![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 54. This is the beginning of the thread.
Posted by SLS on April 21, 2005, at 19:50:04
Has anyone used Keppra to treat bipolar disorder?
- Scott
Posted by Ritch on April 22, 2005, at 0:09:53
In reply to Keppra, posted by SLS on April 21, 2005, at 19:50:04
> Has anyone used Keppra to treat bipolar disorder?
>
>
> - ScottI tried it as an adjunct to Depakote with an eye to possibly dropping the Depakote a couple of years ago. My pdoc (I think) was looking at it as more of a potential clonazepam replacement. If you search posts by SusanC she kept a journal here and didn't find it of much help. The only thing I can say in Keppra's defense is that it worked remarkably well and consistently well for sleep. Downside.. it seemed to worsen irritability. But, I've recently found SSRI discontinuation to nearly eliminate dysphoric episodes... so I may have been blaming Keppra for something that citalopram was causing...
Posted by theo on April 22, 2005, at 9:02:37
In reply to Keppra, posted by SLS on April 21, 2005, at 19:50:04
Keppra is interesting because it works in a way that is hard to put a finger on. I can cause assertive behavior and with it's short half life, found it only effective taken 3 times daily versus 2 as published. It doesn't accumulate and is in and out almost like a stimulant in that regard.
I've been thinking about trying it again but might give a low dose Depakote a try first.
Posted by emme on April 22, 2005, at 17:09:33
In reply to Keppra, posted by SLS on April 21, 2005, at 19:50:04
Hi Scott,
Yes, I have used Keppra. I liked it and still consider an option to go back to. I found it calming.
At first it dulled my brain and left me "...unencumbered by the thought process". That was much less of a problem when I was careful to keep the dose lower.
emme
Posted by theo on April 23, 2005, at 6:50:50
In reply to Re: Keppra » SLS, posted by emme on April 22, 2005, at 17:09:33
> Hi Scott,
>
> Yes, I have used Keppra. I liked it and still consider an option to go back to. I found it calming.
>
> At first it dulled my brain and left me "...unencumbered by the thought process". That was much less of a problem when I was careful to keep the dose lower.
>
> emme
>When I took it I felt a little clumsy at 250, 500 then when I hit 750 (250mg 3 times daily) it was like a wave of alert clarity. The higher I went the more intense it got, which means I got a little over assertive above 750mg.
Posted by SLS on April 23, 2005, at 7:20:53
In reply to Re: Keppra, posted by theo on April 23, 2005, at 6:50:50
Hi Theo.
> When I took it I felt a little clumsy at 250, 500 then when I hit 750 (250mg 3 times daily) it was like a wave of alert clarity. The higher I went the more intense it got, which means I got a little over assertive above 750mg.
Why did you stop taking it?
- Scott
Posted by theo on April 23, 2005, at 8:23:09
In reply to Re: Keppra » theo, posted by SLS on April 23, 2005, at 7:20:53
> Hi Theo.
>
> > When I took it I felt a little clumsy at 250, 500 then when I hit 750 (250mg 3 times daily) it was like a wave of alert clarity. The higher I went the more intense it got, which means I got a little over assertive above 750mg.
>
> Why did you stop taking it?
>
Hey Scott,Sorry this is a little long, but also need to babble and get some input.
I was still feeling a little depression, so my doc added Lamictal instead of an SSRI.
At the time, I had never tried Lamictal and I was a little overwhelmed about taking two anticonvulsants. I really didn't have any side effects on Keppra alone but when the Lamictal was added, I had bloodshoot eyes and various side effects that were bothersome but did pass somewhat. At that point I wanted to get a true read on the Lamictal, so that's why I stopped the Keppra. I also stopped the Lamictal and was off meds for about 2 months just to see how I really felt since I haven't been off meds since I quit drinking 2 years ago. I'm glad I took a break from meds because I've learned that most of my nervous anxiety was from some SSRI's and Lamictal. I was suprised in that I tried Concerta 18mg and had no anxiety. My pdoc would never let me try a stim because she said it would make me a nervous wreck. It helped some but I would not consider it good for monotherapy.
