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Re: Zeuma - some information, please Kacy

Posted by zeugma on October 22, 2003, at 9:24:48

In reply to Zeuma - some information, please, posted by Kacy on October 21, 2003, at 14:51:57

> My doctor suggested I drop Effexor and add Desipramine to Strattera. Effexor (75 mg) helps with excessive ruminating and I don't want to give it up. I am add/inattentive. I have very low energy.

Why does your dr. want you to drop Effexor? 75 mg is a fairly low dose of effexor.

> I have been thinking he was nuts to do two norepinephrine drugs and have been a little depressed over the options he is giving me. I want a dopamine drug. What are the differences? I am confused about what they are, even though I put desipramine in the search page here and read five or six (20 per page) pages of links. Don't you think that is an odd combination? I know your drug is similar to desipramine.
> Strattera only lasts about seven hours for me. It's decline is really noticable at that point, and within an hour I have anxiety setting in. Does your TCA last longer?

TCA's have half lives that are about 5 times longer than Strattera, i.e. 20-25 hours or more. If the Strattera wears off and anxiety returns it's probably the noradrenergic effect that is giving you the anxiety relief. On nortriptyline the effect is pretty 'smooth,' I'm not conscious of anxiety or lack of focus suddenly coming back (and unmedicated I have a lot of both).

Desipramine sems to be the most Strattera-like of the TCA's. It has only minimal sedation effect. The reason I added Strattera to nortriptyline was the nortriptyline simply wasn't waking me up enough. I still needed huge amounts of caffeine to stay awake through the day and my concentration was still poor. I did ask my pdoc about the differences between the drugs. The main one I gathered was that the Strattera was not cardiotoxic. I took this to mean that augmenting with Strattera would add NE effect without causing dangerous side effects elsewhere in the system- apparently norepinephrine agonism by itself is fairly safe, it's the effects on the heart that give TCA's their lethal potential. it seems that Strattera and TCA's stay out of each other's way in the cytochrome P450 system. It says in the Strattera prescribing info (at the website) that Strattera did not interfere with the metabolism of desipramine and therefore Strat won't cause desipramine to rise unexpectedly to dangerous levels as might happen with many SSRI's.

Are you having trouble sleeping? Nortriptyline is more sedating than desipramine and it helps me a lot with this problem. Proprtionally, nortriptyline affects norepinephrine less and serotonin more (relative to desipramine), and also blocks histamine, muscarinic and serotonin receptors more, leading either to increased side effects (weight gain, sleepiness) or to increased antidepressant/anxiolytic efficacy (if you have trouble sleeping, maintaining weight, etc.) Desipramine is a better treatment for ADD on its own (one study I read gave a 68 percent response rate to desip, while only 42 percent to nortrip). Nortriptlyine might be a better antidepressant.

Is there any particular reason you can't just increase the EFfexor? If you you have the XR version it will have a fairly long half life and will also block NE at higher doses. In fact some people have compared the effect of high-dose Effexor to nortriptyline. If you also need the sedation, though, nortriptyline itself would be better. Desipramine would probably be somewhere in between these two drugs in terms of its sedation effect, and would give a stronger noradrenergic effect.




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