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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by banga on February 14, 2005, at 12:15:45
Hi
What do you think of the formula for anxious depression, amotivation and ADHD symptoms?Desipramine 100mg
Lamictal 200mg
Adderall XR 15mg BID(assuming it is still on market)
Abilify 2.5mg (may discontinue)
Luvox ??mg.I have yet to add the luvox for residual anxiety and low moods. I may ask my pdoc if I can try dexedrine instead of adderall, people here saying it may be anxiolytic (my pdoc didņt believe me, maybe this time around I can convince him)
This formula may overdo the norepinephrine--desipramine and adderall potentiate each other, maybe part of why I have anxious tension but my mind is SO much clearer and my depression is so much less that I fear reducing the doses. Maybe once I get the Lvox on board I can lessen the desipramine....
I figure Luvox plus desipramine together is sort of like imipramine but with better overall clinical and side effect profile.....
Posted by Ritch on February 14, 2005, at 13:37:35
In reply to My Formula for MD, ANX, ADHD.?, posted by banga on February 14, 2005, at 12:15:45
> Hi
> What do you think of the formula for anxious depression, amotivation and ADHD symptoms?
>
> Desipramine 100mg
> Lamictal 200mg
> Adderall XR 15mg BID(assuming it is still on market)
> Abilify 2.5mg (may discontinue)
> Luvox ??mg.
>
> I have yet to add the luvox for residual anxiety and low moods. I may ask my pdoc if I can try dexedrine instead of adderall, people here saying it may be anxiolytic (my pdoc didņt believe me, maybe this time around I can convince him)
> This formula may overdo the norepinephrine--desipramine and adderall potentiate each other, maybe part of why I have anxious tension but my mind is SO much clearer and my depression is so much less that I fear reducing the doses. Maybe once I get the Lvox on board I can lessen the desipramine....
> I figure Luvox plus desipramine together is sort of like imipramine but with better overall clinical and side effect profile.....
The Luvox will inhibit the liver enzymes that eliminate the desipramine resulting in higher TCA blood levels. You may *need* to reduce the desipramine if you use Luvox.
Posted by banga on February 14, 2005, at 13:46:48
In reply to Re: My Formula for MD, ANX, ADHD.? » banga, posted by Ritch on February 14, 2005, at 13:37:35
Aha,
see I knew there was a reason to post....i did hear that luvox can interact with many meds.I will most likely then at least halve the desip dose--two other drugs potentiating it.
Would nortryptiline have the same interactions? I tried this drug but gained weight at a bizarre rate; but with the adderall perhaps the weight gain will be counteracted....
Posted by Phillipa on February 14, 2005, at 21:07:52
In reply to Re: My Formula for MD, ANX, ADHD.?, posted by banga on February 14, 2005, at 13:46:48
I know it affects xanax. It increases it's effects. Fondly, Phillipa
Posted by Ritch on February 15, 2005, at 0:18:35
In reply to Re: My Formula for MD, ANX, ADHD.?, posted by banga on February 14, 2005, at 13:46:48
> Aha,
> see I knew there was a reason to post....i did hear that luvox can interact with many meds.
>
> I will most likely then at least halve the desip dose--two other drugs potentiating it.
> Would nortryptiline have the same interactions? I tried this drug but gained weight at a bizarre rate; but with the adderall perhaps the weight gain will be counteracted....... Well Luvox, Prozac, and Paxil are the most potent enzyme inhibitors. Less inhibiting would be Zoloft. Much less so would be Celexa or Lexapro. Little inhibition would occur from Effexor (from what I understand). Switching TCA isn't going to affect that too much (it is the "substrate" med). I have tried Zoloft + Nortriptyline with some good success. Actually, it isn't too bad a deal (if you are careful).. you get to take less TCA! Basically, choose the TCA that you "like" the best, and add the SSRI you "like" the best and carefully adjust the doses of both. The bottom line is not to let yourself get "toxic" on too high a serum level of the TCA. Stims and TCA happen, but they are generally frowned on. There's another spot you will need to watch out and have doctor guidance on.
Posted by banga on February 15, 2005, at 7:55:52
In reply to Re: My Formula for MD, ANX, ADHD.? » banga, posted by Ritch on February 15, 2005, at 0:18:35
I am pretty sure zoloft has pooped out on me (the cveat being that at the time I was still using alcohol, which complicates a med trial to say the least....Lexapro is definitely pooped out. Hmm. What to do...
Thanks for the info!
Posted by ed_uk on February 15, 2005, at 8:44:43
In reply to Re: My Formula for MD, ANX, ADHD.?, posted by banga on February 15, 2005, at 7:55:52
Hi,
>Well Luvox, Prozac, and Paxil are the most potent enzyme inhibitors.
They inhibit different enzymes though. Luvox (fluvoxamine) can significantly raise the plasma concentration of some TCAs but desipramine is generally little affected.
Effect of fluvoxamine on the pharmacokinetics of imipramine and desipramine in healthy subjects.Spina E, Pollicino AM, Avenoso A, Campo GM, Perucca E, Caputi AP.
Institute of Pharmacology, University of Messina, Italy.
