching the lithium) and see what happens. I have to take 125mg-250mg every so often when I get a mild mixed state and it really helps that.
Yes, I am starting to have an increased level of agitation and may need to start taking some Dep. a little bit here myself. That goes away by the end of March and then I just deal with plain-old bubbly hypomania during April, March, and part of June-which I don't mind :)
good luck,
Mitch
Posted by Chloe on January 26, 2002, at 18:30:46
In reply to Re: Depakote and Neurontin-yes » Chloe, posted by Ritch on January 26, 2002, at 10:43:19
> You've had trouble before with lithium at doses that are going to be helpful. I found I have to get my dose up to about 450mg/day to really notice a difference-but for me those doses make me *really* foggyheaded and cause severe cramping and diarrhea.Mitch,
You know what is funny, I really like the "foggyheaded" feeling. I feel really sensitive to noise and things around me. I prefer not being so *sharp*. I know that must sound strange. But I find the world very harsh, and I like how lithium tones things down, or reduces the volume for me...Is there any chance Depakote will do that at low doses? I don't remember feeling much cognitive "dulling" at all after adjusting to the stuff...But perhaps it has a different way of reducing the volume???
> The Neurontin also seems to help you (I think you said it does?). So you could leave that one in-and you appear to tolerate it ok.There is something about neurontin that makes it so I can't stop it! Everytime I try to reduce the dose, I go crashing into an unmodivated, teary depression. And oh, my body aches, and I get horrible charlie horses in my arches and calves...I really do like N. But I think it adds to my skin troubles. And feel mixed about leaving it out, but I just can't!
So, I would like to increase the dose a bit. I think it's useful for calming me, and not letting me get too enraged. But everytime I increase the dose, I get such dry skin and scalp pain. Go figure. So people take 3600 mgs of this stuff without a side effect! Not me!
> So, the tiny dose of amitrip. is definitely helping your neuropathic pain, right? It probably is working together with the Neurontin on that one. It does help you sleep better. I was taking nortrip. with my Celexa before (also nortrip. and Zoloft) and it worked fairly well. The NE boost *can* increase the likelihood for raging behavior. I popped off a little more often than otherwise-but I could focus a *lot* better at work and it didn't make me anxious.I know it's the ami that's making me "pop off." But I would describe it as I feel like my "blood is boiling." And the first person to look at me wrong is going to get hurt! Backing off to 10 mgs of ami has helped with the rages already...But my scalp is more "burny" with the lower dose. Also, I do wonder if it's causing my hair to fall out. I haven't even started the dep. and I seem to be shedding an awful lot. I thought I saw alot of scalp today, too...My hair is just not tolerating any of these meds well. My long thick hair is definitely no more. I just hope I can have moderate amount of hair, not desperately thin hair, where I am headed :(
> So...the only thing left to try is the Depakote... I would suggest it. I have extra 125mg, 250mg, and 500mg tabs around just in case. I didn't notice any increased hairloss on it. I *did* gain some weight though. You could try adding just 125mg to your current mix (ditching the lithium) and see what happens. I have to take 125mg-250mg every so often when I get a mild mixed state and it really helps that.I have never heard of depakote prn...And you gained weight on lower doses of 500 or less? Was it related to increased appetite? God, I dread that. I hate the idea that medication can change the way I desire and consume food. Just doesn't seem fair...I do remember gaining weight when I was on 750 a few years ago. It was amazing. The weight just appeared. I never really felt any shift in eating or exercise...
> Yes, I am starting to have an increased level of agitation and may need to start taking some Dep. a little bit here myself. That goes away by the end of March and then I just deal with plain-old bubbly hypomania during April, March, and part of June-which I don't mind :)Boy, I love how predictable your cycling is. At least you have some idea as to when all hell is going to break loose! But I am sure it doesn't make you suffering any less.
