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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by jujube on December 12, 2004, at 14:28:18
It has been just over a month since my pdoc put me on Anafranil. I am currently at 50 mg, and had hoped to be able to go up to 75 mg, but am finding some side effects unpleasant for me (dizziness/lightheadedness, constipation, weight gain - 6 pounds with no change to eating habits). I know if I go up to 75 mg, these side effects will likely get worse. And, at 50 mg, I do not see much difference in therapeutic benefits compared to the Celexa I had been taking prior to the Anafranil (at pdoc's instruction, I continue to take at a small dose of Celexa).
So, I am thinking of keeping a small dose of Celexa and trying some natural alternatives (NADH, Sam-e, DMAE). If those fail me, after an adequate trial, I will go back to an AD. If that ends up being the case, what should I pursue? Imipramine? Nortriptyline? Provigil with the Celexa?
Any and all views would be greatly appreciated. I am beginning to sound like a broken record here, but I am getting frustrated and starting to run out of hope that anything will help me regain my zest for life.
Thanks.
Tamara
Posted by zeugma on December 12, 2004, at 15:23:28
In reply to Should I just cut my losses or what?, posted by jujube on December 12, 2004, at 14:28:18
tamara,
I didn't know you were continuing to take Celexa with clomipramine.
While 50 mg clomipramine is well below the therapeutic threshold for clomipramine, it's in the range for nortriptyline. To me the combination nortriptyline plus Celexa makes more sense than combining clompramine with Celexa.
Adding nortriptyline will almost certainly result in similar s/e to the ones you are experiencing with clomipramine. The difference is that dose escalation beyond that point will probably not be necessary.
Provigil is a strange drug, and made me gain weight (more than nortriptyline!). Its effects can be unpredictable. For me, its efficacy was remarkable, but so were its side effects.
Cutting one's losses has to be balanced against symptom control. This necessitates hard choices, and often the outcome is less than perfect, but outcomes seldom are.
Posted by jujube on December 12, 2004, at 17:10:16
In reply to Re: Should I just cut my losses or what?, posted by zeugma on December 12, 2004, at 15:23:28
Zeugma,
Thanks for the response. I was surprised when the pdoc told me to continue to take Celexa as well, particularly since I understood clomipramine to be very serotogenic. I had such high hopes for the clomipramine. And, I really thought it was having more of an effect on me than the Celexa. But, it really hasn't at 50 mg when I think about it. I think 75 mg would probably do the trick, but I am just finding the dizziness particularly to be problematic.
I know that most of my problem is anxiety, all stemming from a huge panic attack I had a number of months ago when I was getting over the flu and suffering from really bad iron deficiency and when I was slightly burnt-out from working 11 - 12 hour days for years with minimal, if any, time off. I keep replaying that stupid panic attack, and it makes me anxious when I go to do anything (the old "what if" mind set that just won't shut off). The pdoc does not want me using Xanax. I told him months ago that when I go through something like this I only need the Xanax for a week or 2 at a dose of only .25 mg (or half of that) once or twice a day. Then I am fine. Oh well. I do have a small amount of Xanax on hand, so perhaps I will test my theory.
If you don't mind my asking, what side effects, besides weight gain, made you give up on the Provigil? Provigil is something I remain intersted in, particularly if my trials with NADH and DMAE don't pan out.
Thanks again, and sorry for rambling on so much.
Tamara
Posted by zeugma on December 12, 2004, at 17:37:46
In reply to Re: Should I just cut my losses or what? » zeugma, posted by jujube on December 12, 2004, at 17:10:16
If you don't mind my asking, what side effects, besides weight gain, made you give up on the Provigil? Provigil is something I remain intersted in, particularly if my trials with NADH and DMAE don't pan out.
The Provigil weight gain was actually desirable in my case, as I am underweight and continue to struggle with appetite problems on Ritalin; Ritalin-induced anorexia is considered one of the limiting factors when dosing.
Weird side effects: sweating profusely; feeling overheated in my body while my brain would 'freeze'; constant queasiness (actually, this was similar to, though less severe than, my experience on SSRI's); lymph node enlargement in my neck (this one scared the crap out of me).
