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Re: Desipramine

Posted by SLS on May 4, 2001, at 21:21:48

In reply to Desipramine, posted by Cindylou on May 2, 2001, at 11:50:42

Hi Cindy.

> Desipramine --
> - what is the lowest effective dose?

The lowest effective dose is always the minimum dosage that gets the results you are looking for and maintains them.

I am not trying to be a wise guy (it comes naturally). Each individual must find this dosage by clinical (observation) adjustment of dosage. I think it is safe to say that 40mg was too low to expect much. You might have felt some sort of energy boost temporarily, but larger dosages are usually needed in cases of moderate to severe depression. Just as a general guideline, I would consider dosages between 100mg - 200mg to be average for most moderate depressions in an outpatient setting. Dosages up to 300mg are often needed for more severe depressions. However, the rate at which people metabolize (break-down) and excrete desipramine is highly variable. That is why one must methodically discover which dosage is ideal for them. Blood tests can help with this. Depending on your tolerance of side effects, I would think 150mg to be a good target.

> - What are side effects?

This again is variable for each individual, but some of the more common side effects are: dry mouth, blurred vision, constipation, difficulty initiating urination, dizziness (especially when standing from a seated or lying position), drowsiness, increased perspiration, mild tremors, anxiety, and insomnia. You may experience only a few of these. The side effects of desipramine diminish and are generally mild once one has been taking it for awhile.

> - What is it best for treating (e.g. depression, anxiety, social anxiety, etc.)

Desipramine can effectively treat all of these. It depends upon exactly what is going on within the three pound organ located between your ears. Often, anxiety and social inhibition are features of the depression itself, and improve when the depression improves. For instances in which true social phobia is prominent or in cases of generalized anxiety disorder, the SSRIs and MAO-inhibitors, particularly Nardil (phenelzine), are usually better choices. From the standpoint of statistics, there is a small tendency for males to respond to tricyclics and females to respond to SSRIs.

So, what do you do now?

I don't know.

There are lots of things that you might take into consideration. How many drugs have you tried without success, and at what dosages? What combinations of medications have you tried? Are you, or is anyone in your family bipolar? Should any of your immediate family members suffer from a mood or anxiety disorder, which drugs have been effective for them? Have you had your thyroid function checked? Does your depression include constant melancholic, morbid thoughts and feelings of doom? Do you have trouble sleeping, especially in the early morning? Does you depression have any psychotic features? Do you sleep to little or too much? Do you eat too little or too much? Do you feel agitated and have trouble sitting still? Do you have too little energy to get out of a chair?

These questions and more are relevant in making a best *guess* as to which medication or combinations of medication have the best chance of working for you. A good psychiatrist would take all of these things into consideration.

So, what do you do now?

I think desipramine is a reasonable choice. If you are comfortable with trying it first, and your doctor feels that it is a good first choice for you in particular, I can't think of any reason to hesitate other than the presence of preexisting abnormal heart function.

I have probably made things more complicated for you. Sorry.


- Scott

 

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