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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on March 17, 2009, at 20:33:20
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by JadeKelly on March 17, 2009, at 18:48:41
> So, I do have a couple questions:
> How long after he offered to raise to 350, did you counter with, how about 400? 1-2 secs max?LOL
> Really, though, I'm confused about your dosing. You added 100 yesterday.
> You felt results today. I think you know where I'm headed. I geuss I'm asking, doesn't that mean you need 400, not 350?
The 400mg was what is called a loading-dose. Average of 300mg and 400mg over two days is 350mg/day. I guess you have to know the personality of these drugs and how they affect you to know what you can and cannot get away with. It usually takes a week or so to reach steady state. I wanted a quicker answer.
> Also by now you should at least be as good as earlier-one would think ;-) Let me know!
By the way, I am SO happy for you! I'll throw a few prayers around that your remission should be a permanent one.
:-)
- Scott
Posted by JadeKelly on March 18, 2009, at 12:33:06
In reply to Re: I want to switch from nortriptyline to desipramine » JadeKelly, posted by SLS on March 17, 2009, at 20:33:20
Hey Scott,
Hope you're feeling okay and I want to hear about it, but I'm really worried about poster "Myco" right at the moment. He's been messin around for a few days with Nardil stuff, well, I'll just let you read his post. I retitled Myco needs help. Your name is on it. If you get this can you talk some sense into him please? Look at his latest symptoms. Thank You! I'll post you later...
~Jade
Posted by JadeKelly on March 18, 2009, at 17:28:57
In reply to Re: I want to switch from nortriptyline to desipramine » JadeKelly, posted by SLS on March 17, 2009, at 20:33:20
Hey Scott,
You okay? Not like you to not answer a plea for help, lol. I think crisis has been diverted. He says he'll go to hospital today, his ride is on the way. I think I sufficiently scared him into it. Da*n kids adding this and that to MAOI's! But we wouldn't know anything about that.
So, I do have a couple questions:
> > How long after he offered to raise to 350, did you counter with, how about 400? 1-2 secs max?
>
> LOLI'm betting that you actually DID laugh out loud at that. Probably because its exactly what you did. I bet you play a mean game of poker.
So I'm wondering why we haven't heard from you yet. I think you're probably feeling okay, but if not, remember new dose will take some time, AND, if "loading dose" has worn off and 350 isn't enough, you'll just have to find a way to get back up to 400. Point being, you have felt enough response, however transient, it seems its just a matter now of time and dose, right? Well I wont say anymore on that for now, you could be outside doing cartwheels for all I know, lol.
> By the way, I am SO happy for you! I'll throw a few prayers around that your remission should be a permanent one.
>
> :-)
>
>
> - ScottYour gonna throw the prayers around? I get on my hands and knees and thank my higher power for my remission and (uncharacteristically) beg for duration and continued wellness. That was hell. Its hard, isnt it. Remember I had those ten days and we debated about was that remission? When that ended, and I couldn't get it back I was so discouraged. And to find out it was the simple addition of a 5mg tab of ritalin. Crazy.
I'm sure you do this at times like these, but when I wake up and take my meds, and maybe I'm just tired that day, there is still that whisper "is today the day it will stop working? OMG is it working? Am I going down hill? Jeez. I'm learning that I'm great the next day and it wasn't like I was euphoric every day before depression. Happy most of the time? Yes. Normal ups and downs? yes. Even responders can be in a sh*tty mood sometimes. Sorry for the extreme running of the mouth. Well, its 6pm, usually you would have posted by now. Remember our deal! 1-10? It'll just take you a second, if thats all you have. Okay, I can see its story time, but its gonna get ugly with the stories if you don't post today!
Btw- remember my remission is your remission. For now. There were a few key parts to my puzzle. I certainly put in my dues.(I also know what happens when you hang out with people smarter than you ;-) With out your advice it is not only possible, it is likely I would still be in misery. Which causes my kids pain, and on and on and on. You leave quite a wake in your path Scott....remember that while you wait for your remission to return. And when it does, we'll both celebrate.
