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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by incubusfan5 on February 10, 2009, at 11:45:24
After only three days on Clomipramine, I've decided I can't do a trial of it due to the side effects. I became so weak/lethargic, all I could do was lay down and watch tv. I need to attend class and do homework, so this is a problem.
I suffer from the full gammut of depresson, GAD, SAD, OCD, and inattentive ADD. My doctor seems to think nortryptaline has the least amount of side effects, but doesn't think it would be helpful with OCD like the Clomipramine would. I know my mom took imipramine in the past with success, before later switching to Paxil.
I've tried multiple SSRIs, but never Luvox, which is indicated in OCD. If all other SSRIs have failed, is Luvox still worth trying? Any opinions of which tricyclic would be best besides Clomipramine? Sedation is no good for me.
Thanks.
Posted by SLS on February 10, 2009, at 12:02:18
In reply to Not tolerating Clomipramine well, which TCA to try, posted by incubusfan5 on February 10, 2009, at 11:45:24
> After only three days on Clomipramine, I've decided I can't do a trial of it due to the side effects.
They go away!!!
What dosage did you start at?
- Scott
Posted by incubusfan5 on February 10, 2009, at 12:15:42
In reply to Re: Not tolerating Clomipramine well, which TCA to try, posted by SLS on February 10, 2009, at 12:02:18
> > After only three days on Clomipramine, I've decided I can't do a trial of it due to the side effects.
>
> They go away!!!
>
> What dosage did you start at?
>
>
> - ScottJust 25mg. I know they most likely go away, but it's hard to be productive if I have no energy...
I'm going to start taking Trilafon before bed tonight.
Posted by Phillipa on February 10, 2009, at 12:28:32
In reply to Re: Not tolerating Clomipramine well, which TCA to try, posted by incubusfan5 on February 10, 2009, at 12:15:42
I must say that even though my luvox dose is not considered theraputic that I no longer count numbers as much, can step on cracks as that is the kind of OCD I had. Do still need to do things the same. First time took luvox at 250mg actually felt wonderful it faded in two weeks and couldn't take high doses anymore so only 50mg. It's the most sedating supposedly SSRI as SSRI and SNRI's cause my anxiety to be sky high even with benzos on board. Well I'm a wierd one. Just one experience in the world. Phillipa
Posted by SLS on February 10, 2009, at 15:00:01
In reply to Re: Not tolerating Clomipramine well, which TCA to try, posted by incubusfan5 on February 10, 2009, at 12:15:42
> > What dosage did you start at?
> >
> >
> Just 25mg. I know they most likely go away, but it's hard to be productive if I have no energy...Perhaps you could have started lower. You really don't know until you see things with 20/20 hindsight.
I would stick with the 25mg until the side effects abate before moving up to 50mg or somewhere in between. You can open capsules and discard half their contents. This is too potent an OCD drug not to give it every chance of working and assess its tolerability.
I would fully appreciate any decision you come to. I am not in your shoes. No pressure. It is wishful thinking on my part that you can establish a therapeutic level of clomipramine, even if it be very gradually.
Good luck.
- Scott
Posted by Incubusfan on February 10, 2009, at 15:39:40
In reply to Re: Not tolerating Clomipramine well, which TCA to try » incubusfan5, posted by SLS on February 10, 2009, at 15:00:01
>
> Perhaps you could have started lower. You really don't know until you see things with 20/20 hindsight.
>
> I would stick with the 25mg until the side effects abate before moving up to 50mg or somewhere in between. You can open capsules and discard half their contents. This is too potent an OCD drug not to give it every chance of working and assess its tolerability.
>
> I would fully appreciate any decision you come to. I am not in your shoes. No pressure. It is wishful thinking on my part that you can establish a therapeutic level of clomipramine, even if it be very gradually.
>
> Good luck.
>
>
> - ScottYou're right. I need to be rational and just deal with the side effects. No pain, no gain, right? I'll keep with it at 25mg.
Thanks for the advice.
