![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 21 to 45 of 45. Go back in thread:
Posted by Elizabeth on October 26, 1999, at 19:15:47
In reply to Re: Marplan & stuff - Anita, posted by anita on October 19, 1999, at 23:58:24
> Hee hee. Nope, just in a book that used an old study. I'll email them to you in a few days.
Cool. I'm starting it in a few days (now on 25mg of nortriptyline).
> Well, irritability is listed as a possible ("less common") side effect, and in one of my books I read that it can paradoxically increase anxiety and associated tenseness.
If it's listed under "less common" side effects, that probably means it isn't a drug effect at all, IMHO, but an incidental event.
Posted by John on October 27, 1999, at 9:49:36
In reply to Marplan & stuff - Anita, posted by Elizabeth on October 19, 1999, at 12:05:56
hi,
i've tried nardil (phenelzine), parnate (tranylcypromine) and other psychotropics to treat my social phobia. nardil has been the most efficacious, by far. like you, parnate would not initially let me sleep. i found slowly titrating the dosage upward works well - your body adjusts. also, if you're using a benzodiazepine as adjunctive therapy, then taking that at night will also help. problem for me was that parnate just was not efficacious in minimizing my social phobia.
i've now been on marplan for several weeks. no sleep problems. haven't experienced the weight gain associated with nardil, either. initial dose of 30 mg was not efficacious, so i'm now on 60 mg/day. sexual dysfunction is also not an issue - at least yet.
Posted by Just a little... on July 9, 2004, at 9:58:19
In reply to My marplan experience, posted by John on October 27, 1999, at 9:49:36
I'm currently on 30 mg's of parnate and 300 mg of lithium carbonate (which will be increased to 600 mg later this week), Overall I'd say I feel good. No problems with weight gain and my sleep is slowly but steadily improving as well.
Be that as it may my Pdoc says he doesn't notice an "adequate" anti depressant effect in me, meaning interest in things, social stuff... etc.
Also my energy is kinda low in the afternoon which seems normal from what I've read.We have been thinking about adding an amphetamine (even though they are contraindicated) to help me get through the morning and afternoon, but my Pdoc would like me to switch to Marplan first because of it's less severe side effects(?).
He is worried about my hypertension and tachycardia (in normal situations) which supposedly are caused by Parnate... He believes Marplan will not have these side effects in me.
The tachycardia part is indeed very annoying for me, I can't do a proper target heartrate workout because my heart rate already is in it's optimal range... usually in the 110's when I start.
Has anyone experienced tachycardia with Marplan? I really like to exercise and parnate is giving me a hard time.
Thanks and take care everyone =D
Just a little... a.k.a. Falco
> hi,
>
> i've tried nardil (phenelzine), parnate (tranylcypromine) and other psychotropics to treat my social phobia. nardil has been the most efficacious, by far. like you, parnate would not initially let me sleep. i found slowly titrating the dosage upward works well - your body adjusts. also, if you're using a benzodiazepine as adjunctive therapy, then taking that at night will also help. problem for me was that parnate just was not efficacious in minimizing my social phobia.
>
> i've now been on marplan for several weeks. no sleep problems. haven't experienced the weight gain associated with nardil, either. initial dose of 30 mg was not efficacious, so i'm now on 60 mg/day. sexual dysfunction is also not an issue - at least yet.
Posted by Questionmark on July 9, 2004, at 10:38:27
In reply to Re: My marplan experience » John, posted by Just a little... on July 9, 2004, at 9:58:19
> I'm currently on 30 mg's of parnate and 300 mg of lithium carbonate (which will be increased to 600 mg later this week), Overall I'd say I feel good. No problems with weight gain and my sleep is slowly but steadily improving as well.
>
> Be that as it may my Pdoc says he doesn't notice an "adequate" anti depressant effect in me, meaning interest in things, social stuff... etc.
> Also my energy is kinda low in the afternoon which seems normal from what I've read.
>
> We have been thinking about adding an amphetamine (even though they are contraindicated) to help me get through the morning and afternoon, but my Pdoc would like me to switch to Marplan first because of it's less severe side effects(?).
>
> He is worried about my hypertension and tachycardia (in normal situations) which supposedly are caused by Parnate... He believes Marplan will not have these side effects in me.
>
> The tachycardia part is indeed very annoying for me, I can't do a proper target heartrate workout because my heart rate already is in it's optimal range... usually in the 110's when I start.
>
> Has anyone experienced tachycardia with Marplan? I really like to exercise and parnate is giving me a hard time.
>
> Thanks and take care everyone =D
> Just a little... a.k.a. Falcoi've never used Marplan but i'm pretty sure it would be much less likely to cause tachycardia than Parnate. In fact, it very well might cause bradycardia to some extent.
Posted by King Vultan on July 9, 2004, at 14:32:58
In reply to Re: My marplan experience » John, posted by Just a little... on July 9, 2004, at 9:58:19
If Marplan is at all like Nardil (they are both hydrazine derivatives, while Parnate is not), you may actually have the opposite problem where your heart rate is too slow, as suggested by Questionmark. My experience, having experienced tachycardia on tricyclics and bradycardia on Nardil, is that the bradycardia is more of a problem in practice.
The tachycardia had no real effect on my workouts, but I do not do anything that is heartrate targeted; I occasionally monitor my heartrate while I'm running out of curiousity. At age 39 earlier this year on a tricyclic (desipramine), my pulse was running about 155 bpm on the flats and as high as 168 climbing hills at a moderately strenuous pace. This may seem high, but it was simply a natural result of the pace of the workout, which was not uncomfortable. My resting heart rate on desipramine was about 90 bpm.
However, on Nardil, with a resting heartrate of about 55, I am having problems even climbing the stairs without feeling faint, and I just cannot go as fast when I'm running. I've felt my pulse sometimes at the top of the stairs (when I've laid down to avoid fainting), and it's clear that it's not going fast enough to begin with and also can't accelerate fast enough to keep up with the needed increase in cardiovascular output. Better the reflex tachycardia I experienced on the tricyclics. BTW, both types of drugs caused me hypotension. My normal BP is 140/90; on the Nardil it is about 105/65, and on desipramine it was about 110/70.
The Marplan may be better than the Nardil in this way, but I thought I would share my experience. Good luck whatever you decide to do.
Todd
Posted by KaraS on July 9, 2004, at 17:50:13
In reply to Re: tachycardia vs. bradycardia » Just a little..., posted by King Vultan on July 9, 2004, at 14:32:58
> If Marplan is at all like Nardil (they are both hydrazine derivatives, while Parnate is not), you may actually have the opposite problem where your heart rate is too slow, as suggested by Questionmark. My experience, having experienced tachycardia on tricyclics and bradycardia on Nardil, is that the bradycardia is more of a problem in practice.
