![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 29. Go back in thread:
Posted by jujube on November 3, 2004, at 11:26:37
In reply to Re: Saw pdoc - didn't go as I had hoped - scared, posted by banga on November 3, 2004, at 10:43:55
Thanks. I feel some relief that Anafranil worked for you, and there was no serotonin syndrome issues when combining it with an SSRI.
As far as the pdoc appointment goes, I think I just felt that I didn't get to cover everything I had wanted to. Plus, he shot down the suggestion of adding Provigil (kind of figured he would). I don't think it is used in psychiatric circles in Canada very often. Anyways, he showed me all the possible side effects, and he is probably right that it wouldn't necessarily be a good addition for me at this time. I think he worries about all the research I do. Maybe he's concerned that I am scaring myself away from treatments and meds that could potentially help me. Don't laugh, but I am a bit of a freak when it comes to meds. I am so weird at times, that I will suffer with an excrutiating sinus headache all day because I worry about having a reaction to Sinutab (I had a bad reaction once, but I think I had taken something else just before). The first med I took was Paxil, and that was in my mid-thirties. It was the only psychotropic I was ever on, until I fell into an anxious depression again late last year and have had to experience the frustration and despair of having to try one med after another.
Thanks again. And, I do wish you luck and success on Cymbalta.
Tamara
> Sorry you felt it didn't go well. That's so frustrating. The consolation I could give you from my own case: I combined Anafranil with Lexapro, with no serotonin syndrome problems. I think if the doses aren't huge, it could be OK. My pdoc is very leery of drug interactions, so I doubt he'd have done it if he thought it was risky.
> Anafranil did not make me tired in the least. When it did work for me, it was wonderful--it helped my anxiety too, and on it the antidepressant effect seemed--well more colorful, it seemed my emotions were less flat than they were on the SSRI alone. The ONLY side effect was some weight gain. I had no trouble adjusting doses, no trouble with withdrawal effects--even when I would bend to my impatience and decrease it rapidly. So I can at least be one example that it doesn't necessarily come with a whole load of bad side effects.
> We're each different of course. I too am considering nortryptiline as a next drug, thinking it may be more antianxiety than the Anafranil (currently trying Cymbalta, wish me luck!). But I still have some anafranil around, I feel it is always there if nothing else works. It's just that as soon as I gain 5 lbs, my back hurts....
> Hang in there, it's a tough feeling when you walk away feeling you weren't heard...
Posted by banga on November 3, 2004, at 12:15:30
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » banga, posted by jujube on November 3, 2004, at 11:26:37
I used to be terrified of any meds, now I am just so desperate to return to a normal life....I was never considering a TCA but then a clinic I went to simply prescribed it with no input from me, and my experience with it got me to lower barriers to drug classes other than SSRIs-I saw they weren't as evil as made out to be. In fact, now I am open to anything BUT SSRIs, the sexual side effects and brain-deadedness now keeps me away from those. I also wanted Provigil, my pdoc was not happy but said OK...but my insurance pushed me to try other (cheaper) things first. Good luck with these meds and your pdoc.
Posted by jujube on November 3, 2004, at 12:27:33
In reply to Re: Saw pdoc - didn't go as I had hoped - scared, posted by banga on November 3, 2004, at 12:15:30
I thank you. I appreciate your reassuring and understanding words. I know what you mean about the SSRIs and brain deadness. Although my first experience on a SSRI eight years ago was positive, my recent experiences have been more of a dead from the neck up feeling. Being in the here and now in body but not in mind and spirit. It's kind of like life is passing you by, and you don't or can't give a damn. Well, I hope I have the same positive experience you had on Anafranil.
Take good care, and good luck to you in your treatment.
Tamara
> I used to be terrified of any meds, now I am just so desperate to return to a normal life....I was never considering a TCA but then a clinic I went to simply prescribed it with no input from me, and my experience with it got me to lower barriers to drug classes other than SSRIs-I saw they weren't as evil as made out to be. In fact, now I am open to anything BUT SSRIs, the sexual side effects and brain-deadedness now keeps me away from those. I also wanted Provigil, my pdoc was not happy but said OK...but my insurance pushed me to try other (cheaper) things first. Good luck with these meds and your pdoc.