After being off meds, I can get by, but probably shouldn't make myself suffer. I think I'm finally getting passed my denial and realizing I need something, but what? I have this low grade feeling of negative energy (like a dog with his tail between his legs) and feel like I'm stuck and going nowhere. I'm 40 and feel like I've lost all direction and feel good about nothing, which in itself is depressing. It's kind of weird because I had these feelings even as a young child, always scared to get involved, always avoid situations and feeling inadequate. I could also never make a commitment, which probably explains why when I'm on one med, I'm wondering if something else would be better. Another good habit I have is when I do make a mistake or do something embarrassing, I'll obsess about it for days instead of just dusting myself off and going forward.
I'm now stuck on whether I need an antidepressant, Depakote, Lithium, maybe try imipramine? I'm frustrated because I know if I go to my pdoc, her guess of what med to try will probably be no more logical than mine since you don't know till you try.
I feel so exhausted about thinking about what to try next and so fed up with whatever I'm feeling. Don't know whether I'm unipolar depression with underlying anxiety(OCD), BPII, ADD.
Any input based off of how I'm feeling would be greatly appreciated.
Posted by theo on April 23, 2005, at 10:44:54
In reply to Re: Keppra » SLS, posted by emme on April 22, 2005, at 17:09:33
> Hi Scott,
>
> Yes, I have used Keppra. I liked it and still consider an option to go back to. I found it calming.
>
> At first it dulled my brain and left me "...unencumbered by the thought process". That was much less of a problem when I was careful to keep the dose lower.
>
> emme
>How low of a dose?
Posted by SLS on April 23, 2005, at 13:29:19
In reply to Re: Keppra, posted by theo on April 23, 2005, at 8:23:09
Hi Theo.
So, you must feel really lost at this point. Regaining orientation and direction might take a little while as you begin to sort out what are the true symptomatic features of your illness.
Without trying to diagnose yourself or thinking about previous treatments, can you give a summary of what you experience? What are your major complaints? At what age did they appear? Is there any history of mental illness in the family? What does your illness prevent you from doing, and how?
- Scott
Posted by theo on April 24, 2005, at 9:37:59
In reply to Re: Keppra » theo, posted by SLS on April 23, 2005, at 13:29:19
> Hi Theo.
>
> So, you must feel really lost at this point. Regaining orientation and direction might take a little while as you begin to sort out what are the true symptomatic features of your illness.
>
> Without trying to diagnose yourself or thinking about previous treatments, can you give a summary of what you experience? What are your major complaints? At what age did they appear? Is there any history of mental illness in the family? What does your illness prevent you from doing, and how?
>
>
> - Scott
>
>
>Scott,
I little long so hang in there.
Let me start off be saying I have been sober for 2 years now but drank for the past 20 so as far as emotional growth, I'm 2 years old! Actually really 40. During my drinking career, I was pretty successful, owned my own business and was the single guy everyone liked to have at there parties. As a child, I was a small skinny kid and was always teased and always felt scared about everything.
I have a hard time communicating my thoughts, expressing emotion. I've been going to AA meetings for 2 years and have only shared a couple of times. I want to talk but am scared if I open my mouth, I'll say something stupid and beat myself up about it for days. What's funny is I'm in sales and talk to people all day. The kicker is I'm terrified to get in front of large groups and present something. I also have a hard time going with my instincts and end up letting others (family, girlfriends) influence my decisions, which I later then regret and ruminate about my mistakes. Definitely a people pleaser. I feel like my brain's on hold. I have a hard time making decisions, so much that I'll overthink a situation until I'm exhausted. An example is looking for a job. I'm capable, but think if I start a job it has to be "the" job, instead of going with something and if it doesn't work, simply moving on. I have a hard time in relationships this way. I know in my gut when one isn't right but stay in because I'm scared if I end it I'll end up obsessing that maybe I gave up a good thing. Everytime a make a decision I doubt it. I can find something wrong with every decision I make. If I buy something like a car and get a great deal, I still get buyers remorse. I have this "fear" or low feeling of self worth running like an endless loop tape.