>
> The tachycardia had no real effect on my workouts, but I do not do anything that is heartrate targeted; I occasionally monitor my heartrate while I'm running out of curiousity. At age 39 earlier this year on a tricyclic (desipramine), my pulse was running about 155 bpm on the flats and as high as 168 climbing hills at a moderately strenuous pace. This may seem high, but it was simply a natural result of the pace of the workout, which was not uncomfortable. My resting heart rate on desipramine was about 90 bpm.
>
> However, on Nardil, with a resting heartrate of about 55, I am having problems even climbing the stairs without feeling faint, and I just cannot go as fast when I'm running. I've felt my pulse sometimes at the top of the stairs (when I've laid down to avoid fainting), and it's clear that it's not going fast enough to begin with and also can't accelerate fast enough to keep up with the needed increase in cardiovascular output. Better the reflex tachycardia I experienced on the tricyclics. BTW, both types of drugs caused me hypotension. My normal BP is 140/90; on the Nardil it is about 105/65, and on desipramine it was about 110/70.
>
> The Marplan may be better than the Nardil in this way, but I thought I would share my experience. Good luck whatever you decide to do.
>
> Todd
Todd,I am considering taking Parnate down the road (if what I'm trying now doesn't work out). I also got tachycardia from desipramine and nortryptiline. Even on small doses I was getting heart rates of 100 BPM in a resting state. Plus I had terrible insomnia from them. Sadly I gave them up because they were the only things that had given me energy and motivation. Was your tachycardia worse on Parnate than on the tricyclics? If so, I'm thinking I probably won't be able to tolerate it. Also, did you have insomnia from the TCAs as well as Parnate? If so, what did you take?
Thanks,
Kara
Posted by King Vultan on July 9, 2004, at 19:49:55
In reply to Re: tachycardia vs. bradycardia, posted by KaraS on July 9, 2004, at 17:50:13
>
>
> Todd,
>
> I am considering taking Parnate down the road (if what I'm trying now doesn't work out). I also got tachycardia from desipramine and nortryptiline. Even on small doses I was getting heart rates of 100 BPM in a resting state. Plus I had terrible insomnia from them. Sadly I gave them up because they were the only things that had given me energy and motivation. Was your tachycardia worse on Parnate than on the tricyclics? If so, I'm thinking I probably won't be able to tolerate it. Also, did you have insomnia from the TCAs as well as Parnate? If so, what did you take?
>
> Thanks,
> Kara
I was responding to someone who is on Parnate; actually, I have only taken Nardil so far in the MAOI class. I don't think tachycardia is necessarily all that big a deal in itself; when I was on the tricyclics, my resting heart rate was over 100 bpm on several occasions, the three highest being 107, 109, and 114 bpm as I look back through my records. Generally, though, mine was very close to 90 bpm, which is nothing for someone in good condition. My pdoc expressed concern if my heart rate was constantly over 100 bpm, which mine didn't happen to be. I don't know if this is the standard cautionary threshold for tachycardia or not.I found nortriptyline to be so sedating that it was problematic and had no real trouble sleeping on it. Desipramine was activating for me and the 2nd best med I have tried behind Nardil. I did suffer a fair amount of insomnia on it and used Ambien at the time but would probably now employ the combination I am using for Nardil--alternating every other night between 50 mg Benadryl and 0.125 mg Halcion, along with using a sleep/relaxation CD. However, I recall the insomnia on desipramine easing after a month or two such that it really was not a problem anymore.
I can tell you that after trying about 10 drugs, more than half of which gave me insomnia, that it makes sense to employ whatever safe and effective sleep aids are available. The insomnia I have suffered on the Nardil is the worst of any of the drugs I've taken, but I have put much more effort into trying different sleep aids than I have with any drugs in the past. The net result is that I am sleeping better than on any other drug that has given me insomnia, and if I can successfully combat the brutal (for me, anyway) insomnia of this stuff, my thought is that other people should generally be able to do likewise on the particular drugs they are on.
Todd
Posted by SLS on July 10, 2004, at 12:55:17
In reply to Re: tachycardia vs. bradycardia, posted by KaraS on July 9, 2004, at 17:50:13
Hi Kara.
> I am considering taking Parnate down the road (if what I'm trying now doesn't work out). I also got tachycardia from desipramine and nortryptiline.
What exactly were your reasons for discontinuing the tricyclics? Perhaps you didn't need to. I don't think what you consider to be "tachycardia" should be of much concern, especially if accepting it as a side-effect yields a huge pay-off.
A number of years ago, I began taking a combination of Parnate 60mg + desipramine 150mg.
1. My resting HR went from 54 to 110-120 at first. This didn't affect any aspect of my life. I continued to perform my day to day activities as usual, including athletic training (weight-lifting). Over the course of several months, my resting HR gradually came down and settled to about 80-90.
2. I experienced total insomnia for nearly two weeks before intervening aggressively with a combination of Halcion 1.0mg + Ativan 4.0mg. I slept great afterwards, sleeping between 11:00pm - 6:30am and experiencing brief awakenings at 2:00am and 5:00am.
I don't know how severe your condition is, but I guess the seriousness of a particular side-effect is a matter of perspective.
Best wishes.
- Scott
Posted by KaraS on July 10, 2004, at 16:55:21
In reply to Re: tachycardia vs. bradycardia » KaraS, posted by SLS on July 10, 2004, at 12:55:17
> Hi Kara.
>
> > I am considering taking Parnate down the road (if what I'm trying now doesn't work out). I also got tachycardia from desipramine and nortryptiline.
>
> What exactly were your reasons for discontinuing the tricyclics? Perhaps you didn't need to. I don't think what you consider to be "tachycardia" should be of much concern, especially if accepting it as a side-effect yields a huge pay-off.Those were the two reasons - the 100 bpm heart rate and the insomnia. I can't remember what dosage of nortriptyline I was on but I don't think I was anywhere near a therapeutic dosage yet either when I got that much tachycardia.
(More on that below)>
> A number of years ago, I began taking a combination of Parnate 60mg + desipramine 150mg.
>
> 1. My resting HR went from 54 to 110-120 at first. This didn't affect any aspect of my life. I continued to perform my day to day activities as usual, including athletic training (weight-lifting). Over the course of several months, my resting HR gradually came down and settled to about 80-90.You didn't feel uncomfortable with your heart beating that quickly? I was always aware of it because it felt so strange. Plus I was scared that maybe we have only so many heart beats in the old ticker and that I was too quickly using them up. I'm particularly sensitive to heart issues because my father died of a heart attack at age 45 (and that wasn't his first attack).
