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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by KaraS on February 8, 2005, at 18:39:18
I just started on a small amount of doxepin a few days ago and I'm already seeing amazing results. My anxiety was so bad that I was not able to eat or sleep - the only things I managed to consume were Gatorade and Ensure. Also, I was starting to get agoraphobic. Now I'm eating and sleeping again. I'd say that my anxiety is about 90% under control. I don't know why this isn't used more for anxiety. Maybe because it's old, it's cheap, it's dirty and it's not terribly lucrative for the drug companies. It's not a long-term solution for me but it will enable me to tolerate other medications that I've been unable to tolerate recently because they were too stimulating.
There is no question here. I just wanted others to know about this option if they're having a lot of trouble with anxiety.
K
Posted by Colleen D. on February 8, 2005, at 19:17:22
In reply to nothing like a sedating TCA for anxiety/panic, posted by KaraS on February 8, 2005, at 18:39:18
Hi Kara!
Congrats on your new find!!! What dosage are you taking? I just take 25mg at night for sleep. Please tell me more!
Thanks,
Colleen60mmg Cymablta
1.25mg clonazepam
25mg doxepin
Posted by Ritch on February 8, 2005, at 23:49:05
In reply to nothing like a sedating TCA for anxiety/panic, posted by KaraS on February 8, 2005, at 18:39:18
> I just started on a small amount of doxepin a few days ago and I'm already seeing amazing results. My anxiety was so bad that I was not able to eat or sleep - the only things I managed to consume were Gatorade and Ensure. Also, I was starting to get agoraphobic. Now I'm eating and sleeping again. I'd say that my anxiety is about 90% under control. I don't know why this isn't used more for anxiety. Maybe because it's old, it's cheap, it's dirty and it's not terribly lucrative for the drug companies. It's not a long-term solution for me but it will enable me to tolerate other medications that I've been unable to tolerate recently because they were too stimulating.
>
> There is no question here. I just wanted others to know about this option if they're having a lot of trouble with anxiety.
>
>
> K
>
>My first two AD's were doxepin and amitriptyline and they settled down a severe insomniac agitated depression like a charm (along with some lithium and chlordiazepoxide).
Posted by KaraS on February 9, 2005, at 0:29:37
In reply to Re: nothing like a sedating TCA for anxiety/panic, posted by Colleen D. on February 8, 2005, at 19:17:22
> Hi Kara!
>
> Congrats on your new find!!! What dosage are you taking? I just take 25mg at night for sleep. Please tell me more!
>
> Thanks,
> Colleen
>
> 60mmg Cymablta
> 1.25mg clonazepam
> 25mg doxepin
Hi Colleen,Not really a new find for me. I took doxepin over 20 years ago and then stayed on it in low dose for sleep purposes for a few years after that. I'm currently taking only 12.5 mg. of doxepin. I may go up to 25 mg. but even at this low dosage it manages to hit the anxiety. I'm not taking anything else at this point.
K
Posted by KaraS on February 9, 2005, at 0:33:51
In reply to Re: nothing like a sedating TCA for anxiety/panic » KaraS, posted by Ritch on February 8, 2005, at 23:49:05
> > I just started on a small amount of doxepin a few days ago and I'm already seeing amazing results. My anxiety was so bad that I was not able to eat or sleep - the only things I managed to consume were Gatorade and Ensure. Also, I was starting to get agoraphobic. Now I'm eating and sleeping again. I'd say that my anxiety is about 90% under control. I don't know why this isn't used more for anxiety. Maybe because it's old, it's cheap, it's dirty and it's not terribly lucrative for the drug companies. It's not a long-term solution for me but it will enable me to tolerate other medications that I've been unable to tolerate recently because they were too stimulating.
> >
> > There is no question here. I just wanted others to know about this option if they're having a lot of trouble with anxiety.
> >
> >
> > K
> >
> >
>
> My first two AD's were doxepin and amitriptyline and they settled down a severe insomniac agitated depression like a charm (along with some lithium and chlordiazepoxide).
