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Dr. Bob is Robert Hsiung, MD,
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Posted by bearfan on May 17, 2010, at 15:24:15
In reply to Imipramine really that good?, posted by med-amorphosis on May 17, 2010, at 14:11:37
I'm trying a trial with it, and it takes about 9 days for steady state and to feel any effects. It does seem slightly stronger than a activating SSRI, although its not really all that much better. Were talking if you get 65% efficacy on an SSRI then maybe 70% with Imipramine (if you can tolerate some of its annoying side effects).
Posted by SLS on May 17, 2010, at 15:30:02
In reply to Re: Imipramine really that good? » ed_uk2010, posted by med-amorphosis on May 17, 2010, at 15:11:22
> So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI,
Perhaps he has experience with it. However, if he is relying on "theoretical" safety, I must reiterate that I have had a SS reaction to imipramine in combination with Nardil on two occassions. I experienced severe hypotension, hyperreflexia, and rigidity.
The potencies of imipramine to inhibit the reuptake of serotonin and norepinephrine are about the same.
- Scott
Posted by Phillipa on May 17, 2010, at 15:36:58
In reply to Re: Imipramine really that good?, posted by SLS on May 17, 2010, at 15:30:02
Best to be careful not something to take chances with. Phillipa
Posted by ed_uk2010 on May 17, 2010, at 15:38:39
In reply to Re: Imipramine really that good? » ed_uk2010, posted by med-amorphosis on May 17, 2010, at 15:11:22
>So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI, as well as amitriptyline?
I must say that I am very surprised.
>Anyway, imipramine is greatly more potent as an NRI than SRI, esp as its broken down to desipramine anyway. No?
Imipramine itself acts as a moderate SRI and a NRI. Desipramine is an NRI. I would be very concerned about combining imipramine with any of the MAOIs. Fatalaties have been reported.
eg. Imipramine added to the MAOI tranylcypromine (Parnate)...
http://www.ncbi.nlm.nih.gov/pubmed/12927331
Posted by ed_uk2010 on May 17, 2010, at 15:41:24
In reply to Re: Imipramine really that good? » SLS, posted by med-amorphosis on May 17, 2010, at 15:18:22
>Not even MDMA produces serotonin syndrome with my meds. Its quite pleasant.
Now that does sound risky. Take care of yourself.
Posted by ed_uk2010 on May 17, 2010, at 15:41:56
In reply to Re: Imipramine really that good? » ed_uk2010, posted by SLS on May 17, 2010, at 14:59:27
Thanks Scott :)
Posted by Bob on May 17, 2010, at 17:33:29
In reply to Re: Imipramine really that good? » med-amorphosis, posted by SLS on May 17, 2010, at 14:57:24
>
> When combined with an MAOI, imipramine might have a greater potential to produce serotonin toxicity when compared to lofepramine. I think lofepramine is a prodrug that is converted to desipramine in the body. Desipramine is selective enough for NE that it be safer with an MAOI. I experience a degree of serotonin syndrome when I combine imipramine with Nardil.
>>
> Thanks.
>
>
> - Scott
Scott -What exactly do you feel when you experience "a degree of serotonin syndrome"? I'm not sure I would know what that feels like.
Bob
Posted by Bob on May 17, 2010, at 17:43:07
In reply to Re: Imipramine really that good?, posted by SLS on May 17, 2010, at 15:30:02
>
> The potencies of imipramine to inhibit the reuptake of serotonin and norepinephrine are about the same.
>
>
> - ScottSo would it be reasonable to say that imipramine is sort of like a tricyclic version of milnacipran, or vice versa? Not that there exactly the same, but both of them are similar in their approximately even reuptake of serotonin and norepinephrine.
I'm trying to create such a balance with nortriptyline and citalopram, but am not sure what dose combination might do that.
Posted by med-amorphosis on May 17, 2010, at 17:56:23
In reply to Re: Imipramine really that good?, posted by SLS on May 17, 2010, at 15:30:02
> > So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI,
>
> Perhaps he has experience with it. However, if he is relying on "theoretical" safety, I must reiterate that I have had a SS reaction to imipramine in combination with Nardil on two occassions.He leads a whole team of psychopharms. And I'm not on Nardil. Im on Marplan- a VERY different drug. I've used both long term.
> I experienced severe hypotension, hyperreflexia, and rigidity.
Sounds more like fits/convulsions to me...Lots of drugs can cause them- even wellbutrin on its own.
> The potencies of imipramine to inhibit the reuptake of serotonin and norepinephrine are about the same.Thanks. Sounds about right, but I need to find some hard fact about this drug i think.
> - Scott
p.s. no disrespect intended
Posted by med-amorphosis on May 17, 2010, at 17:58:21
In reply to Re: Imipramine really that good?, posted by Phillipa on May 17, 2010, at 15:36:58
> Best to be careful not something to take chances with. Phillipa
So your saying I shouldn't trust my pdoc? Then who do I trust?
Posted by med-amorphosis on May 17, 2010, at 18:05:23
In reply to Re: Imipramine really that good?, posted by ed_uk2010 on May 17, 2010, at 15:38:39
> >So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI, as well as amitriptyline?