>
> 2. I experienced total insomnia for nearly two weeks before intervening aggressively with a combination of Halcion 1.0mg + Ativan 4.0mg. I slept great afterwards, sleeping between 11:00pm - 6:30am and experiencing brief awakenings at 2:00am and 5:00am.At the time I started the nortriptyline I had recently become addicted to Ativan and managed to get off of it so I was very reticent to take a benzo for sleep. I tried adding a little doxepin and got a very strange reaction - my heart felt like it was going to beat right out of my body all of a sudden about an hour after taking it. That scared the hell out of me. Trazadone made me so nauseous. (Back then there was no Ambien around either nor did I know anything about tryptophan or Valerian.) I think that were it to happen now, I'd know of other options to add for sleep.
>
> I don't know how severe your condition is, but I guess the seriousness of a particular side-effect is a matter of perspective.
>
I find it encouraging that your bpm did eventually drop. Did anyone ever suggest a beta blocker for you? I had asked my pdoc at the time but she nixed that idea. I guess that can produce depression as well so probably wasn't a good idea anyway.It might be worth it for me to revisit that drug. I didn't get to a high enough dosage to know if it would help depression much for me but I sure did love that energy! I could always combine it with something else for depression. Also, I'm beginning to think that if I do find something(s) that will help with the energy, that they will have a strong noradrenergic effect and therefore I will always have the tachycardia issue.
Take care,
Kara
> Best wishes.
>
>
> - Scott
>
Posted by SLS on July 10, 2004, at 18:15:39
In reply to Re: tachycardia vs. bradycardia, posted by KaraS on July 10, 2004, at 16:55:21
Hi Kara.
> Those were the two reasons - the 100 bpm heart rate and the insomnia.
In the grand scheme of things, I don't consider that very high. I hope I am not coming off as insensitive. I probably am. Sorry.
> I can't remember what dosage of nortriptyline I was on but I don't think I was anywhere near a therapeutic dosage yet either when I got that much tachycardia.
It really isn't dosage dependant in my experience. It starts at a very low dosage and remains static through the dosage range. That's been my experience, anyway. I am currently taking imipramine 300mg, and my heart rate is 85. Before your last post, I was thinking about a beta blocker too if you were still skittish about HR. I would use pindolol rather than propranalol if you are worrying about depressogenic potential. Pindolol is even considered by some to be an augmentor of antidepressants. It is a somato-dendritic 5-HT1a antagonist as well as a beta blocker. I still don't think it is necessary, though. Your "tachycardia" is absolutely the norm for these drugs. I would love to hold your hand through your first few weeks with them - really. :-)
As far as benzodiazepines are concerned, being physiologically dependant on them is not the same as being addicted to them. Too much fuss is made of all of this. Once you are brought into remission with an antidepressant, you are no less physiologically dependant upon it to maintain your wellbeing and staving off a discontinuation syndrome. If you have reached an impasse using the easy and convenient first-line alternatives, it is time to use the less convenient, more aggressive, and less pallatable ones. If nortriptyline is the miracle drug for you (and that's exactly what it would feel like), you will just have to get used to a *moderately* accelerated heartrate and the need to take a perfectly safe sleeping medication that might be difficult to discontinue *if* you should ever deem it desirable to do so. (You probably will be able to discontinue it within a few months). Who cares if you end up taking these two drugs for the rest of your life? I won't tell if you don't.
I'm just having a bit of fun poking at you a little bit.
:-)
- Scott
Posted by KaraS on July 11, 2004, at 2:19:28
In reply to Re: tachycardia vs. bradycardia » KaraS, posted by SLS on July 10, 2004, at 18:15:39
> Hi Kara.
>
> > Those were the two reasons - the 100 bpm heart rate and the insomnia.
>
> In the grand scheme of things, I don't consider that very high. I hope I am not coming off as insensitive. I probably am. Sorry.
>
Scott, I don't see it as insensitive. You're just giving me your opinion.> > I can't remember what dosage of nortriptyline I was on but I don't think I was anywhere near a therapeutic dosage yet either when I got that much tachycardia.
> It really isn't dosage dependant in my experience. It starts at a very low dosage and remains static through the dosage range. That's been my experience, anyway. I am currently taking imipramine 300mg, and my heart rate is 85. Before your last post, I was thinking about a beta blocker too if you were still skittish about HR. I would use pindolol rather than propranalol if you are worrying about depressogenic potential. Pindolol is even considered by some to be an augmentor of antidepressants. It is a somato-dendritic 5-HT1a antagonist as well as a beta blocker. I still don't think it is necessary, though. Your "tachycardia" is absolutely the norm for these drugs. I would love to hold your hand through your first few weeks with them - really. :-)
RE: My "tachycardia" being the norm for these TCAs... REALLY? My doctor was quite concerned about it at the time. You really get used to that feeling of your heart racing?
Two really good points you made - that the rate of heart beats isn't dosage dependent and that the pindolol isn't a depressant. I always thought all beta blockers were. I did know that pindolol was used to potentiate antidepressants but I didn't realize that it was also a beta blocker. Really good to know! The technical reason behind that ("somato-dendritic 5-HT1a antagonist") is a bit over my head but I get the gist of it anyway.
I don't know that this would definitely be a dream med for me but I think it is worth revisiting. I still have plenty of others that I want to try as well including imipramine. Hard to believe after several years of trying medications that I've never tried the gold standard. How are you doing on that BTW? That was so sweet of you to say about holding my hand throughout the first weeks of trying nortriptyline. If I do go back on the medication, I will hold you to it... though I doubt your girlfriend would like that (LOL) But seriously, I think that one upside (and perhaps the only upside) to suffering from depression is that it can help to make people very sensitive and empathetic. That certainly seems to be the case with you.>
> As far as benzodiazepines are concerned, being physiologically dependant on them is not the same as being addicted to them. Too much fuss is made of all of this. Once you are brought into remission with an antidepressant, you are no less physiologically dependant upon it to maintain your wellbeing and staving off a discontinuation syndrome. If you have reached an impasse using the easy and convenient first-line alternatives, it is time to use the less convenient, more aggressive, and less pallatable ones. If nortriptyline is the miracle drug for you (and that's exactly what it would feel like), you will just have to get used to a *moderately* accelerated heartrate and the need to take a perfectly safe sleeping medication that might be difficult to discontinue *if* you should ever deem it desirable to do so. (You probably will be able to discontinue it within a few months). Who cares if you end up taking these two drugs for the rest of your life? I won't tell if you don't.
>
I'm also concerned with needing to take more and more of the benzo in order to get the effect of getting me to sleep. I remember with the Ativan that I would start getting nauseous in the evening a couple of hours before it was time to take it. I don't want to live with that kind of side effect. I have learned how to go off of things very slowly to minimize withdrawal so I'm less concerned with that aspect of it. Perhaps a longer lasting benzo like Klonopin would work better - but don't the benzos increase depression? Or is it a matter of the antidepressant more than compensating for that?