- Mike
Posted by jms600 on February 10, 2009, at 17:05:14
In reply to Not tolerating Clomipramine well, which TCA to try, posted by incubusfan5 on February 10, 2009, at 11:45:24
I agree with SLS - you need to give it a chance of at least a few weeks. As you're probably aware, taking antidepressants is always the hardest at the start. Unpleasant side effects with no apparent beneficial action from the drug. After a week or two, some of the side effects start to go and (hopefully) the depression/anxiety etc begins to diminish.
I had a slight 'weak' feeling when I started Amitriptyline - it gradually lessened over the following week or so.
Clomipramine is supposed to be a very good drug for phobias/OCD; however, it also possesses anticholinergic properties which can make the side effects a little troublesome. I believe Lofepramine has a weaker anticholinergic profile; however, it's not as good for phobias/OCD.
My psychiatrist claims that Luvox isn't as good as the other SSRIs but that really is his own opinion. I've read on here that people have done well with it.
Posted by yxibow on February 11, 2009, at 2:07:16
In reply to Re: Not tolerating Clomipramine well, which TCA to try, posted by Incubusfan on February 10, 2009, at 15:39:40
>
> >
> > Perhaps you could have started lower. You really don't know until you see things with 20/20 hindsight.
> >
> > I would stick with the 25mg until the side effects abate before moving up to 50mg or somewhere in between. You can open capsules and discard half their contents. This is too potent an OCD drug not to give it every chance of working and assess its tolerability.
> >
> > I would fully appreciate any decision you come to. I am not in your shoes. No pressure. It is wishful thinking on my part that you can establish a therapeutic level of clomipramine, even if it be very gradually.
> >
> > Good luck.
> >
> >
> > - Scott
>
> You're right. I need to be rational and just deal with the side effects. No pain, no gain, right? I'll keep with it at 25mg.
>
> Thanks for the advice.
>
> - Mike
There are always choices -- medication does have its side effects, and its a question of whether the balance of good is better than the un-pleasantries.
That being said, I guess I'm biased because I am taking Anafranil at the moment. Whether it is better than Luvox for the OC component of my disorder, I can't say yet. I slowly ramped up on it, my doctor is a bit more conservative now about medications since I am sensitive to various medications.I currently am at 75mg. When we went to 100mg things got a bit iffy, because of the NE component of the agent. These days NE tends to make my anxiety worse.
Hope the worst of the side effects dissipate -- the sleepiness usually wears out, at least on some TCAs. I assume that you are taking it at night which is basically the best or even only time for some to take them, considering they are also used off label as sleep medications.-- tidings
Jay
Posted by SLS on February 11, 2009, at 6:52:13
In reply to Re: Not tolerating Clomipramine well, which TCA to try » Incubusfan, posted by yxibow on February 11, 2009, at 2:07:16
Hi Jay.
> I currently am at 75mg. When we went to 100mg things got a bit iffy, because of the NE component of the agent. These days NE tends to make my anxiety worse.What would happen if you were to take clonidine to counteract the NE anxiety?
- Scott
Posted by Incubusfan on February 11, 2009, at 11:48:50
In reply to Not tolerating Clomipramine well, which TCA to try, posted by incubusfan5 on February 10, 2009, at 11:45:24
So I took 25mg again last night, along with 2mg Trilafon. Woke up normal time(6:30am), ate breakfast, and felt the fatigue set it. Today was a gym day for me, and I was pretty much set in taking it off, due the fatigue. However, after a few hours, it seems as if I snapped out of the fatigue, and was able to work out.
I noticed my heart rate is definitely increased, and I sweat a lot more. My normal resting heart rate is quite low, upper 30s, to the 50s at the highest. Mostly genetic, and partly due to being in decent shape. I haven't taken it on the Clomipramine yet, but I'm sure it's a good 20-30 beats higher; nothing I'm concerned about. Hell, I had cardiac arrhythmia on Parnate, and I just accepted it.