Posted by KaraS on November 3, 2004, at 14:34:27
In reply to Saw pdoc - didn't go as I had hoped - scared, posted by jujube on November 3, 2004, at 10:25:56
Tamara,
It's probably good to have a bit of fear (or a healthy respect for some of the potential problems) concerning these medications. As long as you don't let it stop you from getting the help that you need. I am the same way. I usually start at 1/2 or even 1/4 of the dosage the doctor tells me to just so I can more gradually ease into it and feel safer with the medication. It takes a bit longer to get to the therapeutic dosage but for me it's the only way I'm able to do it.I hope the Anafranil works well for you. Please keep us posted.
Kara
Posted by KaraS on November 3, 2004, at 14:52:09
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » jujube, posted by Sad Panda on November 3, 2004, at 10:41:49
> > I saw the pdoc yesterday. I am currently on 40 mg of Celexa, after not having any success with Paxil (2nd time); Prozac and Effexor.
> >
> > I raised the issue of a return to Paxil, which had been really effective for me in the past. He said there was no point in trying Paxil (since I didn't respond to it the second time late last year). I should have asked about Remeron, but I couldn't stop crying for most of the appointment.
> >
> > The issue of a TCA came up, and he thought that was the way to go. He said he was going prescribe Anafranil (25 mg to start). Having been a psychiatrist for about 40 years, he has a lot of experience with all types of meds, and he felt that Anafranil would be the most effective. I told him that a chart that I have shows that nortryptline has fewer side effects and maybe that would be better and not as sedating. He didn't think so, given his experience with Anafranil. He wants me reduce my dose of Celexa to 20 mg, and add the Anafranil. Should I be concerned about serotonin syndrome with this combination.
> >
> > I am scared! I want this andhedonic depression gone, but I don't want to be plagued with side effects. I haven't had much of life for a few months now (no energy, no interest, etc.), and it's starting to take its toll on me, my family and my friends. I want to go back to enjoying life again, including all the small pleasures. But, I don't want to be tired and walking around in a fog all the time. I mean, I couldn't even tolerate 25 mg of Trazadone. Am I setting myself up for weeks of side effect misery by starting the Anafranil? Is there a possibility that it could really help my depression and anxiety?
> >
> > I don't know what to do. Anyone have any advice or words of wisdom?
> >
> > Thanks, and sorry for the desperate plea.
> >
> > Tamara
> >
> >
>
> Hi Tamara,
>
> Anafranil is one of the best antidepressants of all time & is well worth trying. Serotonin syndrome is not a worry with Anafranil because it serves as it's own antidote via 5-HT2A antagonism. Nortriptyline is great when added on to a SSRI that is working, but isn't as good as Anafranil when used as monothearpy.
>
> Cheers,
> Paul.
>
Panda,Why do you think it is that we don't hear more or talk more about Anafranil on this board if it is such an effective AD? Also, how would you compare it to maprotiline? (I have been considering trying maprotiline but am a bit worried about weight gain.)
K
Posted by jujube on November 3, 2004, at 16:09:39
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » jujube, posted by KaraS on November 3, 2004, at 14:34:27
Kara,
Thanks. My fear is subsiding somewhat, so I will likely get the script filled in the next couple of days. I will see how I react to the 25mg the first night, and if the side effects are too much, I will start with half the dose. So, thanks for that tip about starting slow. My pdoc actually thinks it's funny that I seem so afraid of meds (not in a malicious way of course). He's quite reassuring though. When I express concern, he pulls out the PDR and goes through all the possible side effects with me, etc. So, he is quite patient in that regard.
I know you are still looking for a new med. How is your search going? What happened to the Cymbalta? Did you have a bad reaction to it?
Take care, and best of luck to you.
Tamara
> Tamara,
>
> It's probably good to have a bit of fear (or a healthy respect for some of the potential problems) concerning these medications. As long as you don't let it stop you from getting the help that you need. I am the same way. I usually start at 1/2 or even 1/4 of the dosage the doctor tells me to just so I can more gradually ease into it and feel safer with the medication. It takes a bit longer to get to the therapeutic dosage but for me it's the only way I'm able to do it.
>
> I hope the Anafranil works well for you. Please keep us posted.