I don't care about being on medication(s) for the rest of my life. I just want the quality of it to be better. Life is too short and too difficult to be a purist about it. But I digress... I'd better sign off now before I get too philosophical. Thanks again,
Kara> I'm just having a bit of fun poking at you a little bit.
>
> :-)
>
>
> - Scott
>
>
Posted by Just a little... on July 11, 2004, at 4:44:40
In reply to Re: tachycardia vs. bradycardia, posted by KaraS on July 11, 2004, at 2:19:28
> > Hi Kara.
> >
> > > Those were the two reasons - the 100 bpm heart rate and the insomnia.
> >
> > In the grand scheme of things, I don't consider that very high. I hope I am not coming off as insensitive. I probably am. Sorry.
> >
> Scott, I don't see it as insensitive. You're just giving me your opinion.
>
> > > I can't remember what dosage of nortriptyline I was on but I don't think I was anywhere near a therapeutic dosage yet either when I got that much tachycardia.
>
> > It really isn't dosage dependant in my experience. It starts at a very low dosage and remains static through the dosage range. That's been my experience, anyway. I am currently taking imipramine 300mg, and my heart rate is 85. Before your last post, I was thinking about a beta blocker too if you were still skittish about HR. I would use pindolol rather than propranalol if you are worrying about depressogenic potential. Pindolol is even considered by some to be an augmentor of antidepressants. It is a somato-dendritic 5-HT1a antagonist as well as a beta blocker. I still don't think it is necessary, though. Your "tachycardia" is absolutely the norm for these drugs. I would love to hold your hand through your first few weeks with them - really. :-)
>
> RE: My "tachycardia" being the norm for these TCAs... REALLY? My doctor was quite concerned about it at the time. You really get used to that feeling of your heart racing?
>
> Two really good points you made - that the rate of heart beats isn't dosage dependent and that the pindolol isn't a depressant. I always thought all beta blockers were. I did know that pindolol was used to potentiate antidepressants but I didn't realize that it was also a beta blocker. Really good to know! The technical reason behind that ("somato-dendritic 5-HT1a antagonist") is a bit over my head but I get the gist of it anyway.
>
> I don't know that this would definitely be a dream med for me but I think it is worth revisiting. I still have plenty of others that I want to try as well including imipramine. Hard to believe after several years of trying medications that I've never tried the gold standard. How are you doing on that BTW? That was so sweet of you to say about holding my hand throughout the first weeks of trying nortriptyline. If I do go back on the medication, I will hold you to it... though I doubt your girlfriend would like that (LOL) But seriously, I think that one upside (and perhaps the only upside) to suffering from depression is that it can help to make people very sensitive and empathetic. That certainly seems to be the case with you.
>
> >
> > As far as benzodiazepines are concerned, being physiologically dependant on them is not the same as being addicted to them. Too much fuss is made of all of this. Once you are brought into remission with an antidepressant, you are no less physiologically dependant upon it to maintain your wellbeing and staving off a discontinuation syndrome. If you have reached an impasse using the easy and convenient first-line alternatives, it is time to use the less convenient, more aggressive, and less pallatable ones. If nortriptyline is the miracle drug for you (and that's exactly what it would feel like), you will just have to get used to a *moderately* accelerated heartrate and the need to take a perfectly safe sleeping medication that might be difficult to discontinue *if* you should ever deem it desirable to do so. (You probably will be able to discontinue it within a few months). Who cares if you end up taking these two drugs for the rest of your life? I won't tell if you don't.
> >
> I'm also concerned with needing to take more and more of the benzo in order to get the effect of getting me to sleep. I remember with the Ativan that I would start getting nauseous in the evening a couple of hours before it was time to take it. I don't want to live with that kind of side effect. I have learned how to go off of things very slowly to minimize withdrawal so I'm less concerned with that aspect of it. Perhaps a longer lasting benzo like Klonopin would work better - but don't the benzos increase depression? Or is it a matter of the antidepressant more than compensating for that?
> I don't care about being on medication(s) for the rest of my life. I just want the quality of it to be better. Life is too short and too difficult to be a purist about it. But I digress... I'd better sign off now before I get too philosophical. Thanks again,
> Kara
>
>
>
> > I'm just having a bit of fun poking at you a little bit.
> >
> > :-)
> >
> >
> > - Scott
> >
> >
>
>Kara,
I think you are having problems with another side effect: palpitation? When I started Parnate (and when increasing the dose) I was also very aware of my heart racing in my chest, this did pass for me after a couple of weeks though... Still it was very uncomfortable to painful even.
My Pdoc gave me propranolol which helped and also help with the tachycardia but ... I hesitate taking it in combination with the lithium I'm on.
I've also read that Pindolol can be activating in combination with an anti depressant, it seems preferrable over propranolol.As for the benzodiazepine sleep aids, I have nitrazepam but dislike using them because the messing up of the natural sleep stages. Other than those I don't have much experience with other types of sleep aids. :|
Good luck anyway. ^^
Posted by SLS on July 11, 2004, at 10:12:25
In reply to Re: tachycardia vs. bradycardia, posted by KaraS on July 11, 2004, at 2:19:28
Hi Kara
> > > Those were the two reasons - the 100 bpm heart rate and the insomnia.
> > Your "tachycardia" is absolutely the norm for these drugs. I would love to hold your hand through your first few weeks with them - really. :-)
> RE: My "tachycardia" being the norm for these TCAs... REALLY? My doctor was quite concerned about it at the time.Your concern is not a silly one to be sure. It would not be a bad idea to get a baseline ECG before beginning the TCA and then one after, especially since you have a family history of heart disease.
I think it might be worthwhile starting a new thread asking people taking TCAs what were their initial experiences with HR and if they changed over time.
> You really get used to that feeling of your heart racing?
Yes. I was very aware of it in the beginning. After a few months, I didn't notice it at all. Although the heart is beating more often, it is not beating as hard. It does not have as much of a pressure load to overcome because the TCA antagonizes NE alpha-1 receptors and dilates blood vessels.
> Two really good points you made - that the rate of heart beats isn't dosage dependent and that the pindolol isn't a depressant.
There are still those who will debate whether any of them produce depression. I'm all but sure that propranolol does, though. It passes through the blood-brain barrier more easily than any of the others.
> I don't know that this would definitely be a dream med for me but I think it is worth revisiting. I still have plenty of others that I want to try as well including imipramine. Hard to believe after several years of trying medications that I've never tried the gold standard.
Yeah. The old drugs are just sitting on the sidelines sulking because of their underutilization.
> How are you doing on that BTW?
Not too well, but I've been worse. The combination of Lamictal 300mg + imipramine 300mg gives me about a 15% improvement over my unmedicated baseline, allowing me to function well enough to take care of my basic needs and participate on Psycho-Babble. Otherwise, well, I don't like thinking about how sick I can get. My previous doctor, a professor at NYU, described my condition as being horrendous. Nice.
