![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 29 to 53 of 67. Go back in thread:
Posted by SLS on October 11, 2010, at 7:00:27
In reply to Re: dumb drug, posted by Brainbeard on October 11, 2010, at 5:55:16
> > Is it just me or does clomipramine possibly have the worst cognitive side-effects of any legitimate AD? It feels like the drug is punching holes in my brain, which is quite a feat, given that I was severely depressed before trialling it. 90% of my vocabulary is missing; when I try and think simple, everyday thoughts, it's like my brain lacks the language to fill in what I'm thinking.
> Well, the TCA's do tend to cause much more cognitive dumbing than the newer antidepressants. Your ability to think and speak may (partially) recover in the course of treatment; when I was on 75mg of clomipramine two years ago, I suffered from much worse cognitive dumbing than I do now on 225mg!
Yes. I was going to suggest giving clomipramine a bit more time and focus less on the cognitive side effects that are more robust at the beginning of treatment. Cognitive impairment might be the consequence on the anticholinergic effects of clomipramine. However, things like having trouble with word finding and brain fog can just as easily be attributed to its pro-serotonergic actions.
I may be a bit premature in my suggestion.
What are you being treated for and why was clomipramine started? How long are you on it and what dosage are you at. Sorry if these are redundant questions.
- Scott
Posted by kizzie2 on October 11, 2010, at 7:05:44
In reply to Re: dumb drug, posted by Brainbeard on October 11, 2010, at 5:55:16
Hi Brainbeard - I also take anafranil.
I really really struggle with it at first - terrible side effects but these eventually settle down and im left with muscle spasms, dry mouth, tiredness and constipation.I am currently taking 50mg which twice in the past has helped me regain stability. This time that hasnt happened. (I am unable to take more than 50mg because of side effects including my blood pressure going very low.)
You mentioned that previously you used 75mg so just wondered if you think you need more now because it loses efficiency over time. just wondering if that is what has happened to me.
Thanks
Kizzie
Posted by g_g_g_unit on October 11, 2010, at 7:42:50
In reply to Re: dumb drug » Brainbeard, posted by SLS on October 11, 2010, at 7:00:27
Oh no, your questions are by no means redundant! I appreciate the support . .
I suffer from major depressive disorder, OCD and inattentive ADD.
the clomipramine was begun with the hopes of treating the OCD and depression. I've been taking 75mg for just over four weeks now. I've seen a modest improvement in my depression, a very slight improvement in my OCD, with an unfortunate exacerbation of my ADD (I feel uncomfortably hyperactive, and am experiencing a lot less impulse control).
>
> Yes. I was going to suggest giving clomipramine a bit more time and focus less on the cognitive side effects that are more robust at the beginning of treatment. Cognitive impairment might be the consequence on the anticholinergic effects of clomipramine. However, things like having trouble with word finding and brain fog can just as easily be attributed to its pro-serotonergic actions.
>
> I may be a bit premature in my suggestion.
>
> What are you being treated for and why was clomipramine started? How long are you on it and what dosage are you at. Sorry if these are redundant questions.
>
>
> - Scott
>
>
>
Posted by SLS on October 11, 2010, at 9:27:02
In reply to Re: dumb drug » SLS, posted by g_g_g_unit on October 11, 2010, at 7:42:50
I am not sure if a response to clomipramine follows the same pattern as that seen with SSRIs when treating OCD, but it often takes a higher dosage and more time for the OCD to remit. I would continue to titrate your dosage of clomipramine upwards very slowly. What you might want to do is to discuss setting a target dosage and establishing a time-line for evaluating its effectiveness. Taking tests to assay blood levels of clomipramine/desmethylclomipramine might be helpful along away. Most people do well with nortriptyline for depression when they take 75mg. Yet, I need 150mg because I am a rapid-metabolizer. Blood tests helped confirm this so that I did not miss an opportunity to respond to nortriptyline by being chronically underdosed.
- Scott
Posted by Conundrum on October 11, 2010, at 11:12:03
In reply to Re: dumb drug » Brainbeard, posted by SLS on October 11, 2010, at 7:00:27
What about taking a muscarinic agonist? could that help?
Posted by SLS on October 11, 2010, at 12:32:12
In reply to Re: dumb drug, posted by Conundrum on October 11, 2010, at 11:12:03
> What about taking a muscarinic agonist? could that help?
Atomoxetine (Strattera) perhaps.
- Scott
Posted by ed_uk2010 on October 11, 2010, at 14:17:53
In reply to dumb drug, posted by g_g_g_unit on October 11, 2010, at 1:51:21
>Is it just me or does clomipramine possibly have the worst cognitive side-effects of any legitimate AD?
