![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 49. This is the beginning of the thread.
Posted by KaraS on July 23, 2005, at 14:49:47
I have posted a few messages here over the past couple of months about my having heart palpitations. I may have mentioned that when I'm on a small amount of doxepin, I don't have or notice the palpitations. I thought that maybe the doxepin ironically provided some kind of buffer against them. Ed said that it was entirely possible. Now, however, I found out that a friend of mine has just gone off of a TCA and she started having palpitations as well. I am wondering if our bodies don't adjust to the TCA and then are thrown out of balance when we stop the TCA, therefore causing the palpitations. It just seems too coincidental that another person, who normally does not have any palpitations or history of heart problems, should also experience these palpitations upon discontinuing a tricyclic.
Does this make sense to anyone else?
K
Posted by SLS on July 23, 2005, at 15:24:28
In reply to Can stopping a TCA cause palpitations?, posted by KaraS on July 23, 2005, at 14:49:47
Depression very often produces something called dysautonomia, albeit a usually mild form of it. The autonomic nervous system tends to favor the sympathetic and reduce the parasympathetic. This can cause heart palpitation, even in the absence of medication. Now you take a tricyclic, and find that some of these things are temporarily exagerrated. They mitigate over time, particularly if the person responds to the medication. If you take the medication away, you would expect that these things would disappear entirely. Unfortunately, this is not true if the person is actually relapsing into depression. In this case, palpitations might return as a symptom.
- Scott
Posted by med_empowered on July 23, 2005, at 15:24:48
In reply to Can stopping a TCA cause palpitations?, posted by KaraS on July 23, 2005, at 14:49:47
yeah, it makes sense to me. Also, although everyone thinks of SSRIs as the anti-depressants with a withdrawal syndrome, the Tricyclics can be pretty rough to withdraw from, too...what makes it worse is that doctors have noticed this forever, but still many patients aren't adequately informed that stopping a TCA, even gradually, can be mildly uncomfortable and sometimes hellish. When you think about it, a withdrawal-type syndrome specific to TCAs could explain it...TCAs have well-known cardiovascular effects; it makes sense that, upon withdrawing them, the cardiovascular system could be "thrown for a loop," since the system had adjusted to the constant presence of TCA in the blood stream. Add in all the other physical and psychological problems associated with withdrawal-headache, nausea, vomiting, anxiety, etc.--and you could have quite a problem, indeed.
Posted by KaraS on July 23, 2005, at 15:39:02
In reply to Re: Can stopping a TCA cause palpitations?, posted by SLS on July 23, 2005, at 15:24:28
> Depression very often produces something called dysautonomia, albeit a usually mild form of it. The autonomic nervous system tends to favor the sympathetic and reduce the parasympathetic. This can cause heart palpitation, even in the absence of medication. Now you take a tricyclic, and find that some of these things are temporarily exagerrated. They mitigate over time, particularly if the person responds to the medication. If you take the medication away, you would expect that these things would disappear entirely. Unfortunately, this is not true if the person is actually relapsing into depression. In this case, palpitations might return as a symptom.
>
>
> - Scott
Perhaps that's it but I was only on a small amount of doxepin (25 mg.). It did give me some boost in mood - but not much.It's good to understand how depression can cause palpitations in an otherwise healthy heart.
Thanks
K
Posted by KaraS on July 23, 2005, at 15:43:55
In reply to Re: Can stopping a TCA cause palpitations?, posted by med_empowered on July 23, 2005, at 15:24:48
> yeah, it makes sense to me. Also, although everyone thinks of SSRIs as the anti-depressants with a withdrawal syndrome, the Tricyclics can be pretty rough to withdraw from, too...what makes it worse is that doctors have noticed this forever, but still many patients aren't adequately informed that stopping a TCA, even gradually, can be mildly uncomfortable and sometimes hellish. When you think about it, a withdrawal-type syndrome specific to TCAs could explain it...TCAs have well-known cardiovascular effects; it makes sense that, upon withdrawing them, the cardiovascular system could be "thrown for a loop," since the system had adjusted to the constant presence of TCA in the blood stream. Add in all the other physical and psychological problems associated with withdrawal-headache, nausea, vomiting, anxiety, etc.--and you could have quite a problem, indeed.
I was only taking a small amount of doxepin and had no other withdrawal problems other than the return of my anxiety and a decrease in mood - which were more a result of just not taking the medication rather than a horrible withdrawal. Still, I think that either the increased depression and/or the body's electrical current being thrown out of whack are responsible.