>
> Kara
>
Posted by KaraS on November 3, 2004, at 19:30:51
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » KaraS, posted by jujube on November 3, 2004, at 16:09:39
> Kara,
>
> Thanks. My fear is subsiding somewhat, so I will likely get the script filled in the next couple of days. I will see how I react to the 25mg the first night, and if the side effects are too much, I will start with half the dose. So, thanks for that tip about starting slow. My pdoc actually thinks it's funny that I seem so afraid of meds (not in a malicious way of course). He's quite reassuring though. When I express concern, he pulls out the PDR and goes through all the possible side effects with me, etc. So, he is quite patient in that regard.
>Sounds like you have a good plan for starting the Anafranil. My doctor doesn't have as much patience as yours does. I generally like him but that would be my only complaint. He doesn't get why I'm so scared. I wish I could have him try these medications - then maybe he'd understand.
As for the Cymbalta, I stopped it because of the side effects. I just couldn't function on it and I needed to function or I'd have lost my temporary job. It's not that the side effects were that awful - it's more that I was groggy and brain fogged and I couldn't even drink coffee to keep awake (it made my heart race even with a tiny bit of caffeine). I was afraid to drive as I was so grogged out. I may try it again in the future but for now it's not feasible to continue with it.
K
Posted by Sad Panda on November 4, 2004, at 1:09:25
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » Sad Panda, posted by jujube on November 3, 2004, at 11:14:20
> Thanks so much, I needed some reassurance. I haven't even had the prescription filled yet. Partly because of fear, and partly because it is my birthday in a couple of days, and I don't want to be even more of a zombie at dinner.
>
> A few more questions, if you don't mind. Do you know how severe the side effects are, and how long I can expect them to last? Also, do you know if Anafranil kicks in relatively quickly? Sorry for all the questions. My pdoc says I med phobic, and he may be right.
>
> Thanks again, your response has relieved some of my anxiety about Anafranil.
>
> Tamara
>
>Hi Tamara,
Ask all the questions you want, Dr. Bobs is all about people helping people. :)
Anafranil might provide anxiety relief fairly early, but you will have to wait a little while for it's AD power to kick in as 25mg is a small dose.
Cheers,
Paul.
Posted by Sad Panda on November 4, 2004, at 1:26:36
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » Sad Panda, posted by KaraS on November 3, 2004, at 14:52:09
> Why do you think it is that we don't hear more or talk more about Anafranil on this board if it is such an effective AD? Also, how would you compare it to maprotiline? (I have been considering trying maprotiline but am a bit worried about weight gain.)
>
> K
>
>
>Hi Kara,
It's an Anglo-Saxon thing. The French started using Clomipramine(Anafranil) in 1966 for OCD & Depression, but it didn't arrive in America or Australia until the '80's. I think it was rejected because it was viewed as a copy cat drug & therefore didn't have any advantages over Imipramine or Amitriptyline. What's good about the TCA's is that they are all so different to each other, while the SSRI's are the same as each other.
I don't know too much about Maprotiline. I can't get it here, so I haven't investigated it much. What I have read about it is it doesn't have any advantages over TCA's, but it is more likely to produce convulsions.
Cheers,
Paul.
Posted by KaraS on November 4, 2004, at 2:19:56
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » KaraS, posted by Sad Panda on November 4, 2004, at 1:26:36
> > Why do you think it is that we don't hear more or talk more about Anafranil on this board if it is such an effective AD? Also, how would you compare it to maprotiline? (I have been considering trying maprotiline but am a bit worried about weight gain.)
> >
> > K
> >
> >
> >
>
> Hi Kara,
>
> It's an Anglo-Saxon thing. The French started using Clomipramine(Anafranil) in 1966 for OCD & Depression, but it didn't arrive in America or Australia until the '80's. I think it was rejected because it was viewed as a copy cat drug & therefore didn't have any advantages over Imipramine or Amitriptyline. What's good about the TCA's is that they are all so different to each other, while the SSRI's are the same as each other.
>
> I don't know too much about Maprotiline. I can't get it here, so I haven't investigated it much. What I have read about it is it doesn't have any advantages over TCA's, but it is more likely to produce convulsions.
>
> Cheers,
> Paul.
>Always politics!
I think that MAP's extra tendency to produce seizures is fairly small - more in line with Wellbutrin. I'm more concerned with the weight gain issue.
Thanks,
K
Posted by jujube on November 4, 2004, at 7:13:41
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » jujube, posted by Sad Panda on November 4, 2004, at 1:09:25
> > Thanks so much, I needed some reassurance. I haven't even had the prescription filled yet. Partly because of fear, and partly because it is my birthday in a couple of days, and I don't want to be even more of a zombie at dinner.