To sum up:
Hard time communicating thoughts, they're in my head but have a hard time putting into words.
Low feelings, emotion
Unorganized, which leads to anxiety because I'm a clean freak.
Lack of direction, purpose.
Negative perception of events, thinking in the negative.
Always worry
Afraid of starting new career only because I'll think through it negatively, obsess about it and think it's hopeless and if I did land one I would lose it because I feel so beat down, won't perform and get fired.
Loss of interest in all areas of life.
Some focus and motivation, drive issues.
Hard time jumping in and taking action.
Hard time making decisions.
Hard time making commitments.I do have some history of alcoholism in my family. I don't know much because my parents divorced when I was 14 and my father has never been a big communicator, and this is the side that mental illness, alcoholism would come from. My grandfather was very successful, died at 51(cerebral hemorrhage) one year after my grandmother(cancer). My father inherited everything, drank and blew threw it. My dad hasn't had a drink in years but never changed his behaviors, so is still the same person. I will say may dad has some grandiose behavior.
I do have a major resentment with my father because I was financially sound, he persuaded me to help him, I did and he never kept his end of the bargain, at least so far. I'm now trying to get my life back together and he seems to have conveniently forgotten how I bailed him out financially, I'm talking high six figures. I think about this day in, day out and this situation is definitely a driving force in my emotions. Maybe it's the loss of control in the situation because he has always been the type to take things and just think he deserves it from his son and that's that.
When I was on meds, I always wondered how life would be without. Now I know and need to adapt. If people only knew they would be shocked. My first reaction to people is a big smile and hello, if they only knew what was going on inside of me! Many people that know me have a hard time understanding because to them, I seem fine.
What's confusing for me is if I start something (meds) I know I need to stick with it and not obsess about it and diagnosis every second of my life. Another point to add to my confusion, my Internist that I've known for 20 years has never mentioned BPII. My pdoc who has known me for 1 year diagnosed me as Anxiety NOS 300.00, and thinks I'm possibly BPII in that my anxiety, fear is my mania. Dr. Amen suggests alcoholics need to take something for OCD(SSRI or anticonvulsant?) and a stimulant. As I mentioned in my last post, my anxiety has dropped quite a bit by not being on meds. When my pdoc diagnosed me (on Zoloft) I was complaining more about anxiety which now I think was from side effects more than true anxiety. Now it seems weighed more on the depressive side than anxiety. What's frustrating is that I originally told her I wanted to stop meds and start from scratch to get a better diagnosis a year ago, but let her over rule my thoughts. So basically I've wasted yet another year.
I use to feel like I had some purpose and direction, but even then felt like something was missing. I know I don't want to go through life as one of those people who is never satisified. Restless, irritable, discontent.
Any thoughts or input would be appreciated. Also on med selection. I will of course consult with my docs, but the more I can tell them will influence there decision on which direction to go as far as SSRI, anticonvulsants, TCA, etc. I am healthy, blood pressure 120/78, cholesteral 164 so there's no limits on what I can try. Although I've tried many SSRI's in the past when I was drinking, I'm only 2 years sober so I can't evaluate much from the past when I was taking them. SSRI's do cause some initial anxiety(OCD) but not mania. The only SSRI's I didn't care much for were Zoloft and Lexapro because they seemed to cause anxiety and avoidance behavior and make it even harder for me to open my mouth. Celexa doesn't cause me any problems which is beyond me since it's suppose to be so close to Lexapro! As a group though, SSRI's (Paxil, Prozac) will make me feel okay but zone me out, leaving me with a smile on my face staring at piles of work that need to be done.
At this point at least I know I can function and am a pretty stable person without meds, but that something is out of balance and void and I feel I'm putting more stress on my brain than I need to be. When I start a med, I will now know what I was like not on meds and have a point of reference, something I didn't have before since I stopped drinking.
