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Dr. Bob is Robert Hsiung, MD,
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Posted by tygereyes on August 12, 2005, at 17:50:30
In reply to TCAs, irritability, and BPD., posted by tygereyes on August 12, 2005, at 17:48:17
... I also have mitral valve prolapse, so cardiotoxicity is an issue as well. I think Clomipramine is more cardiotoxic than Desipramine or Nortriptyline. :-/
Posted by ed_uk on August 13, 2005, at 9:06:28
In reply to TCAs, irritability, and BPD., posted by tygereyes on August 12, 2005, at 17:48:17
>I cannot take SSRIs because they worsen my Interstitial Cystitis (bladder disorder), so I am left with the tricyclics.
But what about the non-TCA, non-SSRI antidepressants? eg. trazodone
~Ed
Posted by tygereyes on August 14, 2005, at 19:43:07
In reply to Re: TCAs, irritability, and BPD. » tygereyes, posted by ed_uk on August 13, 2005, at 9:06:28
> >I cannot take SSRIs because they worsen my Interstitial Cystitis (bladder disorder), so I am left with the tricyclics.
>
> But what about the non-TCA, non-SSRI antidepressants? eg. trazodone
>
> ~EdMy pdoc doesn't prescribe that for depression - sleep only ... do you know if Clomipramine is less likely to cause irritability, though, due to its similarities to SSRIs?
Posted by zeugma on August 14, 2005, at 20:07:36
In reply to Re: TCAs, irritability, and BPD., posted by tygereyes on August 14, 2005, at 19:43:07
hi tygereyes,
I would guess that clomipramine combines the SSRI effect with the one you're used to from desipramine and nortriptyline. I personally wanted to try clomipramine as many people have testified to its potency but my pdoc wouldn't go for it (I take 100 mg nortriptyline).
-z
Posted by ed_uk on August 15, 2005, at 3:55:16
In reply to TCAs, irritability, and BPD., posted by tygereyes on August 12, 2005, at 17:48:17
It's difficult to say how you'd react to clomipramine. Like desipramine and nortriptyline, one of clomipramine's major metabolites inhibits the reuptake of NE - perhaps this is what's causing your irritability.
~ed
Posted by SLS on August 15, 2005, at 10:03:09
In reply to TCAs, irritability, and BPD., posted by tygereyes on August 12, 2005, at 17:48:17
Trileptal + Zyprexa is a good combination to treat BPD.
Clomipramine would probably aggravate your symptoms in ways similar to the other TCAs. If there is any one TCA that might spare you these side effects, it would be trimipramine. It does not act as a monoamine reuptake inhibitor and seems to have effects on sleep that are in opposition to the other TCAs and generally beneficial.
How did you respond to Remeron and Wellbutrin?
- Scott
Posted by tygereyes on August 15, 2005, at 16:32:30
In reply to Re: TCAs, irritability, and BPD., posted by SLS on August 15, 2005, at 10:03:09
> Trileptal + Zyprexa is a good combination to treat BPD.
>
> Clomipramine would probably aggravate your symptoms in ways similar to the other TCAs. If there is any one TCA that might spare you these side effects, it would be trimipramine. It does not act as a monoamine reuptake inhibitor and seems to have effects on sleep that are in opposition to the other TCAs and generally beneficial.
>
> How did you respond to Remeron and Wellbutrin?
>
>
> - ScottI refuse to take Remeron (or Zyprexa, for that matter) since I've had a long history of anorexia nervosa and a pathological fear of weight gain. I can't take Wellbutrin for this reason - my doctor wants six months without any eating disordered behaviors before she'll consider prescribing it.
Posted by ed_uk on August 15, 2005, at 17:04:07
In reply to Re: TCAs, irritability, and BPD., posted by tygereyes on August 15, 2005, at 16:32:30
Hi again :-)
Which symptoms are you currently trying to treat with medication?
~ed
Posted by tygereyes on August 15, 2005, at 17:48:30
In reply to Re: TCAs, irritability, and BPD. » tygereyes, posted by ed_uk on August 15, 2005, at 17:04:07
> Hi again :-)
>
> Which symptoms are you currently trying to treat with medication?
