![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 121. Go back in thread:
Posted by Roslynn on January 3, 2009, at 18:00:39
In reply to I want to switch from nortriptyline to desipramine, posted by SLS on January 3, 2009, at 16:30:10
> I want to switch from nortriptyline to desipramine.
>
> Now, all I need to do is convince my doctor that it is worth trying. I am 50 pounds overweight and my triglycerides are well over 300mg/dL. I am sure that these are side effects of nortriptyline. I am betting that desipramine will substitute effectively for nortriptyline, as I once attained an extended remission when desipramine was combined with Parnate. I would need 300mg. I do not gain weight on desipramine, and will probably experience a further improvement in motivation and energy.
>
> I am hoping my doctor will allow me to switch over without using a cross taper. I doubt he will, though. He is very cautious when it comes to treating with Parnate. One of his patients experienced a spontaneous hypertensive episode with it.
>
> I am sure that this is the right thing to do at this juncture, even if a trial of desipramine should fail.
>
> As an aside, I was prescribed Crestor (rosuvastatin) to treat my hypertriglyceridemia. I discontinued it after 4 weeks because it seemed it was making me feel more depressed.
>
> It's always something.
>
> Still, I am blessed. Fat, but blessed.
>
> Currently:
>
> Parnate 80mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 20mg
>
> I am very anxious to make this change.
>
>
> - Scott
>Hi Scott,
There's no chance the weight gain could be from Abilify?
Posted by SLS on January 3, 2009, at 18:26:45
In reply to Re: I want to switch from nortriptyline to desipramine, posted by Roslynn on January 3, 2009, at 18:00:39
> Hi Scott,
Hi.
> There's no chance the weight gain could be from Abilify?
I used to think that Abilify was weight-neutral. However, I see more and more reports of moderate weight gain. So, you could be right. However, amitriptyline and its daughter drug, nortriptyline are notorious as TCA weight gainers. Perhaps nortriptyline and Abilify are working together synergistically to produce the weight gain.
Thanks.
- Scott
Posted by Roslynn on January 3, 2009, at 18:56:17
In reply to Re: I want to switch from nortriptyline to desipramine » Roslynn, posted by SLS on January 3, 2009, at 18:26:45
> > Hi Scott,
>
> Hi.
>
> > There's no chance the weight gain could be from Abilify?
>
> I used to think that Abilify was weight-neutral. However, I see more and more reports of moderate weight gain. So, you could be right. However, amitriptyline and its daughter drug, nortriptyline are notorious as TCA weight gainers. Perhaps nortriptyline and Abilify are working together synergistically to produce the weight gain.
>
> Thanks.
>
>
> - ScottHi Scott,
Yikes, nortriptyline was my next choice for an AD. I may need to ask my doc for desipramine instead, like you are...
Posted by Phillipa on January 3, 2009, at 19:04:44
In reply to Re: I want to switch from nortriptyline to desipramine, posted by Roslynn on January 3, 2009, at 18:56:17
And I seriously was thinking abilify low dose to substitute for benzos. Phillipa
Posted by bulldog2 on January 3, 2009, at 19:27:58
In reply to Re: I want to switch from nortriptyline to desipramine, posted by Phillipa on January 3, 2009, at 19:04:44
> And I seriously was thinking abilify low dose to substitute for benzos. Phillipa
Neurotin would be better...works on gaba and has ad properties
Posted by JadeKelly on January 3, 2009, at 19:28:58
In reply to I want to switch from nortriptyline to desipramine, posted by SLS on January 3, 2009, at 16:30:10
> I want to switch from nortriptyline to desipramine.
I want a million dollars.
Since both are tca's why a problem?
Now, all I need to do is convince my doctor that it is worth trying.
I am 50 pounds overweight and my triglycerides are well over 300mg/dL. I am sure that these are side effects of nortriptyline. I am betting that desipramine will substitute effectively for nortriptyline, as I once attained an extended remission when desipramine was combined with Parnate. I would need 300mg.
Even tho thats a little higher than normal, Doc's do go over if they can check your heart, correct? I would think the health gain from losing 50lbs would outweight the concerns you've mentioned.I do not gain weight on desipramine, and will probably experience a further improvement in motivation and energy.
>
> I am hoping my doctor will allow me to switch over without using a cross taper. I doubt he will, though. He is very cautious when it comes to treating with Parnate. One of his patients experienced a spontaneous hypertensive episode with it.When I had the spontaneous HT and subsequent high BP, PDoc wanted to take me off Parnate. I asked (begged) if I could take Nifedipine everyday for few days could I stay on, surprizingly, he said yes. Could you do that as you cross over? I'm assuming you have cuff, etc.
I'm surprised to hear you think of your Doc as cautious (I'm sure he is) the rest of us have to beg, borrow and steel to get what you get!!!