~Jade
Posted by SLS on March 19, 2009, at 6:53:21
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by JadeKelly on March 18, 2009, at 17:28:57
I feel kind of crappy this morning.
I can feel the desipramine levels in my body increasing based upon side effects. Unfortunately, I am not getting the improvement I had hoped for. So now, I guess the thing to do is to wait for 3 weeks and make a decision at that point. Of course, I am disappointed, but still hopeful. Another disappointment is that I haven't lost weight for having changed from nortriptyline to desipramine. I think Abilify is most likely responsible for this.
- Scott
Posted by Phillipa on March 19, 2009, at 19:29:25
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 19, 2009, at 6:53:21
Scott darn how bout now? Later in the day? Sorry about weight also. Love Phillipa
Posted by JadeKelly on March 20, 2009, at 8:25:38
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 19, 2009, at 6:53:21
Good Morning Sunshine. Haha. Hope it is anyway ;-)
Patience and tolerance, two outstanding qualities in a human being...don't you think?
Glad you have both. So what are you thinking to do about that Abilify? I think it's the culprit in your weight gain as well. My son is just now losing the last of it.
My PDoc raised my Parnate to 90mg yesterday. I'm also taking 60mg of Ritalin. I dropped down in Klonopin from 3mg to 1.5mg but had to go back up to 2 cause my neck started hurting.
Well, I'm gonna see if I can track Myco down the little brat.
Hope this morning is better for you...
~Jade
Posted by JadeKelly on March 20, 2009, at 10:34:37
In reply to Re: I want to switch from nortriptyline to desipramine, posted by JadeKelly on March 20, 2009, at 8:25:38
> Good Morning Sunshine. Haha. Hope it is anyway ;-)
>
> Patience and tolerance, two outstanding qualities in a human being...don't you think?
>
> Glad you have both. So what are you thinking to do about that Abilify? I think it's the culprit in your weight gain as well. My son is just now losing the last of it.
>
> My PDoc raised my Parnate to 90mg yesterday. I'm also taking 60mg of Ritalin. I dropped down in Klonopin from 3mg to 1.5mg but had to go back up to 2 cause my neck started hurting.
>
> Well, I'm gonna see if I can track Myco down the little brat.
>
> Hope this morning is better for you...
>
> ~Jadebtw- was looking at stuff about Nifedipine and came across this thread with you, Oky, and Undopamingeric-sp? In July, 08, just before I came along I think.
"Although MAOI + TCA is a potentially useful option that probably should be used more frequently than is currently the case, I presume the same to be even more accurate for MAOI + stimulant."
I think that was Undop, I lost the rest of it. You obviously do better with MAOI + TCA. Did you say you tried stims with MAOI and didn't do as well? In what way? Did it "poop out" sooner, or did it just never work as well for you? What is better about the TCA's for you than stims?
I notice my remission, and treatment, are very dose dependent right now, as in I HAVE to take doses at certain times or it doesn't have the same result. Not complaining you understand!! I'll do it forever if I have to. Just wondered if TCA's were a more "around the clock" feeling. Not to be greedy or anything, but have you seen all three combined, in lower doses? Just wondered.
As for nifedipine, sounds like under the tongue is not a good choice, nor is squirting a gel cap in your mouth. I have nifedipine, in a hard capsule to swallow. I think the idea is that its not a good idea to change BP too rapidly. Don't want to scare people off, but do you think a thread is in order? To have some and when to use it? Just a thought. I had to ask my my PDoc for it (old one) he didn't offer it as an option. I think a lot more people are taking MAOI's, I'd bet they would be interested to know what you would recommend in certain situations (as would I).
An example: I accidently eat a slice of pizza loaded with pepperoni (dumb, I know lol) I develop a headache that gets increasingly bad towards the back of my head. I take my BP, systolic is 190.