Posted by ed_uk on July 23, 2005, at 16:44:33
In reply to Can stopping a TCA cause palpitations?, posted by KaraS on July 23, 2005, at 14:49:47
Hi K,
I was wondering why you were replacing doxepin with clonazepam. I thought doxepin was taking care of your anxiety?
Ed xx
Posted by KaraS on July 23, 2005, at 20:14:38
In reply to Re: Can stopping a TCA cause palpitations? » KaraS, posted by ed_uk on July 23, 2005, at 16:44:33
> Hi K,
>
> I was wondering why you were replacing doxepin with clonazepam. I thought doxepin was taking care of your anxiety?
>
> Ed xx
Good question. Dr. Emory wants me to replace it with the clonazepam. TCAs are contraindicated with stimulants aren't they? As I build up on stimulants he wants me to be getting off of the doxepin. I don't think he's wild about doxepin to begin with. It's fairly dirty, as we know. I think he feels that the clonazepam will also add some mood stabilization that might be good for me.I have mixed feelings about getting on the clonazepam. I am worried that it might add to my depression and that even a short trial could result in a long tapering period. I know that Gabbi said in an earlier post that she thought her dexedrine had stopped working for her at one point but then she realized that it was the clonazepam that was killing the effect. If the clonazepam doesn't work for me, then I wonder what he would have in mind for the anxiety. He did mention mood stabilizers. Also, he doesn't like Xanax. He thinks it's too stimulating.
Kara
xxx
Posted by Phillipa on July 23, 2005, at 20:49:48
In reply to Re: Can stopping a TCA cause palpitations? » ed_uk, posted by KaraS on July 23, 2005, at 20:14:38
I guess I just have wierd chemistry. Xanax started to make me tired after a while. At first it did a good job of relieving my anxiety. As far as klonopin is concerned it just made me numb. Fondly, Phillipa
Posted by med_empowered on July 24, 2005, at 1:48:10
In reply to Re: Can stopping a TCA cause palpitations? » KaraS, posted by Phillipa on July 23, 2005, at 20:49:48
hey! Yeah, TCA's + stimulants= trouble. In some cases, its good short term; they tend to play off one another, so in cases of depression accompanied by extreme fatigue and what not, the combo can be kinda of beneficial, but its really only helpful b/c the combo kicks in so fast. Benzos+stimulants CAN be tricky; you run the risk of overstimulating, oversedating, or generally overmedicating. But, if you look back historically, one of the first "antidepressants" was Dexamyl, a one-pill combo of Dexedrine and Amobarbital. The idea was that the two meds, when combined, would last about the same amount of time in the system, and that the the two seemingly contradictory meds ("upper" and "downer") would play off one another, compelementing one another. It sounds ridiculous today, but Dexamyl hit the market in the 40s, I believe, and stuck around until the 70s. It appears that some people managed to get very impressive, fast relief without becoming addicted (the addictive potential of barbiturates, and later benzodiazpenes, was way overhyped). ANYWAY, my point is you can balance it out. Personally, I wouldn't do Klonpin with a stimulant; the chances of over-sedation and worsening the mood are a little too high. I think Tranxene would be a good idea; Librium and Valium could work well, also. As for Xanax...its an odd drug. On the one hand, its amazing for panic attacks, and it can be really helpful in some cases of depression. On the other hand..there are more psychotic reactions to xanax reported than for the other BZDs, even when you account for the relative popularity of the meds and the patient populations to whom they are prescribed (i.e, Klonopin and Ativan are commonly RX'd to those with bipolar, schizophrenia, and schizoaffective, so there will be more psychotic episodes in that group than in some others). Based on my own experiences, I prefer something that works a little more "in the background" than xanax, which seems to kind of take over my whole brain somehow. To that end, I prefer Ativan for short-acting BZDs, and Tranxene or Librium for longer-acting ones. When I need a BZD for sleep, I like to either use Ativan or Restoril.
Posted by ed_uk on July 24, 2005, at 5:22:58
In reply to Re: Can stopping a TCA cause palpitations?, posted by med_empowered on July 24, 2005, at 1:48:10
Hi Med,
In your personal experience, how does Librium differ from Valium? I'd imagine that Valium 'kicks in' more rapidly after a dose.
