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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by Glydin 3.9 on February 21, 2009, at 7:44:16
In reply to Imipramine.. damn hypotension, posted by mav27 on February 21, 2009, at 0:49:24
> Normal pressure for me is 140/90 Pulse around 87
~~~ I just went on an ACE inhibitor for having consistent number readings like that for about a year.hmmmm?
Posted by desolationrower on February 21, 2009, at 9:47:12
In reply to Imipramine.. damn hypotension, posted by mav27 on February 21, 2009, at 0:49:24
tried mirtazapine? yohimbe might be better, increases sympathetic activation & is an effective augment to sris, but not really on most pdocs radar.
-d/r
Posted by Phillipa on February 21, 2009, at 10:55:07
In reply to Re: Imipramine.. damn hypotension, posted by desolationrower on February 21, 2009, at 9:47:12
That's strange seems that all the meds you try cause hypertension and low blood pressure. Could something else be wrong? Physically I mean? Phillipa
Posted by Glydin 3.9 on February 21, 2009, at 17:18:55
In reply to Re: Imipramine.. damn hypotension, posted by Phillipa on February 21, 2009, at 10:55:07
> That's strange seems that all the meds you try cause hypertension ****and**** low blood pressure. >
~~~ Huh?AND or OR or just AND? I don't understand....
Posted by Phillipa on February 21, 2009, at 19:19:36
In reply to Re: » Phillipa, posted by Glydin 3.9 on February 21, 2009, at 17:18:55
Was to mav. Phillipa
Posted by Phillipa on February 21, 2009, at 19:21:41
In reply to Imipramine.. damn hypotension, posted by mav27 on February 21, 2009, at 0:49:24
Sorry was in a hurry meant low BP. So any suggestions from the docs? Phillipa
Posted by Glydin 3.9 on February 21, 2009, at 19:31:33
In reply to Re: » Glydin 3.9, posted by Phillipa on February 21, 2009, at 19:19:36
Sorry
Posted by mav27 on February 21, 2009, at 20:27:02
In reply to Re: Imipramine.. damn hypotension, posted by Phillipa on February 21, 2009, at 10:55:07
hypertension is normal for me, not med induced. But so far most anti depressant or anti-psychotic causes the low pressure. Havn't been able to find any reason for it happening, i've tried every blood test i could posibly think of or read of on here. Just seems my brain doesn't like the meds that help
> That's strange seems that all the meds you try cause hypertension and low blood pressure. Could something else be wrong? Physically I mean? Phillipa
Posted by mav27 on February 21, 2009, at 23:29:11
In reply to Re: Imipramine.. damn hypotension » mav27, posted by SLS on February 21, 2009, at 6:16:16
Just wondering if you can help me interprate what this means, i was looking up info on noradrenaline and came across thins.
Noradrenaline
CARDIOVASCULAR EFFECTS
The major difference between noradrenaline and adrenaline is that the a- stimulating effects of noradrenaline are clinically apparent at lower doses of the drug, producing pronounced arteriolar vasoconstriction and an increase in SVR. Renal, hepatic and cerebral blood flow are all reduced. Normally this results in a reflex bradycardia and CO may be reduced
So to start with it mentions it being a vasconstrictor as we know it to be which should increase my BP instead of lowering it i assume. But what about the second half of the paragraph... could that have anything to do with my problem?
http://www.usyd.edu.au/anaes/lectures/pforrest/Vasopressor%20lecture%20-Part%201.htm
> > Iam serously getting sick of this problem.. every med i've tried that has actually had good results also causes such severe hypotension that it makes it hard to stay standing up for long. First it was nardil and parnate.. they made me faint. Went on to prozac and it lowered my blood pressure and also made me agitated so i switched to imipramine and it works but it is also making my blood pressure drop and my pule is so weak i can't feel it when im standing (my blood pressure monitor also can't get a ready on rate or pressure when im standing)
> >
> > Normal pressure for me is 140/90 Pulse around 87
> > Now its at laying 138/86 pulse of 52
> > sitting : 117/87 pulse 113
> > and standing, if im really quick to take it: 85/67 pulse 133.
