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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.
Posted by Phillipa on December 5, 2017, at 9:38:33
In reply to Re: Everything is good, except for depression, posted by Christ_empowered on December 5, 2017, at 9:17:21
No definitely not opiods. They can cause respiratory depression leading to death. Legalization of drugs is a different category. Phllipa
Posted by Christ_empowered on December 5, 2017, at 9:54:51
In reply to Re: Everything is good, except for depression » Christ_empowered, posted by Phillipa on December 5, 2017, at 9:38:33
I do not do drugs myself, but I think its time to stop criminalizing drug use. I think anti-drug laws make the situation far, far worse than it would be if drugs were legalized, plus the harsh end of The War on Drugs falls on poor people and minorities, in a big way.
Posted by Phillipa on December 5, 2017, at 11:35:48
In reply to Re: Everything is good, except for depression, posted by Christ_empowered on December 5, 2017, at 9:54:51
Opiods do they or can they cause addiction or tolerance? In some yes in others no. Phillipa
Posted by baseball55 on December 5, 2017, at 15:46:32
In reply to Re: Tolerence vs Addition of Opiods pain meds » Christ_empowered, posted by Phillipa on December 5, 2017, at 11:35:48
1. People become tolerant to opioids, addicted or not. This is why people with chronic pain conditions need higher and higher doses, even when they are not "addicted."
2. Opioids cause physical dependence, whether or not people are "addicted" (in the sense of abusing them, taking more than prescribed, engaging in drug-seeking behavior). Nobody who has used opioids long-term can simply stop them without painful withdrawal. They need to be tapered.
3. Opioids always cause euphoria. This is why they control pain. They don't stop the pain, they merely move people into a psychological state where the pain becomes tolerable. It's not that some people don't feel euphoria when on opioids. It's just that, for many (hopefully most?) people, that euphoria doesn't fulfill some psychological need that makes them want more even when the pain is gone.
4. I agree that oxycodone should not be taken off the market. It is an amazing and absolutely necessary drug for post-surgical pain and pain from terminal cancer. It is an absolutely terrible drug for chronic, non-terminal pain, like orthopedic pain. Way too addictive, builds tolerance requiring higher and higher doses and doesn't even work as well as physical therapies and mind-body work. Personally, I believe insurance companies should start covering Feldenkrais, which is the very best way, I have found, to help people with chronic orthopedic pain.5. Some countries have legalized, or at least de-criminalized opioids. Addicts need to register to get drugs, so they can be monitored medically. I don't know of any country where they are just over-the-counter legal (at least any developed country). I see this as highly unlikely in the US, where drug use still evokes these moral responses - she's lazy, undisciplined, needs to suffer for her sins. Phillipa is absolutely right. Without regular monitoring and counseling, overdoses are way too common. The problem with legalization is that, though currently illegal in the US, they are almost unbelievably easy to obtain. Maybe some form of decriminalization would allow the government to regulate what's sold - so heroin laced with fentanyl could be taken off the market.
6. Most addicts want to quit. Currently, drugs like methadone and suboxone, which make quitting much easier and safer, are very difficult to get access to. Methadone is only available through clinics, where addicts need to line up daily to get their dose. Suboxone can be prescribed, but few doctors are licensed and the DEA limits the number of patients they can treat. As a result, suboxone prescribing has become a gold-mine for licensed prescribers - few take insurance and charge hundreds of dollars for visits.
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