Posted by platinumbride on April 25, 2005, at 11:45:11
In reply to Re: Keppra » SLS, posted by theo on April 24, 2005, at 9:37:59
Theo,
FWIW, I read your posts and wanted to give you a hug and say that you are a pretty brave person to have stayed the sourse and remained sober for 2 years. Seems to me that you know a lot about loss but, perhaps, have yet to see the fruits of your labor vis a vis your sobriety. I hope that you will see them very, very soon. What you are doing is extraordinary. Most people would never have bothered.
I don't know what more to say, Theo, except that I admire you.
Diane> > Hi Theo.
> >
> > So, you must feel really lost at this point. Regaining orientation and direction might take a little while as you begin to sort out what are the true symptomatic features of your illness.
> >
> > Without trying to diagnose yourself or thinking about previous treatments, can you give a summary of what you experience? What are your major complaints? At what age did they appear? Is there any history of mental illness in the family? What does your illness prevent you from doing, and how?
> >
> >
> > - Scott
> >
> >
> >
>
> Scott,
>
> I little long so hang in there.
>
> Let me start off be saying I have been sober for 2 years now but drank for the past 20 so as far as emotional growth, I'm 2 years old! Actually really 40. During my drinking career, I was pretty successful, owned my own business and was the single guy everyone liked to have at there parties. As a child, I was a small skinny kid and was always teased and always felt scared about everything.
>
> I have a hard time communicating my thoughts, expressing emotion. I've been going to AA meetings for 2 years and have only shared a couple of times. I want to talk but am scared if I open my mouth, I'll say something stupid and beat myself up about it for days. What's funny is I'm in sales and talk to people all day. The kicker is I'm terrified to get in front of large groups and present something. I also have a hard time going with my instincts and end up letting others (family, girlfriends) influence my decisions, which I later then regret and ruminate about my mistakes. Definitely a people pleaser. I feel like my brain's on hold. I have a hard time making decisions, so much that I'll overthink a situation until I'm exhausted. An example is looking for a job. I'm capable, but think if I start a job it has to be "the" job, instead of going with something and if it doesn't work, simply moving on. I have a hard time in relationships this way. I know in my gut when one isn't right but stay in because I'm scared if I end it I'll end up obsessing that maybe I gave up a good thing. Everytime a make a decision I doubt it. I can find something wrong with every decision I make. If I buy something like a car and get a great deal, I still get buyers remorse. I have this "fear" or low feeling of self worth running like an endless loop tape.
>
> To sum up:
>
> Hard time communicating thoughts, they're in my head but have a hard time putting into words.
> Low feelings, emotion
> Unorganized, which leads to anxiety because I'm a clean freak.
> Lack of direction, purpose.
> Negative perception of events, thinking in the negative.
> Always worry
> Afraid of starting new career only because I'll think through it negatively, obsess about it and think it's hopeless and if I did land one I would lose it because I feel so beat down, won't perform and get fired.
> Loss of interest in all areas of life.
> Some focus and motivation, drive issues.
> Hard time jumping in and taking action.
> Hard time making decisions.
> Hard time making commitments.
>
> I do have some history of alcoholism in my family. I don't know much because my parents divorced when I was 14 and my father has never been a big communicator, and this is the side that mental illness, alcoholism would come from. My grandfather was very successful, died at 51(cerebral hemorrhage) one year after my grandmother(cancer). My father inherited everything, drank and blew threw it. My dad hasn't had a drink in years but never changed his behaviors, so is still the same person. I will say may dad has some grandiose behavior.
>
> I do have a major resentment with my father because I was financially sound, he persuaded me to help him, I did and he never kept his end of the bargain, at least so far. I'm now trying to get my life back together and he seems to have conveniently forgotten how I bailed him out financially, I'm talking high six figures. I think about this day in, day out and this situation is definitely a driving force in my emotions. Maybe it's the loss of control in the situation because he has always been the type to take things and just think he deserves it from his son and that's that.