~Ed
Posted by ed_uk on July 24, 2005, at 5:31:24
In reply to Re: Can stopping a TCA cause palpitations? » ed_uk, posted by KaraS on July 23, 2005, at 20:14:38
Hi Kara,
>TCAs are contraindicated with stimulants aren't they?
Hmm, well......... Here's what I'd want to do if I were you, which I'm not LOL, but anyway.......
1. Find the minimum dose of doxepin which is effective for your anxiety eg. 20mg/day or whatever.
2. Monitor your pulse and blood pressure to obtain a baseline.
3. Start Dexedrine at a very low dose. Monitor your pulse and BP regularly to monitor for changes.
3. Increase the Dexedrine dose in small steps until relief is obtained.
4. Carefully monitor pulse and BP after each dose increase. Keep a record. Agree a maximum acceptable BP. If your BP exceeds the maximum, consult your doctor.
>It's fairly dirty, as we know.
I thought it was excellent in treating your anxiety with minimum side effects?
>I have mixed feelings about getting on the clonazepam. I am worried that it might add to my depression and that even a short trial could result in a long tapering period.
Clonazepam also concerns me. I find it a little odd that your doc is so keen to abandon the doxepin when it's working for your anxiety.
>I think he feels that the clonazepam will also add some mood stabilization that might be good for me.
Hmmm
Ed xxx
>
Posted by ed_uk on July 24, 2005, at 8:41:56
In reply to Re: Can stopping a TCA cause palpitations? » ed_uk, posted by KaraS on July 23, 2005, at 20:14:38
Hi Kara,
Perhaps it would be useful to have an ECG when you're having palpitations.
I can see why doxepin + dex is worrying, especially given your previous experience with tachy on nortriptyline and your current palpitations. On the other hand, low doses of doxepin probably don't have much effect on the reuptake of norepinephrine. AFAIK, your pulse is normal on doxepin whereas it was elevated on nortriptyline. Nortriptyline is a potent norepi reuptake inhibitor whereas doxepin is not.
If you did decide to combine doxepin with dex, it would be wise to initiate dex at a very low dose and to increase the dose in small steps every few days. You could take 1.25mg as a test dose.
Ed x
Posted by med_empowered on July 24, 2005, at 12:31:54
In reply to Re: Can stopping a TCA cause palpitations? » KaraS, posted by ed_uk on July 24, 2005, at 8:41:56
hey! In response to Ed_UK's question about librium vs. valium....they're really similar, but Librium is nice for nite time anxiety. I always took it in 25mgs tablets, whereas I've taken valium in a range of 5 to 10mgs at a time. Anyway. for me the Librium had a more sedating effect and a bigger effect on tension headaches (thank god) which made it awesome for nite time use.
Posted by KaraS on July 24, 2005, at 14:52:46
In reply to Re: Can stopping a TCA cause palpitations?, posted by med_empowered on July 24, 2005, at 1:48:10
> hey! Yeah, TCA's + stimulants= trouble. In some cases, its good short term; they tend to play off one another, so in cases of depression accompanied by extreme fatigue and what not, the combo can be kinda of beneficial, but its really only helpful b/c the combo kicks in so fast. Benzos+stimulants CAN be tricky; you run the risk of overstimulating, oversedating, or generally overmedicating. But, if you look back historically, one of the first "antidepressants" was Dexamyl, a one-pill combo of Dexedrine and Amobarbital. The idea was that the two meds, when combined, would last about the same amount of time in the system, and that the the two seemingly contradictory meds ("upper" and "downer") would play off one another, compelementing one another. It sounds ridiculous today, but Dexamyl hit the market in the 40s, I believe, and stuck around until the 70s. It appears that some people managed to get very impressive, fast relief without becoming addicted (the addictive potential of barbiturates, and later benzodiazpenes, was way overhyped). ANYWAY, my point is you can balance it out. Personally, I wouldn't do Klonpin with a stimulant; the chances of over-sedation and worsening the mood are a little too high. I think Tranxene would be a good idea; Librium and Valium could work well, also. As for Xanax...its an odd drug. On the one hand, its amazing for panic attacks, and it can be really helpful in some cases of depression. On the other hand..there are more psychotic reactions to xanax reported than for the other BZDs, even when you account for the relative popularity of the meds and the patient populations to whom they are prescribed (i.e, Klonopin and Ativan are commonly RX'd to those with bipolar, schizophrenia, and schizoaffective, so there will be more psychotic episodes in that group than in some others). Based on my own experiences, I prefer something that works a little more "in the background" than xanax, which seems to kind of take over my whole brain somehow. To that end, I prefer Ativan for short-acting BZDs, and Tranxene or Librium for longer-acting ones. When I need a BZD for sleep, I like to either use Ativan or Restoril.