I'll bump it up to 50mg tomorrow, as per was the original dosage plan. I'll just need to drag my *ss out of bed, and make it to my 8am class.
I do sometimes wonder if I'm BPII. As sometimes I'll be at the gym,have all negative thoughts about the present and future, and later on, I'll start looking at all the positives and how I'm going to succeed. I'm definitely more on the depressive side, but I might have some hypomania going on. My doctor doesn't think I'm BP at all though.
- Mike
Posted by yxibow on February 11, 2009, at 20:11:35
In reply to Re: Not tolerating Clomipramine well, which TCA to try » yxibow, posted by SLS on February 11, 2009, at 6:52:13
> Hi Jay.
>
> > I currently am at 75mg. When we went to 100mg things got a bit iffy, because of the NE component of the agent. These days NE tends to make my anxiety worse.
>
> What would happen if you were to take clonidine to counteract the NE anxiety?
>
>
> - ScottWell that's an interesting thought Scott, but...
Medication #7 (not including OTC)? I don't think my doctor or myself are terribly fond of adding things. The idea is to reduce/replace what is really necessary.
Also I use propranolol at times PRN, and I doubt he'd be thrilled of the combination.
I agree, that it could be a possibility for some people -- and an anxiolytic / rage reducer (not that I really have it, I just have psychological anger issues which are justified). It nor guanfacine did anything for my tic though.
-- tidings
Jay
Posted by Vincent_QC on February 13, 2009, at 7:05:32
In reply to Not tolerating Clomipramine well, which TCA to try, posted by incubusfan5 on February 10, 2009, at 11:45:24
> After only three days on Clomipramine, I've decided I can't do a trial of it due to the side effects. I became so weak/lethargic, all I could do was lay down and watch tv. I need to attend class and do homework, so this is a problem.
>
> I suffer from the full gammut of depresson, GAD, SAD, OCD, and inattentive ADD. My doctor seems to think nortryptaline has the least amount of side effects, but doesn't think it would be helpful with OCD like the Clomipramine would. I know my mom took imipramine in the past with success, before later switching to Paxil.
>
> I've tried multiple SSRIs, but never Luvox, which is indicated in OCD. If all other SSRIs have failed, is Luvox still worth trying? Any opinions of which tricyclic would be best besides Clomipramine? Sedation is no good for me.
>
> Thanks.Hi incubusfan5,
I just to know some basic facts...What was the dosage of Clomipramine you take at the begining ?I just started the Clomipramine yesterday at 20mg/day for one week, after also severals try of AD's (All the SSRI's, SRNI's, MAOI'S - Nardil-Parnate, as well as anticonvulsive drugs like Gabapentin , lyrica...) name all of them, I try everything avaible in the Canada to treat my Social anxiety with general anxiety,BDD (body dismorphic disorder), panic disorder and depression...nothing improve me, with the exception of the Rivotril but only the first months I was on it...after I became addicted and the rest is history...
Normally i'm very sensible to the side effects of new drugs I try... The only one AD I try 2 times and when I never get any side-effects and never feel anything weak or strange on it was the Zoloft, I Was able to take more than the maximum dosage of it for a lot of months without improving at all, in fact I only gain a lot of weight on it...
So it's why I ask you what was your start dosage for Clomipramine, because people who suffer from GAD and SAD often have more difficulties finding the good drug to help them because all the AD seem to do the inverse effect at the begining of the treatment, mean more anxiety and less social interraction...
I drop out several tries of drugs because I was unable to wait until the bad side-effects disepear...
The Clomipramine seem to be the best choice for you since you have OCD...it's the most selective of all the TCA's for the SE, with less effect on the NE and a weak effect on the DA...but it's not the best choice for the ADD, since you need something who will hit more the NE for this...but if you have GAD and SAD, it's probably better to stay on the Clomipramine...