> >
> > A few more questions, if you don't mind. Do you know how severe the side effects are, and how long I can expect them to last? Also, do you know if Anafranil kicks in relatively quickly? Sorry for all the questions. My pdoc says I med phobic, and he may be right.
> >
> > Thanks again, your response has relieved some of my anxiety about Anafranil.
> >
> > Tamara
> >
> >
>
> Hi Tamara,
>
> Ask all the questions you want, Dr. Bobs is all about people helping people. :)
>
> Anafranil might provide anxiety relief fairly early, but you will have to wait a little while for it's AD power to kick in as 25mg is a small dose.
>
> Cheers,
> Paul.
>
>Thanks Paul. I will try to be patient!
Tamara
Posted by jujube on November 4, 2004, at 8:14:41
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » KaraS, posted by Sad Panda on November 4, 2004, at 1:26:36
> > Why do you think it is that we don't hear more or talk more about Anafranil on this board if it is such an effective AD? Also, how would you compare it to maprotiline? (I have been considering trying maprotiline but am a bit worried about weight gain.)
> >
> > K
> >
> >
> >
>
> Hi Kara,
>
> It's an Anglo-Saxon thing. The French started using Clomipramine(Anafranil) in 1966 for OCD & Depression, but it didn't arrive in America or Australia until the '80's. I think it was rejected because it was viewed as a copy cat drug & therefore didn't have any advantages over Imipramine or Amitriptyline. What's good about the TCA's is that they are all so different to each other, while the SSRI's are the same as each other.
>
> I don't know too much about Maprotiline. I can't get it here, so I haven't investigated it much. What I have read about it is it doesn't have any advantages over TCA's, but it is more likely to produce convulsions.
>
> Cheers,
> Paul.
>Hmmm. That's interesting about Anafranil. My pdoc is French. Could explain why Anafranil is his first choice when there is only a partial response to SSRIs.
T
Posted by jboud24 on November 4, 2004, at 10:03:43
In reply to Saw pdoc - didn't go as I had hoped - scared, posted by jujube on November 3, 2004, at 10:25:56
Hey Tamara,
Sorry to hear about the pdoc and stuff. Try to look on the upside though: anafranil (sp?) or clomipramine almost always shows superiority to the SSRI's for a multitude of reasons, one of which, like Paul said, is to increase dopamine outflow by blocking the 2a receptor of serotonin. Another thing going for anafranil is that it has clinically meaningful inhibition of the norepinephrine uptake pump, so to a lesser degree it acts like an NRI.From my experience, Lexapro and Celexa are worthless, and if I was you, I'd fully substitue the Anafranil for the lex. Other than that, I know you'll be feeling better soon, so keep your chin up. Oh, and of course let us know how the anafranil works out.
Best wishes,
Justin
Posted by Jasmineneroli on November 5, 2004, at 0:02:31
In reply to Re: Saw pdoc - didn't go as I had hoped - scared, posted by jboud24 on November 4, 2004, at 10:03:43
Sorry to read things are not going so well for you Tamara. You're always so supportive of everyone on the board, don't apologise for expressing your own down times and fears :).
I have never tried Anfranil, but I too have heard good things about it.
I've now given up my 2nd Celexa trial due to S/E's (on my Pdocs recommendation). I'm fed up of SSRI's!!! I'm experimenting with Tryptophan for now, cuz my doc feels I get side effects to everything But a TCA is the next on the list if this doesn't work, so i'll be interested to see how the Anfranil works for you. Keep us updated
and warmest wishes, hang in there!
Jas
Posted by Sad Panda on November 5, 2004, at 9:34:18
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » Sad Panda, posted by KaraS on November 4, 2004, at 2:19:56
> > > Why do you think it is that we don't hear more or talk more about Anafranil on this board if it is such an effective AD? Also, how would you compare it to maprotiline? (I have been considering trying maprotiline but am a bit worried about weight gain.)
> > >
> > > K
> > >
> > >
> > >
> >
> > Hi Kara,
> >
> > It's an Anglo-Saxon thing. The French started using Clomipramine(Anafranil) in 1966 for OCD & Depression, but it didn't arrive in America or Australia until the '80's. I think it was rejected because it was viewed as a copy cat drug & therefore didn't have any advantages over Imipramine or Amitriptyline. What's good about the TCA's is that they are all so different to each other, while the SSRI's are the same as each other.