Thanks. I intend to be very careful. I think the Klonopin was chosen because I probably have a soft bipolar condition.k
Posted by KaraS on July 24, 2005, at 15:15:35
In reply to Re: Can stopping a TCA cause palpitations? » KaraS, posted by ed_uk on July 24, 2005, at 5:31:24
> Hi Kara,
>
> >TCAs are contraindicated with stimulants aren't they?
>
> Hmm, well......... Here's what I'd want to do if I were you, which I'm not LOL, but anyway.......
>
> 1. Find the minimum dose of doxepin which is effective for your anxiety eg. 20mg/day or whatever.
>
> 2. Monitor your pulse and blood pressure to obtain a baseline.
>
> 3. Start Dexedrine at a very low dose. Monitor your pulse and BP regularly to monitor for changes.
>
> 3. Increase the Dexedrine dose in small steps until relief is obtained.
>
> 4. Carefully monitor pulse and BP after each dose increase. Keep a record. Agree a maximum acceptable BP. If your BP exceeds the maximum, consult your doctor.
>
> >It's fairly dirty, as we know.
>
> I thought it was excellent in treating your anxiety with minimum side effects?
>
> >I have mixed feelings about getting on the clonazepam. I am worried that it might add to my depression and that even a short trial could result in a long tapering period.
>
> Clonazepam also concerns me. I find it a little odd that your doc is so keen to abandon the doxepin when it's working for your anxiety.
>
> >I think he feels that the clonazepam will also add some mood stabilization that might be good for me.
>
> Hmmm
>
> Ed xxx
>
> >
Hi Ed,I've already stopped the doxepin. I do know that I can function on 12.5 mg. but 25 mg. is a more complete fix for the anxiety problem. I think that Dr. E. thinks I may need to go up a ways on the dexedrine and so doesn't want me on doxepin. Also, I think that he is very concerned with finding the cleanest solutions that don't hit other receptors that I don't need to have involved. He always thinks in terms of how this will affect the brain scans. It's hard to describe because he works differently than other pdocs.
I think I should probably get a blood pressure monitor anyway because of the dexedrine. That way if I were to decide to add doxepin back in for any reason, then I could follow your advice above.
The doxepin does work well for me but not without side effects. I'm a little bit groggy on it and it does dumb me down a bit. It's not great for memory either. I love it because it enables me to function and I can go on it and off of it so quickly without a problem but I think a better solution might exist.
I was going to start on the Klonopin last night but chickened out. I'm worried that it won't be good for me - that it will make me too groggy and add to the depression. I develop dependence quickly so I'm thinking that a short trial of even a week or two could leave me with 9 months of tapering and increased anxiety and depression because of that. I was hoping that if this didn't work out that he could switch me to Xanax. At least with that one I could have more of an antidepressant effect but Dr. E. doesn't like Xanax. He says it's too stimulating. I'm sure that has to do with how he sees it's effects on the brain scans.
I wish I weren't so neurotic and could just easily follow the doctor's orders!! Why do I have to agonize so much over new medications????
K
xxxx
Posted by ed_uk on July 24, 2005, at 16:20:06
In reply to Re: Can stopping a TCA cause palpitations? » ed_uk, posted by KaraS on July 24, 2005, at 15:15:35
Hi K :-)
> I'm a little bit groggy on it and it does dumb me down a bit. It's not great for memory either.
Even at 12.5mg? I was thinking you could try a few different doses eg. 20mg etc. You could divide the 10mg capsules to adjust the dose. Dexedrine might reduce the groggyness (sp). Perhaps you could try a less anticholinergic TCA - less memory problems.
>I love it because it enables me to function and I can go on it and off of it so quickly without a problem.......
But that's great! Clonazepam can be difficult to d/c. Although clonazepam can be very effective for anxiety, you're already taking a drug which is very effective for your anxiety. I suppose I'm just concerned that clonazepam might not be necessary. Clonazepam affects memory - just like doxepin. Clonazepam might make you groggy - just like doxepin. In addition, you haven't developed tolerance to the doxepin :-)
>I think that Dr. E. thinks I may need to go up a ways on the dexedrine and so doesn't want me on doxepin.