>
> ~edDepression is a big one ... plus, general mood swings, agitation/irritability/hostility ... body dysmorphia, hysterical fear of abandonment, and self-destructive behavior, though I really don't think any pill could fix THAT one quite so easily!
I am like a psychopharmacologist's worst nightmare. Lately I have really been thinking that Parnate might help with some of these symptoms, though, so perhaps there is hope.
Posted by zeugma on August 15, 2005, at 17:52:30
In reply to Re: TCAs, irritability, and BPD., posted by tygereyes on August 15, 2005, at 17:48:30
Lately I have really been thinking that Parnate might help with some of these symptoms, though, so perhaps there is hope. >>
At one time Parnate was the first line treatment for BPD. (I am quoting the illustrious SLS from memory and any errors in transcription are mine.)
-z
Posted by SLS on August 15, 2005, at 18:28:38
In reply to Re: TCAs, irritability, and BPD. » tygereyes, posted by zeugma on August 15, 2005, at 17:52:30
> Lately I have really been thinking that Parnate might help with some of these symptoms, though, so perhaps there is hope. >>
>
> At one time Parnate was the first line treatment for BPD. (I am quoting the illustrious SLS from memory and any errors in transcription are mine.)
>
> -zYou devil, you!
1: Arch Gen Psychiatry. 1988 Feb;45(2):111-9. Related Articles, Links
Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.Cowdry RW, Gardner DL.
Intramural Research Program, National Institute of Mental Health, Bethesda, MD 20892.
Sixteen female outpatients with borderline personality disorder and prominent behavioral dyscontrol, but without a current episode of major depression, were studied in a double-blind, crossover trial of placebo and the following four active medications: alprazolam (average dose, 4.7 mg/d); carbamazepine (average dose, 820 mg/d); trifluoperazine hydrochloride (average dose, 7.8 mg/d); and tranylcypromine sulfate (average dose, 40 mg/d). Each trial was designed to last six weeks. Tranylcypromine and carbamazepine trials had the highest completion rates. Physicians rated patients as significantly improved relative to placebo while receiving tranylcypromine and carbamazepine. Patients rated themselves as significantly improved relative to placebo only while receiving tranylcypromine. Patients who tolerated a full trial of trifluoperazine showed improvement, those receiving carbamazepine demonstrated a marked decrease in the severity of behavioral dyscontrol, and those receiving alprazolam had an increase in the severity of the episodes of serious dyscontrol. As an adjunct to psychotherapy, pharmacotherapy can produce modest but clinically important improvement in the mood and behavior of patients with borderline personality disorder. As a research tool, patterns of pharmacological response may provide clues to biological mechanisms underlying dysphoria and behavioral dyscontrol.
Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 3276280 [PubMed - indexed for MEDLINE]
Posted by ed_uk on August 15, 2005, at 19:05:50
In reply to Re: TCAs, irritability, and BPD., posted by tygereyes on August 15, 2005, at 17:48:30
>Depression is a big one ... plus, general mood swings, agitation/irritability/hostility ... body dysmorphia, hysterical fear of abandonment, and self-destructive behavior...
What have you tried so far?
~Ed
Posted by tygereyes on August 15, 2005, at 21:14:18
In reply to Re: TCAs, irritability, and BPD., posted by SLS on August 15, 2005, at 18:28:38
> > Lately I have really been thinking that Parnate might help with some of these symptoms, though, so perhaps there is hope. >>
> >
> > At one time Parnate was the first line treatment for BPD. (I am quoting the illustrious SLS from memory and any errors in transcription are mine.)
> >
> > -z
>
>
>
> You devil, you!
>
>
>
>
> 1: Arch Gen Psychiatry. 1988 Feb;45(2):111-9. Related Articles, Links
>
>
> Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.
>
> Cowdry RW, Gardner DL.
>
> Intramural Research Program, National Institute of Mental Health, Bethesda, MD 20892.
