Posted by zeugma on October 29, 2004, at 19:57:49
In reply to Re: Cymbalta and coffee? » zeugma, posted by karaS on October 29, 2004, at 1:25:28
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> > > I'm wondering if I shouldn't have tried a higher dose of Effexor. I tolerated it so well (as long as it was XR). Maybe I should have gone up to 300.
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> > I'm guessing you don't have a dr. you trust to discuss your concerns about increased blood pressure on the higher doses of Effexor. That's a shame, because it's a necessity. Your concerns about blood pressure are a real concern that any M.D. should be able to provide reliable advice about.
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> Actually I did run that by him many moons ago. He wasn't that concerned about the rise at that point but I was. I am such a coward. My blood pressure had gone from about 100 to 120 and I didn't want it to go over 120. Since I wasn't having much AD effect at 225 mg, I thought it wasn't worth the risk. However, if that last 75 mg. is much more noradrenergic, then I should have given it a try. It sure would have been nice to be able to have something work that you get so few side effects from. That's probably why I'm thinking about this now even though SE boosting is not the best way for me to go now. You are not a big fan of anything SSRI related, are you?
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Well, some of my comments were more driven by some of your worries concerning the indirect anti-dopaminergic effects of powerful SRI's. I was also reacting to your comments that, simply, Zoloft and Effexor did nothing for your depression despite their cleanness. I read at Preskorn's web site (not the pdf I linked to) that 375 mg Effexor was equivalent in its noradrenergic effect to 150 mg maprotiline. I don't know if going from 225 to 300 mg Effexor would have helped you. But clearly Effexor at 75 mg + is an SRI equivalent to zoloft etc. Since the SRI component did nothing for you, why not try the NRI by itself?> > > I'm curious why you suggested maprotiline. I used to take a small amount of it for years for sleep. I tolerated it well but I gained too much weight from it.
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> > I suggested maprotiline because it is the most NE-selective (relative to serotonin) reuptake inhibitor on the market that I'm aware of. It is also has less anticholinergic effects than desipramine, the least anticholinergic of the TCA's, according to the chart I am going by:
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> > http://www.primarypsychiatry.com/pdf/art_453.pdf
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> > (If you scroll down past the dull text you get to the useful info.) I seem to remember that you had tachycardia from desipramine and nortriptyline. That sounds like an anticholinergic s/e.
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> So it's the anticholinergic effects that cause the tachycardia? That would probably explain why some noradrenergics produce this effect and others don't. That always puzzled me.
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> I didn't see a chart on there that measured that. What am I not getting? That's a great source though, lots of information. Thanks.
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>There's charts for various AP's and AD's that list potencies for specific sites, you will find MAP listed among secondary amine TCA's. Of note, maprotiline and nortriptyline share a common property: they are the only two AD's whose highest affinities are for the NE reuptake protein and the H1 receptor, although nortriptyline is more selective for the NE reuptake mechanism and MAP is more selective for H1 (which is why you were able to use it as a sleep aid). But maprotiline is cleaner in general than nortriptyline, so there is a chance you might be able to tolerate an AD dose of it. If nortriptyline is dirty, then doxepin is pure filth, as you can see from the chart.
> > As for weight gain, that's because of MAP's potent H1 blockade, but if you are using it at doses higher than those needed for sleep, its NE reuptake inhibition might counteract the sleepiness and weight gain. At the very least, you might be less depressed. It's easier to lose weight in that condition. And a good night's sleep is not a useless commodity. >
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> Once I adjusted to the small doses I took, 25 mg or 50 mg., I didn't have much daytime sleepiness... or did I? I'm trying to remember. Actually I think I did feel groggy in the AM. I realize now that I tend to feel that way in the morning anyway though so I don't know how much of that to attribute to the maprotiline. I also used to attribute all of my blurry morning vision to meds but recently I realized that I get that even when I don't take any medication.
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> I just remembered that I did try a therapeutic dosage of doxepin many, many years ago. It didn't help much. I wonder if maprotiline would be any different. I wonder if anything would be any different for that matter.
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See comment above on doxepin's filthiness. I don't know if maprotiline would be any different, either. Well, it would be different, but it might not work. But what do you think is more worth trying?
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> > > Caffeine isn't an AD for me but it's sure the best drug I've ever taken for energy!
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> > The Ritalin LA at 50 mg requires supplementation from caffeine. I can tell you that it seems much less stimulating than Provigil, and provides none of the 'jolting' effects of Strattera. It is doing something, though. Ask me in a week about it.
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> OK, I will. Thank goodness for coffee! I've been lost without it on the Cymbalta. Hoping that the 50 Ritalin LA ends up working sufficiently for you.
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Thanks. I am more 'there' at work. This is both good and bad, but I cannot say more here.> I've toyed with the idea of using the Ritalin I have here for a sleeping pill. I doubt there's any harm in using it periodically (assuming it isn't contrainidicated with anything else I'm taking) but I wonder if there would be any harm in usuing it frequently. I don't need it now but when I get stressed out and can't sleep, it could come in very handy.
Other than the bizarreness of using a stimulant as a sleeping pill, I don't see what the harm is in using it frequently- people use it frequently to wake themselves up! Of course, there could be something weird in the chemistry of the paradoxical reaction. I would be wary.
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> Well, I know you're really busy and you must be very tired so I won't ask you any more questions for now.
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Well, I've answered a little, and asked a question or two of you. We're probably both too tired now to solve all of our problems. Those will have to wait :)> Take care of yourself and try not to let all of the stress get to you.
I'm trying, I'm trying. But trying not to stress is like trying not to think of a purple elephant. It is dancing now in my head :)-z>
> K
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poster:zeugma
thread:406397
URL: http://www.dr-bob.org/babble/20041029/msgs/408897.html