Posted by KaraS on July 11, 2004, at 2:19:28
In reply to Re: tachycardia vs. bradycardia » KaraS, posted by SLS on July 10, 2004, at 18:15:39
> Hi Kara.
>
> > Those were the two reasons - the 100 bpm heart rate and the insomnia.
>
> In the grand scheme of things, I don't consider that very high. I hope I am not coming off as insensitive. I probably am. Sorry.
>
Scott, I don't see it as insensitive. You're just giving me your opinion.> > I can't remember what dosage of nortriptyline I was on but I don't think I was anywhere near a therapeutic dosage yet either when I got that much tachycardia.
> It really isn't dosage dependant in my experience. It starts at a very low dosage and remains static through the dosage range. That's been my experience, anyway. I am currently taking imipramine 300mg, and my heart rate is 85. Before your last post, I was thinking about a beta blocker too if you were still skittish about HR. I would use pindolol rather than propranalol if you are worrying about depressogenic potential. Pindolol is even considered by some to be an augmentor of antidepressants. It is a somato-dendritic 5-HT1a antagonist as well as a beta blocker. I still don't think it is necessary, though. Your "tachycardia" is absolutely the norm for these drugs. I would love to hold your hand through your first few weeks with them - really. :-)
RE: My "tachycardia" being the norm for these TCAs... REALLY? My doctor was quite concerned about it at the time. You really get used to that feeling of your heart racing?
Two really good points you made - that the rate of heart beats isn't dosage dependent and that the pindolol isn't a depressant. I always thought all beta blockers were. I did know that pindolol was used to potentiate antidepressants but I didn't realize that it was also a beta blocker. Really good to know! The technical reason behind that ("somato-dendritic 5-HT1a antagonist") is a bit over my head but I get the gist of it anyway.
I don't know that this would definitely be a dream med for me but I think it is worth revisiting. I still have plenty of others that I want to try as well including imipramine. Hard to believe after several years of trying medications that I've never tried the gold standard. How are you doing on that BTW? That was so sweet of you to say about holding my hand throughout the first weeks of trying nortriptyline. If I do go back on the medication, I will hold you to it... though I doubt your girlfriend would like that (LOL) But seriously, I think that one upside (and perhaps the only upside) to suffering from depression is that it can help to make people very sensitive and empathetic. That certainly seems to be the case with you.>
> As far as benzodiazepines are concerned, being physiologically dependant on them is not the same as being addicted to them. Too much fuss is made of all of this. Once you are brought into remission with an antidepressant, you are no less physiologically dependant upon it to maintain your wellbeing and staving off a discontinuation syndrome. If you have reached an impasse using the easy and convenient first-line alternatives, it is time to use the less convenient, more aggressive, and less pallatable ones. If nortriptyline is the miracle drug for you (and that's exactly what it would feel like), you will just have to get used to a *moderately* accelerated heartrate and the need to take a perfectly safe sleeping medication that might be difficult to discontinue *if* you should ever deem it desirable to do so. (You probably will be able to discontinue it within a few months). Who cares if you end up taking these two drugs for the rest of your life? I won't tell if you don't.
>
I'm also concerned with needing to take more and more of the benzo in order to get the effect of getting me to sleep. I remember with the Ativan that I would start getting nauseous in the evening a couple of hours before it was time to take it. I don't want to live with that kind of side effect. I have learned how to go off of things very slowly to minimize withdrawal so I'm less concerned with that aspect of it. Perhaps a longer lasting benzo like Klonopin would work better - but don't the benzos increase depression? Or is it a matter of the antidepressant more than compensating for that?
I don't care about being on medication(s) for the rest of my life. I just want the quality of it to be better. Life is too short and too difficult to be a purist about it. But I digress... I'd better sign off now before I get too philosophical. Thanks again,
Kara> I'm just having a bit of fun poking at you a little bit.
>
> :-)
>
>
> - Scott
>
>
poster:KaraS
thread:13117
URL: http://www.dr-bob.org/babble/20040710/msgs/364922.html