> > As far as benzodiazepines are concerned, being physiologically dependant on them is not the same as being addicted to them. Too much fuss is made of all of this.
> I'm also concerned with needing to take more and more of the benzo in order to get the effect of getting me to sleep.
During my Parnate + desipramine treatment, I reached a point where I no longer needed to increase the dosages of the benzos to be able to sleep. I'm not sure how common this is, though. I was taking twice the amount of Halcion than is currently recommended. (The recommended dosage of Halcion was cut in half when there was an uproar in the media regarding iatrogenic amnesia. Ambien is no less offensive in this regard). Again, who cares? What difference does it make? You take as much as you need to get the job done. These are clean drugs that are perfectly safe at high dosages. Sometimes, I think the dosage recommendations of benzodiazepines are almost arbitrary. I think these are important tools that are grossly underutilized.
> I remember with the Ativan that I would start getting nauseous in the evening a couple of hours before it was time to take it. I don't want to live with that kind of side effect.
Hmmm. That is quite a nuissance. What about using Remeron? If anxiety were a feature of your depression, you could rationalize taking more Ativan either at night or in divided doses. What other drugs have you tried for insomnia? It might not be a bad idea to try a few different ones for a few nights at a time to see which ones work best for you. Restoril is pretty smooth. Ambien might not cause the nausea. There's also the option of riding it out and allowing your system to adjust, using a sleep aid perhaps every third night if necessary. I don't know, but I think you can effectively treat the insomnia such that it doesn't preclude you from using a potentially effective antidepressant.
> I have learned how to go off of things very slowly to minimize withdrawal so I'm less concerned with that aspect of it. Perhaps a longer lasting benzo like Klonopin would work better - but don't the benzos increase depression?
Generally speaking, I would say no. However, Klonopin is the one that I would point at as being the exception.
- Scott
Posted by KaraS on July 11, 2004, at 16:14:00
In reply to Re: tachycardia vs. bradycardia, posted by Just a little... on July 11, 2004, at 4:44:40
I did have the palpitations at one point as well as the racing heart. The palpitations didn't last for me either but they can be really scary.
Pindolol is definitely preferable to propanolol for my purposes.
Good point about the benzos messing up the natural sleep stages. I had forgotten about that. I think I'll find another way to sleep if the medication I'm taking is too stimulating.
Thanks for your input.
Kara
Posted by KaraS on July 11, 2004, at 17:22:53
In reply to Re: tachycardia vs. bradycardia » KaraS, posted by SLS on July 11, 2004, at 10:12:25
Hi Kara
>
>
> > RE: My "tachycardia" being the norm for these TCAs... REALLY? My doctor was quite concerned about it at the time.
>
> Your concern is not a silly one to be sure. It would not be a bad idea to get a baseline ECG before beginning the TCA and then one after, especially since you have a family history of heart disease.
>I don't have health insurance now so that's out of the question. Starting on a TCA is something that will need to wait until I have good insurance. I have other things that I can try in the meantime.
> I think it might be worthwhile starting a new thread asking people taking TCAs what were their initial experiences with HR and if they changed over time.
>
Good idea. Think I'll do that. Hope there are still enough TCA users around to answer!> > You really get used to that feeling of your heart racing?
>
> Yes. I was very aware of it in the beginning. After a few months, I didn't notice it at all. Although the heart is beating more often, it is not beating as hard. It does not have as much of a pressure load to overcome because the TCA antagonizes NE alpha-1 receptors and dilates blood vessels.Good to know!
>
> > Two really good points you made - that the rate of heart beats isn't dosage dependent and that the pindolol isn't a depressant.
>
> There are still those who will debate whether any of them produce depression. I'm all but sure that propranolol does, though. It passes through the blood-brain barrier more easily than any of the others.
>
> > I don't know that this would definitely be a dream med for me but I think it is worth revisiting. I still have plenty of others that I want to try as well including imipramine. Hard to believe after several years of trying medications that I've never tried the gold standard.
>
> Yeah. The old drugs are just sitting on the sidelines sulking because of their underutilization.
>
> > How are you doing on that BTW?
>
> Not too well, but I've been worse. The combination of Lamictal 300mg + imipramine 300mg gives me about a 15% improvement over my unmedicated baseline, allowing me to function well enough to take care of my basic needs and participate on Psycho-Babble. Otherwise, well, I don't like thinking about how sick I can get. My previous doctor, a professor at NYU, described my condition as being horrendous. Nice.
>
I'm so sorry to hear that you're not doing well, Scott. Is it too early for judgment on the imipramine or are you trying to find something else to take at this point? What has worked for you in the past?> > > As far as benzodiazepines are concerned, being physiologically dependant on them is not the same as being addicted to them. Too much fuss is made of all of this.
>
> > I'm also concerned with needing to take more and more of the benzo in order to get the effect of getting me to sleep.
>
> During my Parnate + desipramine treatment, I reached a point where I no longer needed to increase the dosages of the benzos to be able to sleep. I'm not sure how common this is, though. I was taking twice the amount of Halcion than is currently recommended. (The recommended dosage of Halcion was cut in half when there was an uproar in the media regarding iatrogenic amnesia. Ambien is no less offensive in this regard). Again, who cares? What difference does it make? You take as much as you need to get the job done. These are clean drugs that are perfectly safe at high dosages. Sometimes, I think the dosage recommendations of benzodiazepines are almost arbitrary. I think these are important tools that are grossly underutilized.
>
> > I remember with the Ativan that I would start getting nauseous in the evening a couple of hours before it was time to take it. I don't want to live with that kind of side effect.
>
> Hmmm. That is quite a nuissance. What about using Remeron? If anxiety were a feature of your depression, you could rationalize taking more Ativan either at night or in divided doses. What other drugs have you tried for insomnia? It might not be a bad idea to try a few different ones for a few nights at a time to see which ones work best for you. Restoril is pretty smooth. Ambien might not cause the nausea. There's also the option of riding it out and allowing your system to adjust, using a sleep aid perhaps every third night if necessary. I don't know, but I think you can effectively treat the insomnia such that it doesn't preclude you from using a potentially effective antidepressant.
>There are several things that I could try for sleep. I think the benzos for me would be the last resort. No, maybe Remeron would be the last resort. I don't want to gain a lot of weight.
> > I have learned how to go off of things very slowly to minimize withdrawal so I'm less concerned with that aspect of it. Perhaps a longer lasting benzo like Klonopin would work better - but don't the benzos increase depression?
>
> Generally speaking, I would say no. However, Klonopin is the one that I would point at as being the exception.