The drug made me feel immediately ill, when I took 50 mg the first time. At the low dose, it was the queasiness that reminded me of my days on SRRI's, although I did not experience severe nausea on Provigil. I didn't like it, and it never went away, but I stuck with it, and as I reached 100 mg, the other s/e started to become prominent, and they simply refused to diminish. I finally had to ask myself if the major improvements in my functioning (Provigil was FAR AND AWAY the most effective drug I have ever taken for my ADHD, which is quite disabling, and did not increase my anxiety- only the hepatotoxic pemoline matches Provigil in this regard) were worth these troubling side effects. I decided that it was not, my performance on the job promptly declined, and I have had to deal with Ritalin, whose relative ineffectiveness frustrates the crap out of me, but Rit at least does not come with weird s/e (anxiety and weight loss are very common). So I'm anxious, skeletal, and needing high doses of Ritalin to approximate the Provigil effect, but at least I don't spend every day wondering how many years the meds will shave off my life.
If you try provigil, I certainly hope you have better luck with it than I did.
Posted by jujube on December 12, 2004, at 17:49:13
In reply to Re: Should I just cut my losses or what? » jujube, posted by zeugma on December 12, 2004, at 17:37:46
Yipes! Those side effects sound incredibly unpleasant. I am surprised you lasted as long as you did. I must seem like a wimp to be giving up on clomipramine because of the side effects I am experiencing.
Have you ever tried DMAE? I had thought that it was simply a natural supplement. However, it apparently was first developed as an ADD/ADHD med (deanol). When the FDA asked the company to undertake more clinical trials (I think that was the case), it was decided that more trials would be too costly. So, it is now sold as a nutritional supplement. At the place where I bought mine recently, the lady who runs the place told me that one of her clients was able to take her son off of Ritalin when he started using DMAE. The nice thing is no side effects.
Anyways, thanks again for the response and the info. Much appreciated.
Tamara
Posted by zeugma on December 13, 2004, at 15:55:34
In reply to Re: Should I just cut my losses or what? » zeugma, posted by jujube on December 12, 2004, at 17:49:13
> Yipes! Those side effects sound incredibly unpleasant. I am surprised you lasted as long as you did. I must seem like a wimp to be giving up on clomipramine because of the side effects I am experiencing.
It depends on the severity of symptoms; the worse they are, the more unpleasant side effects you'll put up with: my ADHD, fatigue, and probable narcolepsy are quite disabling. I have also gone unmedicated for prolonged periods, and those side effects sometimes seemed like a picnic in comparison.
>
> Have you ever tried DMAE? I had thought that it was simply a natural supplement. However, it apparently was first developed as an ADD/ADHD med (deanol). When the FDA asked the company to undertake more clinical trials (I think that was the case), it was decided that more trials would be too costly. So, it is now sold as a nutritional supplement. At the place where I bought mine recently, the lady who runs the place told me that one of her clients was able to take her son off of Ritalin when he started using DMAE. The nice thing is no side effects.
>I simply do not believe that an efficacious medication can have no side effects. However, I am willing to be pleasantly surprised :) I will look up and research DMAE. The thing is that the Ritalin dosing is so tricky (30 mg Ritalin LA am then 30 mg noon, to have ANY effect at all)that I anticipate problems if I try to come off this dosage. Plus I am taking other meds, and I will have to investigate for interactions. With this kind of thing, too, you're on your own, because pdocs are unsure enough about the interactions between prescribed medications: for a pdoc to be well-informed about interactions with DMAE... well, I'll have to look at the literature available and see.
> Anyways, thanks again for the response and the info. Much appreciated.
Very welcome.-z>
> Tamara
Posted by jasmineneroli on December 14, 2004, at 22:50:11
In reply to Re: Should I just cut my losses or what? » jujube, posted by zeugma on December 13, 2004, at 15:55:34
Tamara:
If you're a broken record, I must be the dumpster behind the record factory!!!