Nope, that would be amitriptyline ;-)
Posted by Brainbeard on October 11, 2010, at 15:54:58
In reply to Re: dumb drug » g_g_g_unit, posted by ed_uk2010 on October 11, 2010, at 14:17:53
> >Is it just me or does clomipramine possibly have the worst cognitive side-effects of any legitimate AD?
>
> Nope, that would be amitriptyline ;-)Exactly! Here's a chance to lose that remaining 10 percent of your vocabularly, G_g_G! ;)
Posted by g_g_g_unit on October 11, 2010, at 19:43:21
In reply to Re: dumb drug, posted by Conundrum on October 11, 2010, at 11:12:03
> What about taking a muscarinic agonist? could that help?
I'm trying to get my pdoc interested in Memantine for the OCD. In that regard, there's this . .
The non-competitive NMDA receptor antagonist memantine, currently prescribed for the treatment of Alzheimer's disease, is assumed to prevent the excitotoxicity implicated in neurodegenerative processes. Here, we investigated the actions of memantine on hippocampal function and signalling. In behavioural experiments using the water maze, we observed that memantine (at 2 mg/kg) reversed scopolamine-induced learning deficits in mice. When acutely applied to mouse hippocampal slices, memantine caused a significant upward shift in the population spike input-output relationship at 10 and 100 μM, and a corresponding downward shift in latency, indicative of overall enhanced synaptic transmission. This action was blocked by the muscarinic antagonist scopolamine (10 μM) but not by the NMDA antagonist MK-801 (10 μM) or the GABA antagonist bicuculline (20 μM). Further, memantine occluded potentiation induced by 50 nM carbachol (CCh), while enhancing inhibitory actions of CCh at 1 μM, suggesting additive actions. As anticipated for an NMDA antagonist, 100 μM (but not 10 μM) memantine also inhibited tetanus-induced long-term potentiation (LTP), and NMDA-induced Ca^{2+} signals were blocked in cultured hippocampal neurones at 10 μM (by 88%).
Overall, our data suggest actions of memantine beyond NMDA receptor antagonism, including stimulating effects on cholinergic signalling via muscarinic receptors. These interactions with the cholinergic system are likely to contribute to memantine's therapeutic potential.
Posted by Brainbeard on October 12, 2010, at 2:41:35
In reply to Re: dumb drug » Conundrum, posted by g_g_g_unit on October 11, 2010, at 19:43:21
Memantine seems to have some dirty side-effects though, potentially. Cardiac trouble if you belong to an unhappy 1 percent of users.
Posted by SLS on October 12, 2010, at 7:23:58
In reply to Re: dumb drug » Conundrum, posted by g_g_g_unit on October 11, 2010, at 19:43:21
Posted by SLS on October 12, 2010, at 7:26:21
In reply to Re: dumb drug » Conundrum, posted by g_g_g_unit on October 11, 2010, at 19:43:21
I found 20mg of memantine to be a very clean drug. It was only when I raised the dosage did I experience cognitive disturbances. I felt drunk. However, I didn't continue with memantine to see if this side effect would disappear.
- Scott
Posted by g_g_g_unit on October 15, 2010, at 6:06:05
In reply to Re: dumb drug » g_g_g_unit, posted by SLS on October 12, 2010, at 7:26:21
sorry for all the negative clomipramine press, but I'm growing completely disillusioned with the drug. I've been really patient, but after more than five weeks have literally seen no improvement whatsoever in my panic/anxiety/OCD symptoms (which render me almost completely non-functional). in fact, if anything, it's exacerbating my dissociation/depersonalization episodes, and the constant sleep disruption is just making me manic. is it possible that I'm sensitive to the NRI?
Posted by SLS on October 15, 2010, at 6:21:22
In reply to why no relief from anxiety with clomipramine?, posted by g_g_g_unit on October 15, 2010, at 6:06:05
> sorry for all the negative clomipramine press, but I'm growing completely disillusioned with the drug. I've been really patient, but after more than five weeks have literally seen no improvement whatsoever in my panic/anxiety/OCD symptoms (which render me almost completely non-functional). in fact, if anything, it's exacerbating my dissociation/depersonalization episodes, and the constant sleep disruption is just making me manic. is it possible that I'm sensitive to the NRI?
Imipramine had been the drug of choice for panic disorder until more recently. I have seen Nardil work well for the symptoms you describe. However, you might think about using a mood stabilizer given your history of mania. I would think about trying Trileptal.
What drugs have you tried so far, and what were your reactions to them?
