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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by Phillipa on December 3, 2017, at 21:04:59
In reply to Re: Everything is good, except for depression, posted by baseball55 on December 3, 2017, at 18:28:04
And that is how it all started docs prescribing too many opiods agree 100%. Now at least here being judicially prescribed in low and small amounts. I've been prescribed opiods also but didn't take the full script. Just because one has the meds doesn't mean you should take them all. When fell off bike last summer I refused pain meds in the ER took motrin instead generic. I see a lot of people have surgeries now one recently where I live for breast cancer double mastectomy wasn't given more than three days RX for them. Lidocaine inserted into the incision which slowly drained into the wound. I had this also with a tummy tuck over 10 years ago. Less than three days of half the amount of vicodin I was precribed I stopped them as the pain had subsided. No withdrawal no addiction. Phillipa
Posted by SLS on December 3, 2017, at 22:11:33
In reply to Re: Everything is good, except for depression, posted by baseball55 on December 3, 2017, at 18:28:04
> In fact, many of "the addicts" were average people who got hooked on opioids prescribed by doctors. I did.
In what ways were you addicted?
- Scott
Posted by Phillipa on December 4, 2017, at 9:15:44
In reply to Re: Everything is good, except for depression » baseball55, posted by SLS on December 3, 2017, at 22:11:33
Scott good question as addict is someone who escalates doses and then lots of times actively seeks out the drug or begins to abuse now those meds. Where one can develop a tolerance to the meds and require higher doses just to feel the same. I know personally I just didn't like the spacy feeling of them so go off them fast. No fear of withdrawal as so short term. Phillipa
Posted by baseball55 on December 4, 2017, at 19:07:55
In reply to Re: Everything is good, except for depression » baseball55, posted by SLS on December 3, 2017, at 22:11:33
>
> In what ways were you addicted?
>
> I was prescribed oxycontin, 10 mg, 2/day plus vicodin for breakthrough pain. Within months, I was altering prescriptions, then forging prescriptions. But the end, I was taking about 80mg oxycodone a day. I had DEA numbers for 3 doctors, made prescription blanks in their names and filled them, not using insurance, in three different pharmacies. I ordered drugs from Mexico by Fedex. I had not yet graduated to street purchases. I was not caught and jailed, amazingly (I did this for four years).My nephew was prescribed percocet in high school for football injuries and eventually went on to heroin. He was in and out of jails and rehabs and has now been clean for a year.
Phillipa - Yes, people should throw out what they don't need and not use more than they need for pain. Key word is "should." It's judgmental. What you don't seem to get is that some people just plain get addicted. The euphoria of opiates is too alluring to them. Once started, they can't stop. It's like alcohol. yes, some people can use moderately and stop themselves before becoming drunk, but others just can't. Whether it's genetic or characterological, we don't know. But we know that some people are likely to get addicted.
Posted by baseball55 on December 4, 2017, at 19:19:10
In reply to Re: Everything is good, except for depression, posted by baseball55 on December 4, 2017, at 19:07:55
One more thing. By the end 80-100mg oxycodone didn't do anything for me anymore but keep me from getting dope-sick. I started trying to stop then, because I knew the next step was heroin. It's hard to describe how absolutely horrible opiate withdrawal is, which is why addicts won't stop even when they want to and know they need to.
Eventually, I got on suboxone and tapered off that.BTW, this is not some story of a young person, succumbing to peer pressure or just being an irresponsible youth. I was 44 when I started opiates and 49 when I stopped.
Posted by Phillipa on December 4, 2017, at 22:51:09
In reply to Re: Everything is good, except for depression, posted by baseball55 on December 4, 2017, at 19:19:10
Baseball you don't need to plead a case as know this is true worked in chemical dependency for years. I really felt for those whose body /Brain wouldn't allow them to just take as prescribed. But this is only some. Those that don't share this problem should not be denied pain meds. A good doctor should not prescribe many pain killers or sending now to pain management clinics patients who do require long term pain meds and some do. I'm so sorry this happened to you. The good new is you know now you can't take this form of medication. Phillipa
Posted by SLS on December 5, 2017, at 8:05:17
In reply to Re: Everything is good, except for depression » baseball55, posted by Phillipa on December 4, 2017, at 22:51:09
My fear is that oxycodone will be taken off the market. It has been unjustly demonized in the court of public opinion. Oxycodone is an important tool to relieve people of excruciating pain. Unfortunately, some people have a psychobiology that leaves them predisposed to opioid addiction. I wish I knew what are the percentages. My best guess is that the majority of people do NOT experience euphoria with oxycodone. The thing that makes it difficult for many people to discontinue oxycodone is physiological dependence, not addiction.
- Scott
Posted by Phillipa on December 5, 2017, at 9:06:37
In reply to Re: Everything is good, except for depression, posted by SLS on December 5, 2017, at 8:05:17
I absolutely agree with all the statements you make. My fear also is they will be taken off the market. You can't "punish" people for something that is most likely an inheritated gene. So what happens to those who get operated on or have cancer they have nothing to give them? Here have a tylenol? Each person experiences pain at different thresholds also. Keep the opiods as someone addicted not tolerant or someone tolerant that seeks more meds on their own their docs and the RN's need to be aware of the "Clock Watchers" and intervene then. Phillipa
Posted by Christ_empowered on December 5, 2017, at 9:17:21
In reply to Re: Everything is good, except for depression » SLS, posted by Phillipa on December 5, 2017, at 9:06:37
I think this latest "epidemic" shows us how much better life would be in these United States if they'd just legalize drugs, tax them, and regulate them. I don't think "treatment, not prison" helps enough, nor do I think decriminalization is sufficient. I think anti-drug laws have been a massive waste of resources and a source of way, way, way too much suffering. if people want drugs, they should be able to buy their drugs safely, legally, and carry on with their lives.
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