Say you were on 20mg doxepin..... I doubt it would interact with Dexedrine at all. It is possible though, so you'd need to be cautious.
>At least with that one I could have more of an antidepressant effect but Dr. E. doesn't like Xanax. He says it's too stimulating. I'm sure that has to do with how he sees it's effects on the brain scans.
It certainly didn't stimulate me, it put me to sleep!
>I develop dependence quickly so I'm thinking that a short trial of even a week or two could leave me with 9 months of tapering and increased anxiety and depression because of that.
That's very unlikely. One week *on an adequate dose* should be long enough to find out whether it helps. Some benefit is likely after the first dose. If a given dose hasn't helped after two weeks, it never will. If clonazepam is not effective or tolerable, the trial should be limited to 4 weeks, including tapering, this will minimise the risk of w/d symptoms.
>I was going to start on the Klonopin last night but chickened out.
Don't be scared :-) You won't get dependent after a few doses. If it affects you badly during the first few days, you can decide where to go from there. You could continue clonazepam to see whether the side effects subside or you could return to doxepin. If the side effects haven't subsided after a couple of weeks it might be best to return to doxepin - continuing clonazepam for longer might make w/d difficult, which certainly isn't what you want if you're having side effects!
Kind regards
Ed xxx
Posted by ed_uk on July 24, 2005, at 16:59:39
In reply to Re: Can stopping a TCA cause palpitations? » ed_uk, posted by KaraS on July 24, 2005, at 15:15:35
>I develop dependence quickly.......
Withdrawal symptoms are definitely the major concern, all other side effects can be dealt with by d/cing the Klonopin.......which can be difficult due to withdrawal symptoms........
Although long term benzodiazepine treatment can be effective for some patients with chronic severe anxiety, you've already found a treatment which is very effective for your anxiety :-) Doxepin is causing you some side effects..... but clonazepam can cause side effects too. I don't doubt that clonazepam is likely to be effective :-)
I wouldn't be concerned about taking the first few doses of clonazepam........ the difficult decisions arise after you've been on clonazepam for a couple of weeks. Do you continue?
If I was in your position, I'd probably try taking 3/4 of a 25mg doxepin pill. Buying a BP monitor before starting Dexedrine is an excellent idea.
Kind regards
Ed xoxo
Posted by Phillipa on July 24, 2005, at 19:21:05
In reply to Re: Can stopping a TCA cause palpitations?, posted by med_empowered on July 24, 2005, at 1:48:10
Med_empowered PLEASE I beg answer me. In the 70's, when I had my first panic attack a pdoc[who later lost his license as he had meds in his desk drawer and used to hand them out]prescribed a med for me that he referred to as an upper-downer. I always thought it would have been a TCA. I never knew the name as the first time I took it I was up all night crying walking around the block with my then husband. I never took it again. But do you think it could have been Dexamyl? I was so young 22 at the time and didn't know anything about medications. It's really important for me to know as I've always stayed away from TCA's thinking it was one of them. But when you said upper-downer that's exactly what that doc called the med. Please I beg of you help me solve this mystery as it's kept me from taking TCA's again. Thanks, Phillipa
Posted by Phillipa on July 24, 2005, at 19:36:24
In reply to Re: Can stopping a TCA cause palpitations? » KaraS, posted by ed_uk on July 24, 2005, at 16:20:06
Ed, so xanax made you tired like it did to me in the end? Wow I guess my anxiety was really high when it didn't do this. Fondly, PJ O
Posted by 4WD on July 24, 2005, at 22:54:43
In reply to Can stopping a TCA cause palpitations?, posted by KaraS on July 23, 2005, at 14:49:47
> I have posted a few messages here over the past couple of months about my having heart palpitations. I may have mentioned that when I'm on a small amount of doxepin, I don't have or notice the palpitations. I thought that maybe the doxepin ironically provided some kind of buffer against them. Ed said that it was entirely possible. Now, however, I found out that a friend of mine has just gone off of a TCA and she started having palpitations as well. I am wondering if our bodies don't adjust to the TCA and then are thrown out of balance when we stop the TCA, therefore causing the palpitations. It just seems too coincidental that another person, who normally does not have any palpitations or history of heart problems, should also experience these palpitations upon discontinuing a tricyclic.