>
> I must say that I am very surprised.
>
> >Anyway, imipramine is greatly more potent as an NRI than SRI, esp as its broken down to desipramine anyway. No?
>
> Imipramine itself acts as a moderate SRI and a NRI. Desipramine is an NRI. I would be very concerned about combining imipramine with any of the MAOIs. Fatalaties have been reported.
>
> eg. Imipramine added to the MAOI tranylcypromine (Parnate)...
>
> http://www.ncbi.nlm.nih.gov/pubmed/12927331
>
>
>
>
>
>But im taking Marplan not Parnate. Very different drug. Thats the problem with MAOIs- they are now looked upon as one group of similar drugs, like SSRIs. BUT, MAOIs are totally unique to each other. None are the same, or even similar. Trust me. I've found I can get away with allmost anything with Marplan, unlike Nardil. Pizza? YES! Cheese strait from the block? YES! Could I do this on Nardil? NO!
Posted by SLS on May 17, 2010, at 18:30:27
In reply to Re: Imipramine really that good? » SLS, posted by med-amorphosis on May 17, 2010, at 17:56:23
> > > So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI,
> > Perhaps he has experience with it. However, if he is relying on "theoretical" safety, I must reiterate that I have had a SS reaction to imipramine in combination with Nardil on two occassions.
> He leads a whole team of psychopharms.
It is good that you trust your doctor.
> And I'm not on Nardil. Im on Marplan- a VERY different drug.
Well, I would still consider the possibility that there is some overlap between MAO inhibitors regarding biological effects. That being said, I did not have the problem with Parnate that I had with Nardil when I added imipramine to it.
> > I experienced severe hypotension, hyperreflexia, and rigidity.
> Sounds more like fits/convulsions to meWhy do you say this? How is what I described similar to "fits/convulsions"?
> > The potencies of imipramine to inhibit the reuptake of serotonin and norepinephrine are about the same.
> Thanks. Sounds about right, but I need to find some hard fact about this
drug i think.I think this site will prove useful to you:
http://pdsp.med.unc.edu/indexR.html
- Scott
Posted by SLS on May 17, 2010, at 18:51:15
In reply to Re: Imipramine really that good? » SLS, posted by Bob on May 17, 2010, at 17:33:29
> What exactly do you feel when you experience "a degree of serotonin syndrome"? I'm not sure I would know what that feels like.
The symptoms of serotonin syndrome vary greatly between individuals and the drugs being used. I experienced severe hypotension, mild hyperreflexia, and moderate muscle rigidity when I combined Nardil with imipramine. However, when I combined Parnate with Effexor, in addition to muscle rigidity and ataxia, I became incoherent (altered mental status) and spoke complete gibberish. However, my body temperature was not elevated during any episode, and I did not experience anxiety.
http://uuhsc.utah.edu/poison/healthpros/utox/vol4_no4.pdf
- Scott
Posted by linkadge on May 17, 2010, at 19:34:18
In reply to Re: Imipramine really that good? » Bob, posted by SLS on May 17, 2010, at 18:51:15
Amitriptyline has been combined with MAOI's supposedly without consequence. You will want to watch with the tryptophan though, thats a tripple whammy serotonin boost.
In some studies, long term amitriptyline administration upregulates the serotonin transporter and reduces serotonin levels (hence its antimigrane effect)?
The TCA's inhibit monoamine oxidase themselves (to some extent). Vise versa, parnate inhibits monoamine reuptake. Some degree of overlap is probably ok.
Linkadge
Posted by SLS on May 17, 2010, at 19:46:10
In reply to Re: Imipramine really that good?, posted by linkadge on May 17, 2010, at 19:34:18
> Amitriptyline has been combined with MAOI's supposedly without consequence.
I was treated at Columbia Presbyterian with a combination of Nardil 45mg and amitriptyline 150mg without sequalae. I do wonder, though, if this dosage of Nardil was too low to produce sufficient MAO inhibition to produce a reaction. 45mg is usually too low for me to respond to. These same doctors refused to combine imipramine with Nardil. I am not sure what their concern was.
- Scott
Posted by gman22 on May 17, 2010, at 19:49:23
In reply to Imipramine really that good?, posted by med-amorphosis on May 17, 2010, at 14:11:37
Imipramine was discovered by accident. One can infer that there was no experimental bias in evaluating it's effectiveness, as opposed to the way that drugs are developed today. They were giving the drug to psych patients and found out it made psychotic patients worse, but depressed patients much better. It does hit a lot of receptors and have some side effects, but it is very effective when given at proper dosages. It is considered very safe and doesn't lose effectiveness like SSRI's can over the years.
It helped me immensely.
Posted by med-amorphosis on May 18, 2010, at 5:40:33
In reply to Re: Imipramine really that good? » med-amorphosis, posted by SLS on May 17, 2010, at 18:30:27
> > > > So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI,
>
> > > Perhaps he has experience with it. However, if he is relying on "theoretical" safety, I must reiterate that I have had a SS reaction to imipramine in combination with Nardil on two occassions.
>
> > He leads a whole team of psychopharms.
>
> It is good that you trust your doctor.
