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Re: Somebody! I need advice fast! Ame

Posted by zeugma on August 13, 2004, at 5:26:22

In reply to Re: Somebody! I need advice fast! » Ame Sans Vie, posted by Sad Panda on August 13, 2004, at 3:31:51

> > > Hi Michael,
> > >
> > > I like Nort myself & I find it anxiolytic. Desipramine is a potent NE reuptake inhibitor with the least side effects of any TCA. Nortriptyline is also a potent NE reuptake inhibitor, but it's toned down because it adds 5-HT2A antagonism which can be anxiolytic & does improve sleep & counters most SSRI side effects, downside is it does have more A1 & M1 blockade than Desipramine, it also is a modest H1 blocker.
> >
> > Thanks a bunch for your opinion! So, from what you've said I'm drawing the conclusion that you've tried both desipramine and nortriptyline... could I trouble you to go any deeper into the subjective differences between the two drugs? What *did* each help with?...What *didn't* each help? Sorry, I'm just really wanting to become very knowledge on this subject in case the time comes again that I must weigh nortriptyline as an option.
> >
> > My pdoc became ill and had to leave the office, so he referred me to a general practitioner friend of his. I figured I'd just go for the desipramine (and *why* I'll explain in a moment <g>) and so she wrote up a script for 180 x 100mg tablets, with one refill, lol (talk about overkill -- thank goodness I haven't experienced suicidal ideation in several years). But hey, if it works well at least I have plenty on hand. About six months plenty to be exact, lol.
> >
> > ~Why I went with desipramine:
> >
> > I am constantly coming across the following quote in various places on the web, and it has me intrigued. Maybe I'll be able to cut back on the Adderall? ....
> >
> > "Amphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause striking and sustained increases in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated."
> >
> > I had taken 30mg Adderall two hours prior to taking my first two desipramine; the peak of the drug's effect was waning, but within fifteen minutes of taking the desipramine, I felt that nice amphetamine "kick" all over again. I'm *definitely* going to try decreasing my dose of Adderall to 15 or 20mg four times daily starting tomorrow.
> >
> > ~Michael
>
> Hi Michael,
>
> I haven't tried Desipramine. I chose Nort because I need help with sleep & it is the metabolite of Amitriptyline, an AD that has the highest efficacy of all reuptake inhibitors. I believe Zeugma would have the best info on this because he is ADHD like you & is on Nort. Desipramine is the most potent NE reuptake inhibitor with the least side effects, but if you have insomnia and/or anxiety and/or are taking an SSRI, then Nort is probably the better choice.
>
> Cheers,
> Panda.
>
>
>
>
Hi Panda and Ame,

I've never tried desipramine either, but I researched it extensively because of its efficacy in ADHD. The consensus seemed to be that it worked better for this condition than NOR, presumably because of less antihistaminic interference and/or greater affinity for the NE transporter. I do have substantial experience with Strattera, whose profile seemed almost identical to desipramine's (in fact I believe that it was reports of DMI's efficacy that spurred Lilly to develop atomoxetine for ADHD). Strat worked well at first, but in a very non-stimulant-like manner (i.e. it seemed to 'force' me to pay attention, without increasing energy at all- a peculiar effect, but at the time it seemed great). It turns out that Strat's major metabolite, 4-hydroxyatomoxetine, is a kappa opioid partial agonist- probably responsible for the dysphoria and fatigue so many have experienced on it! Significantly, it was NOT Lilly's lab team that discovered this effect.

The potentiation of amphetamine's effects, good and bad, probably makes it a wise idea to lower the Adderall dosage. While on the subject of Adderall, do you think you could compare the subjective effects of Adderall with Ritalin? Ritalin LA seems to work well, so far, much better than Provigil. From an abstract in Pub med, Ritalin has more pharmacokinetic interactions with TCA's, while amphetamine has more pharmacodynamic interactions (the 'potentiation' factor). My dr. will probably want me to have a plasma level taken for NOR because of this.

And just to share one other bit of arcana- desipramine has a linear dose-response curve, but one study showed that its metabolite, 2-hydroxydesipramine, has a curvilinear one! The complexities of these drugs are mind-boggling- it's no wonder people have such differing responses to them. I suppose it's a miracle that they work at all.

-z


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