> Does this make sense to anyone else?
>
>
> K
>
Kara,I found that when I started meds (among them were Prozac, Celexa and imipramine) or increased or reduced dosage, I was prone to palpitations. They subsided as I adjusted to the drug or the different dosage.
Marsha
Posted by KaraS on July 25, 2005, at 0:41:23
In reply to Re: Can stopping a TCA cause palpitations? » KaraS, posted by 4WD on July 24, 2005, at 22:54:43
> Kara,
>
> I found that when I started meds (among them were Prozac, Celexa and imipramine) or increased or reduced dosage, I was prone to palpitations. They subsided as I adjusted to the drug or the different dosage.
>
> Marsha
Now that you and my other friend have had similar experiences as me, I'm not at all concerned about the palpitations. They definitely subside when I adjust to a drug or adjust to being off of it.
Thanks!K
Posted by KaraS on July 25, 2005, at 2:01:15
In reply to Re: Can stopping a TCA cause palpitations? » KaraS, posted by ed_uk on July 24, 2005, at 16:20:06
Hi Ed,
> > I'm a little bit groggy on it and it does dumb me down a bit. It's not great for memory either.
>
> Even at 12.5mg? I was thinking you could try a few different doses eg. 20mg etc. You could divide the 10mg capsules to adjust the dose. Dexedrine might reduce the groggyness (sp). Perhaps you could try a less anticholinergic TCA - less memory problems.I don't know if groggy is the right word as I'm not tired from it just a little slowed down. I could try to find out what the perfect dose of doxepin is for me for the anxiety. I could try two 10 mg. capsules. (My mood also goes up as dose increases which is something to take into account.) The other TCAs that aren't as anticholinergic, give me tachycardia. I used to be able to take 25 mg. of maprotiline. It also helped immensely with less grogginess or slowness. Now, however, it gives me tachycardia also. It's possible that I'll try one of the other TCAs with a beta blocker in the future - probably desipramine as that's on Dr. E's list for me.
> >I love it because it enables me to function and I can go on it and off of it so quickly without a problem.......
>
> But that's great! Clonazepam can be difficult to d/c. Although clonazepam can be very effective for anxiety, you're already taking a drug which is very effective for your anxiety. I suppose I'm just concerned that clonazepam might not be necessary. Clonazepam affects memory - just like doxepin. Clonazepam might make you groggy - just like doxepin. In addition, you haven't developed tolerance to the doxepin :-)
I understand and I share your concerns. Partly I think that Dr. E. just doesn't like doxepin. Also I think he feels that I could benefit from the mood stabilization effects of the Klonopin. I'm really torn about starting on it when my anxiety is already under control. It's been a wonderful medication for many people here but it's also caused more depression for others.
> >I think that Dr. E. thinks I may need to go up a ways on the dexedrine and so doesn't want me on doxepin.
>
> Say you were on 20mg doxepin..... I doubt it would interact with Dexedrine at all. It is possible though, so you'd need to be cautious.
My pulse rate shoots up very quickly and stays there a while at the slightest provocation - either from something emotional or from medications so I think the combination may be more dangerous for me than for most. Also, I think he's hoping that the Klonopin will bring down the pusle rate from the dex.
> >At least with that one I could have more of an antidepressant effect but Dr. E. doesn't like Xanax. He says it's too stimulating. I'm sure that has to do with how he sees it's effects on the brain scans.
>
> It certainly didn't stimulate me, it put me to sleep!
I suppose he thinks of it like he does the SSRIs. He sees them as creating high voltage in the frontal lobe (but I could be wrong about the location in the brain). The way he thinks about things is quite different. He supposedly has good success rates with TRDs so maybe there's some validity to the way he looks at things. I feel that I've gained some valuable insights into my condition already from seeing him. I have been impressed by how quickly he diagnosed an attention deficit problem with me. So I want to go along with him here ... but I still have many doubts about the Klonopin for me.> >I develop dependence quickly so I'm thinking that a short trial of even a week or two could leave me with 9 months of tapering and increased anxiety and depression because of that.
>
> That's very unlikely. One week *on an adequate dose* should be long enough to find out whether it helps. Some benefit is likely after the first dose. If a given dose hasn't helped after two weeks, it never will. If clonazepam is not effective or tolerable, the trial should be limited to 4 weeks, including tapering, this will minimise the risk of w/d symptoms.