>
> Sixteen female outpatients with borderline personality disorder and prominent behavioral dyscontrol, but without a current episode of major depression, were studied in a double-blind, crossover trial of placebo and the following four active medications: alprazolam (average dose, 4.7 mg/d); carbamazepine (average dose, 820 mg/d); trifluoperazine hydrochloride (average dose, 7.8 mg/d); and tranylcypromine sulfate (average dose, 40 mg/d). Each trial was designed to last six weeks. Tranylcypromine and carbamazepine trials had the highest completion rates. Physicians rated patients as significantly improved relative to placebo while receiving tranylcypromine and carbamazepine. Patients rated themselves as significantly improved relative to placebo only while receiving tranylcypromine. Patients who tolerated a full trial of trifluoperazine showed improvement, those receiving carbamazepine demonstrated a marked decrease in the severity of behavioral dyscontrol, and those receiving alprazolam had an increase in the severity of the episodes of serious dyscontrol. As an adjunct to psychotherapy, pharmacotherapy can produce modest but clinically important improvement in the mood and behavior of patients with borderline personality disorder. As a research tool, patterns of pharmacological response may provide clues to biological mechanisms underlying dysphoria and behavioral dyscontrol.
>
> Publication Types:
> Clinical Trial
> Randomized Controlled Trial
>
> PMID: 3276280 [PubMed - indexed for MEDLINE]
>I actually read that study recently, when researching Parnate. It's unfortunate that Tegretol and Parnate are contraindicated [and I'm assuming that Trileptal, which I currently take, is contraindicated as well, but I'm not certain]; the two would seem to pack quite a punch for those with BPD.
Posted by tygereyes on August 15, 2005, at 21:25:58
In reply to Re: TCAs, irritability, and BPD., posted by ed_uk on August 15, 2005, at 19:05:50
> >Depression is a big one ... plus, general mood swings, agitation/irritability/hostility ... body dysmorphia, hysterical fear of abandonment, and self-destructive behavior...
>
> What have you tried so far?
>
> ~EdI currently take Trileptal (600 mg - anything higher causes cognitive deficits), Seroquel (25 mg and 25 mg PRN) and Desipramine (100 mg).
In the past I have taken:
Zoloft - amazing, amazing response, improved mood AND body dysmorphia, no irritability/hostility, but SSRIs cause enuresis (bed-wetting) and worsen my other Interstitial Cystitis symptoms
Prozac - no response, caused enuresis/worsened IC
Celexa - no response, caused enuresis/worsened IC
Effexor - minimal mood response but caused enuresis/worsened IC
Cymbalta - no response, caused enuresis/worsened IC
Lamictal - not on it long enough to exhibit response, caused enuresis/worsened IC
Zonegran - no response, cognitive deficits present, caused weight loss
Wellbutrin - brief trial so no chance for response, taken off of it when started relapsing into anorexia
Nortriptyline - depression improved but caused irritability/hostility and weight gain
Clomipramine - brief trial so no chance for response, discontinued when appetite sharply increased
Zyprexa - VERY brief trial (one day!), discontinued because of appetite increase and bingeing behavior
Risperdal - amazing response in terms of body dysmorphia and body image distortion as related to anorexia but caused enuresis/worsened IC so had to stop taking itTrileptal and Seroquel, without Desipramine, have led to enuresis before, so I can't take those two without a tricyclic. Some drugs (Zoloft, Risperdal, Lamictal) have such a profound effect on my bladder that even a tricyclic does not fix the problem. I am hoping that if I try Parnate, this will not occur. If it does, I could always go back to the combination I'm on now - but the irritability/hostility/agitation is just so overwhelming.
Posted by ed_uk on August 16, 2005, at 5:35:00
In reply to Re: TCAs, irritability, and BPD., posted by tygereyes on August 15, 2005, at 21:14:18
Hi,
>It's unfortunate that Tegretol and Parnate are contraindicated.......
They're not. The manufacturer of Tegretol 'invented' the contraindication to protect themselves....... they didn't bother to study the interaction.
Trileptal isn't contraindicated with MAOIs either.
~ed
Posted by ed_uk on August 16, 2005, at 5:42:34
In reply to Re: TCAs, irritability, and BPD., posted by tygereyes on August 15, 2005, at 21:25:58
Hi,
>Zoloft - amazing, amazing response, improved mood AND body dysmorphia, no irritability/hostility, but SSRIs cause enuresis (bed-wetting) and worsen my other Interstitial Cystitis symptoms.