>
> > And I'm not on Nardil. Im on Marplan- a VERY different drug.
>
> Well, I would still consider the possibility that there is some overlap between MAO inhibitors regarding biological effects. That being said, I did not have the problem with Parnate that I had with Nardil when I added imipramine to it.
>
> > > I experienced severe hypotension, hyperreflexia, and rigidity.
>
> > Sounds more like fits/convulsions to me
>
> Why do you say this? How is what I described similar to "fits/convulsions"?Only because when my pdoc gave me Optimax the SS warnings he gave to look out for were somewhat different. I see him again today. I'll check whith him what the 1st signs are again. I've only had one SS episode when I stupidly took MDEA along with my Nardil. Feeling cold with hot sweats im sure is one symptom. I feel that mildy whenever I've started an SSRI too. But everyone different so I dont discount your claim. Just how it sounds to me thats all :)
> I think this site will prove useful to you:
>
> http://pdsp.med.unc.edu/indexR.html
>
>
> - ScottThanks Scott
Posted by med-amorphosis on May 18, 2010, at 5:48:41
In reply to Re: Imipramine really that good? » SLS, posted by med-amorphosis on May 18, 2010, at 5:40:33
> I've only had one SS episode when I stupidly took MDEA along with my Nardil.Actually my mistake. It was MDEA combined with paroxetine.
Posted by med-amorphosis on May 18, 2010, at 5:53:58
In reply to Re: Imipramine really that good?, posted by gman22 on May 17, 2010, at 19:49:23
Theres a glimmer of hope! Thanks gman22. Off to docs. I'll let you all know the outcome later.
Posted by med-amorphosis on May 18, 2010, at 11:13:10
In reply to Re: Imipramine really that good? » gman22, posted by med-amorphosis on May 18, 2010, at 5:53:58
Surprisingly, my pdoc's first suggestion was to add bupropion the the mixture, keeping the lofepramine too. But I opted for a switch in TCAs 1st. He was willing to try 3 TCAs starting with trimipramine (Surmontil). If that fails then amitryptyline and finally, imipramine. Although imipramine would be used after various other options have been tried- ie a last resort.
So im swapping 210mg/day lofepramine to 25mg trimipramine, slowly titrating to 100mg at week 3.
Any trimipramine experiences anyone would like to share? Any knowledgable babblers explain how its meant to work? Apart from re-uptake inhibition the remainder of its actions slightly baffle me in this description:
http://en.wikipedia.org/wiki/Trimipramine
maybe its not the best source. Can anyone explain its effects in plain english (or there abouts)?med
Posted by ed_uk2010 on May 18, 2010, at 15:36:15
In reply to Re: Imipramine really that good? » ed_uk2010, posted by med-amorphosis on May 17, 2010, at 18:05:23
>But im taking Marplan not Parnate. Very different drug. Thats the problem with MAOIs- they are now looked upon as one group of similar drugs, like SSRIs.
I know, but they both inhibit the break down of serotonin. Just looking out for you :)
Posted by med-amorphosis on May 19, 2010, at 13:32:53
In reply to Re: Imipramine really that good? » med-amorphosis, posted by ed_uk2010 on May 18, 2010, at 15:36:15
> >But im taking Marplan not Parnate. Very different drug. Thats the problem with MAOIs- they are now looked upon as one group of similar drugs, like SSRIs.
>
> I know, but they both inhibit the break down of serotonin. Just looking out for you :)
>
>Cool! Thanx
Posted by Dr. Bob on May 20, 2010, at 18:43:41
In reply to Gone with trimipramine, posted by med-amorphosis on May 18, 2010, at 11:13:10
> Any knowledgable babblers explain how its meant to work? Apart from re-uptake inhibition the remainder of its actions slightly baffle me in this description:
> http://en.wikipedia.org/wiki/TrimipramineSorry to interrupt, but I'd like to redirect follow-ups regarding more advanced medication-related issues to Psycho-Babble Neurotransmitters. Here's a link:
http://www.dr-bob.org/babble/neuro/20100223/msgs/948075.html
That'll be considered a new thread, so if you'd like to be notified by email of follow-ups to it, you'll need to request that there.
> Any trimipramine experiences anyone would like to share?
Please feel free, however, to continue to use this board to share your experiences. Thanks,
Bob
Posted by topcatclr on May 21, 2010, at 1:06:46
In reply to Re: Imipramine really that good?, posted by ed_uk2010 on May 17, 2010, at 14:50:01
Took it years ago, in 1995. Doctor combined with a blood pressure med as she new it would ramp it! My memories of it were not great. Like a very sloppy form of Cymbalta. Uneven feeling of it in my system. Sometimes sleepy, hyper, anxiety, rapid heartbeat. No thanks, i will stick with Cymbalta.
Posted by Dr. Bob on May 25, 2010, at 17:34:51
In reply to Imipramine really that good?, posted by med-amorphosis on May 17, 2010, at 14:11:37
> My current regime is...
Please don't change your posting name without following these steps:
http://www.dr-bob.org/babble/faq.html#names
Follow-ups regarding this should be redirected to Psycho-Babble Administration.
Thanks,
Bob
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