Did you ever try a MAOI before? The parnate seem to be the best choice for you...if you dont have heart problems of course since it can give hypertension...but for MY experience, the Parnate hit more the NE at first, in MY case, I can't tolerate NE action of a drug cause my blood pressure always get higher....Another time, I drop the Parnate because I was feeling a lot tired on it and I had hypertension crisis often...but it was GOOD for my anxiety (social and general)...
For now i'm only at 20mg of Clomipramine day for one week, will be at 50mg the weeks after and me and the PDoc will see how I react...I dont feel any negatives side-effects at all at this low dosage...that's a miracle because normally I always feel something (exception of the Zoloft of course)...
What I can say for now, is that I'm already in a panic disorder state since more than 2 weeks...I have severals panic attacks that occurs everywhere (my car, alone in front of my LapTop, in my bed...and of course in social situation)...So The Clomipramine don't worse my state for now, I don't feel sedation from it as well...in fact I think we are all different for the sedation effect...I take it at bedtime with a low dose of Seroquel (50mg) to prevent insomnia and be able to sleep more at night (around 5-6 hours), the 50mg of Seroquel begin to loose some of is power so I will ask for 75mg...
I'm not sure if I can mix the Clomipramine of the Seroquel together but for now everything is fine, it can't be worse anyway...I had to take 30mg of Valium each day now because I feel too much anxious....before I was only at 20mg...the strange sensation I feel inside my head make me crazy...I feel A LOT ANXIOUS and I fear a seizure so I take more Valium pills...but they do nothing...That's weird this sensation (like someone play with my brain and pus it really hard)...
Anyway, take care of you and do what you feel it's the best for you...maybe your start dosage was too high also, cut the pills by half sometimes help to reduce the side-effects...anyway I think TCA's , like all the SSRI's, take more than 2-4 weeks before some improvements occurs...
I wish you a good luck and also I hope everything will be fine ;-)
Have a nice day!
Vincent ;-)
Posted by Incubusfan on February 13, 2009, at 15:49:20
In reply to Re: Not tolerating Clomipramine well, which TCA to try » incubusfan5, posted by Vincent_QC on February 13, 2009, at 7:05:32
> Hi incubusfan5,
> I just to know some basic facts...What was the dosage of Clomipramine you take at the begining ?
>
> I just started the Clomipramine yesterday at 20mg/day for one week, after also severals try of AD's (All the SSRI's, SRNI's, MAOI'S - Nardil-Parnate, as well as anticonvulsive drugs like Gabapentin , lyrica...) name all of them, I try everything avaible in the Canada to treat my Social anxiety with general anxiety,BDD (body dismorphic disorder), panic disorder and depression...nothing improve me, with the exception of the Rivotril but only the first months I was on it...after I became addicted and the rest is history...
>
> Normally i'm very sensible to the side effects of new drugs I try... The only one AD I try 2 times and when I never get any side-effects and never feel anything weak or strange on it was the Zoloft, I Was able to take more than the maximum dosage of it for a lot of months without improving at all, in fact I only gain a lot of weight on it...
>
> So it's why I ask you what was your start dosage for Clomipramine, because people who suffer from GAD and SAD often have more difficulties finding the good drug to help them because all the AD seem to do the inverse effect at the begining of the treatment, mean more anxiety and less social interraction...
>
> I drop out several tries of drugs because I was unable to wait until the bad side-effects disepear...
>
> The Clomipramine seem to be the best choice for you since you have OCD...it's the most selective of all the TCA's for the SE, with less effect on the NE and a weak effect on the DA...but it's not the best choice for the ADD, since you need something who will hit more the NE for this...but if you have GAD and SAD, it's probably better to stay on the Clomipramine...
>
> Did you ever try a MAOI before? The parnate seem to be the best choice for you...if you dont have heart problems of course since it can give hypertension...but for MY experience, the Parnate hit more the NE at first, in MY case, I can't tolerate NE action of a drug cause my blood pressure always get higher....Another time, I drop the Parnate because I was feeling a lot tired on it and I had hypertension crisis often...but it was GOOD for my anxiety (social and general)...
