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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Julia on October 20, 2002, at 10:43:18
I am on 110mg trimipramine, but do find day time over sedation a big problem,especially as I have ME.I feel spaced out a lot of the time And it helps insomnia and agitation,but does nothing for the despair. Would changing to another, somewhatless sedating tricyclic be a good option(eg dothiepin, doxepin )or adding in some nortriptyline.I have tried increasing the trimipramine,but can't get it any higher and 110 might not be enough, but I might be able to tolerate a high enough dose of another TCA? when swopping TCAs should it be done gradually or straight swap?? I seem intolerant to most other a/ds .
Posted by Chloe on October 22, 2002, at 21:40:08
In reply to trimipramine versus other TCAs, posted by Julia on October 20, 2002, at 10:43:18
> I am on 110mg trimipramine, but do find day time over sedation a big problem,especially as I have ME.I feel spaced out a lot of the time And it helps insomnia and agitation,but does nothing for the despair. Would changing to another, somewhatless sedating tricyclic be a good option(eg dothiepin, doxepin )or adding in some nortriptyline.I have tried increasing the trimipramine,but can't get it any higher and 110 might not be enough, but I might be able to tolerate a high enough dose of another TCA? when swopping TCAs should it be done gradually or straight swap?? I seem intolerant to most other a/ds .
Hi Julie,
I am not really much help because I find that most AD's either make me high, irritable or they don't work. But I am having good success with Doxepin, and that was one that you are considering.
It is rather sedating, but quite good for sleep and anxiety. And if I don't go over 60 mgs, I manage to stay out of the manic range. IMHO, if you are not happy with the AD you are taking, find one that fits your needs better. There are plenty of TCA's to choose from. You might not want to try Dox. if you are having problem with daytime sedation. I hear Nortripyline is a relatively well tolerated one.
Best of luck
Chloe
Posted by Ritch on October 22, 2002, at 22:47:11
In reply to Re: trimipramine versus other TCAs » Julia, posted by Chloe on October 22, 2002, at 21:40:08
Hi Chloe, how are you doing? You sound like you are doing well. What meds do they have you on after ECT? I am assuming you are done with your ECT sessions, or are your maintenance sessions being spread out? Are you still taking lithium, doxepin, celexa, and diazepam? What do you think about Lexapro? Did you get your TSH/thyroid tests completed? [sorry for the questions!]
I am on too many meds now I think. Me and my pdoc became optimistic about treating my ADHD without cycling probs with WB but I can't hack the anxiety/agitation/insomnia from it. I think I am going to have to quit it altogether (again). I just "freeze" around people and feel panicky. I'm taking Ritalin in the afternoons, and it doesn't cause much anx. or sleep problems, but I don't feel any help in the mood department. I HAVE to have a DA and/or NE med for my seasonal depression coming up soon. I am thinking about going back on nortriptyline with Effexor (instead of WB/Ritalin), but don't know what to do.
Posted by Chloe on October 23, 2002, at 18:31:36
In reply to Re: trimipramine versus other TCAs » Chloe, posted by Ritch on October 22, 2002, at 22:47:11
> Hi Chloe, how are you doing? You sound like you are doing well. What meds do they have you on after ECT? I am assuming you are done with your ECT sessions, or are your maintenance sessions being spread out? Are you still taking lithium, doxepin, celexa, and diazepam? What do you think about Lexapro? Did you get your TSH/thyroid tests completed? [sorry for the questions!]
Hi Mitch,
Thanks for asking. I am doing really well, but also really badly. I am having weekly maintanence treatments, and I can't seem to make it to the next session. As I wrote to you in the other post, I tend to get very elated after ECT. It lasts for about 3 days, than I start to sink in the mood department. I get SO hopeless, because I think there is no cure for me if ECT doesn't work...But it does...It just doesn't last the whole week. AND, the Tuesday before my wednesday ECT treatment, I have to completely hold my lithium. So by Wednesday, I tend to be edgy and agitated. I wonder if I need to hold the Li the whole day. I am going to ask my pdoc if I can take the dose on Tues. morning...instead of suppertime. That would give at least 24 hours without, and may not make me so edgy by not taking it for over 36 hours.
I am taking
450 mgs Li once a day
1.5 mgs Celexa
5 mgs Diazapam BID
60 mgs Doxepin HSAnd the weekly maintanence ECT for the time being. I am not sure how long that will continue. But my pdoc and edoc don't seem in a rush to discontinue it. AND it's so effective for me. (And my insurance is completely covering it! Phew) I have never felt so elated, ever from an AD. This is the best I have felt in years. If I could just maintain it thoughout the week!!!