Take tablet?
Call 911?
Lay down, take advil?
Call PDoc?
If headache is severe?
As in need relief asap?Just thought you might make yourself useful while you wait. Hah. Thought you were getting a break?
~grasshopper ;-)
What was that show? "patience grasshopper, patience" lol
Posted by SLS on March 28, 2009, at 10:46:02
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 11, 2009, at 6:57:51
> Encouraged.
Now discouraged.
I have been on 350mg of desipramine for 12 days. I am not feeling very well. I certainly am not feeling the improvement I was expecting.
I am not sure how much longer I will give this thing. I would like to take it for another week or two, just to allow it 3 weeks to work at this higher dosage. If there is no discernible improvement, my intention is to return to nortriptyline.
- Scott
Posted by Phillipa on March 28, 2009, at 20:29:39
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 28, 2009, at 10:46:02
Scott so sorry. Love Phillipa
Posted by desolationrower on March 28, 2009, at 23:52:48
In reply to I want to switch from nortriptyline to desipramine, posted by SLS on January 3, 2009, at 16:30:10
also, i think its good you are concerned for your health. i wonder if a fibrate might be better (if you take it, i think green tea would be good supplement). might want to look into the PPAR system, like everything else it probably has psychiatric effects. while i started reading, caome across this, which is interesting since nadil reduces gluconeogenesis i think:
Mice lacking PPAR{alpha} have elevated free fatty acid levels and fatty livers, consequences of their inability to combust fatty acids. Not surprisingly, these mice are hypoglycemic as a result of their reliance on glucose as an energy resource and the lack of fatty acidderived carbon chains for gluconeogenesis.46 PPAR{alpha} agonists fail to induce peroxisomal proliferation in PPAR{alpha}-deficient mice, a genetic proof of principle, although not specifically relevant to human biology. This is one of several examples of biological divergence in PPAR biology between mice and humans. Species-specific differences are clinically relevant, given some of the animal toxicity observed with PPAR agonists and how such data can influence drug development.47 PPAR{alpha} effects also may vary, depending on different tissue locations. Although PPAR{alpha} agonists have been suggested to decrease weight,4850 recent data with PPAR{alpha} overexpression in mouse muscle suggest that PPAR{alpha} may promote obesity-related diabetes.51 The relationship of these findings to PPAR{alpha} in humans is not clear. Although much remains to be understood, PPAR{alpha} clearly is a molecular sensor of the metabolic milieu and a functional nodal point coordinating the transcriptional regulation of energy balance and lipid metabolism. The role of metabolism and energy balance in determining vascular responses makes the potential importance of PPAR{alpha} in the vasculature clear.
Posted by desolationrower on March 28, 2009, at 23:53:11
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 28, 2009, at 10:46:02
scott, maybe it was the 5ht antagonism of nortrytaline that was helping you, more than the nri. and i think you said reboxetine wasn't effective either? i might try a small dose of geodome and see if it helps, or even cyproheptadine. this action is often activating, maybe more so once you have a few days of it improving sleep. and it wouldn't take too many days to see if you see an improvement.
-d/r
Posted by SLS on March 29, 2009, at 9:46:14
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by desolationrower on March 28, 2009, at 23:53:11
> scott, maybe it was the 5ht antagonism of nortrytaline that was helping you,
Yes. I think you are right. I am on Abilify, though.
> more than the nri. and i think you said reboxetine wasn't effective either?
Correct. It made me much worse. It was intolerable.
> i might try a small dose of geodome and see if it helps, or even cyproheptadine.
What mechanisms in particular do you feel are important with these drugs?
Thanks.
- Scott
Posted by dcruik518 on March 29, 2009, at 18:36:31
In reply to Re: I want to switch from nortriptyline to desipramine » desolationrower, posted by SLS on March 29, 2009, at 9:46:14
cyproheptadine and geodone are both 5ht2 antagonists. so I assume that was what she was referring to.