>
> For now i'm only at 20mg of Clomipramine day for one week, will be at 50mg the weeks after and me and the PDoc will see how I react...I dont feel any negatives side-effects at all at this low dosage...that's a miracle because normally I always feel something (exception of the Zoloft of course)...
>
> What I can say for now, is that I'm already in a panic disorder state since more than 2 weeks...I have severals panic attacks that occurs everywhere (my car, alone in front of my LapTop, in my bed...and of course in social situation)...So The Clomipramine don't worse my state for now, I don't feel sedation from it as well...in fact I think we are all different for the sedation effect...I take it at bedtime with a low dose of Seroquel (50mg) to prevent insomnia and be able to sleep more at night (around 5-6 hours), the 50mg of Seroquel begin to loose some of is power so I will ask for 75mg...
>
> I'm not sure if I can mix the Clomipramine of the Seroquel together but for now everything is fine, it can't be worse anyway...I had to take 30mg of Valium each day now because I feel too much anxious....before I was only at 20mg...the strange sensation I feel inside my head make me crazy...I feel A LOT ANXIOUS and I fear a seizure so I take more Valium pills...but they do nothing...That's weird this sensation (like someone play with my brain and pus it really hard)...
>
> Anyway, take care of you and do what you feel it's the best for you...maybe your start dosage was too high also, cut the pills by half sometimes help to reduce the side-effects...anyway I think TCA's , like all the SSRI's, take more than 2-4 weeks before some improvements occurs...
>
> I wish you a good luck and also I hope everything will be fine ;-)
>
> Have a nice day!
>
> Vincent ;-)Hey Vincent,
I've previously tried EMSAM and Parnate. EMSAM didn't really do anything, and my body can't tolerate Parnate. It causes such terrible fatigue that I'd be out of breath going up the stairs in my home; it also caused severe hypotension for me. I do believe it helped me a bit though.
I'm now on 2mg of Trilafon(an anti-psychotic), and 50mg of Clomipramine a night. I managed to drag my *ss to the gym on Wednesday, as it was a normal gym day for me(I go 4 days a week typically). However, this morning I didn't have the energy to go until it was about 11am, so I decided to just take a needed day off from it.
I think I need to drink Coffee in the morning to wake me up while on he Clomipramine. I'm also hoping it doesn't make me fat. I've also got body dysmorphic disorder, so I'm well aware of how I look and what I eat. We'll see if there are any metabolic changes taking place. I'm 5'11", 145lbs, and somewhat toned, somy body fat is low, but Paxil got me up to 195 back in 2002, and Zoloft up to 180 back in 2003...
Let me know how you're doing, and keep me up to date.
- Mike
Posted by Vincent_QC on February 14, 2009, at 10:33:47
In reply to Re: Not tolerating Clomipramine well, which TCA to try, posted by Incubusfan on February 13, 2009, at 15:49:20
> Hey Vincent,
>
> I've previously tried EMSAM and Parnate. EMSAM didn't really do anything, and my body can't tolerate Parnate. It causes such terrible fatigue that I'd be out of breath going up the stairs in my home; it also caused severe hypotension for me. I do believe it helped me a bit though.
>
> I'm now on 2mg of Trilafon(an anti-psychotic), and 50mg of Clomipramine a night. I managed to drag my *ss to the gym on Wednesday, as it was a normal gym day for me(I go 4 days a week typically). However, this morning I didn't have the energy to go until it was about 11am, so I decided to just take a needed day off from it.
>
> I think I need to drink Coffee in the morning to wake me up while on he Clomipramine. I'm also hoping it doesn't make me fat. I've also got body dysmorphic disorder, so I'm well aware of how I look and what I eat. We'll see if there are any metabolic changes taking place. I'm 5'11", 145lbs, and somewhat toned, somy body fat is low, but Paxil got me up to 195 back in 2002, and Zoloft up to 180 back in 2003...
>
> Let me know how you're doing, and keep me up to date.
>
> - MikeHi Mike!
