Posted by Elizabeth on July 11, 2001, at 16:08:04
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by Lorraine on July 11, 2001, at 10:15:48
> Thanks for the tip. I'll look into nadolol.
I'm not positive that's the one. There are oodles of beta blockers in clinical use, and it's hard to keep track of all of them.
> My hunch is the sleeping issue with me (which is a very recent thing) is due to being overstimulated by my meds and the propranolol cuts through that like a hot knife thru butter < vbg >
Lucky that you discovered it, then.
> > For your purposes, imipramine or nortripytline might be the best choices: they have moderate effects at muscarinic ACh receptors (anticholinergic side effects), H1 receptors (antihistaminic effects -- sedation in particular), and alpha1-adrenergic receptors (blood pressure effects).
>
> Sounds like weight gain and sedation--(sexual dysfunction as well?) Yeah, I know, picky, picky, picky. But sedation is not good with me.Weight gain and sedation are both attributed to the antihistaminic actions of tricyclics. Nortriptyline would be better than imipramine if you're concerned about this; it's generally well tolerated. Desipramine might be too activating.
> > My concern is that a TCA would not be an effective drug for you. What can you tell me about your depression (and/or other disorders)?
>
> I thought you'd never ask < vbg >. My depression is like walking through mud--no energy, weepy weepy hopeless stuff at its worst, poor working memory, impairment of cognitive skills (can not think my way out of a box--this from someone who graduated in the top of her class law school and 15 years later top of class in business school--"of all the things I've lost, it's my mind I miss the most".) What I do when I am depressed is hybernate--all my systems wink out bit-by-bit until I sit alone (social withdrawal) in a room (no activity) in the dark. I do not have eating disruption or sleep disruption normally. Since last November anxiety (especially physical as in hyperventilating--but also some mental, I don't read the newspaper, I can't follow the stock market--I used to run some portfolios for friends, family and so forth). I am not a big ruminator. Before the anxiety hit, after reading Stahl's book I decided I was NE deficient as opposed to Serotonin deficient.I think that it's been pretty well-established that the original monoamine hypothesis of depression was a vast oversimplification. Anyway, this is just a hunch, but if I were in your situation I'd give MAOIs a try before TCAs. Well, it's not entirely a hunch: the "hibernation," lethargy, social withdrawal, and anxiety/panic symptoms, and the lack of disturbances in eating or sleeping, suggest to me that TCAs might not be the best meds for you. OTOH, there are always surprises. I just think it'd be better to try a TCA only if MAOIs fail. FWIW, the traditional antidepressant MAOIs -- Nardil, Parnate, and Marplan -- worked pretty well for me, but selegiline sucked when I tried it.
> I think I should give the TCAs a try first because of their lower side effect profile, especially desipramine.
Having taken several TCAs and several MAOIs, I have to disagree about the side effects. The desipramine seems to be going okay for me so far (comparable to Parnate), but I'm not generally prone to overstimulation from ADs. If overstimulation has been a problem for you in the past, you might want to stay away from desipramine.
> The reason I suspect that there may be a P450 issue is because very low doses of meds affect me strongly and I am hypersensitive to side effects.
It's a possibility, but side effect sensitivity is very common among people with anxiety disorders. My pdoc described people with panic disorder as typically being "somatically attuned" -- they are very aware of what's going on in their bodies, and sometimes they overreact to minor changes.
> Probably Klonopin would do it for me--my emergencies are not very immediate and I took Xanax for a couple of days while I was working (long ago far away on a distant planet) and found it too sedating.
They're not exactly equipotent -- you might have taken more Xanax than you needed. But anyway, if Klonopin works for you, then that's probably for the best; its effects last a long time, which is nice.
> > Definitely a possibility. Two of its metabolites (as I'm sure you know) are l-amphetamine and l-methamphetamine. I experienced jitters, agitation, and worsened insomnia and appetite on it.
>
> Yes, but then dexidrine didn't have this effect; nor is adderral having this effect.Dexedrine is d-amphetamine -- fewer peripheral side effects. Adderall is a weird combination of isomers of amphetamine salts, but it seems (for whatever reason) to cause less "jittery"-type side effects than plain d,l-amphetamine.
> By the way, even tho "weeks" is the official time table for meds--I felt Wellbutrin within a couple days, Moclobemide and Selegiline as well. (maybe it's the puppy upper effect of these drugs).
Yes, those are all stimulating drugs. I also think that MAOIs sometimes work faster than other types of ADs.
[re melancholia]
> > It's "classic" depression. It tends to be rather severe, but it responds well to TCAs and ECT. That's why I'm hoping desipramine will be good for me.
>
> It also responds well to MAOs, doesn't it?The available evidence says yes (it's important to use a sufficient dose of the MAOI -- older studies used low doses, e.g., 45 mg of phenelzine). My experience is that MAOIs work as well as any other AD I've tried has. TCAs are still the ADs of choice for this type of depression, though, and I'm hoping that desipramine will help with the problems that Parnate didn't address. (It is possible to combine them safely, which I may try if I respond partially to the desipramine.)
-elizabeth
poster:Elizabeth
thread:67742
URL: http://www.dr-bob.org/babble/20010708/msgs/69757.html