> >
> > Ive now been on every AD available in australia.. any that show promise also causes hypotension and it's a total pain and all the doctors and pdocs including the hospital say there is nothing i can do but go off the med.
> >
> > oh well enough ranting.. time to lay back down so the tinitus can stop.
>
>
> I hope it dissipates over time.
>
>
> - Scott
Posted by Phillipa on February 22, 2009, at 0:37:29
In reply to Re: » Phillipa, posted by Glydin 3.9 on February 21, 2009, at 19:31:33
That's okay my fault miss you. Love Phillipa
Posted by SLS on February 22, 2009, at 6:39:37
In reply to Re: Imipramine.. damn hypotension » SLS, posted by mav27 on February 21, 2009, at 23:29:11
Hi.
:-)
The article is right about the effects of norepinephrine (NE) / noradrenaline as it acts on the central and peripheral nervous systems.
However, imipramine does things other than inhibit the reuptake of NE. One thing it does is antagonize (block) peripheral NE alpha-1 postsynaptic receptors. Normally, NE would stimulate these receptors and cause vasoconstriction, thereby raising blood pressure. Now, imipramine moves in and blocks this from happening. This allows for a reduction in the tone of vascular tissue - vasodilation. The low blood pressure effect is stronger than the high blood pressure effect, so, blood pressure drops.
I wish I could guarantee you that the dizziness gets better over time. I have found this to be true with tricyclics, but it can take weeks or even months to disappear. Everyone is different, though. I guess you are going to have to take one week at a time to see what the trend is.
As an aside, I was hoping that a drug like prazosin, another NE alpha-1 receptor antagonist, would produce an upregulation of these receptors. It doesn't, so I can't suggest a mechanism by which the hypotension might be ameliorated.
You can take Florinef in the meantime to keep your pressure up. It works by increasing the amount of fluid retained in the blood vessels.
- Scott
Posted by mav27 on February 23, 2009, at 1:11:26
In reply to Re: Imipramine.. damn hypotension » mav27, posted by SLS on February 22, 2009, at 6:39:37
arghh i'm sick of all this crap with meds... the blood pressure problams have improved a little.. my pulse is now feelable when standing.. but my body always feels like ive just done a massive weight lifting workout.. every muscle hurts for no reason. I'm only on 75mg too. I'm thinking i might just jump up to 200mg and see what happens. I don't remember it feeling like this when i last took it 2 years ago.. in fact i remember being upset when the doc made me stop taking it. It was energising last time.. only problem i remember with it was sweating a bit, but i was getting out of the house more while on it.. the doc made me stop because of my high pulse rate.. Turns out the pulse rate was my normal one anyway :P
Posted by mav27 on February 23, 2009, at 9:20:19
In reply to Imipramine.. damn hypotension, posted by mav27 on February 21, 2009, at 0:49:24
Well tonight after upping the dose from 75 to 150mg things actually seem better. I went to sleep for about 2 hours thanks to the anti-histamine stuff but it's now 7 hours later and i dont feel sleepy ( i actually didn't notice when the sleepy feeling went away so i don't know how long it lasted) and my standing blood pressure is 100/80 pulse 120 which is a good improvment.
Posted by SLS on February 23, 2009, at 9:47:03
In reply to Re: Imipramine.. damn hypotension, posted by mav27 on February 23, 2009, at 9:20:19
> Well tonight after upping the dose from 75 to 150mg things actually seem better. I went to sleep for about 2 hours thanks to the anti-histamine stuff but it's now 7 hours later and i dont feel sleepy ( i actually didn't notice when the sleepy feeling went away so i don't know how long it lasted) and my standing blood pressure is 100/80 pulse 120 which is a good improvment.
Very cool.
I am glad you found the secret by yourself.
I was going to suggest increasing the dosage, but I know that would have been counter-intuitive. What you now experience might be due to:
1. The relative contributions of NE alpha-1 receptor antagonism versus NE reuptake inhibition changing as the reuptake inhibition becomes more prominent.
2. A reduction in dysautonomia as the drug begins to exert antidepressant effects. These tend to show up as physiological changes at first, followed by mood improvements. If you have LESS dry mouth, sweating, blurred vision, hypotension, and feel less cold, then the partial resoulution of dysautonomia is a likely explanation.