>They are definitely good at calming down severe anxiety fairly quickly. Sometimes the oldies work the best.
Posted by sabre on February 9, 2005, at 1:51:47
In reply to Re: nothing like a sedating TCA for anxiety/panic, posted by KaraS on February 9, 2005, at 0:33:51
Kara, what are the side effects like?
Everytime I start reading about a TCA, the side effect list seems so daunting that I usually give the idea away.
sabre
Posted by ed_uk on February 9, 2005, at 8:25:06
In reply to nothing like a sedating TCA for anxiety/panic, posted by KaraS on February 8, 2005, at 18:39:18
Hi Kara,
Have you ever tried hydroxyzine (Atarax, Vistaril) for anxiety? It takes effect within about half an hour. At the very low dose that you're taking, doxepin has a stong antihistamine action; it's other effects are quite weak at this dose. Hydroxyzine is an antihistamine which is sometimes used to treat anxiety. For most people, hydroxyzine doesn't seem to be very effective but I thought you might like it :-) Since it takes effect quickly, it could be useful prn.
Ed.
Posted by Phillipa on February 9, 2005, at 15:58:53
In reply to Re: nothing like a sedating TCA for anxiety/panic » KaraS, posted by ed_uk on February 9, 2005, at 8:25:06
I've been afraid of the TCA's too since I was tried on one years ago and the side effects were so bad I only took one dose. I don't remember the name "an upper-downer? Fondly, Phillipa
Posted by KaraS on February 9, 2005, at 16:39:56
In reply to Re: nothing like a sedating TCA for anxiety/panic, posted by sabre on February 9, 2005, at 1:51:47
> Kara, what are the side effects like?
> Everytime I start reading about a TCA, the side effect list seems so daunting that I usually give the idea away.
>
> sabre
Right now I'm on a low dose so I haven't had a lot of side effects besides the grogginess and a little bit of dry mouth. I'll be building up a bit and will probably get the really dry mouth, orthostatic hypotension and delayed urination. Also, it does tend to hinder memory and cognition. I don't want to stay on this long-term but for acute anxiety/panic, it's a good fix. It will then allow me to transition to something else (currently the anxiety has prevented me from tolerating other meds).
Posted by KaraS on February 9, 2005, at 16:43:28
In reply to Re: nothing like a sedating TCA for anxiety/panic » KaraS, posted by ed_uk on February 9, 2005, at 8:25:06
> Hi Kara,
>
> Have you ever tried hydroxyzine (Atarax, Vistaril) for anxiety? It takes effect within about half an hour. At the very low dose that you're taking, doxepin has a stong antihistamine action; it's other effects are quite weak at this dose. Hydroxyzine is an antihistamine which is sometimes used to treat anxiety. For most people, hydroxyzine doesn't seem to be very effective but I thought you might like it :-) Since it takes effect quickly, it could be useful prn.
>
> Ed.
Thanks Ed. I haven't tried hydroxyzine but I have tried Benedryl. The latter makes me jumpy as well as sedated which is a very uncomfortable state to be in. I was using niacinamide which was calming and exerted its effects because of its antihistaminic activity as well. It isn't enough for me right now however.K
Posted by ed_uk on February 10, 2005, at 9:53:02
In reply to Re: nothing like a sedating TCA for anxiety/panic, posted by KaraS on February 9, 2005, at 16:43:28
Hi,
>I haven't tried hydroxyzine but I have tried Benedryl. The latter makes me jumpy as well as sedated which is a very uncomfortable state to be in. I was using niacinamide which was calming and exerted its effects because of its antihistaminic activity as well. It isn't enough for me right now however.
I also hate Benadryl, it makes me very sedated as well as causing anxiety. Hydroxyzine would probably be more pleasant for you.
Ed.
