Posted by sukarno on April 15, 2005, at 2:04:40
In reply to Panic » sukarno, posted by ed_uk on April 14, 2005, at 10:00:54
Hi Ed! :-)
My imipramine level was monitored once by my psychiatrist and she had said it was low. Maybe I am a slow metaboliser nevertheless. I found nortriptyline to have less side effects.. that's the reason she put me on that after the cardiac events triggered by imipramine. Both were very sedating in the beginning and although she had warned me that those medications could worsen my panic disorder before it became better, I only got better after beginning treatment. With despramine, I had tried the lowest possible dose. I forgot what the dosage was..maybe 10mg? Definitely it was less than 25mg.
With SSRIs she told me that panic disorder patients just cannot tolerate standard doses and must be started out on low doses and maybe gradually increase it over time. She gave me Prozac elixir and told me to take 5mg/day, but I only took 1mg/day because of my previous experience with Prozac in 1990 where I felt like my body was on fire at the standard dose of 20mg.
Within 36 hours after taking 1mg Prozac in 1995 for seasonal depression, the depression began to lift and a few days later I was normal. It was very nice. I had to lower the dose to 0.5mg/day because I would get heart palpitations at only 1mg/day. It still maintained a strong antidepressant effect and made me nauseated in the beginning and briefly exacerbated my anxiety and panic attacks.The unfortunate thing about Prozac, even in such a low dose, was that it killed my libido. Other than that, I was ok, but gradually began to feel a burning sensation in my stomach which persisted for several weeks.
One night I felt nauseated and weak and was passing black, tarry stools, so I went to the hospital and the nurse did some tests and said my blood levels were dropping. The GI doc came in the next day and I underwent endoscopy where he diagnosed gastritis. He couldn't find H. Pylori bacteria and then couldn't understand why I had gastritis, since I didn't take aspirin or other NSAIDs, didn't eat black pepper, etc...didn't drink or smoke or fit any of the risk factors.Later on, evidence has been shown that SSRIs increase by 7 times the risk of haemorrhaging in the GI tract. I'm not sure how they do that.
I also had developed a rash and fevers during that time. I quit Prozac and it disappeared. Three months later I tried Prozac once more and had a worse reaction: purplish-red rash on both arms and legs along with itchy throat. I would also feel chills in the morning. That was the last time I ever took that. It is possible it could have been an ingredient in the elixir and not the Prozac which caused the allergy, but I am not sure or willing to try it again to find out. hehheh.The bad experience with Prozac could have been the symptoms of Serum Sickness Syndrome, which has been reported rarely with fluoxetine. It too begins with a rash and is followed by multiple organ failure. After that experience I never tried another SSRI since my pdoc was afraid that all of other SSRIs could provoke similar reactions. The only one I tried after Prozac was Effexor in 2002 but it gave me hypertension even at an extremely low dose of 6.25mg (1/4 of 25mg tablet).
(I had also tried Paxil in 1993 but forgot to mention that I experienced "zaps" for several days after that single 1/2 tablet dose. Zaps weren't documented at that time and neither was SSRI dependence...I was worried that I was having seizures but my pdoc had no idea what was going on. I wonder if the "zaps" are evidence of neurotoxicity rather than true withdrawal reactions? I'm afraid to start Paxil even on a low dose due to the possibility of having those zaps...and of course the sexual side effects.)
That is a good idea though about trying the TCAs at a lower dose. Maybe I should try nortriptyline at 10mg/day and see what happens.
Is there a way to find out if I am a slow metaboliser?
I've never tried amphetamines or Ritalin. Is it fair to compare caffeine to amphetamine? I know that for panic disorder patients, caffeine is one of the most offending substances. I wonder if poor response to caffeine (e.g. palpitations, severe anxiety) predicts future response to amphetamines. Have you ever tried Survector or other CNS stimulants?
Don't amphetamines make you more nervous or anxiety-prone than caffeine, or do you think caffeine is worse?"Were your LFTs elevated on Tranxene as well? Perhaps you could try Tranxene again."
Yes, unfortunately they were elevated each time I had a LFT over the years. In 1996 they were elevated, but not by much. In 2000 they were elevated (I took a glance at my chart) and couldn't figure out why the doctor didn't make mention of it, so I asked her if it was ok to take paracetamol and she told me to avoid that due to the elevated liver enzymes.