>> - Scott
I'm not sure I understand. Are you saying that Klonopin is the one that does or doesn't increase depression?Kara
Posted by zeugma on July 11, 2004, at 17:33:20
In reply to Re: tachycardia vs. bradycardia, posted by KaraS on July 11, 2004, at 17:22:53
I'm not sure I understand. Are you saying that Klonopin is the one that does or doesn't increase depression?
Klon aggravates depression in my experience. Unfortunately it is the only thing that has kept my social phobia even minimally under control.
Posted by KaraS on July 11, 2004, at 18:10:04
In reply to Re: tachycardia vs. bradycardia » KaraS, posted by zeugma on July 11, 2004, at 17:33:20
> I'm not sure I understand. Are you saying that Klonopin is the one that does or doesn't increase depression?
>
> Klon aggravates depression in my experience. Unfortunately it is the only thing that has kept my social phobia even minimally under control.
>What a drag. What do you do to counteract the depression?
Posted by SLS on July 11, 2004, at 19:42:38
In reply to Re: tachycardia vs. bradycardia, posted by KaraS on July 11, 2004, at 17:22:53
> > > Perhaps a longer lasting benzo like Klonopin would work better - but don't the benzos increase depression?
> > Generally speaking, I would say no. However, Klonopin is the one that I would point at as being the exception.> I'm not sure I understand. Are you saying that Klonopin is the one that does or doesn't increase depression?
From what I have seen, Klonopin has a higher rate of increasing depression than the other benzodiazepines.
> I'm so sorry to hear that you're not doing well, Scott. Is it too early for judgment on the imipramine or are you trying to find something else to take at this point? What has worked for you in the past?
The only thing that ever worked well for me was a combination of Parnate + desipramine. Unfortunately, my doctor took me off of it prematurely due to a manic reaction. When I relapsed back into depression two months later, he elected to avoid the original combination and decided to try Prozac. To make a long story short, now nothing works. I have responded partially or transiently to a few TCAs, Parnate, Nardil, Effexor, Lamictal, and Namenda. I also experience rebound improvements upon abrupt discontinuations of TCAs and MAOIs that can last a week or two. It ain't no way to live.
I am currently taking:
imipramine 300mg
Lamictal 300mg
Zonegran 200mg
Namenda 20mg
Abilify 10mgThe Zonegran is the newbie. I have been on it for only two weeks. I can't pass judgment on it for several more. I am waiting for Cymbalta (duloxetine), an antidepressant that inhibits the reuptake of both NE and 5-HT, to be approved by the FDA. It had been scheduled to arrive over a year ago. Now it's actionable date has been pushed back until late September. The drug company insists that it will be out this summer. I don't know what to think. Of course, the date of September 21 would satisfy both proclamations. I'll know more when I speak to the doctor sometime this week.
- Scott
Posted by zeugma on July 11, 2004, at 22:00:50
In reply to Re: tachycardia vs. bradycardia, posted by KaraS on July 11, 2004, at 18:10:04
> > I'm not sure I understand. Are you saying that Klonopin is the one that does or doesn't increase depression?
> >
> > Klon aggravates depression in my experience. Unfortunately it is the only thing that has kept my social phobia even minimally under control.
> >
>
> What a drag. What do you do to counteract the depression?
>
>
I take nortriptyline and have taken other drugs that are to all intents and purposes antidepressants- Strattera and buspirone. Their actions on my sleep cycle are exactly the opposite of Klonopin's. If I wasn't so addled from Provigil-induced insomnia I would explain my theory of why klonopin induces depression. In fact I did explain my theory, but like your post the other day mine didn't go through and now I am not up to more explaining. I wonder if I'm going to have to take Ambien every night to sleep in order to stay on Provigil, which is otherwise very promising as far as cognitive and mood effects.
Posted by KaraS on July 11, 2004, at 23:43:31
In reply to Re: tachycardia vs. bradycardia » KaraS, posted by SLS on July 11, 2004, at 19:42:38
> > > > Perhaps a longer lasting benzo like Klonopin would work better - but don't the benzos increase depression?
>
> > > Generally speaking, I would say no. However, Klonopin is the one that I would point at as being the exception.
>
> > I'm not sure I understand. Are you saying that Klonopin is the one that does or doesn't increase depression?
>
> From what I have seen, Klonopin has a higher rate of increasing depression than the other benzodiazepines.
>
> > I'm so sorry to hear that you're not doing well, Scott. Is it too early for judgment on the imipramine or are you trying to find something else to take at this point? What has worked for you in the past?
>
> The only thing that ever worked well for me was a combination of Parnate + desipramine. Unfortunately, my doctor took me off of it prematurely due to a manic reaction. When I relapsed back into depression two months later, he elected to avoid the original combination and decided to try Prozac. To make a long story short, now nothing works. I have responded partially or transiently to a few TCAs, Parnate, Nardil, Effexor, Lamictal, and Namenda. I also experience rebound improvements upon abrupt discontinuations of TCAs and MAOIs that can last a week or two. It ain't no way to live.
>
> I am currently taking:
>
> imipramine 300mg
> Lamictal 300mg
> Zonegran 200mg
> Namenda 20mg
> Abilify 10mg
>
> The Zonegran is the newbie. I have been on it for only two weeks. I can't pass judgment on it for several more. I am waiting for Cymbalta (duloxetine), an antidepressant that inhibits the reuptake of both NE and 5-HT, to be approved by the FDA. It had been scheduled to arrive over a year ago. Now it's actionable date has been pushed back until late September. The drug company insists that it will be out this summer. I don't know what to think. Of course, the date of September 21 would satisfy both proclamations. I'll know more when I speak to the doctor sometime this week.
>
>
> - Scott
>Scott, unfortunately I don't know much about treating bipolar disorder. Was that your first episode or have you been battling that for a while now? I imagine it does make treatment a lot trickier. I've been straight unipolar depression so I don't have the fear of feeling too high. You said that you haven't had the same response to Parnate since your episode. Did you also add in the desipramine again? I would think that if that combo worked, you could add something else to keep the mania in check. I am probably showing my naive perspective with that remark but I felt I had to ask.
I have been following Cymbalta for quite a while now also. Since I had a partial response to Effexor and needed more of the NE response and Cymbalta supposedly has that, I was convinced that would be an ideal med for me too. I think it will eventually be released. In the meantime there are many other things in the pipeline. I'm especially interested in the selegiline patch as well. Don't know if that's anything that you're interested in. Also, do you have a lot of confidence in your doctor?
Have you ever considered trying any herbal, nutritional or nutraceutical remedies in addition to the meds? They could have some interesting adjunctive benefits.
Anyway, wish I could give you a hug but since I can't, I'll just say hang in there. It may take longer than you'd like but there are still plenty of options.
Kara
Posted by KaraS on July 11, 2004, at 23:46:17
In reply to Re: tachycardia vs. bradycardia » KaraS, posted by zeugma on July 11, 2004, at 22:00:50
> > > I'm not sure I understand. Are you saying that Klonopin is the one that does or doesn't increase depression?