>
> I am sure that this is the right thing to do at this juncture, even if a trial of desipramine should fail.Then you should do it. Be careful tho. Nifedipine and cuff.
>
>
As an aside, I was prescribed Crestor (rosuvastatin) to treat my hypertriglyceridemia. I discontinued it after 4 weeks because it seemed it was making me feel more depressed.What about Lipitor?
>
> It's always something. Isn't it tho.
>
> Still, I am blessed. Fat, but blessed.
>
> Currently:
>
> Parnate 80mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 20mgBtw- I checked on the amount of Abilify they prescibed for my son, it was total 20mg day. He gained ALOT of weight. He lost almost all of it when he switched to Seroquel. I thought I saw recently that they found there is some A/D property to Seroquel. I'm sure you know about it.
>
> I am very anxious to make this change.Good luck with it!
>
> ~Jade- Scott
>
Posted by SLS on January 3, 2009, at 19:39:12
In reply to Re: I want to switch from nortriptyline to desipramine, posted by Phillipa on January 3, 2009, at 19:04:44
> > And I seriously was thinking abilify low dose to substitute for benzos. Phillipa
Phillipa, if one searches hard enough, one can almost always find an undesirable trait of potentially effective treatment.
> Neurotin would be better...works on gaba and has ad properties
Not a bad idea.
Have you ever tried Neurontin, Phillipa?
- Scott
Posted by SLS on January 3, 2009, at 20:00:09
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by JadeKelly on January 3, 2009, at 19:28:58
> > I want to switch from nortriptyline to desipramine.
> I want a million dollars.It's 2009. You'll need a lot more than that.
> Since both are tca's why a problem?
It is crucial not to choose a TCA that has significant serotonin reuptake inhibition properties. Even imipramine can produce serotonin syndrome when combined with MAOIs. Of course, clomipramine (Anafranil) is absolutely contraindicated for this reason.
> I am 50 pounds overweight and my triglycerides are well over 300mg/dL. I am sure that these are side effects of nortriptyline. I am betting that desipramine will substitute effectively for nortriptyline, as I once attained an extended remission when desipramine was combined with Parnate. I would need 300mg.
> Even tho thats a little higher than normal, Doc's do go over if they can check your heart, correct? I would think the health gain from losing 50lbs would outweight the concerns you've mentioned.I am a rapid metabolizer of tricyclics.
> Btw- I checked on the amount of Abilify they prescibed for my son, it was total 20mg day. He gained ALOT of weight. He lost almost all of it when he switched to Seroquel.
Gosh.
> I thought I saw recently that they found there is some A/D property to Seroquel. I'm sure you know about it.
More recently, it has been recognized that a metabolite of Seroquel, N-desalkylquetiapine, is a potent inhibitor of NE reuptake - just like desipramine. I have seen Seroquel produce a robust antidepressant response in a friend of mine who added it to Wellbutrin.
> > I am very anxious to make this change.
> Good luck with it!Thanks.
- Scott
Posted by Phillipa on January 3, 2009, at 20:17:03
In reply to Re: I want to switch from nortriptyline to desipramine » Phillipa, posted by SLS on January 3, 2009, at 19:39:12
Scott no any good links? Love Phillipa
Posted by SLS on January 3, 2009, at 20:58:53
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by Phillipa on January 3, 2009, at 20:17:03
> Scott no any good links? Love Phillipa
Yes. All over the place. I'm going to make you work for this one on your own. Google keywords: gabapentin, anxiety.
In the simplest terms possible, what exactly is wrong with you?
- Scott
Posted by Phillipa on January 4, 2009, at 0:21:31
In reply to Re: I want to switch from nortriptyline to desipramine » Phillipa, posted by SLS on January 3, 2009, at 20:58:53
Was panic attacks, now benzos make me tired, chronic lymes still tests positive to Western blot docs say forget it, thyroid still not stable don't know why, fear but have to get out. I will google always do and my newsletter helps. I can meet the challenge. Have to do the ebay posting most nights til now. Always work better at night. Love Phillipa
Posted by Phillipa on January 4, 2009, at 0:27:30
In reply to Re: I want to switch from nortriptyline to desipramine » Phillipa, posted by SLS on January 3, 2009, at 20:58:53
Oh neurotin hence lyrica got some of that source unknown to others here. Haven't taken it. Love Phillipa
Posted by SLS on January 4, 2009, at 6:32:42
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by Phillipa on January 4, 2009, at 0:21:31
> panic attacks
> chronic lymes
> thyroid
> fear but have to get out1. When do you think the Lyme Disease started?