My GGT was quite high in 2002... approximately 205 and ALT was roughly double the normal limit. The Malaysian doctors weren't interested in those values. The only thing they said to me was that I must be a heavy drinker, but I told them I don't drink at all. This really puzzled one of my doctors when I was there as an inpatient. He couldn't understand why my GGT was so high. Maximum limit of normal is 50. I did eat a high fat, fast-food diet on a daily basis and have learned that high fat diets are hard on the liver and can cause fatty liver.
My last LFT was in 2003 and I had been on Xanax for several months at that time. The results were near normal then.
Even if the benzos do raise your liver enzymes, do you think it is ok to continue on them? I haven't seen a liver specialist, but I remember asking many doctors about my LFT and they didn't think it was much to worry about. They kept thinking that I must be a drinker. hehheh.I requested a test for Hepatitis B and C and both came back negative, so that was ruled out as the cause.
If high GGT is not dangerous, then I would rather be back on Valium. I liked the muscle relaxant effect and rapid onset of action. I could see Valium being useful as PRN for panic attacks. Somehow I think marketing is what influenced doctors to prescribe Xanax for panic attacks as PRN, since Xanax is of much slower onset than Valium.
"Did the sedation wear off? You said you found it very sedating at first."
At first it made me feel quite "out of it" or sometimes "high". lol... but after a few days it wasn't sedating in that way anymore. I could still enjoy the muscle relaxation and anxiolytic effects in the long term."What physical side effects did Valium cause? It sometimes makes me feel weak due to the muscle relaxation."
Mostly ataxia..feeling a bit uncoordinated, but nothing major. The kind of feeling you get in your muscles when you've had a few beers, but not yet drunk. :-) I preferred to take 10mg in the morning since my level of anxiety in the morning has always been higher, even prior to medication. I would take the remaining two 5mg tablets in the late afternoon and before falling asleep.
"I also once tried clobazam (Frisium) which was rubbish, it didn't make me drowsy but it made me feel confused and my anxiety got worse! I like diazepam's muscle relaxant, it relieves the tension."
I was prescribed that here from an Indonesian psychiatrist, but I had never heard of it, although I suspected it was a benzo. I never filled the prescription and instead sought a second opinion. How much Frisium did you try? Have you ever tried Rivotril (Klonopin)? I wonder if they are similar since they are both anticonvulsants.
"Survector is often said to be quite stimulant-like. I not sure how long the supply of amineptine will last, I don't think it's being manufactured anymore."
I've been told that Survector is now out-of-patent and is available in Brazil, perhaps being manufactured by a generic drug company. Here in Indonesia I am not sure who makes it...it might be the brand name or it could be a generic. I guess I could try it once and find out what it's like.
I am just afraid of the liver toxicity associated with it. Maybe the FDA and media blew it out of proportion. I'm not sure how high the incidence of liver dysfunction/damage is with amineptine use.
I wanted to try Dostinex (cabergoline) as an antidepressant because I've heard good things about it and it is good for low-libido...but maybe that's anecdotal. Seems to have a favourable side-effect profile but isn't available in Indonesia.
With my lack of motivation, I was thinking that dopamine agonists and/or norepinephrine reuptake inhibitors might be useful for me. Tianeptine is making me feel good, but still isn't helping with motivation.
With all these antidepressants there are so many positives and negatives. It's difficult to figure out which one is the appropriate one for treatment. I would go to a psychiatrist here, but I have a feeling they are on the SSRI bandwagon and I just don't want to risk dependence or loss of libido again. I've heard of them losing efficacy in long-term use too. They are great for some folks though, I admit.
So, I have Stablon, Survector and nortriptyline on my list. I guess I'll just have to give Stablon another month or so to find out if it will really work for more than just depression. If not, then it will be on to Survector....and then nortriptyline as a last resort. :)
Here you can buy prescription drugs without a prescription at some pharmacies..that's what I do, but with the exception of Xanax, which definitely requires a prescription as that is controlled.
I'm interested to hear more about Survector from people who have tried it. It seems that information on it (and even Stablon) is very limited. It might be that if I got on Valium or Klonopin/Rivotril that I could handle any stimulant effects from Survector and yet still feel motivated. It surely has been a miracle for some people where other antidepressants have failed.
:-)
My email is hunstad2@yahoo.com
Paul
poster:sukarno
thread:474445
URL: http://www.dr-bob.org/babble/20050413/msgs/484541.html