Posted by KaraS on February 10, 2005, at 14:18:11
In reply to Re: nothing like a sedating TCA for anxiety/panic » KaraS, posted by ed_uk on February 10, 2005, at 9:53:02
> Hi,
>
> >I haven't tried hydroxyzine but I have tried Benedryl. The latter makes me jumpy as well as sedated which is a very uncomfortable state to be in. I was using niacinamide which was calming and exerted its effects because of its antihistaminic activity as well. It isn't enough for me right now however.
>
> I also hate Benadryl, it makes me very sedated as well as causing anxiety. Hydroxyzine would probably be more pleasant for you.
>
> Ed.
So have you tried hydroxyzine? If so, did it not cause anxiety like Benadryl?K
Posted by ed_uk on February 11, 2005, at 6:50:21
In reply to Re: nothing like a sedating TCA for anxiety/panic » ed_uk, posted by KaraS on February 10, 2005, at 14:18:11
Hi,
Yes, I tried it a while ago. Antihistamines don't help my anxiety but at least hydroxyzine didn't make me feel more anxious like diphenhydramine did!
Ed.
Posted by KaraS on February 11, 2005, at 16:12:23
In reply to Re: nothing like a sedating TCA for anxiety/panic » KaraS, posted by ed_uk on February 11, 2005, at 6:50:21
> Hi,
>
> Yes, I tried it a while ago. Antihistamines don't help my anxiety but at least hydroxyzine didn't make me feel more anxious like diphenhydramine did!
>
> Ed.
Good to know! Thanks.K
Posted by temoigneur on February 12, 2005, at 3:40:45
In reply to nothing like a sedating TCA for anxiety/panic, posted by KaraS on February 8, 2005, at 18:39:18
Hi, Kara, I've had severe anxiety/OCD for 10+ yrs, I read that tricyclics share some things with antipsychotics. Clomipramine feels quite similar to zyprexa, I feel numb, detached, dull, with really littl drive of any kind> . I've never combined Clomipramine with a stimulant - in your opinion, is this worth trying, if I could get my mind back, this would be a miracle, stimulants, make me obsessive, and produce emotionaly lability - please let me know if anyone has experience combining a tricylic for anxiety with something to stimulate them, where their OCD/anxiety would have previously been aggravated,
Ben
I just started on a small amount of doxepin a few days ago and I'm already seeing amazing results. My anxiety was so bad that I was not able to eat or sleep - the only things I managed to consume were Gatorade and Ensure. Also, I was starting to get agoraphobic. Now I'm eating and sleeping again. I'd say that my anxiety is about 90% under control. I don't know why this isn't used more for anxiety. Maybe because it's old, it's cheap, it's dirty and it's not terribly lucrative for the drug companies. It's not a long-term solution for me but it will enable me to tolerate other medications that I've been unable to tolerate recently because they were too stimulating.
>
> There is no question here. I just wanted others to know about this option if they're having a lot of trouble with anxiety.
>
>
> K
>
>
Posted by KaraS on February 12, 2005, at 17:05:22
In reply to Clomipramine numbs mind, emtions,.. med combo?, posted by temoigneur on February 12, 2005, at 3:40:45
Hi Ben,
I couldn't really tell you if a stimulant would work for you when added to clomipramine. It doesn't sound all that promising though if you've been unable to tolerate stimulants in the past. There are other stimulating medications that your doctor might prescribe in addition to the clomipramine or perhaps that isn't the best medcation for you.K
> Hi, Kara, I've had severe anxiety/OCD for 10+ yrs, I read that tricyclics share some things with antipsychotics. Clomipramine feels quite similar to zyprexa, I feel numb, detached, dull, with really littl drive of any kind> . I've never combined Clomipramine with a stimulant - in your opinion, is this worth trying, if I could get my mind back, this would be a miracle, stimulants, make me obsessive, and produce emotionaly lability - please let me know if anyone has experience combining a tricylic for anxiety with something to stimulate them, where their OCD/anxiety would have previously been aggravated,
>
> Ben
>
>
>
>
> I just started on a small amount of doxepin a few days ago and I'm already seeing amazing results. My anxiety was so bad that I was not able to eat or sleep - the only things I managed to consume were Gatorade and Ensure. Also, I was starting to get agoraphobic. Now I'm eating and sleeping again. I'd say that my anxiety is about 90% under control. I don't know why this isn't used more for anxiety. Maybe because it's old, it's cheap, it's dirty and it's not terribly lucrative for the drug companies. It's not a long-term solution for me but it will enable me to tolerate other medications that I've been unable to tolerate recently because they were too stimulating.