Oh, and I haven't even considered trying Lexapro. I don't want to mess with (marginal!) success. The celexa seems to be doing the trick so far...It's the only SSRI that hasn't giving me increased anxiety and night sweats-yuck.
>
> I am on too many meds now I think. Me and my pdoc became optimistic about treating my ADHD without cycling probs with WB but I can't hack the anxiety/agitation/insomnia from it. I think I am going to have to quit it altogether (again). I just "freeze" around people and feel panicky. I'm taking Ritalin in the afternoons, and it doesn't cause much anx. or sleep problems, but I don't feel any help in the mood department. I HAVE to have a DA and/or NE med for my seasonal depression coming up soon. I am thinking about going back on nortriptyline with Effexor (instead of WB/Ritalin), but don't know what to do.I am sorry you are having panic problems with the WB. When I tried that years ago, I had the worst sweats, I would be drenched and so worried for no reason. It sounds like WB isn't being very useful to you now. I do remember you reporting good success with nortrip. And it may help you sleep at night. Maybe with the season changing, it's time to go back to the tried and true. But I know how hard it is to go through med changes. I'm cheering for you and hope you find something that works better than what you have now.
Hang in there and keep us posted
Chloe
Posted by Ritch on October 23, 2002, at 23:26:33
In reply to Re: trimipramine versus other TCAs » Ritch, posted by Chloe on October 23, 2002, at 18:31:36
> Hi Mitch,
> Thanks for asking. I am doing really well, but also really badly. I am having weekly maintanence treatments, and I can't seem to make it to the next session. As I wrote to you in the other post, I tend to get very elated after ECT. It lasts for about 3 days, than I start to sink in the mood department. I get SO hopeless, because I think there is no cure for me if ECT doesn't work...But it does...It just doesn't last the whole week. AND, the Tuesday before my wednesday ECT treatment, I have to completely hold my lithium. So by Wednesday, I tend to be edgy and agitated. I wonder if I need to hold the Li the whole day. I am going to ask my pdoc if I can take the dose on Tues. morning...instead of suppertime. That would give at least 24 hours without, and may not make me so edgy by not taking it for over 36 hours.
> I am taking
> 450 mgs Li once a day
> 1.5 mgs Celexa
> 5 mgs Diazapam BID
> 60 mgs Doxepin HS
>
> And the weekly maintanence ECT for the time being. I am not sure how long that will continue. But my pdoc and edoc don't seem in a rush to discontinue it. AND it's so effective for me. (And my insurance is completely covering it! Phew) I have never felt so elated, ever from an AD. This is the best I have felt in years. If I could just maintain it thoughout the week!!!
>
> Oh, and I haven't even considered trying Lexapro. I don't want to mess with (marginal!) success. The celexa seems to be doing the trick so far...It's the only SSRI that hasn't giving me increased anxiety and night sweats-yuck.> I am sorry you are having panic problems with the WB. When I tried that years ago, I had the worst sweats, I would be drenched and so worried for no reason. It sounds like WB isn't being very useful to you now. I do remember you reporting good success with nortrip. And it may help you sleep at night. Maybe with the season changing, it's time to go back to the tried and true. But I know how hard it is to go through med changes. I'm cheering for you and hope you find something that works better than what you have now.
> Hang in there and keep us posted
> Chloe
>
>Chloe, what do the "edocs" say about your response to the maintenance ECT (the few days up and then back down again-is that typical for many)? Just curious, but how do you wind up with 60mg of doxepin? Back when I was on it, there were 10,25,50,75,100,150mg dosages (from what I can remember). I maxed at 75mg twice daily.
Yes, the WB caused too much generalized anxiety for sure. No panic attacks, but it got close a couple of times. The nortrip. defnitely was anxiolytic, but I don't like the cardiac effects of TCA's, and I had a hiatal hernia before (from the doxepin), and forget eating any bread if I am taking a TCA!