2. What are your most recent titer and blot measurements?
3. What are your most current thyroid measurements?
4. Is there a pattern of hyperthyroid = fear and panic attacks?
5. When did your tiredness to Valium start?
- Scott
Posted by seldomseen on January 4, 2009, at 9:28:30
In reply to I want to switch from nortriptyline to desipramine, posted by SLS on January 3, 2009, at 16:30:10
I guess I am just as concerned about the triglycerides as I am the psych meds. Did the docs also check your activated protein C (APC) levels? High tiglycerides and elevated APC are strong predictors of coronary artery disease.
Fatigue is a known side effect of the statins and can indicate some nasty liver problems.
Did you call your doc and let them know you've discontinued? They may want you to come in for liver function tests.
If crestor doesn't work out, then I would highly recommend lipitor. It's older, has a better side effect profile and is well tolerated. Frankly, lipitor is not as "strong" as crestor, but either drug will only work if you take it.
I would strongly urge you to please aggresively follow up on this.
Seldom
Posted by SLS on January 4, 2009, at 11:01:12
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by seldomseen on January 4, 2009, at 9:28:30
> I would strongly urge you to please aggresively follow up on this.
Thanks for the advice. I guess I should continue to work with my GP on this. My father and his father have had coronary heart disease; my father having with nearly complete occlusions in various arteries.
Thanks for not being so seldom seen.
:-)
- Scott
Posted by Phillipa on January 4, 2009, at 13:32:40
In reply to Re: I want to switch from nortriptyline to desipramine » Phillipa, posted by SLS on January 4, 2009, at 6:32:42
Scott they have no idea when contracted lymes could have been many years even before move to NC as lived in Ct. But infection control specialist that treated me in hospital with Iv rocephin pic line did so for only a week as side effects put me on biaxin xl for three years for three months at a time. The chart with the bands is much too complicated for me to understand some bands positive high and some low. Spinal fluid taps done twice and MRI of brain. Both those negative at time but lymes hides. When moved to Charlotte took the full infection control specialists chart I had copied to a rheumatololigist here he tested and of course Western blot still positive the health dept called and wanted to know why I wasn't being treated and the rheumatologist said forget it you've had enough antibiotics so no idea as he now isn't even in Charlotte. As for thyroid in the mail yesterday a letter and was tested before Christmas for a checkup that was cancelled and the paper said they unsuccessfully tried to contact us Christmas Eve And in eight weeks TSH has gone from .764 with Free T4 of 1.74 which was looking better. This paper said latest now TSH is 11.91 and Free T4 l.22. And the cell phone is my husbands who said there was a message and it wasn't important. So now it's change dose of synthroid again from taking 50mcg six days a week and l00mcg l day a week now its' 100mcg three times a week and 50mcg four times a week. And husband still refuses to believe anything is wrong with me. I quit don't even know how or where to research this anymore. Phillipa who is extremely upset. Extremely.
Posted by bleauberry on January 4, 2009, at 15:30:19
In reply to I want to switch from nortriptyline to desipramine, posted by SLS on January 3, 2009, at 16:30:10
It sounds like smart thinking, Scott. With its stronger potentiation of norepinephrine, I would think there is some risk there that warrants a cautious introduction of desipramine. You are an expert at these kinds of med manipulations and you know yourself better than anyone.
So while your doctor might have some concerns, I don't. I'm just glad you are feeling better than I recall you did in previous times. If it can be made even better, I know of no one more qualified to make med decisions than you.
Posted by dcruik518 on January 5, 2009, at 18:47:10
In reply to I want to switch from nortriptyline to desipramine, posted by SLS on January 3, 2009, at 16:30:10
Having taken both Nortriptyline and Abilify, I think you're almost certainly correct that the Nortriptyline is causing the weight gain. I gained twenty lbs on it, in just six weeks. I think Abilify causes weight gain, too, but much more slowly, like maybe one or two lbs per month. I'm trying to reduce it to 5mg, to see if I lose any weight.
~Dwight
Posted by SLS on January 6, 2009, at 6:59:05
In reply to Re: I want to switch from nortriptyline to desipramine, posted by dcruik518 on January 5, 2009, at 18:47:10
Thanks, Dwight.
-Scott
> Having taken both Nortriptyline and Abilify, I think you're almost certainly correct that the Nortriptyline is causing the weight gain. I gained twenty lbs on it, in just six weeks. I think Abilify causes weight gain, too, but much more slowly, like maybe one or two lbs per month. I'm trying to reduce it to 5mg, to see if I lose any weight.
>
> ~Dwight
Posted by SLS on January 8, 2009, at 16:04:31
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on January 6, 2009, at 6:59:05
Woohoo!
My doctor is letting me crossover from nortriptyline to desipramine. He is being rather cautious, but methodical in the way he makes the switch. I told him that, in the past, I needed 300mg of desipramine to get the most out of it. His first reaction was to not go so high in dosage. I explained to him that I am a rapid metabolizer of tricyclics. Seeing that I demonstrated a need to take 150mg of nortriptyline, it makes sense that I would need 300mg of desipramine. It is well known that 1mg nortriptyline = 2mg desipramine in terms of clinical equivalency. I guess I will just have to suffer for awhile. I will be reducing the nortriptyline and increasing the desipramine simultaneously.