> > >
> > > Klon aggravates depression in my experience. Unfortunately it is the only thing that has kept my social phobia even minimally under control.
> > >
> >
> > What a drag. What do you do to counteract the depression?
> >
> >
> I take nortriptyline and have taken other drugs that are to all intents and purposes antidepressants- Strattera and buspirone. Their actions on my sleep cycle are exactly the opposite of Klonopin's. If I wasn't so addled from Provigil-induced insomnia I would explain my theory of why klonopin induces depression. In fact I did explain my theory, but like your post the other day mine didn't go through and now I am not up to more explaining. I wonder if I'm going to have to take Ambien every night to sleep in order to stay on Provigil, which is otherwise very promising as far as cognitive and mood effects.
>If it all works well for you and the Ambien allows you to sleep and keep the rest of your regimen without daytime sleepiness, then that isn't too bad of a problem to have.
Posted by SLS on July 12, 2004, at 6:49:24
In reply to Re: tachycardia vs. bradycardia, posted by KaraS on July 11, 2004, at 23:43:31
> Scott, unfortunately I don't know much about treating bipolar disorder.That's quite alright. Apparently, neither do doctors, or I wouldn't be writing this.
> Was that your first episode or have you been battling that for a while now?
I became severely depressed at age 17. I was first diagnosed and treated at age 22. With few exceptions, I have been severely depressed for every hour of every day ever since. I am 44 now (ouch - that hurt). It is an anergic and anhedonic depression with profound cognitive impairments that limit my abilities to read, learn, and remember. My writing style is deceptive.
> I've been straight unipolar depression so I don't have the fear of feeling too high.
I was originally diagnosed as unipolar. It wasn't until I was 26 that a manic phenomenon occurred, and that was the result of a reaction to medication. I have never had a spontaneous manic episode.
> You said that you haven't had the same response to Parnate since your episode. Did you also add in the desipramine again?
Yes. :-(
> I would think that if that combo worked, you could add something else to keep the mania in check. I am probably showing my naive perspective with that remark but I felt I had to ask.
Actually, that is exactly what the doctor should have done. He should have continued me on the antidepressants and treated the mania with lithium and Klonopin. Given my previous history of treatment resistance, he should have at least returned to the same combination of antidepressants once I relapsed. Unfortunately, Prozac had just come out, and it was a new toy for him to play with.
I have tried returning to Parnate + TCA several times, and have added other things to the combo - Parnate 120mg + desipramine 300mg + Dexedrine + T4 for example.
> Also, do you have a lot of confidence in your doctor?
I have been working with my present doctor for over a year. I have quite a bit of confidence in him. Of all the doctors I have seen, he has been the most willing to extend himself beyond traditional treatments.
> Have you ever considered trying any herbal, nutritional or nutraceutical remedies in addition to the meds?
Not as many as some of the people on the PB Alternative Board. I don't have much confidence in them, and I don't want to foster adverse interactions with the drugs I am taking.
> Anyway, wish I could give you a hug but since I can't, I'll just say hang in there. It may take longer than you'd like but there are still plenty of options.
Hmm. Not so many I don't think. You should see my list of the things I've tried. (Actually, that's how my drug chart got started). I guess there are enough things left untried that I haven't given up just yet. However, I don't know how I will react emotionally if Cymbalta doesn't work. That the FDA pissed on gepirone doesn't help. That would have been one more thing to keep me going. I don't know how much rope I have left.
- Scott
Posted by Just a little... on July 12, 2004, at 7:40:27
In reply to Re: tachycardia vs. bradycardia » KaraS, posted by SLS on July 12, 2004, at 6:49:24
>
> > Scott, unfortunately I don't know much about treating bipolar disorder.
>
> That's quite alright. Apparently, neither do doctors, or I wouldn't be writing this.I am going to be treated for autism, after being treated for schizophrenia and borderline after that. It makes me wonder what's next... ADHD? Maybe I'll be even diagnosed "healthy"... I guess I know what you mean.
> > Was that your first episode or have you been battling that for a while now?
>
> I became severely depressed at age 17. I was first diagnosed and treated at age 22. With few exceptions, I have been severely depressed for every hour of every day ever since. I am 44 now (ouch - that hurt). It is an anergic and anhedonic depression with profound cognitive impairments that limit my abilities to read, learn, and remember. My writing style is deceptive.I first got "in touch" with dutch psychiatric care when I was 13 and got weekly "chats" with a social worker... when I was 15 I got diagnosed schizophrenic and I think from that point my life has gone down hill (21 now). The funny part is that the one who diagnosed me only saw me once for half an hour maybe... she put me on paxil and pimozide.
> > I've been straight unipolar depression so I don't have the fear of feeling too high.
>
> I was originally diagnosed as unipolar. It wasn't until I was 26 that a manic phenomenon occurred, and that was the result of a reaction to medication. I have never had a spontaneous manic episode.Ironically they told me I had unipolar depression as well although I now take lithium after going through a manic episode on parnate (coincidence?).
> > You said that you haven't had the same response to Parnate since your episode. Did you also add in the desipramine again?
>
> Yes. :-(
>
> > I would think that if that combo worked, you could add something else to keep the mania in check. I am probably showing my naive perspective with that remark but I felt I had to ask.
>
> Actually, that is exactly what the doctor should have done. He should have continued me on the antidepressants and treated the mania with lithium and Klonopin. Given my previous history of treatment resistance, he should have at least returned to the same combination of antidepressants once I relapsed. Unfortunately, Prozac had just come out, and it was a new toy for him to play with.That sounds familiar... I remember complaining about a side effect of the pimozide (my lip making unvoluntary movements - found funny by my peers but eh... well not by me.) she (the woman who gave me pimozide in the first place) wanted to try a new atypical anti psychotic while she could have given me something against the parkinson like side effects, which was done at a later stage anyway since the atypical (seroquel I believe) had more severe side effects.
> I have tried returning to Parnate + TCA several times, and have added other things to the combo - Parnate 120mg + desipramine 300mg + Dexedrine + T4 for example.
>
> > Also, do you have a lot of confidence in your doctor?
>
> I have been working with my present doctor for over a year. I have quite a bit of confidence in him. Of all the doctors I have seen, he has been the most willing to extend himself beyond traditional treatments.I just got a new psychiatrist (the one diagnosing me with autism), I guess I'll see how it works out :\
> > Have you ever considered trying any herbal, nutritional or nutraceutical remedies in addition to the meds?
>
> Not as many as some of the people on the PB Alternative Board. I don't have much confidence in them, and I don't want to foster adverse interactions with the drugs I am taking.I know what you mean, I'm a little hesitant of taking them myself. I have tried some things though, ranging from vitamins to supplements that are supposed to help against depression...