I know exactly how you feel, so tired of trying things...hopeful each time, frustrated by side effects...waiting for a therapeutic effect, being patient, so patient, then realizing it's not working, or the S/E's are not abating, and "OK Doc, what next?". Research, research and bug everyone at Babble AGAIN! Aaagh!!!!
Don't apologise...it seems to be the way of things with mental health issues.I think you probably know yourself well enough to decide when you've given the Anafranil a long enough chance.
I don't have any experience with Provigil, but all the research on Nortryptiline I've done, makes that drug seem like a good bet. I've been considering it myself, but I found it uses a liver enzyme that doesn't work well for me.I did take DMAE, a few years ago, before my GAD exploded, and found it did give me mental clarity and focus. I don't take it now, simply because I'm always experimenting with drugs (or tryptophan right now), that it will just confuse the situation. Also, I'm afraid it may exascerbate my anxiety.
Good luck with your ongoing search for the Holy Grail!!!
Jas
Posted by jujube on December 15, 2004, at 15:01:17
In reply to Re: Should I just cut my losses or what?, posted by jasmineneroli on December 14, 2004, at 22:50:11
> Tamara:
> If you're a broken record, I must be the dumpster behind the record factory!!!-- LOL - You are too funny!
> I know exactly how you feel, so tired of trying things...hopeful each time, frustrated by side effects...waiting for a therapeutic effect, being patient, so patient, then realizing it's not working, or the S/E's are not abating, and "OK Doc, what next?". Research, research and bug everyone at Babble AGAIN! Aaagh!!!!
-- It's frustrating trying things, but doing the research before hand can be quite interesting, not to mention therapeutic. I'm glad I found this board. It sure helps to read antecdotal evidence about the meds instead of having to go in cold to the pdoc.
> Don't apologise...it seems to be the way of things with mental health issues.
-- So true. What works for one, will not necessarily work for another. But when you find something that works, it is so nice just to feel normal again (if there really is such a thing as normal!).
> I think you probably know yourself well enough to decide when you've given the Anafranil a long enough chance.-- I told myself that there would be no more 8 week trials. It just prolongs the agony staying on a med you already know is not going to work and at the same time having to deal with the side effects that further impede your quality of life.
> I don't have any experience with Provigil, but all the research on Nortryptiline I've done, makes that drug seem like a good bet. I've been considering it myself, but I found it uses a liver enzyme that doesn't work well for me.
-- Like you, I am going to try the natural route for a while (with a small dose of Celexa and Xanax when I really need it). I am going to try DMAE with NADH and either Rhodiola or Sam-e. If that does not work, then I will ask for nortryptiline.
> I did take DMAE, a few years ago, before my GAD exploded, and found it did give me mental clarity and focus. I don't take it now, simply because I'm always experimenting with drugs (or tryptophan right now), that it will just confuse the situation. Also, I'm afraid it may exascerbate my anxiety.-- In the few days that I have taken the DMAE, I have not found that it has exacerbated my anxiety (knock on wood and I'll keep my fingers crossed). The NADH seems to have had a bit of an effect already. The first day I took 2.5 mg, second day 5 mg, and I intend to try 7.5 mg next. I am thinking that 7.5 mg or 10 mg might be the optimum dose for me.
>
> Good luck with your ongoing search for the Holy Grail!!!-- Right back atcha Jas!
Tamara
>
Posted by ravenstorm on December 15, 2004, at 20:06:21
In reply to Re: Should I just cut my losses or what? » jasmineneroli, posted by jujube on December 15, 2004, at 15:01:17
Pardon my intrusion, but what is DMAE?
If you suffer from anxiety at all, I would recommend staying away from SAME, it sent me right through the roof. I shook all day!!!!
Posted by Dr. Bob on December 16, 2004, at 22:00:05
In reply to Re: Should I just cut my losses or what?, posted by ravenstorm on December 15, 2004, at 20:06:21
> Pardon my intrusion, but what is DMAE?
Sorry to interrupt, but I'd like to redirect follow-ups regarding DMAE (and other alternative treatments) to Psycho-Babble Alternative. Here's a link:
http://www.dr-bob.org/babble/alter/20041212/msgs/430543.html
Thanks,
Bob
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