- Scott
Posted by g_g_g_unit on October 15, 2010, at 6:40:03
In reply to Re: why no relief from anxiety with clomipramine? » g_g_g_unit, posted by SLS on October 15, 2010, at 6:21:22
what I'm experiencing isn't true mania, as far as I'm aware, and my psychologist hasn't expressed any concern that I might be manic. it's more the byproduct of constant sleep disruption induced by the drug, and closer to ADHD-like hyperactivity (I have inattentive ADD).
in fact, Nardil had the exact same effect, and I gave up after 12 weeks of tattered sleep. Seroquel offers me no relief from insomnia - I experience restless legs and akathisia.
My Dx is inattentive ADD, OCD and major depression, with the ADD only diagnosed recently.
I've tried various SSRI's which relieve the OCD, but exacerbate the ADD.
Neurontin and Memantine which significantly helped my anxiety but not my attention.
Dexamphetamine which profoundly improves my attention.
Parnate which improved my attention, but made me feel really flat, and caused a lot of insomnia.
Nardil which improved my depression, but caused a lot of insomnia and didn't do a lot for my anxiety.
> Imipramine had been the drug of choice for panic disorder until more recently. I have seen Nardil work well for the symptoms you describe. However, you might think about using a mood stabilizer given your history of mania. I would think about trying Trileptal.
>
> What drugs have you tried so far, and what were your reactions to them?
>
>
> - Scott
>
>
Posted by Brainbeard on October 15, 2010, at 6:54:45
In reply to why no relief from anxiety with clomipramine?, posted by g_g_g_unit on October 15, 2010, at 6:06:05
That's why my doc adds fluvoxamine: to reverse the SRI/NRI ratio. Normally, blood levels of the NRI metabolite dominate over blood levels of the SRI motherdrug. When fluvoxamine is added, the mother drug is boosted while the metabolite is suppressed. He finds this an excellent combo for OCD.
Posted by SLS on October 15, 2010, at 7:07:34
In reply to Re: why no relief from anxiety with clomipramine?, posted by g_g_g_unit on October 15, 2010, at 6:40:03
Strattera would be an interesting drug to work with, perhaps in combination Effexor.
- Scott
Posted by floatingbridge on October 24, 2010, at 16:24:38
In reply to Re: why no relief from anxiety with clomipramine?, posted by g_g_g_unit on October 15, 2010, at 6:40:03
Hi g_g_g,
Sounds like you are having ongoing frustrations with meds. I know you have a complex illness. I don't post you often because I don't have anything helpful to add.
In addition, this post is off-topic, but you mention add-inattentive which I deal
with, too. I found zanaflex is used in conjunction with stimulant therapy. It is a milder muscle relaxant AND it helps with my occasional RLS.Google add + zanaflex (tizanidine).
Best to you :)
Posted by Brainbeard on October 25, 2010, at 9:51:55
In reply to Re: why no relief from anxiety with clomipramine?, posted by g_g_g_unit on October 15, 2010, at 6:40:03
Maybe, and I know this may sound harsh - MAYBE you are not worth the drug.
Posted by Brainbeard on October 25, 2010, at 9:52:58
In reply to Re: why no relief from anxiety with clomipramine? » g_g_g_unit, posted by Brainbeard on October 25, 2010, at 9:51:55
Posted by g_g_g_unit on October 26, 2010, at 6:13:48
In reply to Re: why no relief from anxiety with clomipramine? » g_g_g_unit, posted by floatingbridge on October 24, 2010, at 16:24:38
Hey, thanks for your concern. I'll definitely look into zanaflex . . I'm not officially 'on' stims yet, but I know that during the few times I've sampled them they've exacerbated my neck and shoulder tension.
Take care.
> Hi g_g_g,
>
> Sounds like you are having ongoing frustrations with meds. I know you have a complex illness. I don't post you often because I don't have anything helpful to add.
>
> In addition, this post is off-topic, but you mention add-inattentive which I deal
> with, too. I found zanaflex is used in conjunction with stimulant therapy. It is a milder muscle relaxant AND it helps with my occasional RLS.
>
> Google add + zanaflex (tizanidine).
>
> Best to you :)
Posted by Brainbeard on October 28, 2010, at 3:17:02
In reply to Re: why no relief from anxiety with clomipramine? » g_g_g_unit, posted by floatingbridge on October 24, 2010, at 16:24:38
Triple G, sorry for my hideous joke.
I think you could have given clomipramine a little bit longer. On 225mg for more than a month now, I'm beginning to feel more and more stable (as long as I don't do my wicked med and drug experiments). The side-effects can feel very acute and nasty, but in the end, they would be worth the trade if my brain gets tweaked long enough to relief me from a chunk of anxiety and depression.