>
> When I was on meds, I always wondered how life would be without. Now I know and need to adapt. If people only knew they would be shocked. My first reaction to people is a big smile and hello, if they only knew what was going on inside of me! Many people that know me have a hard time understanding because to them, I seem fine.
>
> What's confusing for me is if I start something (meds) I know I need to stick with it and not obsess about it and diagnosis every second of my life. Another point to add to my confusion, my Internist that I've known for 20 years has never mentioned BPII. My pdoc who has known me for 1 year diagnosed me as Anxiety NOS 300.00, and thinks I'm possibly BPII in that my anxiety, fear is my mania. Dr. Amen suggests alcoholics need to take something for OCD(SSRI or anticonvulsant?) and a stimulant. As I mentioned in my last post, my anxiety has dropped quite a bit by not being on meds. When my pdoc diagnosed me (on Zoloft) I was complaining more about anxiety which now I think was from side effects more than true anxiety. Now it seems weighed more on the depressive side than anxiety. What's frustrating is that I originally told her I wanted to stop meds and start from scratch to get a better diagnosis a year ago, but let her over rule my thoughts. So basically I've wasted yet another year.
>
> I use to feel like I had some purpose and direction, but even then felt like something was missing. I know I don't want to go through life as one of those people who is never satisified. Restless, irritable, discontent.
>
> Any thoughts or input would be appreciated. Also on med selection. I will of course consult with my docs, but the more I can tell them will influence there decision on which direction to go as far as SSRI, anticonvulsants, TCA, etc. I am healthy, blood pressure 120/78, cholesteral 164 so there's no limits on what I can try. Although I've tried many SSRI's in the past when I was drinking, I'm only 2 years sober so I can't evaluate much from the past when I was taking them. SSRI's do cause some initial anxiety(OCD) but not mania. The only SSRI's I didn't care much for were Zoloft and Lexapro because they seemed to cause anxiety and avoidance behavior and make it even harder for me to open my mouth. Celexa doesn't cause me any problems which is beyond me since it's suppose to be so close to Lexapro! As a group though, SSRI's (Paxil, Prozac) will make me feel okay but zone me out, leaving me with a smile on my face staring at piles of work that need to be done.
>
> At this point at least I know I can function and am a pretty stable person without meds, but that something is out of balance and void and I feel I'm putting more stress on my brain than I need to be. When I start a med, I will now know what I was like not on meds and have a point of reference, something I didn't have before since I stopped drinking.
>
>
>
>
>
>
>
>
>
>
>
Posted by platinumbride on April 25, 2005, at 11:48:38
In reply to Keppra, posted by SLS on April 21, 2005, at 19:50:04
Hi Scott,
I tried keppra over a year ago. I think I am weird; it had no effect on me whatsoever - neither good nor bad. I don't remember the doseagae, but I took it for 3 months before I went on another anticonvulsant that had no effect either.
I know the buzz is all about cognitive enhancement.
I sure hope it does something positive for you.
Diane
> Has anyone used Keppra to treat bipolar disorder?
>
>
> - Scott
Posted by theo on April 25, 2005, at 12:15:13
In reply to Re: Keppra, posted by platinumbride on April 25, 2005, at 11:45:11
Thank You! It's tough to hold on when confronting situations like this and not see immediate results, but hopefully in the near future it will be worth it.
Posted by platinumbride on April 25, 2005, at 22:43:34
In reply to Re: Keppra » platinumbride, posted by theo on April 25, 2005, at 12:15:13
You are most welcome.....
I really wish you all good things. I see recovering addicts a lot and I just can't believe that they are managing to confront life, unaided by substance, day after day...especially after many years of substance making everything "all right".
Be well,
Diane
> Thank You! It's tough to hold on when confronting situations like this and not see immediate results, but hopefully in the near future it will be worth it.
Posted by SLS on April 26, 2005, at 7:28:28
In reply to Re: Keppra » SLS, posted by theo on April 24, 2005, at 9:37:59
Hi Theo.
I'm still thinking...