I think you are on the right track.
- Scott
Posted by SLS on February 23, 2009, at 9:48:18
In reply to Re: Imipramine.. damn hypotension, posted by SLS on February 23, 2009, at 9:47:03
Less heart palpitations, too.
- Scott
Posted by mav27 on February 23, 2009, at 10:57:02
In reply to Re: Imipramine.. damn hypotension, posted by SLS on February 23, 2009, at 9:47:03
>
> 2. A reduction in dysautonomia as the drug begins to exert antidepressant effects. These tend to show up as physiological changes at first, followed by mood improvements. If you have LESS dry mouth, sweating, blurred vision, hypotension, and feel less cold, then the partial resoulution of dysautonomia is a likely explanation.
>The dry mouth has improved slightly.. sweating hasn't started yet.. Slight ringing in my ears after i stand up. the only other side effect i had was urinary hesitation/retention but that seems to have improved a fair bit.
Oh and sexual dysfunction as usual but not bad enough to care about.. nothing like the horrid ssri's.
Posted by JadeKelly on February 23, 2009, at 19:18:17
In reply to Re: Imipramine.. damn hypotension » SLS, posted by mav27 on February 23, 2009, at 10:57:02
Hi Mav,
I went through hell with hypotension with my last PDoc. I was on Parnate but he would not augment. The only thing he said was if my BP went over 150 (systolic) he wanted me to go the emergency room.
My pharmasist was very confused by my low BP when I took pressure there. He said call DR. My PDoc said he really wasn't concerned with low BP.
Thats fine for him. It left me in bed, dizzy, cognitively impaired, and almost fainting at times.
My new PDoc added Stim to my Parnate.... my BP is 120/80. I have to page him if it falls below 90.
Its been as low as 69 with out stim/old Doc.I would not settle for 80's which is where I was for along time. It really pissed me off that old PDoc let me stay that way. I'm sorry if I missed anything in your thread. Don't stay in 80's.
I am in remission from the depression from hel* btw, feel free to contact me. I am happy again or at least normal! I'm getting all kinds of things done. When my BP was in 80's, I was lucky to make to the kitchen for coffee.
~Jade ;-)
Posted by Phillipa on February 23, 2009, at 19:55:14
In reply to Re: Imipramine.. damn hypotension » mav27, posted by JadeKelly on February 23, 2009, at 19:18:17
Jade you mean 80's systolic right not diastolic as 80's is fine. Love Phillipa
Posted by JadeKelly on February 23, 2009, at 20:58:15
In reply to Re: Imipramine.. damn hypotension » JadeKelly, posted by Phillipa on February 23, 2009, at 19:55:14
> Jade you mean 80's systolic right not diastolic as 80's is fine. Love Phillipa
Well, I'll just give you an example, today was 120(systolic)/80(diastolic), so 120/80. Normal.
A month ago it was 93/70 93S/70D
Before that, systolic was in 80's for a good while. Sometimes even lower. 69 was lowest I remember. Course I probly passed out then.
~Jade
Posted by Phillipa on February 23, 2009, at 21:01:16
In reply to Re: Imipramine.. damn hypotension » Phillipa, posted by JadeKelly on February 23, 2009, at 20:58:15
Jade sounds good now. Phillipa
Posted by mav27 on February 23, 2009, at 22:47:38
In reply to Re: Imipramine.. damn hypotension » Phillipa, posted by JadeKelly on February 23, 2009, at 20:58:15
Parnate is a beauty.. it lowered my pressure to 70/40.. i don't know what it dropped to after standing up for long because i would be out like a light on the floor somewhere rather quickly.
> > Jade you mean 80's systolic right not diastolic as 80's is fine. Love Phillipa
>
> Well, I'll just give you an example, today was 120(systolic)/80(diastolic), so 120/80. Normal.
>
> A month ago it was 93/70 93S/70D
>
> Before that, systolic was in 80's for a good while. Sometimes even lower. 69 was lowest I remember. Course I probly passed out then.