I am going to need to be patient to follow my doctor's protocol for making the switch. I am probably going to feel worse for some period of time until I get up to 300mg with the desipramine.
Practicing patience really sucks.
I want to be feeling good yesterday.
- Scott
Posted by Phillipa on January 9, 2009, at 0:07:43
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on January 8, 2009, at 16:04:31
Scott well seriously congratulations. Hope you don't feel to horrible. Remember support is here. Love Phillipa
Posted by desolationrower on January 9, 2009, at 3:06:07
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on January 8, 2009, at 16:04:31
hm, good luck with the change.
i think betahistine would be ideal to counter weight gain, but probably not something you could get a doc to do. modafinil might be helpful in its stead, i sort of remember you saying you didn't take it, but a low dose might not bother you?
not sure what else you take, but at minimum i'd suggest
fish oil
vitamin d3
vitamin k2
magnesium
sounds like you excercise and i assume eat healthy.for weight loss also sesamin would be useful especially for triglycerides too, tho some people find it makes them sluggish or less libido. ashwaghadha is interesting, can't think if its ok with your regimine. green tea extract too. i would give it a try. those numbers are scary.
also, can't you just ask for plasma level of the tca if you think its not high enough?
-d/r
Posted by SLS on January 9, 2009, at 7:36:47
In reply to Re: I want to switch from nortriptyline to desipramine, posted by desolationrower on January 9, 2009, at 3:06:07
> hm, good luck with the change.
>
> i think betahistine would be ideal to counter weight gain, but probably not something you could get a doc to do. modafinil might be helpful in its stead, i sort of remember you saying you didn't take it, but a low dose might not bother you?
>
> not sure what else you take, but at minimum i'd suggest
> fish oil
> vitamin d3
> vitamin k2
> magnesium
> sounds like you excercise and i assume eat healthy.
>
> for weight loss also sesamin would be useful especially for triglycerides too, tho some people find it makes them sluggish or less libido. ashwaghadha is interesting, can't think if its ok with your regimine. green tea extract too. i would give it a try. those numbers are scary.That's a nice list of alternatives, D/R. Thank you. I think I'll try them. My fear is that without knowing it, my consuming any other substances might destabilize me and prevent me from responding to the medication regime. I think I'll wait until I am stable on the desipramine before adding anything.
> also, can't you just ask for plasma level of the tca if you think its not high enough?
If I have to fight my doctor on this one, I will go for blood levels at that point. I have been on desipramine often enough to know where my clinical range lies. One time, I was told to take 450mg of imipramine, and my blood levels still had not exceeded the therapeutic range. As purported in the PDR and other medical literature, most people will need no more than 200mg of desipramine. However, outpatients and people with more severe depressions are encouraged to target 300mg if necessary.
Thanks again.
- Scott
Posted by JadeKelly on January 9, 2009, at 9:40:30
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on January 8, 2009, at 16:04:31
> Woohoo!
>
> My doctor is letting me crossover from nortriptyline to desipramine. He is being rather cautious, but methodical in the way he makes the switch. I told him that, in the past, I needed 300mg of desipramine to get the most out of it. His first reaction was to not go so high in dosage. I explained to him that I am a rapid metabolizer of tricyclics. Seeing that I demonstrated a need to take 150mg of nortriptyline, it makes sense that I would need 300mg of desipramine. It is well known that 1mg nortriptyline = 2mg desipramine in terms of clinical equivalency. I guess I will just have to suffer for awhile. I will be reducing the nortriptyline and increasing the desipramine simultaneously.
>
> I am going to need to be patient to follow my doctor's protocol for making the switch. I am probably going to feel worse for some period of time until I get up to 300mg with the desipramine.
>
> Practicing patience really sucks.
>
> I want to be feeling good yesterday.
>
>
> - Scott
Some smart guy told me once that practicing patience really pays off (even tho it sucks).Good luck, hope you are feeling good soon.
~Jade
>
Posted by SLS on January 9, 2009, at 9:52:15
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by JadeKelly on January 9, 2009, at 9:40:30
> > Practicing patience really sucks.
> >
> > I want to be feeling good yesterday.> Some smart guy told me once that practicing patience really pays off (even tho it sucks).
>
> Good luck, hope you are feeling good soon.I really appreciate your sincere sentiments. I might go through a bad spell. Knowing that people are behind me helps immensely.
Thanks.
Since we are not on the subject, how are you doing?
:-)
If Parnate 60mg doesn't seem to be doing the trick for you, would you increase the dosage of methylphenidate first, or increase the Parnate?
- Scott
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
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.