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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by ThankYouforyourhelp on July 15, 2013, at 11:45:37
I have been taking imipramine with dexedrine for severe depression. The weight gain is a problem even with the dexedrine. My doctor suggested that sometimes (like with remeron) a higher dosage decreases the weight gain side affect. Everything I have read online, and from what I remember when I was on a higher dose the weight gain was worse. I have tried to substitue the imipramine with desipramine but it did not work for my depression. Any insight? Weight gain is causing me to not be able to live my life like I want and enjoy the things that I do. I eat very healthy and workout 7 days a week, but the weight still creeps up. Any insight at all or even a possible substitute will be greatly appreciated.
Posted by ThankYouforyourhelp on July 15, 2013, at 11:50:41
In reply to Less weight gain with Imipramine on higher dose?, posted by ThankYouforyourhelp on July 15, 2013, at 11:46:20
currently I am on 25 mg with 10mg dexedrine sometimes 15mg dexedrine, the dexedrine dose increase the blood levels of the imipramine, reason for a small dose working.
Posted by Phillipa on July 15, 2013, at 14:35:14
In reply to Re: Less weight gain with Imipramine on higher dose?, posted by ThankYouforyourhelp on July 15, 2013, at 11:50:41
I Just saw that patients on TCA's before the SSRI's gained a phenominal amount of weight?
Posted by alchemy on July 18, 2013, at 20:32:46
In reply to Less weight gain with Imipramine on higher dose?, posted by ThankYouforyourhelp on July 15, 2013, at 11:45:37
Sorry that I don't have an answer for you. I have recently started nortiptyline which is also causing weight gain. This is something I don't know if I can handle. I have also stopped taking ritalin (also previously on dex) because of the crashes. So I am facing 2 whamies.
I am just curious how much weight you have gained and if it continues.
You might want to ask your pdoc about phentermine. It is a stimulant so I'm not sure how it would work with your dex. It is prescribed for obese weight loss. Works on appetite and metabolism but unfortunately not the positive dopamine effects. I have stopped it because I suspect it was playing with my mood and gave me the weird wavy feelings that I get with stimulants. But it might be helpful for you.
Posted by SLS on July 18, 2013, at 20:44:23
In reply to Re: Less weight gain with Imipramine on higher dose?, posted by alchemy on July 18, 2013, at 20:32:46
> I have recently started nortiptyline which is also causing weight gain.
How much have you gained so far? I'm taking several drugs that are known to produce weight gain - 50 pounds worth. I don't know if nortriptyline is contributing to it or not.
Thanks.
How are you feeling?
If you decide to discontinue nortriptyline, what would you do next?
- Scott
Posted by Thankyouforyourhelp on July 18, 2013, at 21:07:40
In reply to Re: Less weight gain with Imipramine on higher dose?, posted by alchemy on July 18, 2013, at 20:32:46
> Sorry that I don't have an answer for you. I have recently started nortiptyline which is also causing weight gain. This is something I don't know if I can handle. I have also stopped taking ritalin (also previously on dex) because of the crashes. So I am facing 2 whamies.
> I am just curious how much weight you have gained and if it continues.
> You might want to ask your pdoc about phentermine. It is a stimulant so I'm not sure how it would work with your dex. It is prescribed for obese weight loss. Works on appetite and metabolism but unfortunately not the positive dopamine effects. I have stopped it because I suspect it was playing with my mood and gave me the weird wavy feelings that I get with stimulants. But it might be helpful for you.
>I am sorry about your meds causing those problems. I would love to go on phertermine but my pdoc is mostly opposed to it since I am not obese. I have gained close to 20-30 pounds on imipramine while taking the dexedrine.
Posted by alchemy on July 19, 2013, at 0:28:09
In reply to Re: Less weight gain with Imipramine on higher dose?, posted by Thankyouforyourhelp on July 18, 2013, at 21:07:40
> > Sorry that I don't have an answer for you. I have recently started nortiptyline which is also causing weight gain. This is something I don't know if I can handle. I have also stopped taking ritalin (also previously on dex) because of the crashes. So I am facing 2 whamies.
> > I am just curious how much weight you have gained and if it continues.
> > You might want to ask your pdoc about phentermine. It is a stimulant so I'm not sure how it would work with your dex. It is prescribed for obese weight loss. Works on appetite and metabolism but unfortunately not the positive dopamine effects. I have stopped it because I suspect it was playing with my mood and gave me the weird wavy feelings that I get with stimulants. But it might be helpful for you.
> >
>
> I am sorry about your meds causing those problems. I would love to go on phertermine but my pdoc is mostly opposed to it since I am not obese. I have gained close to 20-30 pounds on imipramine while taking the dexedrine.Dr's are weird. Mine is pretty conservative and suggested it because I was so distraught. I didn't even know about it and my weight is still in the normal range for my height. Although that may soon change despite my efforts as I increase my dose.