> >
> > There is no question here. I just wanted others to know about this option if they're having a lot of trouble with anxiety.
> >
> >
> > K
> >
> >
>
>
Posted by Sarah T. on February 13, 2005, at 22:46:11
In reply to nothing like a sedating TCA for anxiety/panic, posted by KaraS on February 8, 2005, at 18:39:18
Are you taking anything else besides Doxepin? I think you said that you were only taking Doxepin a few days ago. How about now? I'm just wondering how Doxepin combines with other meds. I took some other sedating tricyclics a long time ago and I remember having difficulty combining them with anything else due to cardiovascular side effects.
Posted by KaraS on February 14, 2005, at 21:11:20
In reply to Re: nothing like a sedating TCA for anxiety/panic » KaraS, posted by Sarah T. on February 13, 2005, at 22:46:11
> Are you taking anything else besides Doxepin? I think you said that you were only taking Doxepin a few days ago. How about now? I'm just wondering how Doxepin combines with other meds. I took some other sedating tricyclics a long time ago and I remember having difficulty combining them with anything else due to cardiovascular side effects.
Hi,
I'm taking 25 mg. of doxepin now. I have combined that in the past with SSRIs and had no problem (probably because it's such a low dose). I am probably going to add in an SSRI but I don't anticipate any cardiovascular problems. I'm more concerned at this point about being able to tolerate the initial stimulation of the SSRIS since my anxiety has been so bad lately.Kara
Posted by Sarah T. on February 15, 2005, at 0:08:01
In reply to Re: nothing like a sedating TCA for anxiety/panic » Sarah T., posted by KaraS on February 14, 2005, at 21:11:20
Is the Doxepin in capsule form? Did you say earlier that you'd taken 12.5 mg? How do you do that if it's a capsule? I still think that the TCA's are much better antidepressants than any AD that's come out in the past 15 years. The trouble I have with TCA's is that I get very rapid heart rates, especially when the blood levels are peaking. For this reason, I'm very scared about combining TCA's with other meds, especially anything stimulating, like Wellbutrin or a stimulant.
Posted by KaraS on February 15, 2005, at 1:44:29
In reply to Re: nothing like a sedating TCA for anxiety/panic » KaraS, posted by Sarah T. on February 15, 2005, at 0:08:01
> Is the Doxepin in capsule form? Did you say earlier that you'd taken 12.5 mg? How do you do that if it's a capsule?
Yes, I opened the capsules and split the amount. I have empty capsules here at home that I would use. Now I'm taking the full capsule so I don't have to bother with any of that.
>I still think that the TCA's are much better antidepressants than any AD that's come out in the past 15 years. The trouble I have with TCA's is that I get very rapid heart rates, especially when the blood levels are peaking. For this reason, I'm very scared about combining TCA's with other meds, especially anything stimulating, like Wellbutrin or a stimulant.
I also get tachycardia with many of the TCAs (nortriptyline and desipramine). I used to be able to tolerate maprotiline but now that makes my heart race as well. I'm still able to handle the sedating doxepin though. I have never combined a TCA with Wellbutrin or a stimulant so I don't know if that would be a problem. It hasn't been a problem to take the doxepin with Prozac, Paxil, Zoloft or Effexor however.
k
Posted by zeugma on February 15, 2005, at 16:50:32
In reply to Re: nothing like a sedating TCA for anxiety/panic » Sarah T., posted by KaraS on February 15, 2005, at 1:44:29
TCA's are hard to combine with stimulants. both can cause tachycardia, and the combination can be very dangerous. You can't combine TCA's with Wellbutrin at all because WB acts like Paxil on your liver enzymes: i.e. it slows down the TCA metabolism to a crawl and you can unintentionally overdose on 25 mg of desipramine.
the one stim that is safe with TCA's is Provigil, which, after a failed Strattera retrial, I am now retrying, out of some desperation, because I have a job in which it is imperative to stay fully awake (ha). early investigators were amazed by Provigil's lack of peripheral s/e, on heart rate and so forth. With my luck, though, I'm afraid it will speed my heart rate like Ritalin did, although I combined Provigil with 100 mg nortrip over the summer with no such consequences.
