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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 Fromage47 on August 17, 2004, at 10:50:20
I am in great need of a very strong anti-depressant (I have been on them all - currently i am on imipramine) - i like the imipramine's effects as an anti-depressant, but it is giving me severe cardiovascular issues in combination with the adderall I take. It is raising my blood pressure and causing a panic disorder that i conquered years ago. I have to quit taking it, but i dont want to quit the adderall. Any suggestions?
Posted by Larry Hoover on August 17, 2004, at 11:13:06
In reply to Strong anti-dep. with no cardio effects with adder, posted by Fromage47 on August 17, 2004, at 10:50:20
> I am in great need of a very strong anti-depressant (I have been on them all - currently i am on imipramine) - i like the imipramine's effects as an anti-depressant, but it is giving me severe cardiovascular issues in combination with the adderall I take. It is raising my blood pressure and causing a panic disorder that i conquered years ago. I have to quit taking it, but i dont want to quit the adderall. Any suggestions?
Lofepramine?
Drugs. 1989 Feb;37(2):123-40.
Lofepramine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness.
Lancaster SG, Gonzalez JP.
ADIS Drug Information Services, Manchester, England.
Lofepramine is a tricyclic antidepressant that is structurally similar to imipramine and is extensively metabolised to desipramine. In the absence of other major pharmacological effects it appears that its antidepressant activity stems from the facilitation of noradrenergic neurotransmission by uptake inhibition, and possibly by the additional facilitation of serotoninergic neurotransmission. The overall therapeutic efficacy of lofepramine is comparable to that of imipramine, amitriptyline, clomipramine, maprotiline and mianserin in patients with depression of varying severity, and coexisting anxiety. Dry mouth is the most commonly reported side effect of usual therapeutic doses of lofepramine, but the incidence of this and other anticholinergic side effects is less among patients treated with lofepramine than with imipramine. Lofepramine has not been associated with adverse effects on cardiac function even in cases of attempted suicide by overdose. Thus, providing its apparent favourable side effect profile is confirmed in practice, lofepramine may be a valuable alternative for treatment of the depressed patient where a tricyclic is indicated.
Posted by Fromage47 on August 17, 2004, at 11:44:25
In reply to Re: Strong anti-dep. with no cardio effects with adder » Fromage47, posted by Larry Hoover on August 17, 2004, at 11:13:06
What are anti-chholigernic side effects? Also, what is its lofepramine's brand name?
Also larry, have you seen this?
Amphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause STRIKING AND SUSTAINED INCREASES in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated."
Do you think that could apply to all trycyclics, including lofepramine?
Posted by crazychickuk on August 17, 2004, at 13:04:36
In reply to Re: Strong anti-dep. with no cardio effects with adder, posted by Fromage47 on August 17, 2004, at 11:44:25
I read somewhere that all tca's affect cardo.. i got same problem as you.. whats adderal for?
Posted by Fromage47 on August 17, 2004, at 20:23:39
In reply to Re: Strong anti-dep. with no cardio effects with adder, posted by crazychickuk on August 17, 2004, at 13:04:36
Adderall is an amphetamine based medication used to treat ADHD and narcolepsy. Certain TCAs (if not all) potentiate its effects. There's a whole other thread on this called "amphetamines and tricyclics" if you want the details. What I am trying to find out is what is the best tca with the least cardio side-effects, or if their is none, what is another good STRONG anti-depressant. however, i like TCAs because they seem to be stronger and more effective on me in curing my depression.
Posted by Larry Hoover on August 19, 2004, at 7:13:54
In reply to Re: Strong anti-dep. with no cardio effects with adder, posted by Fromage47 on August 17, 2004, at 11:44:25
> What are anti-chholigernic side effects?
Dry mouth, constipation, dizziness (particular on standing), heart rate disturbance, eye problems, prostate enlargement....
> Also, what is its lofepramine's brand name?
Gamanil, Lomont.
> Also larry, have you seen this?
>
> Amphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause STRIKING AND SUSTAINED INCREASES in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated."
>
> Do you think that could apply to all trycyclics, including lofepramine?Lofepramine metabolizes to become desipramine, so yes, it would apply. So, the problems you were having are probably an interaction. You may have to just give up one type of drug, or the other.
Lar
Posted by Larry Hoover on August 19, 2004, at 7:15:24
In reply to Re: Strong anti-dep. with no cardio effects with adder, posted by Fromage47 on August 17, 2004, at 20:23:39
> Adderall is an amphetamine based medication used to treat ADHD and narcolepsy. Certain TCAs (if not all) potentiate its effects. There's a whole other thread on this called "amphetamines and tricyclics" if you want the details. What I am trying to find out is what is the best tca with the least cardio side-effects, or if their is none, what is another good STRONG anti-depressant. however, i like TCAs because they seem to be stronger and more effective on me in curing my depression.
Specific testing of lofepramine suggests that it is one of the least likely to affect cardiac function....or at least, that's what they're saying on Pubmed.
Lar
Posted by Fromage47 on August 19, 2004, at 13:55:07
In reply to Re: Strong anti-dep. with no cardio effects with adder » Fromage47, posted by Larry Hoover on August 19, 2004, at 7:15:24
What about Effexor? I know that effexor does little for dopamine and mainly effects serotonin and norepinephrine. Would that mean that it would decrease the effects of the adderall, since adderall largely effects dopamine?
Posted by zeugma on August 19, 2004, at 15:49:14
In reply to Strong anti-dep. with no cardio effects with adder, posted by Fromage47 on August 17, 2004, at 10:50:20
yea, my dilemma is this: i have gotten better on nortriptyline, and it can be less than ideal to combine with a stimulant because of the cardiac issues. I tried Strattera which has no cardiotoxicity, and it eventually drove me into an anhedonic depression (I had melancholia previously but not anhedonia). Nortriptyline works for my depression but I also have narcolepsy (I think) and ADHD... tried Provigil but it gave me insomnia. So I'm taking a pediatric dosage of Ritalin LA (10 mg) and making the best of it.
This is the end of the thread.
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