Many thanks, Mitch
Chloe
Posted by Ritch on January 26, 2002, at 21:45:47
In reply to Re: Depakote/Neurontin/Amitrip » Ritch, posted by Chloe on January 26, 2002, at 18:30:46
>
>
>
> > You've had trouble before with lithium at doses that are going to be helpful. I found I have to get my dose up to about 450mg/day to really notice a difference-but for me those doses make me *really* foggyheaded and cause severe cramping and diarrhea.
>
> Mitch,
> You know what is funny, I really like the "foggyheaded" feeling. I feel really sensitive to noise and things around me. I prefer not being so *sharp*. I know that must sound strange. But I find the world very harsh, and I like how lithium tones things down, or reduces the volume for me...Is there any chance Depakote will do that at low doses? I don't remember feeling much cognitive "dulling" at all after adjusting to the stuff...But perhaps it has a different way of reducing the volume???Well, Chloe, all I can say is that you are lucky in some ways not to be bothered with this stuff. My job is so horrendously demanding-so left-brained-so draining. *Anything* that reduces my cognitive abilities-it shows straight away.
>
> > The Neurontin also seems to help you (I think you said it does?). So you could leave that one in-and you appear to tolerate it ok.
>
> There is something about neurontin that makes it so I can't stop it! Everytime I try to reduce the dose, I go crashing into an unmodivated, teary depression. And oh, my body aches, and I get horrible charlie horses in my arches and calves...I really do like N. But I think it adds to my skin troubles. And feel mixed about leaving it out, but I just can't!
> So, I would like to increase the dose a bit. I think it's useful for calming me, and not letting me get too enraged. But everytime I increase the dose, I get such dry skin and scalp pain. Go figure. So people take 3600 mgs of this stuff without a side effect! Not me!Neurontin was the first *anticonvulsant* I have tried that had a clear antidepressant effect-but I can't take more than about 400mg/day. Otherwise-I get blunting from it as well-esp. at doses above 600mg/day.
>
> > So, the tiny dose of amitrip. is definitely helping your neuropathic pain, right? It probably is working together with the Neurontin on that one. It does help you sleep better. I was taking nortrip. with my Celexa before (also nortrip. and Zoloft) and it worked fairly well. The NE boost *can* increase the likelihood for raging behavior. I popped off a little more often than otherwise-but I could focus a *lot* better at work and it didn't make me anxious.
>
> I know it's the ami that's making me "pop off." But I would describe it as I feel like my "blood is boiling." And the first person to look at me wrong is going to get hurt! Backing off to 10 mgs of ami has helped with the rages already...But my scalp is more "burny" with the lower dose. Also, I do wonder if it's causing my hair to fall out. I haven't even started the dep. and I seem to be shedding an awful lot. I thought I saw alot of scalp today, too...My hair is just not tolerating any of these meds well. My long thick hair is definitely no more. I just hope I can have moderate amount of hair, not desperately thin hair, where I am headed :(
>
> > So...the only thing left to try is the Depakote... I would suggest it. I have extra 125mg, 250mg, and 500mg tabs around just in case. I didn't notice any increased hairloss on it. I *did* gain some weight though. You could try adding just 125mg to your current mix (ditching the lithium) and see what happens. I have to take 125mg-250mg every so often when I get a mild mixed state and it really helps that.
>
> I have never heard of depakote prn...And you gained weight on lower doses of 500 or less? Was it related to increased appetite? God, I dread that. I hate the idea that medication can change the way I desire and consume food. Just doesn't seem fair...I do remember gaining weight when I was on 750 a few years ago. It was amazing. The weight just appeared. I never really felt any shift in eating or exercise...Well, Depakote prn is what I *do*. I can take 250mg if I am feeling unusally agitated or panicky and it augments the Neurontin/Klonopin I am taking and makes things a lot easier.
>
> > Yes, I am starting to have an increased level of agitation and may need to start taking some Dep. a little bit here myself. That goes away by the end of March and then I just deal with plain-old bubbly hypomania during April, March, and part of June-which I don't mind :)
>
> Boy, I love how predictable your cycling is. At least you have some idea as to when all hell is going to break loose! But I am sure it doesn't make you suffering any less.