> >
> > I don't know too much about Maprotiline. I can't get it here, so I haven't investigated it much. What I have read about it is it doesn't have any advantages over TCA's, but it is more likely to produce convulsions.
> >
> > Cheers,
> > Paul.
> >
>
> Always politics!
>
> I think that MAP's extra tendency to produce seizures is fairly small - more in line with Wellbutrin. I'm more concerned with the weight gain issue.
>
> Thanks,
> K
>
>Hi Kara,
Weight gain probably applies to all TCA's to some degree. They are nearly all Norepinephrine reuptake inhibitors & NE increase causes an increase in blood sugar. A lot of them are 5-HT2A antagonists & are very likely to be 5-HT2C antagonists which causes an increase in appetite & they are all antihistamines which is said to cause weight gain. Desipramine is probably the one that would cause the least weight gain followed by it's parent Imipramine. Downside to Desipramine & Imipramine is they do the least for anxiety.
Cheers,
Paul.
Posted by jboud24 on November 5, 2004, at 13:33:25
In reply to Re: Saw pdoc - didn't go as I had hoped - scared, posted by Jasmineneroli on November 5, 2004, at 0:02:31
Zoloft was the best anti-anxiety-anti-depressant I took. While all the other SSRI's had a similar feel and effect to them, Zoloft felt different: smoother, greatly reduced anxiety, wiped out depression, and made me feel semi-normal for the first time in many years. I see that you are supplementing with tryptophan. Personally, I doubt it'll do much, but if it does, keep us posted on your progress with that.
Just thought I'd share my experiences with you since alot of the meds we've taken are similar.
Best wishes,
Justin
Posted by Jasmineneroli on November 5, 2004, at 22:33:29
In reply to Jas-Have you tried Zoloft?! » Jasmineneroli, posted by jboud24 on November 5, 2004, at 13:33:25
Hey Justin:
No I haven't tried Zoloft (just Paxil and Celexa of the straight ssri's, plus Buspar, Amitriptyline, Remeron, Effexor and Moclobemide and Clonazepam).
I get s/e's to everything, except Clonazepam. That's why my Pdoc prescribed pharmaceutical grade L-Tryptophan as a new experiment. Don't know if it's helping yet. I had a very "hyper-active" anxious day today.
I'm not worrying or stressed (in the negative sense). Just very creative with ideas and lots of thoughts chasing around, a bit scattered,feeling happy, but my body reacts as though I'm afraid or nervous. Lots of churning, buzzing bees and butterflies in the stomach (a big knotted ball) and a feeling of physical energy that is almost painful and must be released! I have to move a lot! Then I can't speak..trip over my tongue, can't string a sentence together and start to think people are perceiving me as peculiar!
Do you think Zoloft will help with that?
Not too optimistic about the Tryptophan, but at least I have no side effects :)
I go back to the Pdoc in about 3 weeks, so I'll raise the Zoloft suggestion with him.
Thanks for the idea.
Jas
Posted by jboud24 on November 6, 2004, at 6:48:11
In reply to Re: Jas-Have you tried Zoloft?! » jboud24, posted by Jasmineneroli on November 5, 2004, at 22:33:29
Jas,
Zoloft helped me with my anxiety which is severe I would say. It was better than Paxil in that regard and mucho better than Celexa/Lexapro, and it caused the fewest side-effects of the 4 AD's I've taken. It has a very smooth feeling to it. I think it definitely could help you.Hope it goes well at your next pdoc appt.
Justin
Posted by jujube on November 6, 2004, at 10:36:31
In reply to Re: Saw pdoc - didn't go as I had hoped - scared, posted by Jasmineneroli on November 5, 2004, at 0:02:31
Thanks so much for your kind words. I will probably start the Anafranil on Monday once I have psyched myself up, so we'll see how it goes then. All I know is that I want to feel like a human being again, and if Anafranil will help, then I'll do my best to deal with whatever side effects I encounter.
Take care.
Tamara
> Sorry to read things are not going so well for you Tamara. You're always so supportive of everyone on the board, don't apologise for expressing your own down times and fears :).
> I have never tried Anfranil, but I too have heard good things about it.