> > Anyway, wish I could give you a hug but since I can't, I'll just say hang in there. It may take longer than you'd like but there are still plenty of options.
>
> Hmm. Not so many I don't think. You should see my list of the things I've tried. (Actually, that's how my drug chart got started). I guess there are enough things left untried that I haven't given up just yet. However, I don't know how I will react emotionally if Cymbalta doesn't work. That the FDA pissed on gepirone doesn't help. That would have been one more thing to keep me going. I don't know how much rope I have left.It's amazing how much I've learned about drugs since I've started visiting this board, I thought I already know a reasonable bit but I did not... The forum gave me some hope in terms of options might one combination fail, seeing that there are a lot of medications awaiting FDA approval (even though it will still take three years or so to get approved here probably.).
>
> - Scott
It really is too bad there isn't a definite and permanent "cure" for mental disorders, or at least something that makes living the "normal" way possible be it with or without side effects.The awkwardness which I feel when I go out the door and meet other people sometimes leaves me paralyzed, and even though I'm not getting treated for it, I'm sure it must be something in the social phobia area. Hmm, I hope my rambling made some sense... :-\
Take care.
- Falco
Posted by KaraS on July 13, 2004, at 16:29:56
In reply to Re: tachycardia vs. bradycardia » KaraS, posted by SLS on July 12, 2004, at 6:49:24
>
> > Scott, unfortunately I don't know much about treating bipolar disorder.
>
> That's quite alright. Apparently, neither do doctors, or I wouldn't be writing this.
>
> > Was that your first episode or have you been battling that for a while now?
>
> I became severely depressed at age 17. I was first diagnosed and treated at age 22. With few exceptions, I have been severely depressed for every hour of every day ever since. I am 44 now (ouch - that hurt). It is an anergic and anhedonic depression with profound cognitive impairments that limit my abilities to read, learn, and remember. My writing style is deceptive.
>I can relate. I had some signs in my teenage years but really started battling depression in college. I got seriously ill around age 24. I am also now in my 40's (can't hardly believe it myself) and have been dealing at various times with disthymia, major depression and/or atypical depression. Throw in some anxiety/panic disorder in the past and you have the full picture. Well, not really - I may have some ADD that has not been diagnosed as of yet. Currently the anergia and inability to concentrate are my biggest problems and they are preventing me from earning a living (while my money is running out). So I do understand where you're coming from.
Your writing is, as you said, deceptive because you do come across as extremely bright. Your knowledge of the science of brain functioning and psychotropic medications is profound. I suppose I too have some areas where I am very sharp yet still have plenty of cognitive impairment.
> > I've been straight unipolar depression so I don't have the fear of feeling too high.
>
> I was originally diagnosed as unipolar. It wasn't until I was 26 that a manic phenomenon occurred, and that was the result of a reaction to medication. I have never had a spontaneous manic episode.
>I wonder if that really makes you bipolar. Of course that's just semantics isn't it, because if meds can lead you there, then you need to treat it as such.
> > You said that you haven't had the same response to Parnate since your episode. Did you also add in the desipramine again?
>
> Yes. :-(
>
> > I would think that if that combo worked, you could add something else to keep the mania in check. I am probably showing my naive perspective with that remark but I felt I had to ask.
>
> Actually, that is exactly what the doctor should have done. He should have continued me on the antidepressants and treated the mania with lithium and Klonopin. Given my previous history of treatment resistance, he should have at least returned to the same combination of antidepressants once I relapsed. Unfortunately, Prozac had just come out, and it was a new toy for him to play with.
>Yes they do love new toys - but to be fair to your doctor, there was such hype about Prozac back then they he/she probably thought it could really help you a lot.
> I have tried returning to Parnate + TCA several times, and have added other things to the combo - Parnate 120mg + desipramine 300mg + Dexedrine + T4 for example.
>
> > Also, do you have a lot of confidence in your doctor?
>
> I have been working with my present doctor for over a year. I have quite a bit of confidence in him. Of all the doctors I have seen, he has been the most willing to extend himself beyond traditional treatments.
>
> > Have you ever considered trying any herbal, nutritional or nutraceutical remedies in addition to the meds?
>
> Not as many as some of the people on the PB Alternative Board. I don't have much confidence in them, and I don't want to foster adverse interactions with the drugs I am taking.
>
I can tell that you don't have a lot of confidence in althernative treatments but there have been some amazing stories - people who claim never to have responded to anything and then they take SAM-e or Rhodiola or something else and finally the lights go on for the first time. Larry Hoover saw some amazing results in some friends who took Rhodiola which is what led him to seek alternative solutions. In terms of the interaction of alternatives with meds, that is a risk but one that is made minimal by doing your research.If I had the money I would go to someone wholistic and get a full set of tests done. Sometimes they can find things that a shrink can't (or I should say, doesn't) - like you're low in magnesium or l-glutamine or you're missing a key enzyme. Unfortunately science isn't at the point where they can find everything that's missing or malfunctioning, but I would like to see if there is something along these lines that I could try to fix. My feeling is why eliminate anything that could possibly help even a little.
Anyway, I promise I won't hound you about this. In fact, I won't mention it again. I just felt that I had to put it out there.
> > Anyway, wish I could give you a hug but since I can't, I'll just say hang in there. It may take longer than you'd like but there are still plenty of options.
>
> Hmm. Not so many I don't think. You should see my list of the things I've tried. (Actually, that's how my drug chart got started). I guess there are enough things left untried that I haven't given up just yet. However, I don't know how I will react emotionally if Cymbalta doesn't work. That the FDA pissed on gepirone doesn't help. That would have been one more thing to keep me going. I don't know how much rope I have left.
>
> - ScottScott,
My heart broke when I read about the depth of your sadness and the despair in your answers. I wish there were something more that I could do for you other than to tell you to hang in there. I know that it must sound trite after hearing it many times before but it is nonetheless the only way to go. Even if Cymbalta doesn't work for you (you didn't mention anything about the selegiline patch or electromagnetic stimulation?), there are other things on the horizon. The science is expanding exponentially these days relative to the last 40 years and you just don't know what will be discovered next.
Kara
Posted by fires on July 13, 2004, at 23:25:31
In reply to Re: My marplan experience » John, posted by Just a little... on July 9, 2004, at 9:58:19
Sorry for late response and not reading other responses first.
I was on Parnate for 14 years and I was able to tolerate the Othostic hypotension (not hypertension) because my genius doctor gave me 20 mg /day of Reglan. Most Pdocs aren't aware of Reglan's off label benefits.
I stopped Parnate because a cardio. told me it was causing tachycardia. He was wrong and I went to H*ll in a handcart. Turned out I have POTS.
bye
This is the end of the thread.
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