>
> Many thanks, Mitch
> Chloe
Predictability *is* nice-but you have to get your pdoc tuned in to the graph! They have this tendency to think that your "troubles" are the same all year round(static). I think I am going to have to do a Powerpoint presentation and bring in all the hardware, etc. I don't really think they *want* to be lazy, but for what I am paying.......Mitch
Posted by Chloe on January 27, 2002, at 17:50:28
In reply to Re: Depakote/Neurontin/Amitrip » Chloe, posted by Ritch on January 26, 2002, at 21:45:47
Mitch,
Do you think that amitrip in itself, being a "dirty" drug, could be contributing to my rages? Or do you think all the TCA's are pretty much the same?
I like the sedating effect of Ami (at last I sleep at night!!!), but I do think it causes my heart to race at time during the day...And I get so damn furious and hostile, I can't think straight.
Of course I haven't had time for the depokote to work yet...
But is there another "calming" or sedating TCA that might work better than Ami for neuropathic pain (and sleeping at night, too!)?
I have heard that Doxepin has some antihistimine in it. Is it the same kind like in Remeron or Zyprexa? I hate the appetite increase thing. I know I wouldn't like Doxe if it's similar to them..
Any thoughts?Best,
Chloe
Posted by Ritch on January 27, 2002, at 22:05:04
In reply to Re:TCA less likely to cause rage?, posted by Chloe on January 27, 2002, at 17:50:28
> Mitch,
> Do you think that amitrip in itself, being a "dirty" drug, could be contributing to my rages? Or do you think all the TCA's are pretty much the same?
> I like the sedating effect of Ami (at last I sleep at night!!!), but I do think it causes my heart to race at time during the day...And I get so damn furious and hostile, I can't think straight.
> Of course I haven't had time for the depokote to work yet...
> But is there another "calming" or sedating TCA that might work better than Ami for neuropathic pain (and sleeping at night, too!)?
> I have heard that Doxepin has some antihistimine in it. Is it the same kind like in Remeron or Zyprexa? I hate the appetite increase thing. I know I wouldn't like Doxe if it's similar to them..
> Any thoughts?
>
> Best,
> ChloeChloe, I have tried most of the TCA's for several weeks and some cases several years. Doxepin was the first antidepressant I took and I had the dose up to 150mg/day for a while (with lithium). All of the TCA's have antihistaminic effects more or less-one could say they are antihistamines that happen to have antidepressant properties. Doxepin even at 75mg/day gave me tachycardia. For some weird reason it was the worst when I first woke up in the morning. I would be dreaming and then I would startle and wake and my heart would race up to 150+bpm for a few minutes.
I had more *rages* while on high-dose doxepin (doxepin has an anti-serotonin effect) than low-dose amitriptyline (no remarkable rage incidents there). All TCA's are *dirty* to some extent-that is if you look at them as several drugs in one-they can be helpful for irritable bowel(anticholinergic action), insomnia(sedative-antihistaminegic action), neuropathic pain (NE-opioid potentiation?).
Notriptyline was the easiest one for me to tolerate (the active metabolite of amitripytline). I didn't get any dizziness and vertigo on it like the others, and dry mouth wasn't as bad. Also, FWIW, I didn't experience any noticeable appetite increase with it either( unlike Remeron or Seroquel). Desipramine did aggravate temper and caused some hypomania, though. Maybe if you could switch the amitriptyline to nortriptyline and still get the analgesic effect you need with fewer side effects??? Ask your doc. I found low-dose Celexa + low-dose Nortriptyline to work quite well.
BTW, Older antipsychotics like chlorpromazine are structurally quite similar to the first TCA's. Older AP's and even the newer ones like Zyprexa have a fairly powerful antihistaminic effect. Nortrip. has a much lowered antihistaminic effect, but it doesn't increase extracellular serotonin very much-although it *does* downregulate serotonin receptors (which is probably helpful for panic sufferers).
Mitch
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