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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on November 26, 2017, at 16:45:41
In reply to Everything is good, except for depression, posted by phidippus on November 25, 2017, at 14:39:32
Hmm. Have you tried Seroquel? It has a metabolite which acts as an antidepressant.
Mirtazpine is one of the meds which I almost found acted like a mood stabilizer. But, as SLS mentioned, you might need higher doses for depression.
The TCA surmontil may be less likely to induce mania, but it is VERY sedating (more so than mirtazapine, or doxepin). I don't know how good it is for depression, but it has a different mechanism (no monoamine reuptake).
Another med that might be worth looking into is amoxapine. It is an antidepressant with antipsychotic qualities:
https://en.wikipedia.org/wiki/Amoxapine
In theory (just guessing here) the d2 antagonism might provide some protection against mania (and may allow reduction of other antipsychotics).
I get help from vitamin D, omega-3 folic acid, niacin & magnesium, coffee, green tea and cocoa powder.
Linkadge
Posted by SLS on November 26, 2017, at 16:46:41
In reply to Re: Everything is good, except for depression » linkadge, posted by phidippus on November 26, 2017, at 14:29:31
> Wellbutrin works well for me, but takes the pizazz out of my cigarette breaks.
You gotta be kidding me.
-bScott
Posted by phidippus on November 26, 2017, at 18:42:52
In reply to Re: Everything is good, except for depression » phidippus, posted by SLS on November 26, 2017, at 16:44:36
Unfortunately, I am allergic to Saphris.
Eric
Posted by phidippus on November 26, 2017, at 20:27:16
In reply to Re: Everything is good, except for depression » phidippus, posted by SLS on November 26, 2017, at 16:46:41
I thought you might get a kick out of that :)
Eric
Posted by SLS on November 27, 2017, at 19:45:35
In reply to Re: Everything is good, except for depression » SLS, posted by phidippus on November 26, 2017, at 18:42:52
> Unfortunately, I am allergic to Saphris.
That sucks. :(
I can't imagine that you wouldn't have tried desipramine yet. It is better for ADHD than is nortriptyline. Do you think it possible that there is some sort of link to your ADHD with depression such that you would respond to desipramine?
- Scott
Posted by phidippus on November 27, 2017, at 19:55:30
In reply to Re: Everything is good, except for depression » phidippus, posted by SLS on November 27, 2017, at 19:45:35
There is a link between my mood and my ADHD. When I take my Vyvanse, my depression remits about 50%. Instead of a traffic jam of negative thoughts I experience one negative thought at a time. I'll think about desipramine...
Eric
Posted by linkadge on November 28, 2017, at 19:52:01
In reply to Re: Everything is good, except for depression » SLS, posted by phidippus on November 27, 2017, at 19:55:30
Hey SLS,
desipramine seems to have a lower cardiac safety index than the other TCAs. I (personally) would be cautious about using it with lithium. I have been getting some weird cardiac effects from lithium and nortriptyline.
Linkadge
Posted by SLS on November 28, 2017, at 21:28:35
In reply to Re: Everything is good, except for depression, posted by linkadge on November 28, 2017, at 19:52:01
> Hey SLS,
>
> desipramine seems to have a lower cardiac safety index than the other TCAs. I (personally) would be cautious about using it with lithium. I have been getting some weird cardiac effects from lithium and nortriptyline.
>
> Linkadge
Bundle-branch block?When I first started taking desipramine, I experienced rapid heartbeat and palpitations. There was also a sort of "edginess" that disappeared over time. After a few weeks, palpitations disappeared completely, but rapid heartbeat only partially mitigated. I don't think there is anything wrong with having a moderately elevated heart rate, though. I've been on TCAs for over 30 years. I'll let you know after my first stress-test. My EKGs are normal. All I can say is that combining Parnate + desipramine sure packed a wallop the first time they were used together in me. My autonomic nervous system felt like it was being fried. Good stuff. I reached remission within a few months (1987). To keep a long story from becoming longer, I never responded to that treatment again.
It is a matter of risk/cost/benefit.
I hope you are doing reasonably well. It is relative, I guess. When someone asks me how I am doing, I usually answer that I could be doing worse - knowing that I could be doing a hell of a lot better.