Have you ever combined it with an anti-enuresis drug? I'm sure you have! .....but I still thought it was worth asking.
>Risperdal
Perhaps you could try some other APs. Ever tried Abilify? It doesn't usually cause much weight gain. Also, if you live in the UK you could try Solian.
~Ed
Posted by tygereyes on August 16, 2005, at 6:34:49
In reply to Re: TCAs, irritability, and BPD. » tygereyes, posted by ed_uk on August 16, 2005, at 5:42:34
> Hi,
>
> >Zoloft - amazing, amazing response, improved mood AND body dysmorphia, no irritability/hostility, but SSRIs cause enuresis (bed-wetting) and worsen my other Interstitial Cystitis symptoms.
>
> Have you ever combined it with an anti-enuresis drug? I'm sure you have! .....but I still thought it was worth asking.Yes, I've tried it with a TCA (which made it less effective) and DDAVP/Desmopressin, which worked briefly and then stopped working.
>
> >Risperdal
>
> Perhaps you could try some other APs. Ever tried Abilify? It doesn't usually cause much weight gain. Also, if you live in the UK you could try Solian.
>Not in the UK, but Abilify is a good idea. I'll look into it.
Posted by ed_uk on August 16, 2005, at 7:00:18
In reply to Re: TCAs, irritability, and BPD., posted by tygereyes on August 16, 2005, at 6:34:49
Hi,
>Yes, I've tried it with a TCA (which made it less effective) and DDAVP/Desmopressin, which worked briefly and then stopped working.
Have you tried it with tolterodine (Detrol), oxybutynin (Ditropan, Oxytrol), propiverine (Detrunorm), trospium (Sanctura) or solifenacin (Vesicare)?
>Yes, I've tried it with a TCA (which made it less effective).......
Did it help the enuresis?
>Abilify is a good idea. I'll look into it.
Could be good - but start with a nice low dose eg. 1.25mg. Some people get agitated if they start too high.
~ed
Posted by SLS on August 16, 2005, at 8:14:09
In reply to Re: TCAs, irritability, and BPD., posted by tygereyes on August 15, 2005, at 21:14:18
> > > Lately I have really been thinking that Parnate might help with some of these symptoms, though, so perhaps there is hope. >>
> > >
> > > At one time Parnate was the first line treatment for BPD. (I am quoting the illustrious SLS from memory and any errors in transcription are mine.)
> > >
> > > -z
> >
> >
> >
> > You devil, you!
> >
> >
> >
> >
> > 1: Arch Gen Psychiatry. 1988 Feb;45(2):111-9. Related Articles, Links
> >
> >
> > Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.
> >
> > Cowdry RW, Gardner DL.
> >
> > Intramural Research Program, National Institute of Mental Health, Bethesda, MD 20892.
> >
> > Sixteen female outpatients with borderline personality disorder and prominent behavioral dyscontrol, but without a current episode of major depression, were studied in a double-blind, crossover trial of placebo and the following four active medications: alprazolam (average dose, 4.7 mg/d); carbamazepine (average dose, 820 mg/d); trifluoperazine hydrochloride (average dose, 7.8 mg/d); and tranylcypromine sulfate (average dose, 40 mg/d). Each trial was designed to last six weeks. Tranylcypromine and carbamazepine trials had the highest completion rates. Physicians rated patients as significantly improved relative to placebo while receiving tranylcypromine and carbamazepine. Patients rated themselves as significantly improved relative to placebo only while receiving tranylcypromine. Patients who tolerated a full trial of trifluoperazine showed improvement, those receiving carbamazepine demonstrated a marked decrease in the severity of behavioral dyscontrol, and those receiving alprazolam had an increase in the severity of the episodes of serious dyscontrol. As an adjunct to psychotherapy, pharmacotherapy can produce modest but clinically important improvement in the mood and behavior of patients with borderline personality disorder. As a research tool, patterns of pharmacological response may provide clues to biological mechanisms underlying dysphoria and behavioral dyscontrol.