Posted by Chloe on October 24, 2002, at 19:47:08
In reply to Re: trimipramine versus other TCAs, posted by Ritch on October 23, 2002, at 23:26:33
>
> Chloe, what do the "edocs" say about your response to the maintenance ECT (the few days up and then back down again-is that typical for many)? Just curious, but how do you wind up with 60mg of doxepin? Back when I was on it, there were 10,25,50,75,100,150mg dosages (from what I can remember). I maxed at 75mg twice daily.Hey Mitch,
I am not sure if rapid cycling is typical with maintanence ECT. I do know that the edoc conferred with the pdoc, and they are going to try adding T3 to the lithium, dox, diaz, and celexa drops and continue with the weekly treatments. At one time the edoc wanted to add more treatments. But I can't really afford the hour trip down to the hospital. For a time I had to take a cab one way(!), because I couldn't get anyone to drive me there. I could get a friend to take me home. Thank God my insurance is covering the treatments. I also don't want to have ECT forever. I can't imagine it's too good for the body to get all those meds, etc...Can one get too much ECT?
The Doxepin comes in 10's and 50's. I take 10mgs in the am, it kinda chills me out a bit during the day. Then I take 50mgs HS. 60 mgs is about my limit without having even more cycling.>
> Yes, the WB caused too much generalized anxiety for sure. No panic attacks, but it got close a couple of times. The nortrip. defnitely was anxiolytic, but I don't like the cardiac effects of TCA's, and I had a hiatal hernia before (from the doxepin), and forget eating any bread if I am taking a TCA!
>
>
Hum, it sounds like WB's got to go...I know what you mean about the cardiac effects of TCA's. I really had that problem with amitriptyline. But not so much with Doxepin. I like Doxepin alot. No hernias for me, that sounds terrible, and I don't seem to have any problems with weight on TCA's. I guess I am lucky that way. Gee, what med would be useful without nasty, uncomfortable side effects? Maybe you could take the nortriptyline and still be able to eat bread if you continue on the ritalin? But with a stimulant AND a TCA, you really might have cardiac issues. Humm, I wish I knew of something...
I hope you feel better
Chloe
Posted by Ritch on October 24, 2002, at 22:27:19
In reply to Re:ECT and TCAs » Ritch, posted by Chloe on October 24, 2002, at 19:47:08
> Hey Mitch,
> I am not sure if rapid cycling is typical with maintanence ECT. I do know that the edoc conferred with the pdoc, and they are going to try adding T3 to the lithium, dox, diaz, and celexa drops and continue with the weekly treatments. At one time the edoc wanted to add more treatments. But I can't really afford the hour trip down to the hospital. For a time I had to take a cab one way(!), because I couldn't get anyone to drive me there. I could get a friend to take me home. Thank God my insurance is covering the treatments. I also don't want to have ECT forever. I can't imagine it's too good for the body to get all those meds, etc...Can one get too much ECT?Geez, that's something I could't tell you for sure! Never had any ECT. Interesting that he wanted to give you *more* treatments. Maybe you ought to ask him about the "most frequent flyer" he has had to treat and get the skinny on all of that and relate it to us. :-) So... you are going to try a T3+T4 combo right? Please.. tell us how that goes, because if it works out well I might really press that issue with my pdoc. Oh, BTW, that New England Journal of Medicine article is the Feb. 11, 1999 article. It was an editorial and the title was: "Thyroid Hormone Replacemnt-One Hormone or Two".
> The Doxepin comes in 10's and 50's. I take 10mgs in the am, it kinda chills me out a bit during the day. Then I take 50mgs HS. 60 mgs is about my limit without having even more cycling.
OK, I got it!
> > Yes, the WB caused too much generalized anxiety for sure. No panic attacks, but it got close a couple of times. The nortrip. defnitely was anxiolytic, but I don't like the cardiac effects of TCA's, and I had a hiatal hernia before (from the doxepin), and forget eating any bread if I am taking a TCA!
> >
> >
> Hum, it sounds like WB's got to go...I know what you mean about the cardiac effects of TCA's. I really had that problem with amitriptyline. But not so much with Doxepin. I like Doxepin alot. No hernias for me, that sounds terrible, and I don't seem to have any problems with weight on TCA's. I guess I am lucky that way. Gee, what med would be useful without nasty, uncomfortable side effects? Maybe you could take the nortriptyline and still be able to eat bread if you continue on the ritalin? But with a stimulant AND a TCA, you really might have cardiac issues. Humm, I wish I knew of something...
> I hope you feel better
> Chloe
>
>Yes, my pharmacist told me that TCA+stimulant is not a good combo. Don't want to go there. Actually, I don't think I will need to. I really think that a pinch of Effexor + Ritalin in the day and Depakote + Klonopin at bedtime just might work out OK. I am just wondering if I could replace the Ritalin with T3/T4 and it work just as well to keep me out of bipolar seasonal depression.----Mitch
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