> I've now given up my 2nd Celexa trial due to S/E's (on my Pdocs recommendation). I'm fed up of SSRI's!!! I'm experimenting with Tryptophan for now, cuz my doc feels I get side effects to everything But a TCA is the next on the list if this doesn't work, so i'll be interested to see how the Anfranil works for you. Keep us updated
> and warmest wishes, hang in there!
> Jas
Posted by jujube on November 6, 2004, at 15:19:18
In reply to Re: Saw pdoc - didn't go as I had hoped - scared, posted by jboud24 on November 4, 2004, at 10:03:43
Thanks Justin. I have been putting off starting the Anafranil for the past few days. I will probably start on Monday. I'm still a little nervous about side effects, but I guess I'll never know until I start taking it. If the side effects are unbearable, I will stop. But, I will try to give it at least two weeks before I give up. I don't have anything to lose, except this misery of a depression. I'm going to keep my fingers crossed. Who knows, maybe by the time the snow gets here, I will be ready and willing for skiing.
Tamara
> Hey Tamara,
> Sorry to hear about the pdoc and stuff. Try to look on the upside though: anafranil (sp?) or clomipramine almost always shows superiority to the SSRI's for a multitude of reasons, one of which, like Paul said, is to increase dopamine outflow by blocking the 2a receptor of serotonin. Another thing going for anafranil is that it has clinically meaningful inhibition of the norepinephrine uptake pump, so to a lesser degree it acts like an NRI.
>
> From my experience, Lexapro and Celexa are worthless, and if I was you, I'd fully substitue the Anafranil for the lex. Other than that, I know you'll be feeling better soon, so keep your chin up. Oh, and of course let us know how the anafranil works out.
>
> Best wishes,
> Justin
Posted by KaraS on November 6, 2004, at 18:04:49
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » KaraS, posted by Sad Panda on November 5, 2004, at 9:34:18
> > > > Why do you think it is that we don't hear more or talk more about Anafranil on this board if it is such an effective AD? Also, how would you compare it to maprotiline? (I have been considering trying maprotiline but am a bit worried about weight gain.)
> > > >
> > > > K
> > > >
> > > >
> > > >
> > >
> > > Hi Kara,
> > >
> > > It's an Anglo-Saxon thing. The French started using Clomipramine(Anafranil) in 1966 for OCD & Depression, but it didn't arrive in America or Australia until the '80's. I think it was rejected because it was viewed as a copy cat drug & therefore didn't have any advantages over Imipramine or Amitriptyline. What's good about the TCA's is that they are all so different to each other, while the SSRI's are the same as each other.
> > >
> > > I don't know too much about Maprotiline. I can't get it here, so I haven't investigated it much. What I have read about it is it doesn't have any advantages over TCA's, but it is more likely to produce convulsions.
> > >
> > > Cheers,
> > > Paul.
> > >
> >
> > Always politics!
> >
> > I think that MAP's extra tendency to produce seizures is fairly small - more in line with Wellbutrin. I'm more concerned with the weight gain issue.
> >
> > Thanks,
> > K
> >
> >
>
> Hi Kara,
>
> Weight gain probably applies to all TCA's to some degree. They are nearly all Norepinephrine reuptake inhibitors & NE increase causes an increase in blood sugar. A lot of them are 5-HT2A antagonists & are very likely to be 5-HT2C antagonists which causes an increase in appetite & they are all antihistamines which is said to cause weight gain. Desipramine is probably the one that would cause the least weight gain followed by it's parent Imipramine. Downside to Desipramine & Imipramine is they do the least for anxiety.
>
> Cheers,
> Paul.
>Paul,
I never knew all of those reasons the TCAs can promote weight gain. I always assumed that the weight gain was from increased appetite only. I actually lost weight on Nort. because it speeded me up so much and so it decreased my appetite. I wonder if I had been able to tolerate it longer and at higher dosage whether that would have continued to be the case. (Same goes for desipramine for me.)
There doesn't seem to be much reason to take immipramine anymore. It's so much like Cymbalta but with additional anticholinergic effects, don't you think?
Kara
Posted by Sad Panda on November 8, 2004, at 9:14:43
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » Sad Panda, posted by KaraS on November 6, 2004, at 18:04:49
> > > > > Why do you think it is that we don't hear more or talk more about Anafranil on this board if it is such an effective AD? Also, how would you compare it to maprotiline? (I have been considering trying maprotiline but am a bit worried about weight gain.)