Hummm ok I see...I'm only at 20mg of Clomipramine so I assume that dosage is too small to produce side-effects on me...Normally, i'm very sensible to the side-effects of all the AD's...I Will see it in 5 days...I will be at 50mg/day like you...Like Scott write often, TCA's side-effects fade away with time...The sedation and the lack of motivation and energy is normal I think, all the AD's do this, even the ones who work hard on the DA...
I also had a really bad reaction to the Parnate. I had the same physical fatigue than the one you got... One night, I was walking on the street with a friend and he was walking normally, not fast...but I was unable to follow him...I was so tired..I was feeling hurt in each muscles of my body, like I was on fire...it was really strange...and the high BP was untolerable for me, I have to get my heart check the 26th February (EGK) because of the Parnate, since I stop it, my blood pression never return to the normal level I had before the Parnate... So a good EGK will help me to see if something goes wrong with my heart...
I can't try the Emsam patch...that's weird...in the Canada, it's approved by Health canada...but the compagny who produce them don't sell them in the Canada, so the only way is to import the Emsam patch in the Canada...but it's not in the schedule F of drugs that can be imported in the Canada... So that's a no issue... My PDoc already send my folder to Health Canada to import some Marplan in the Canada, my folder will be study soon...it will cost nothing for me if it's approved...but that's a long process...so for now, I will hope the Clomipramine will work...
Did you take the 50mg in one dose or you divided it in 2 doses??? Maybe take it before bedtime will help??? It's what I do for the 20mg...one dose at bedtime...I Will do the same at 50mg...
I also take an anti-pcyshotic to help me to sleep...50mg of Seroquel...it was helping me a lot at the begining but it begin to loose the sedative effect on me...I begin to be awake at 3-4 AM...I have to try really hard to return in my bed and sleep a little bit more...I Will need to increase my dosage to 75mg I think... I don'T know if it will be dangerous to take such a high dosage of Seroquel with the Clomipramine??? Maybe Scott can answer to this???
For the coffee, I understand you...that's the only thing that help me to stay awake at daytime...I try to limit my intake of coffee to 2 big cups in the morning, to be able to stay awake until noon...I always do a nap in the afternoon...and I drink another cup at the end of the afternoon just to give me some energy to take a shower and get dress...and go out of the house...sometimes I drink 2 cups in the afternoon...Anyway, coffee for me don'T disturb my SAD or worse it...BUT coffee worse my panic disorder and my general anxiety...so in other way, it's probably not good for my SAD...but anyway, I always feel more sociable when I drink some coffee...I can interract more well with the others... I find the coffee to be more stimulating than the Ritalin at 20mg dose...that's weird...my brains are probably just a little bit too f*ck up...
For the weight gain...I think it's different for everyone... You see, in 1 1/2 years, I gain more than 20 pounds on the Prozac + Remeron... After I was switch to the Zoloft, who do nothing on me except the weight gain...so I go from 180 in october 2007 to 230 in march 2008...After the Zoloft fail, I do a very strict diet (600 calories day), with protein shake only...and a lot of vitamins...In 2 months, I return to 175 pounds...i'm 6 feet...I was looking like an anorexic guy... Ho I forget, I got a gastric by-pass to loose weight 7 years ago...soon 8 years...I go from 450 to 175 pounds in less than 9 months...I was able to stay at 175 from 2002 until October 2007...
After the summer, I was put on the Cipralex AD...with Ritalin and after with Wellbutrin...From August to November, I gain 50 pounds...i'm now again at 225 pounds...but it'S seem to stay stable for now... I also hope the TCA's will not make me ganing weight...I Can't take another 40 pounds...I think if the Clomipramine work and I can tolerate it well...I Will do another strict diet to loose some weight before the summer...I feel just so fat now...I hate that...and it'S activating my BDD disorder...
Anyway...keep me inform of your situation...I will do the same when I will jump into the 50mg dose /day...I really hope I will not have the same side-effects than yours...
Take care of you ok !!!
Bye!
Vincent ;-)
This is the end of the thread.
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