I read in the archives about a couple of people who said that the apathy/depression set in on the K for them around the 4 week mark. If that were to happen to me, then I'd already be on it long enough to have a sustained tapering, don't you think?
> >I was going to start on the Klonopin last night but chickened out.
>
> Don't be scared :-) You won't get dependent after a few doses. If it affects you badly during the first few days, you can decide where to go from there. You could continue clonazepam to see whether the side effects subside or you could return to doxepin. If the side effects haven't subsided after a couple of weeks it might be best to return to doxepin - continuing clonazepam for longer might make w/d difficult, which certainly isn't what you want if you're having side effects!I took Ativan for three weeks at night to sleep many years ago. Then I stopped it abruptly and all hell broke loose. I didn't think I had taken it long enough to have a problem. Since then I've been a benzophobe. Fortunately then I was able to start on doxepin and taper off of the Ativan very slowly.
Here's the scenario that I'm most concerned about. I need to stop the K and I'm already on the dex. I may not be able to take doxepin in order to stop the K (because of the dex), then how would I cope with the anxiety????? I could stop the dex and start on doxepin but imagine the depression from stopping both of them. I can't even fathom it.
You're very kind to take the time to listen to me and answer all of my questions.
Big hug,
Karaxxx
Posted by ed_uk on July 25, 2005, at 16:08:09
In reply to Re: Can stopping a TCA cause palpitations? » med_empowered, posted by Phillipa on July 24, 2005, at 19:21:05
Hi PJ,
If it made you very restless it might have contained an antipsychotic. It might have been amitriptyline/perphenazine.
~Ed xxx
Posted by ed_uk on July 25, 2005, at 16:29:43
In reply to Re: Can stopping a TCA cause palpitations? » ed_uk, posted by KaraS on July 25, 2005, at 2:01:15
Hi K!
>I could try to find out what the perfect dose of doxepin is for me for the anxiety.
:-)
>My mood also goes up as dose increases which is something to take into account.......
What's the highest dose you've tried? How did it affect you?
>The other TCAs that aren't as anticholinergic, give me tachycardia.
Anticholinergic drugs *cause* tachycardia. The reason low-dose doxepin doesn't cause much tachycardia is because it's only a 'weak' norepinephrine reuptake inhibitor. It's also quite sedating.
Btw, trimipramine (Surmontil) is a strange TCA which doesn't inhibit the reuptake of anything! Larry Hoover takes it.
>Also I think he feels that I could benefit from the mood stabilization effects of the Klonopin.
What does he mean by 'mood stabilization'? If it helped your depression that would be fantastic! Very high doses of clonazepam can be useful as an adjunct to other meds in the treatment of acute mania. I wouldn't really call clonazepam a mood stabiliser though.
Does your doc believe that Dex will improve your depression or just your ADD?
Am I right in thinking that he suggested Lamictal as an AD?
>My pulse rate shoots up very quickly and stays there a while at the slightest provocation - either from something emotional or from medications so I think the combination may be more dangerous for me than for most.
Perhaps........ but isn't your pulse actually quite low on doxepin?
>I read in the archives about a couple of people who said that the apathy/depression set in on the K for them around the 4 week mark.
Perhaps they increased the dose over the first few weeks?
>If that were to happen to me, then I'd already be on it long enough to have a sustained tapering, don't you think?
If you'd been on clonazepam for 4 weeks, I expect you'd need to taper over a few weeks or so. It might be quite unpleasant but I expect you'd make it!
>I took Ativan for three weeks at night to sleep many years ago. Then I stopped it abruptly and all hell broke loose.
Clonazepam's withdrawal symptoms are almost identical to those of Ativan. They should be somewhat less intense though, due to clonazepam's longer half-life.
>Fortunately then I was able to start on doxepin and taper off of the Ativan very slowly.
Doxepin could help you get off clonazepam too.
>I may not be able to take doxepin in order to stop the K (because of the dex), then how would I cope with the anxiety?????
You could always try Surmontil. It's anxiolytic like doxepin but it's not at all noradrenergic.
Ed xx
Posted by Phillipa on July 25, 2005, at 18:22:54
In reply to Re: Can stopping a TCA cause palpitations? » med_empowered, posted by Phillipa on July 24, 2005, at 19:21:05
Ed, I knew it! I thought it had to be a TCA. Amiltriptaline was popular then. Was the other drug/ the European version? Fondly, PJ O
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