:-)
I want to reiterate what Diane said. I have an enormous amount of respect for the strength you have shown to maintain your sobriety in the face of other adversities.
My knee-jerk reaction after reading your post is that you might benefit most from CBT (cognitive-behavioral therapy). This does not obviate the need for pharmacotherapy, but would address true psychological issues that a medication will not be able to help with.
- Scott
Posted by theo on April 26, 2005, at 8:29:12
In reply to Re: Keppra » theo, posted by SLS on April 26, 2005, at 7:28:28
> Hi Theo.
>
> I'm still thinking...
>
> :-)
>
> I want to reiterate what Diane said. I have an enormous amount of respect for the strength you have shown to maintain your sobriety in the face of other adversities.
>
> My knee-jerk reaction after reading your post is that you might benefit most from CBT (cognitive-behavioral therapy). This does not obviate the need for pharmacotherapy, but would address true psychological issues that a medication will not be able to help with.
>
>
> - ScottI agree, but since I quit taking meds, my interest to go to therapy or do anything for that matter is pretty flat. It's like I need something (med) to bridge the gap and help me "feel" like going forward.
I'm a dealer for a high end furniture company and was awarded a bid yesterday for about decent commission. I didn't even feel good about that!!! This worries me because I can't seem to feel excited about anything it seems.
Posted by SLS on April 26, 2005, at 18:34:04
In reply to Re: Keppra » SLS, posted by theo on April 26, 2005, at 8:29:12
> > Hi Theo.
> >
> > I'm still thinking...
> >
> > :-)
> >
> > I want to reiterate what Diane said. I have an enormous amount of respect for the strength you have shown to maintain your sobriety in the face of other adversities.
> >
> > My knee-jerk reaction after reading your post is that you might benefit most from CBT (cognitive-behavioral therapy). This does not obviate the need for pharmacotherapy, but would address true psychological issues that a medication will not be able to help with.
> >
> >
> > - Scott
>
> I agree, but since I quit taking meds, my interest to go to therapy or do anything for that matter is pretty flat. It's like I need something (med) to bridge the gap and help me "feel" like going forward.
>
> I'm a dealer for a high end furniture company and was awarded a bid yesterday for about decent commission. I didn't even feel good about that!!! This worries me because I can't seem to feel excited about anything it seems.
That sounds like a bona-fide biological depression to me. Loss of interest, motivation, and reward. You are right in thinking that it would be more productive to engage in CBT without the depression getting in the way. Therefore, it is logical to attack the depression first. If you hit the bullseye, you can move forward. However, if you don't hit the bullseye, you might benefit from trying to move forward with the CBT anyway. Progress would be slow, but it would still help to chip away at your fears and inhibitions.How did you respond to Parnate?
- Scott
Posted by theo on April 26, 2005, at 23:12:43
In reply to Re: Keppra » theo, posted by SLS on April 26, 2005, at 18:34:04
>
> That sounds like a bona-fide biological depression to me. Loss of interest, motivation, and reward. You are right in thinking that it would be more productive to engage in CBT without the depression getting in the way. Therefore, it is logical to attack the depression first. If you hit the bullseye, you can move forward. However, if you don't hit the bullseye, you might benefit from trying to move forward with the CBT anyway. Progress would be slow, but it would still help to chip away at your fears and inhibitions.
>
> How did you respond to Parnate?
>
>
> - ScottActually, I've never tried Parnate, Nardil or any TCA's, only SSRI's and anticonvulsants. So now's the big question, what to try. Not only what class but then which med within that class?
Posted by SLS on April 27, 2005, at 8:26:02
In reply to Re: Keppra » SLS, posted by theo on April 26, 2005, at 23:12:43
> >
> > That sounds like a bona-fide biological depression to me. Loss of interest, motivation, and reward. You are right in thinking that it would be more productive to engage in CBT without the depression getting in the way. Therefore, it is logical to attack the depression first. If you hit the bullseye, you can move forward. However, if you don't hit the bullseye, you might benefit from trying to move forward with the CBT anyway. Progress would be slow, but it would still help to chip away at your fears and inhibitions.