> > > > >
> > > > > K
> > > > >
> > > > >
> > > > >
> > > >
> > > > Hi Kara,
> > > >
> > > > It's an Anglo-Saxon thing. The French started using Clomipramine(Anafranil) in 1966 for OCD & Depression, but it didn't arrive in America or Australia until the '80's. I think it was rejected because it was viewed as a copy cat drug & therefore didn't have any advantages over Imipramine or Amitriptyline. What's good about the TCA's is that they are all so different to each other, while the SSRI's are the same as each other.
> > > >
> > > > I don't know too much about Maprotiline. I can't get it here, so I haven't investigated it much. What I have read about it is it doesn't have any advantages over TCA's, but it is more likely to produce convulsions.
> > > >
> > > > Cheers,
> > > > Paul.
> > > >
> > >
> > > Always politics!
> > >
> > > I think that MAP's extra tendency to produce seizures is fairly small - more in line with Wellbutrin. I'm more concerned with the weight gain issue.
> > >
> > > Thanks,
> > > K
> > >
> > >
> >
> > Hi Kara,
> >
> > Weight gain probably applies to all TCA's to some degree. They are nearly all Norepinephrine reuptake inhibitors & NE increase causes an increase in blood sugar. A lot of them are 5-HT2A antagonists & are very likely to be 5-HT2C antagonists which causes an increase in appetite & they are all antihistamines which is said to cause weight gain. Desipramine is probably the one that would cause the least weight gain followed by it's parent Imipramine. Downside to Desipramine & Imipramine is they do the least for anxiety.
> >
> > Cheers,
> > Paul.
> >
>
> Paul,
>
> I never knew all of those reasons the TCAs can promote weight gain. I always assumed that the weight gain was from increased appetite only. I actually lost weight on Nort. because it speeded me up so much and so it decreased my appetite. I wonder if I had been able to tolerate it longer and at higher dosage whether that would have continued to be the case. (Same goes for desipramine for me.)
>
> There doesn't seem to be much reason to take immipramine anymore. It's so much like Cymbalta but with additional anticholinergic effects, don't you think?
>
> Kara
>
>Hi Kara,
I wouldn't rush to throw out Imipramine as a possible candidate in the future, I seriously doubt the Cymbalta is going to be any better than it.
Cheers,
Paul.
Posted by KaraS on November 9, 2004, at 12:49:35
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » KaraS, posted by Sad Panda on November 8, 2004, at 9:14:43
> > > > > > Why do you think it is that we don't hear more or talk more about Anafranil on this board if it is such an effective AD? Also, how would you compare it to maprotiline? (I have been considering trying maprotiline but am a bit worried about weight gain.)
> > > > > >
> > > > > > K
> > > > > >
> > > > > >
> > > > > >
> > > > >
> > > > > Hi Kara,
> > > > >
> > > > > It's an Anglo-Saxon thing. The French started using Clomipramine(Anafranil) in 1966 for OCD & Depression, but it didn't arrive in America or Australia until the '80's. I think it was rejected because it was viewed as a copy cat drug & therefore didn't have any advantages over Imipramine or Amitriptyline. What's good about the TCA's is that they are all so different to each other, while the SSRI's are the same as each other.
> > > > >
> > > > > I don't know too much about Maprotiline. I can't get it here, so I haven't investigated it much. What I have read about it is it doesn't have any advantages over TCA's, but it is more likely to produce convulsions.
> > > > >
> > > > > Cheers,
> > > > > Paul.
> > > > >
> > > >
> > > > Always politics!
> > > >
> > > > I think that MAP's extra tendency to produce seizures is fairly small - more in line with Wellbutrin. I'm more concerned with the weight gain issue.
> > > >
> > > > Thanks,
> > > > K
> > > >
> > > >
> > >
> > > Hi Kara,
> > >
> > > Weight gain probably applies to all TCA's to some degree. They are nearly all Norepinephrine reuptake inhibitors & NE increase causes an increase in blood sugar. A lot of them are 5-HT2A antagonists & are very likely to be 5-HT2C antagonists which causes an increase in appetite & they are all antihistamines which is said to cause weight gain. Desipramine is probably the one that would cause the least weight gain followed by it's parent Imipramine. Downside to Desipramine & Imipramine is they do the least for anxiety.