Posted by alchemy on July 19, 2013, at 23:03:11
In reply to Re: Less weight gain with Imipramine on higher dose? » alchemy, posted by SLS on July 18, 2013, at 20:44:23
> > I have recently started nortiptyline which is also causing weight gain.
>
> How much have you gained so far? I'm taking several drugs that are known to produce weight gain - 50 pounds worth. I don't know if nortriptyline is contributing to it or not.
>
> Thanks.
>
> How are you feeling?
>
> If you decide to discontinue nortriptyline, what would you do next?
>I haven't dared to weigh myself but only my fat clothes fit. I would say at least 10 lbs in a month.
Did your appetite increase? Especially for carbs? I have had many days like this but then some that aren't. I am wondering if my body is just adjusting or if it will continue like this.
I'm usually a mood fluctuator within the day or every few days. So it is confusing and hard to tell what it is doing. Yesterday I felt that it was definitely helping a little. But today I had a bad dip for about 7 hrs. Did you have any mood fluxes as your body adjusted to it?
What to try after this? Hell, I am mostly out of options. I even tried the minocyline that helps you. I really need the nortipt to help some more (if it is indeed helping).
Posted by SLS on July 20, 2013, at 2:25:38
In reply to Re: Less weight gain with Imipramine on higher dose? » SLS, posted by alchemy on July 19, 2013, at 23:03:11
> > > I have recently started nortiptyline which is also causing weight gain.
> >
> > How much have you gained so far? I'm taking several drugs that are known to produce weight gain - 50 pounds worth. I don't know if nortriptyline is contributing to it or not.
> >
> > Thanks.
> >
> > How are you feeling?
> >
> > If you decide to discontinue nortriptyline, what would you do next?
> >
>
> I haven't dared to weigh myself but only my fat clothes fit. I would say at least 10 lbs in a month.Ouch.
> Did your appetite increase? Especially for carbs?
I can't tell. The first time I tried nortriptyline, it was added to Parnate, but I didn't monitor my weight nor keep track of my appetite. I guess if I were to have gained a lot of weight, I would have noticed. Several years ago, I switched from nortriptyline to desipramine, hoping for some weight loss to occur. I can lose weight when I take either desipramine or imipramine. I didn't lose any weight at all after the switch. The parent drug of nortriptyline, amitriptyline, is notorious for weight gain. It is very possible that nortriptyline montherapy would cause weight gain in me, but I don't recall ever using it that way. I suspect that my weight gain is due primarily from Abilify, and that nortriptyline might be adding to it. I'm actually having more trouble maintaining my weight since adding minocyline.
I'm sorry that I couldn't provide the answers you were looking for. My taking more than one drug makes it hard to tease out what each one is doing.
> I have had many days like this but then some that aren't. I am wondering if my body is just adjusting or if it will continue like this.
I am unclear as to what you are referring to here. Are you talking about body weight or mood?
> I'm usually a mood fluctuator within the day or every few days. So it is confusing and hard to tell what it is doing. Yesterday I felt that it was definitely helping a little.
The question is, did you feel even slightly better yesterday than what your best is without treatment?
> But today I had a bad dip for about 7 hrs. Did you have any mood fluxes as your body adjusted to it?
I really can't answer that question because of the complications of my treatment regime. However, it is not unusual for the course of improvement of depression to contain blips and dips. The pattern might look sort of like a saw blade tilted upwards. Two steps up; one step back; two steps up; etc.
> What to try after this?
You could always add a serotonergic antidepressant, lithium, a MAOI, an anticonvulsant mood-stabilizer, or an antipsychotic with antidepressant properties.
Make sure that you are taking enough nortriptyline and give it three weeks to work at the optimum dosage. Use tests for blood levels as a guide to establish this dosage. I never saw anything written on this, but it seems to me that you are going to be a either a slow metabolizer (75 mg/day) or a rapid metabolizer (150 mg/day). I don't see too many people taking intermediate doses. I could be wrong on this, of course. Blood level = 50 - 150 ng/ml. You might as well push it towards the high end before giving up. Allow 10 days to pass after a dosage change to test the blood for nortriptyline concentrations.
Are you completely unreactive to treatment, or have there been some drugs that have produced a partial or transient improvement?
What drugs have helped?
I know one person with severe depression who does well with a combination of minocycline, Lamictal, and Abilify. They take no standard antidepressants. You never know what will light up the brain. I have also seen a combination of Pristiq and Wellbutrin work some magic. I suppose you could use Effexor instead of Pristiq if money is an issue.
When you find a drug that produces an unambiguous partial improvement, try building around it. For example, if Wellbutrin helps partially with energy and cognitive function, you could then try adding Zoloft or Effexor to improve anhedonia, interest, and motivation. If doing this helps, but remains inadequate, you could then try adding Lamictal or Abilify. Etc.
I am sick and tired of taking drugs. However, I shutter when I recall what it was like to experience life without them. I really hope you find something that improves the quality of your life.
Keep thinking.
- Scott
This is the end of the thread.
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