- Scott
Posted by Phillipa on November 28, 2017, at 22:26:54
In reply to Re: Everything is good, except for depression, posted by SLS on November 28, 2017, at 21:28:35
Bundle Branch Block is serious. Let me find a link on it quickly. Phillipa
Posted by Phillipa on November 28, 2017, at 22:37:17
In reply to Re: Everything is good, except for depression » SLS, posted by Phillipa on November 28, 2017, at 22:26:54
It's complicated so best to google it yourself. Not sure why that was posted. But TCA are known to be not that great for the heart
Posted by SLS on November 29, 2017, at 7:14:54
In reply to Re: Everything is good, except for depression, posted by Phillipa on November 28, 2017, at 22:37:17
> It's complicated so best to google it yourself. Not sure why that was posted. But TCA are known to be not that great for the heart
Neither is untreated depression.
If desipramine brought me into remission, I would not worry about bundle-branch block unless it actually appeared early in treatment. Some doctors will take a baseline ECG and compare it to one taken after treatment is initiated. I am not very afraid of tricyclics because I have been on and off of them since 1982. It was a time when SSRIs were not yet available. I didn't have much choice. I have no statistics to offer, as they are so variable in the medical literature. Heart block seems to be a rather uncommon event in the absence of preexisting CVD. Personally, I have yet to see or hear of a case in real life when desipramine is used at therapeutic dosaages. Still, as with so many unrelated drugs used for a variety of conditions, TCAs must be used judiciously and monitored by someone who knows their side effect profiles.
- Scott
Posted by Phillipa on November 29, 2017, at 9:14:55
In reply to Re: Everything is good, except for depression » Phillipa, posted by SLS on November 29, 2017, at 7:14:54
I agree with you about TCA's being only available AD's for many years. Now even the SSRI's are being found to have serious side effects. But taken as a one or two combo in low doses I don't fear them. Actually with the new studies in my RN newsletter I don't trust any meds. Even motrin can cause so many side effects. And the TV a neighbor and I were talking and she said the advertisements with all the side effects she won't take a med. And she's older like me. I guess at this point I just try to keep cutting down on any meds and excercising more. This why I suggested googling on own. Personally I'm not pleased with any meds. Sorry to be so negative. Phillipa ps you know ECG can only diagnosis if one has had a heart attack in the past?
Posted by linkadge on November 30, 2017, at 15:09:22
In reply to Re: Everything is good, except for depression, posted by SLS on November 28, 2017, at 21:28:35
I'm not sure of the specific effect, but desipramine appears to have risks beyond what normal NRI would seem to indicate.
For example, there is apparently a high rate of sudden cardiac death in children taking it for ADHD. The risk is above that of other NRIs like stimulants.
I suppose some of the intracellular effects of the drug may be at play (sodium channels?).
Linkadge
Posted by linkadge on November 30, 2017, at 15:11:40
In reply to Re: Everything is good, except for depression » SLS, posted by Phillipa on November 29, 2017, at 9:14:55
Exactly. It must be kept in perspective. Even Lexapro has cardiac effects (in higher doses).
For some reason, however, desipramine pops up quite a bit in my pubmed searches in terms of cardiac concerns. I don't see this with nortriptyline, protriptyline etc.
Linkadge
Posted by SLS on November 30, 2017, at 15:24:53
In reply to Re: Everything is good, except for depression » SLS, posted by linkadge on November 30, 2017, at 15:09:22
> I suppose some of the intracellular effects of the drug may be at play (sodium channels?).
That's a good thought.
- Scott
Posted by Phillipa on November 30, 2017, at 15:56:58
In reply to Re: Everything is good, except for depression, posted by linkadge on November 30, 2017, at 15:11:40
Link this is where I found so much about despramine. So the comment best to gogle on own. Pub med is full or right vs left bundle branch blocks, and having also worked in CCU cardiac care saw plenty with BBB so gets complicated. Phillipa
Posted by SLS on November 30, 2017, at 19:10:30
In reply to Re: Everything is good, except for depression » linkadge, posted by Phillipa on November 30, 2017, at 15:56:58
Would you ever take desipramine?
Would you tell everyone else not to take it?
- Scott
Posted by linkadge on December 1, 2017, at 15:18:24
In reply to Re: Everything is good, except for depression » Phillipa, posted by SLS on November 30, 2017, at 19:10:30
Hi SLS,
As you mentioned, many people take desipramine without apparent significant cardiac effects.
I suppose if there was a compelling reason that desipramine would provide a benefit that other medicaitons wouldn't then it would be worth a shot, with monitoring.