Posted by dcruik518 on March 30, 2009, at 15:08:37
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by dcruik518 on March 29, 2009, at 18:36:31
> cyproheptadine and geodone are both 5ht2 antagonists. so I assume that was what she was referring to.
I assume that's what he (desolationthrower) was referring to.
Posted by SLS on April 2, 2009, at 7:07:38
In reply to Re: I want to switch from nortriptyline to desipramine, posted by dcruik518 on March 30, 2009, at 15:08:37
I am disappointed and dejected. I thought I would become mentally more energetic on desipramine, and experience more of the world around me. It started out that way, but seemed to poop-out.
Back to nortriptyline. I have a difficult time with motivation to action with this drug, but overall, I function better with it. I hope I can recapture what I have lost.
- Scott
Posted by Phillipa on April 2, 2009, at 19:40:29
In reply to Switching back to nortriptyline., posted by SLS on April 2, 2009, at 7:07:38
Scott oh darn!!!! Hope you can also recapture it. Any other adds to the mix you've considered? Love Phillipa
Posted by SLS on April 4, 2009, at 15:20:13
In reply to Re: Switching back to nortriptyline. » SLS, posted by Phillipa on April 2, 2009, at 19:40:29
> Scott oh darn!!!! Hope you can also recapture it. Any other adds to the mix you've considered? Love Phillipa
I skipped a day, and took no TCA at all. I then picked up the next day with a full 150mg of nortriptyline, my therapeutic dosage. I am beginning to feel better. Caffeine helps, too. My experiment to try desipramine was meant (by me) to be accomplished as a quick crossover trial. Unfortunately, my doctor decided to manage this trial. Instead of taking one week to crossover to 300mg of desipramine, it took 3 months! I wanted to do with going from NOR to DMI as I have just done with going from DMI to NOR. I had no intentions of allowing myself to deteriorate so much.
Things are getting better...
- Scott
Posted by Phillipa on April 4, 2009, at 21:49:22
In reply to Re: Switching back to nortriptyline. » Phillipa, posted by SLS on April 4, 2009, at 15:20:13
Scott that is seriously good news. And no one deserves to feel better than you do especially now. You do so much for others it's your turn!!!!! Love Phillipa
Posted by SLS on April 7, 2009, at 6:08:36
In reply to Re: Switching back to nortriptyline. » SLS, posted by Phillipa on April 4, 2009, at 21:49:22
I am feeling better and better for having switched back to nortriptyline. I am happy that I am able to recapture the antidepressant response I had prior to switching over to desipramine.
I will continue to use the following treatment as the core around which to build a more satisfactory improvement:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mgSome of the drugs I am looking to try again include Topamax (topiramate) and Namenda (memantine). These will be untried treatments in that they were never combined with the medications listed above.
Any feedback or suggestions are urgently needed and much appreciated.
Thanks.
- Scott
- Scott
Posted by desolationrower on April 8, 2009, at 6:56:09
In reply to Re: Switching back to nortriptyline., posted by SLS on April 7, 2009, at 6:08:36
its good its working for you again.
(the quick response seems like a bit more evidence the 5ht antaonism is helpful)
have you thought about trying SAMe? i have posted a few things about it in the past.
what symptoms are you trying to target yet?
-d/r
Posted by SLS on April 8, 2009, at 7:50:25
In reply to Re: Switching back to nortriptyline., posted by desolationrower on April 8, 2009, at 6:56:09
> its good its working for you again.
>
> (the quick response seems like a bit more evidence the 5ht antaonism is helpful)
>
> have you thought about trying SAMe? i have posted a few things about it in the past.
>
> what symptoms are you trying to target yet?
>
> -d/r
I would like to be able to better read, learn, and remember. Mental energy and motivation remain problems. I would also like to have the "brightness" I experienced on Nardil.When I first switched from Nardil to Parnate, I experienced an unequivocal improvement in energy and cognition. However, I am now also questioning whether or not I have lost some of my early robust response with Parnate. When changes occur gradually, one doesn't always notice an improvement or deterioration in their condition.