I know kara can't take provigil because of weird side effects, and I had weird s/e too, but I'm rather desperate, and the s/e were not of a cardiac nature, as they would be with any other stim/TCA combination. And unlike kara, the drug worked for me. the side effects were the problem. I suppose the dilemma we all face is that we can either take drugs that might as well be placebos far all their therapeutic effect, or wade through side effects that would daunt any sane person. I think I'm sane, and I'm hardly dauntless, but I also have to earn a living, and I can't very well do that when I'm half asleep all the time.
-z
Posted by Sarah T. on February 17, 2005, at 3:34:07
In reply to Re: nothing like a sedating TCA for anxiety/panic » KaraS, posted by zeugma on February 15, 2005, at 16:50:32
Zeugma, thanks for your reply. I figured that TCA's couldn't be combined with stimulants safely. I was surprised to read that you took Provigil with Nortriptyline. Can you tell me how it helped the TCA? Did the Provigil simply keep you awake or did it help with cognition, focus, etc.? TCA's are just about the only AD's that have really helped my mood, but I'm a numbskull on them. That fellow who writes for the Biopsychiatry.com website refers to TCA's as "dumb drugs," and indeed they are just that, as far as I'm concerned. In addition to impairing my thinking and memory, they must be really bad for the heart. When I took TCA's, I would wake up with resting heart rates of over 100! That was my heart rate before I even got out of bed.
Posted by zeugma on February 18, 2005, at 6:27:41
In reply to Re: nothing like a sedating TCA for anxiety/panic » zeugma, posted by Sarah T. on February 17, 2005, at 3:34:07
> Zeugma, thanks for your reply. I figured that TCA's couldn't be combined with stimulants safely. I was surprised to read that you took Provigil with Nortriptyline. Can you tell me how it helped the TCA? Did the Provigil simply keep you awake or did it help with cognition, focus, etc.? TCA's are just about the only AD's that have really helped my mood, but I'm a numbskull on them. That fellow who writes for the Biopsychiatry.com website refers to TCA's as "dumb drugs," and indeed they are just that, as far as I'm concerned. In addition to impairing my thinking and memory, they must be really bad for the heart. When I took TCA's, I would wake up with resting heart rates of over 100! That was my heart rate before I even got out of bed.
Hi, Sarah. I started taking Provigil to treat my severe ADD and possible narcolepsy. Provigil and nortriptyline actually remind me of each other, specifically in the slight cognitive 'slowing' both cause (Provigil is much stronger in this regard). For me, this action is actually anxiolytic and helps me cognitively. The Provigil helped with the anhedonia/energy aspects, and helped me to focus via the aforementioned 'slowing' (I would have to write a novel to explain why this helpful for me). On my third day of Provigil, I am noticing that it is easier for me to type, a sign that the Provigil is helping me to coordinate my thinking with my physical movements.
Nortriptyline by itself at 100 mg/day, or combined with up to 150 mg Provigil, had no cardiac effects whatsoever. I still need to have a cardiac workup done, as the combination of Ritalin and nortriptyline, which really helped some aspects of my ADD/sleep disorder but had numerous adverse effects, messed with my cardiac function in a major way. I am curious if you have any experience with desipramine and can compare it with nortriptyline, or can compare nortrip with any other TCA for that matter. I am going to a sleep clinic soon for a study, and I know that the TCA/stimulant combination is a classical treatment for narcolepsy, but comes with numerous hazards.
-z
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