>
> ~Jade
>
>
Posted by JadeKelly on February 24, 2009, at 0:23:07
In reply to Re: Imipramine.. damn hypotension » JadeKelly, posted by mav27 on February 23, 2009, at 22:47:38
Yes,
It is a strange med. God bless it. Added to the right amount of Ritalin, and not only is my BP normal, 12/80, it got rid of that hating life depression I was in. I don't know how to tell people how I put up with all the unkowns (it was especially hard with the most incompetent Doc that ever lived). But I learned alot the hard way. It could have been so much easier if I had the Doc I have now.
I'm sorry you're going thru that, its not fun. My kids were worried and I'd go out and have to sit on the sidewalk so I didn't fall. I fell once on my driveway and once on my walkway, haha. I'm only laughing thinking what the neighbors must think.
This is not about me. Sorry. Please get that straightened out asap. I'm not a Doc but I think it really isn't safe, short term or long term. Tell your pDoc you want to augment with something that will raise your BP.
Good Luck, let me know how you do!
~Jade
Posted by mav27 on February 24, 2009, at 5:39:05
In reply to Re: Imipramine.. damn hypotension » mav27, posted by JadeKelly on February 24, 2009, at 0:23:07
It's a bloody pain that adults can't get their hands on ritalin or dexamphetamine ect here in Australia.. the laws are so tough it's near impossible. I even presented a huge paper on all the info and studies i could find on the use of stimulants and MAOI's to combat the hypotension but in the end just couldn't get it. Apparently it needs 5 pdocs to agree you need it and that's the only law i've been able to find out so far, so god knows what else is involved.
> Yes,
>
> It is a strange med. God bless it. Added to the right amount of Ritalin, and not only is my BP normal, 12/80, it got rid of that hating life depression I was in. I don't know how to tell people how I put up with all the unkowns (it was especially hard with the most incompetent Doc that ever lived). But I learned alot the hard way. It could have been so much easier if I had the Doc I have now.
>
> I'm sorry you're going thru that, its not fun. My kids were worried and I'd go out and have to sit on the sidewalk so I didn't fall. I fell once on my driveway and once on my walkway, haha. I'm only laughing thinking what the neighbors must think.
>
> This is not about me. Sorry. Please get that straightened out asap. I'm not a Doc but I think it really isn't safe, short term or long term. Tell your pDoc you want to augment with something that will raise your BP.
>
> Good Luck, let me know how you do!
>
> ~Jade
Posted by incubusfan5 on February 24, 2009, at 10:14:04
In reply to Re: Imipramine.. damn hypotension » JadeKelly, posted by mav27 on February 24, 2009, at 5:39:05
> It's a bloody pain that adults can't get their hands on ritalin or dexamphetamine ect here in Australia.. the laws are so tough it's near impossible. I even presented a huge paper on all the info and studies i could find on the use of stimulants and MAOI's to combat the hypotension but in the end just couldn't get it. Apparently it needs 5 pdocs to agree you need it and that's the only law i've been able to find out so far, so god knows what else is involved.
You and me both with the terrible MAOI hypotension. I suppose it wouldn't lower my BP to an unhealthly level if my BP wasn't already very good. Do you have a link to a document that shows the use of Ritalin to counteract MAOI hypotension? Do TCAs also cause hypotension for you? Also, if I'm not prying too much... what are you currently on?
Thanks,
- Mike
Posted by mav27 on February 24, 2009, at 16:12:43
In reply to Re: Imipramine.. damn hypotension » mav27, posted by incubusfan5 on February 24, 2009, at 10:14:04
Currently on 150mg of imipramine which has actually made the hypotension a lot better than the 75mg that was causing it badly. I also take valproate and alprozolam daily.
I don't remember dothiepin, dozepin or nortriptyline causing hypotension in me though.
There is some info here:
http://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.htmlhttp://www.biopsychiatry.com/maoi-stim.htm
The last link only seems to give a referance of where to find the info which i have no clue about getting.
>
> You and me both with the terrible MAOI hypotension. I suppose it wouldn't lower my BP to an unhealthly level if my BP wasn't already very good. Do you have a link to a document that shows the use of Ritalin to counteract MAOI hypotension? Do TCAs also cause hypotension for you? Also, if I'm not prying too much... what are you currently on?
>
> Thanks,
>
> - Mike
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