For now, I will continue with the combination of Parnate + nortriptyline and establish a stable state that I can then evaluate and make treatment changes if necessary.
As far as deciding which drugs do add, I am open to suggestions. There is still very much more room for improvement in my bipolar depression.
For being back on nortriptyline for only 5-6 days, I should be more patient to see a robust improvement. I was really hoping for more at this point, though. It is possible that my being at a subtherapeutic dosage of desipramine for 15 consecutive weeks allowed for a significant reversal of biological status towards my illness baseline conditions. If this is true, I wouldn't expect to see a maximum improvement for another week or two.
D/R, I really appreciate your concern and advice.
Thanks.
- Scott
Posted by SLS on April 9, 2009, at 8:17:01
In reply to Re: Switching back to nortriptyline. » desolationrower, posted by SLS on April 8, 2009, at 7:50:25
> For being back on nortriptyline for only 5-6 days, I should be more patient to see a robust improvement. I was really hoping for more at this point, though. It is possible that my being at a subtherapeutic dosage of desipramine for 15 consecutive weeks allowed for a significant reversal of biological status towards my illness baseline conditions. If this is true, I wouldn't expect to see a maximum improvement for another week or two.
Woohoo!
Feeling better and smarter today.
Keep it coming!
- Scott
Posted by Phillipa on April 9, 2009, at 19:47:27
In reply to Re: Switching back to nortriptyline., posted by SLS on April 9, 2009, at 8:17:01
Scott seriously that fast? That's fantastic!!!!! Love Phillipa
Posted by Ron Hill on May 30, 2009, at 3:00:13
In reply to Re: Switching back to nortriptyline., posted by SLS on April 7, 2009, at 6:08:36
> I am feeling better and better for having switched back to nortriptyline. I am happy that I am able to recapture the antidepressant response I had prior to switching over to desipramine.
>
> I will continue to use the following treatment as the core around which to build a more satisfactory improvement:
>
> Parnate 80mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 20mg
>
> Some of the drugs I am looking to try again include Topamax (topiramate) and Namenda (memantine). These will be untried treatments in that they were never combined with the medications listed above.
>
> Any feedback or suggestions are urgently needed and much appreciated.
>
> Thanks.
>
>
> - Scott
-------------------------------Hi Scott,
Just a thought. Are you satisfied that you have enough moodstabilizer on-board?
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mgAn MAOI, a TCA, a weak moodstabilizer with antidepressant properties, and Abilify. Does Abilify provide you with enough moodstabilization?
The first three on your list are antidepressants with a weak amount of moodstabilizing effect from lamotrigine.
Be well my friend. On a different topic, Im sorry to hear about your adverse reaction to the generic lamotrigine.
In closing, heres a Readers Digest version of my Nardil-to-Parnate switch: Three week washout of Nardil; first four days GREAT, but the rest of the three weeks was gruesome.
The first two days on Parnate was great, but on the third day it quit working. In spite of me ramping the dosage aggressively, it took 6.5 weeks for it to kick in. I was VERY depressed during the 6.5 weeks.
Its too early to know the long-term efficacy, but so far I love Parnate (actually I take a generic version of tranylcypromine).
Sorry to step on your thread with my Reader's Digest report.
-- Ron
dx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
80 mg/day Parnate
Posted by SLS on June 2, 2009, at 13:11:26
In reply to Re: Switching back to nortriptyline. » SLS, posted by Ron Hill on May 30, 2009, at 3:00:13
> An MAOI, a TCA, a weak moodstabilizer with antidepressant properties, and Abilify. Does Abilify provide you with enough moodstabilization?
You are a shaman!I just added Topamax.
Currently:
Parnate 80mg
nortriptyline 150mg
lamotrigine 200mg
Abilify 20mg
Topamax 50mg
- Scott
This is the end of the thread.
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