> >
> > Publication Types:
> > Clinical Trial
> > Randomized Controlled Trial
> >
> > PMID: 3276280 [PubMed - indexed for MEDLINE]
> >
>
> I actually read that study recently, when researching Parnate. It's unfortunate that Tegretol and Parnate are contraindicated [and I'm assuming that Trileptal, which I currently take, is contraindicated as well, but I'm not certain]; the two would seem to pack quite a punch for those with BPD.
I agree. I know of no reason why Parnate could not be combined with Tegretol or Trileptal. Until this week, I had been combining Parnate 80mg + Trileptal 900mg.I think some of the "contraindication" is nothing more than a simplistic fear that any drug with a tricyclic structure should be avoided when taking a MAOI and does not take into account the actual pharmacology of the drugs.
- Scott
Posted by tygereyes on August 16, 2005, at 16:35:29
In reply to Re: TCAs, irritability, and BPD. » tygereyes, posted by ed_uk on August 16, 2005, at 7:00:18
> Hi,
>
> >Yes, I've tried it with a TCA (which made it less effective) and DDAVP/Desmopressin, which worked briefly and then stopped working.
>
> Have you tried it with tolterodine (Detrol), oxybutynin (Ditropan, Oxytrol), propiverine (Detrunorm), trospium (Sanctura) or solifenacin (Vesicare)?I've tried Detrol and Oxybutynin (alone and in combination) and they didn't help. I've never heard of the other three but will look into them.
>
> >Yes, I've tried it with a TCA (which made it less effective).......
>
> Did it help the enuresis?Yes, but the irritability made it not really worth it, in the end.
>
> >Abilify is a good idea. I'll look into it.
>
> Could be good - but start with a nice low dose eg. 1.25mg. Some people get agitated if they start too high.
>
> ~ed
Posted by ed_uk on August 16, 2005, at 18:20:42
In reply to Re: TCAs, irritability, and BPD., posted by tygereyes on August 16, 2005, at 16:35:29
Hi,
Have you ever tried low dose amitriptyline?
~ed
Posted by tygereyes on August 16, 2005, at 19:39:29
In reply to Re: TCAs, irritability, and BPD. » tygereyes, posted by ed_uk on August 16, 2005, at 18:20:42
> Hi,
>
> Have you ever tried low dose amitriptyline?
>
> ~edTruthfully, I'm afraid of the weight gain.
You know an awful lot about meds - are you a pharmacist? dr?
Posted by ed_uk on August 17, 2005, at 5:04:41
In reply to Re: TCAs, irritability, and BPD., posted by tygereyes on August 16, 2005, at 19:39:29
Hi t,
>Truthfully, I'm afraid of the weight gain.
Amitriptyline can cause irritability in BPD - but I thought perhaps you'd be able to tolerate a low dose. Low-dose amitriptyline can sometimes relieve the symptoms of IC. I was wondering whether Zoloft + a low dose of amitriptyline might help. As you say, weight gain can be a problem.
>are you a pharmacist? dr?
I'm a pharmacy student.
Kind regards
~Ed
Posted by tygereyes on August 17, 2005, at 14:52:08
In reply to Re: TCAs, irritability, and BPD. » tygereyes, posted by ed_uk on August 17, 2005, at 5:04:41
> Hi t,
>
> >Truthfully, I'm afraid of the weight gain.
>
> Amitriptyline can cause irritability in BPD - but I thought perhaps you'd be able to tolerate a low dose. Low-dose amitriptyline can sometimes relieve the symptoms of IC. I was wondering whether Zoloft + a low dose of amitriptyline might help. As you say, weight gain can be a problem.I'm seeing my psychiatrist tomorrow; I will bring up some of the options you've mentioned here.
>
> >are you a pharmacist? dr?
>
> I'm a pharmacy student.
>Good luck to you; you really know your sh*t!
> Kind regards>
> ~Ed
>
>
Posted by ed_uk on August 17, 2005, at 15:03:13
In reply to Re: TCAs, irritability, and BPD., posted by tygereyes on August 17, 2005, at 14:52:08
Hi again,
Don't forget Abilify - but start at a low dose :-)
~Ed
This is the end of the thread.
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