> >
> > How did you respond to Parnate?
> >
> >
> > - Scott
>
> Actually, I've never tried Parnate, Nardil or any TCA's, only SSRI's and anticonvulsants. So now's the big question, what to try. Not only what class but then which med within that class?Don't forget about Effexor or Cymbalta. Either of these are worth a try if you haven't tried them already.
From the land of TCA comes desipramine and nortriptyline. Both of these drugs have mild side effects compared to the others. I would give a small advantage to nortriptyline. However, one must be diligent in establishing blood levels in the beginning such that the dosage chosen results in values between 50-150 ng/ml. There are people, however, whom respond to desipramine and not to nortriptyline.
desipramine 150-300mg
nortriptyline 50-100mgFor MAOIs, it is difficult to choose whether to go with Parnate or Nardil. If lack of energy is not a problem, and there exists anxiety disorders or OCD, Nardil might be the best choice. However, there are some people who respond to Parnate who don't respond to Nardil, so you can't discount all MAO inhibitors based upon your non-response to only one of them.
Parnate 40-80mg
Nardil 60-90mgTheo, it seems to me that there are still quite a few avenues of treatment you have not explored yet. The odds are in your favor that you will find something that works well.
- Scott
Posted by theo on April 27, 2005, at 9:15:15
In reply to Re: Keppra » theo, posted by SLS on April 27, 2005, at 8:26:02
In you response to TCA's, you didn't mention imipramine. How does it compare to the other ones mentioned? Didn't you try it before?
I can usually get by with small doses, which also may be an advantage with some meds.
Posted by SLS on April 27, 2005, at 19:53:17
In reply to Re: Keppra » SLS, posted by theo on April 27, 2005, at 9:15:15
Imipramine is the "gold standard" by which other antidepressants have been measured. If you are not afraid of anticholinergic side effects (dry mouth, blurred vision, constipation, difficulty in urination, etc.), you will probably enhance your chances of getting well by trying imipramine instead of desipramine.
- Scott
Posted by theo on April 27, 2005, at 22:42:59
In reply to Re: Keppra, posted by SLS on April 27, 2005, at 19:53:17
> Imipramine is the "gold standard" by which other antidepressants have been measured. If you are not afraid of anticholinergic side effects (dry mouth, blurred vision, constipation, difficulty in urination, etc.), you will probably enhance your chances of getting well by trying imipramine instead of desipramine.
>
>
> - ScottSo between nortriptyline, desipramine and imipramine, nortriptyline would have the least side effects and imipramine the most? With TCA's are side effects dose related?
Posted by SLS on April 28, 2005, at 6:17:11
In reply to Re: Keppra » SLS, posted by theo on April 27, 2005, at 22:42:59
> > Imipramine is the "gold standard" by which other antidepressants have been measured. If you are not afraid of anticholinergic side effects (dry mouth, blurred vision, constipation, difficulty in urination, etc.), you will probably enhance your chances of getting well by trying imipramine instead of desipramine.
> >
> >
> > - Scott
>
> So between nortriptyline, desipramine and imipramine, nortriptyline would have the least side effects and imipramine the most? With TCA's are side effects dose related?The anticholinergic side effects of TCAs are dose related. I'm partial to nortriptyline right now because it is somewhat less selective than desipramine for amine uptake inhibition. I find nortriptyline to be a more pleasant drug to be on.
Years ago, an idea circulated that responses to desipramine and nortriptyline were mutually exclusive. If you responded to one, you would tend not to respond to the other and vice versa. Again, with antidepressants, it is important not to generalize your reaction to one drug to an entire class.
- Scott
Posted by platinumbride on April 28, 2005, at 8:46:50
In reply to Keppra, posted by SLS on April 21, 2005, at 19:50:04
Posted by theo on April 28, 2005, at 9:28:26
In reply to Re: Keppra, posted by SLS on April 28, 2005, at 6:17:11
Thanks for the input. I'll be speaking with my pdoc soon to discuss options.
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