> > >
> > > Cheers,
> > > Paul.
> > >
> >
> > Paul,
> >
> > I never knew all of those reasons the TCAs can promote weight gain. I always assumed that the weight gain was from increased appetite only. I actually lost weight on Nort. because it speeded me up so much and so it decreased my appetite. I wonder if I had been able to tolerate it longer and at higher dosage whether that would have continued to be the case. (Same goes for desipramine for me.)
> >
> > There doesn't seem to be much reason to take immipramine anymore. It's so much like Cymbalta but with additional anticholinergic effects, don't you think?
> >
> > Kara
> >
> >
>
> Hi Kara,
>
> I wouldn't rush to throw out Imipramine as a possible candidate in the future, I seriously doubt the Cymbalta is going to be any better than it.
>
> Cheers,
> Paul.
>
>
>Looking at Scott's chart I see that immipramine is also an NE-alpha1 antagonist. So it looks like it does have something extra that duloxetine doesn't (besides the ACh(m) antagonism).
K
Posted by violetskyye on November 30, 2004, at 14:12:13
In reply to Re: Saw pdoc - didn't go as I had hoped - scared » KaraS, posted by jujube on November 3, 2004, at 16:09:39
Jujube:
Hang in there. I, too, am so afraid of med side-effects that every time I take a med, in 30 seconds I start feeling weird. Ironically, it was part of my OCD that I felt that every med I try would make me crazy. My doctor had to have a lot of patience.
My experience with Anafranil was not great. It didn't do anything horrible, but I felt weird and disconnected, had ringing in the ears and felt generally strange the whole couple of weeks I tried it. The effects may have gone away if I stuck with it, but I stopped taking it.
The reason I think TCA's are not the "first-line" prescriptions is that they do have more of the dry-mouth, nausea-type side-effects, though many think they are much stronger and more effective than SSRI's. Also, Anafranil is the gold-standard med for OCD [though it did nothing for mine.]
Anyway, try it for a few weeks, and try to fight through the side-effects. My first 4 weeks on Remeron were a hell of confusion and overwhelming sleepiness, but I stuck it out, and it has calmed my anxiety pretty well.
Hang in there, because if the Ananfranil doesn't work, something will, and as my doc told me, even though some meds may feel weird and scary, the side effects won't actually harm you.
Posted by jujube on November 30, 2004, at 18:25:33
In reply to Re: Saw pdoc - didn't go as I had hoped - scared, posted by violetskyye on November 30, 2004, at 14:12:13
Thanks for the encouragement, and for sharing your experience with me. I don't really obsess about the possible side effects. I do, however, like to know what to expect, so if I do experience something adverse, I know what it can be attributed to. I have decided that I will give it a month, and if there is no relief from the anhedonia I am experiencing, I will give up. Anafranil is the fifth AD I have tried in the past year, each of which have left me fatigued and apathetic. I have been on the Anafranil for just over two weeks now, but I am noticing that the dizziness seems to be getting worse and is very unpleasant. The dry mouth I can handle because I drink a lot of water and use an oral rinse two or three times a day. However, I, too, am feeling a bit weird and disconnected on the Anafranil. It's so frustrating.
Anayways, take care and thanks again.
Tamara
> Jujube:
>
> Hang in there. I, too, am so afraid of med side-effects that every time I take a med, in 30 seconds I start feeling weird. Ironically, it was part of my OCD that I felt that every med I try would make me crazy. My doctor had to have a lot of patience.
>
> My experience with Anafranil was not great. It didn't do anything horrible, but I felt weird and disconnected, had ringing in the ears and felt generally strange the whole couple of weeks I tried it. The effects may have gone away if I stuck with it, but I stopped taking it.
>
> The reason I think TCA's are not the "first-line" prescriptions is that they do have more of the dry-mouth, nausea-type side-effects, though many think they are much stronger and more effective than SSRI's. Also, Anafranil is the gold-standard med for OCD [though it did nothing for mine.]
>
> Anyway, try it for a few weeks, and try to fight through the side-effects. My first 4 weeks on Remeron were a hell of confusion and overwhelming sleepiness, but I stuck it out, and it has calmed my anxiety pretty well.
>
> Hang in there, because if the Ananfranil doesn't work, something will, and as my doc told me, even though some meds may feel weird and scary, the side effects won't actually harm you.
This is the end of the thread.
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