Posted by g_g_g_unit on October 28, 2010, at 4:04:27
In reply to Re: why no relief from anxiety with clomipramine?, posted by Brainbeard on October 28, 2010, at 3:17:02
Hey, that's cool. I'm really glad you're seeing the results. The problem is that, when I began clomipramine, I was experiencing a severe, adrenaline-like onslaught of anxiety, which was literally lasting 24/7. After 6 or so weeks on the drug, I have not seen my anxiety (physical or mental) alter *at all*; even SSRIs provide some relief after 2-3 weeks, whereas here, I am just as anxious and fearful as ever. The only positive I have seen is an easing of my depression but I just can't live with anxiety like this. Factor in the sleep deprivation and I am very close to lopping off someone's head. There just haven't been enough gains to justify continuing at this point :(
> Triple G, sorry for my hideous joke.
>
> I think you could have given clomipramine a little bit longer. On 225mg for more than a month now, I'm beginning to feel more and more stable (as long as I don't do my wicked med and drug experiments). The side-effects can feel very acute and nasty, but in the end, they would be worth the trade if my brain gets tweaked long enough to relief me from a chunk of anxiety and depression.
Posted by Brainbeard on October 28, 2010, at 15:13:15
In reply to Re: why no relief from anxiety with clomipramine? » Brainbeard, posted by g_g_g_unit on October 28, 2010, at 4:04:27
I am really sorry to hear that. I wonder if there were any other factors working towards your noradrenergic fear trip.
However, the quest for a mind more sane continues. Meanwhile, responsible insanity provides a welcome break every now and then. Personally, I detest depression more than fear.
My fears, after all, have gotten me as far as I've got now - if Paxil hadn't killed my compulsions, I might have been a lot closer to realizing my dreams. Compulsions show at least an endeavour to recollect the pieces of the perfect object and put them back together. Having had my brain soaked in paroxetine for a couple of years has done severe damage to both compulsions and ambitions, both of which are, let's not forget it, dopamine driven.
Serotonergic obsessions alone lead nowhere. It's better to do insane things than to merely be insane, which will only lead to paralysis.Please let us know all about your upcoming experiences with stimulants!
Posted by g_g_g_unit on October 28, 2010, at 19:09:56
In reply to A Mind More Sane » g_g_g_unit, posted by Brainbeard on October 28, 2010, at 15:13:15
Sure, I'm in a similar boat to you. I used to be highly ambitious and driven by my compulsions, though I think that continuing in that fashion was completely untenable. I fought to stay off meds as long as humanly possible, but in the end, it just wans't worth it anymore. I'm thankful I accomplished *some* of what I set out to before this point, so it's difficult to completely drown myself in regret.
Anyway, I'm not averse to the experience of fear/anxiety, but as long as it's combined with positive affect (which leads to intermittent bursts of pleasure, excitement, etc.). What I was experiencing was more in the realm of unrelenting panic, and was lasting for weeks at a time. I think it was triggered by immigration, but I'm not sure. So you believe it's NE-related? Neurontin helped, but caused too much sedation.
If I ever get my hands on stimulants, I'll let you know. Meanwhile, in a fit of desperation, my (ex?)therapist and (ex)psychiatrist have diagnosed me as schizophrenic! They claim my body dysmorphic symptoms count as (positive) delusions, and that my lack of motivation and concentration difficulties are negative symptoms! My depression-related fatigue is actually schizophrenic catatonia! I also touch my face when I'm anxious while being stared at during conversation, and this is again supposedly a schizophrenic trait!!
My GP think it's a joke, and is referring me to a neurodevelopmental psych for a second opinion on ADHD.
> I am really sorry to hear that. I wonder if there were any other factors working towards your noradrenergic fear trip.
>
> However, the quest for a mind more sane continues. Meanwhile, responsible insanity provides a welcome break every now and then. Personally, I detest depression more than fear.
>
> My fears, after all, have gotten me as far as I've got now - if Paxil hadn't killed my compulsions, I might have been a lot closer to realizing my dreams. Compulsions show at least an endeavour to recollect the pieces of the perfect object and put them back together. Having had my brain soaked in paroxetine for a couple of years has done severe damage to both compulsions and ambitions, both of which are, let's not forget it, dopamine driven.
> Serotonergic obsessions alone lead nowhere. It's better to do insane things than to merely be insane, which will only lead to paralysis.
>
> Please let us know all about your upcoming experiences with stimulants!
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.