I do know that some health orginaziations discourage the use of desipramine for ADHD because of an apparent excess incidence of cardiac side effects.
I would (personallay) look to explore other NRI's such as fetzima and/or nortriptyline.
But hey, who knows.
Linkadge
Posted by SLS on December 1, 2017, at 21:13:36
In reply to Re: Everything is good, except for depression » SLS, posted by linkadge on December 1, 2017, at 15:18:24
Hi, Linkadge.
> As you mentioned, many people take desipramine without apparent significant cardiac effects.
I wish I knew how often CV side effects emerge with desipramine. I think your concern is well-founded. However, my impression remains that the absolute risk perceived by today's doctors is currently exaggerated.
> I suppose if there was a compelling reason that desipramine would provide a benefit that other medicaitons wouldn't then it would be worth a shot, with monitoring.My doctor was reluctant to add desipramine to Parnate, but had no problem with nortriptyline. Desipramine energized me in a way that nortriptyline did not.
> I do know that some health orginaziations discourage the use of desipramine for ADHD because of an apparent excess incidence of cardiac side effects.
>
> I would (personallay) look to explore other NRI's such as fetzima and/or nortriptyline.
>
> But hey, who knows.
>
> LinkadgeUnfortunately, some very important treatment insights and experience are disappearing as we lose older psychiatrists. These doctors found that some responders to desipramine did not respond to nortriptyline and vice-versa. Atomoxetine and reboxetine are extremely selective NE reuptake inhibitors. As antidepressants, they suck. I don't see that Fetzima is much better, despite its 5-HT reuptake inhibition. Of course, not being a doctor who has used it on multiple people, I don't know its true value. For me, milnacipran was inert.
All in all, I will keep my mind open about these things. You input is always appreciated by me.
- Scott
Posted by linkadge on December 2, 2017, at 12:56:12
In reply to Re: Everything is good, except for depression, posted by SLS on December 1, 2017, at 21:13:36
The fact that reboxetine and atomoxetine suck for depression seems to suggest that the NRI action of other 'antidepressants' is not really relevant to their AD effect.
Its pretty sad that we're this far along and we still don't really know how the TCAs work.
Linkadge
Posted by Phillipa on December 2, 2017, at 17:32:59
In reply to Re: Everything is good, except for depression, posted by linkadge on December 2, 2017, at 12:56:12
I don't even know any doctors that still prescribe them. In this area not really any psyciatrists. Just family doctors who are even reluctant or flat out won't prescribe any psych meds. I feel the TCA's are a med of the past. Even advise now is for those who had surgery to really limit any pain killers and use lidocaine inserts that drain slowly into the body. Phillipa
Posted by linkadge on December 2, 2017, at 17:58:54
In reply to Re: Everything is good, except for depression » linkadge, posted by Phillipa on December 2, 2017, at 17:32:59
Hi Phillipa,
Yeah, unfortunately we are moving backwards in a lot of ways. I'm not saying the TCAs shouldn't be prescribed. There is a lot of suffering out there, and we need more knowledgeable doctors willing to prescribe the meds that are needed.
The SSRIs are ineffective for many people, and so there needs to be alternatives that can be tried.
In Canada, we are moving towards legalization of marijuana (likely by June 2018). Its sad that many people will be self medicating with pot for pain, because doctors are in a war on opiates.
Linkadge
Posted by Phillipa on December 2, 2017, at 20:13:41
In reply to Re: Everything is good, except for depression » Phillipa, posted by linkadge on December 2, 2017, at 17:58:54
And it cruel to allow people to suffer in physical pain. It's the addicts that ruined it for the average person. Yes marijuana is being legalized here . Already is in many States. Phillipa
Posted by SLS on December 3, 2017, at 0:08:33
In reply to Re: Everything is good, except for depression » linkadge, posted by Phillipa on December 2, 2017, at 20:13:41
There are some very important tools that are not yet ready to be thrown away.
- Scott
Posted by baseball55 on December 3, 2017, at 18:28:04
In reply to Re: Everything is good, except for depression » linkadge, posted by Phillipa on December 2, 2017, at 20:13:41
It's the addicts that ruined it for the average person.
You talk about "the addicts" like they're a different species. In fact, many of "the addicts" were average people who got hooked on opioids prescribed by doctors. I did. My nephew did. Opioids are addictive, even for average people with pain conditions. Doctors overprescribe them. I once had surgery on my finger and the doctor gave me a scrip for 80(!) percocet.
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