The effect of the selective serotonin reuptake inhibitor fluvoxamine (100 mg/day for 10 consecutive days) on the kinetics of a single oral dose of imipramine (50 mg) and desipramine (100 mg) was investigated in 12 healthy subjects. Compared with a control session, treatment with fluvoxamine caused a significant prolongation of imipramine half-life (from 22.8 +/- 6.4 to 40.5 +/- 5.0 h, means +/- SD, p < 0.01) and a marked decrease in imipramine apparent oral clearance (from 1.02 +/- 0.19 to 0.28 +/- 0.06 L/h/kg, p < 0.0001). No significant changes in desipramine kinetics were observed during fluvoxamine treatment. These findings indicate that, at the dosage tested, fluvoxamine markedly inhibits the demethylation of imipramine without affecting significantly the CYP2D6-mediated hydroxylation of desipramine.
Fluvoxamine-induced alterations in plasma concentrations of imipramine and desipramine in depressed patients.
Spina E, Pollicino AM, Avenoso A, Campo GM, Caputi AP.
Institute of Pharmacology, University of Messina, Italy.
The effect of fluvoxamine maleate, 100 mg/day for 10 days, on plasma concentrations of tricyclic antidepressants was studied in 15 depressed patients on maintenance therapy with imipramine (7 pts.) or desipramine (8 pts.). In the subgroup treated with imipramine, plasma levels of imipramine increased significantly (p < 0.001) during fluvoxamine coadministration, while levels of desipramine were not modified. Addition of fluvoxamine to patients on a stable desipramine dosage regimen resulted in a slight, but statistically not significant, increase in desipramine plasma concentrations. These results suggest that fluvoxamine is a potent inhibitor of imipramine demethylation, while it has a weak effect on the hydroxylation of desipramine.
Posted by banga on February 15, 2005, at 9:13:12
In reply to Re: My Formula for MD, ANX, ADHD.?, posted by ed_uk on February 15, 2005, at 8:44:43
Oh thank you Ed!
I was beginning to think -finally found a med, desipramine, that fits, but now feared there will be too many interactions....
I want to add Luvox for the anxiety that has not left barely at all. I can appreciate thas desipramine may even increase the anxiety, but I'd rather counterbalance rather than give up the desipramine. I finally wake up not dead tired (not bright-eyed and bushy-tailed but hey I guess I will never be a morning person) and with the adderall I feel oddly like my eyesight has improved!! much less fog than I have had for the past three years. At first desipramine interfered with sleep, but now I have a mild, actually gentle "crash" when adderall wears off and I drift off to sleep quite well.Only mild depression, which probably would abate if I got the obsessive ruminations and anxiety under control....my aim is to "create" anafranil by combining luvox and desipramine.
*sigh* I guess I'd better give up the coffee though...adderall, desipramine and the inhibition of caffeinc elimination=will be a ridiculous overkill of norepinephrine I suppose....once I add luvox, perhaps I will regardless drop down the desipramine dose.
There i go rambling. Thanks again.
Posted by banga on February 15, 2005, at 9:29:34
In reply to Re: desipramine... » ed_uk, posted by banga on February 15, 2005, at 9:13:12
Another thought...
Though desipramine and adderall potentiate each other and thus the end result is a little unknown it probably is not something to recommend...but I wonder if the desipramine ameiorates a more notable and drastic crash from Adderall....
Posted by ed_uk on February 15, 2005, at 9:48:06
In reply to Re: desipramine... » ed_uk, posted by banga on February 15, 2005, at 9:13:12
Hi B :-)
Before you consider adding fluvoxamine, I would strongly encourage you to consider discontinuing the Abilify and Lamictal. You seem to be unsure as to whether these medications are helping you and they may be causing side effects. You have had so many med changes in such a short time that it is very difficult to know what each of your meds is actually doing. Theoretically, fluvoxamine may inhibit the metabolism of Abilify, this could increase the effects of Abilify. I think you need to simplify your regimen before making it more complex by adding Luvox! What do you think? You could always restart Abilify or Lamictal at a later date if you felt it was necessary.
Ed.
Posted by banga on February 15, 2005, at 10:04:35
In reply to Re: desipramine... » banga, posted by ed_uk on February 15, 2005, at 9:48:06
Thanks Ed....my thinking exactly. Lamictal worked in the beginning--well enough that I was thinking "maybe this is all I need...."
But it wore off.
And Abilify is definitely a mixed bag. It keeps ruminations down, but not generalized anxiety really. And I am only on 2 1/2mg. As soon as I go higher, I have this wierd thing happen to my tongue. It doesn't seem to fit between my teeth anymore! and it gets all sore on the sides from interference with my teeth. Gives me scary images of the olden psych ward days, where schizophrenia patients had to walk with a shuffle and deal with tongue protrusion....Also Abilify and desipramine potentiate each other.
Somehow I have never had situations where meds interact in a significant way, now I am hitting the problem left and right!
So yes I completely agree and wish to get rid of both Lamictal and Abilify--that is actually the reason I want to add the luvox as I will be left to the mercy of anxiety from norepinephrine increase.
And you are right, i do go through changes way too quickly. I just am so desperate to get functioning--I have to defend my dissertation in June, or bye-bye degree, 10 years gone to waste forever; and if I can't function I wont be able to do it. I am finally on the right track, but the anxiety is agonizing and I am not doing a good job of tackling avoidance behaviors. Here I am avoiding work and writing here, my anxiety goes through the roof every time i sit down to work.If only Anafranil hadn't pooped out on me.....
And theory? that brain fog from depression, or SSRI long term use, is due to norepineohrine/dopamine depletion...I wonder if some people would benefit from small doses of desipramine, I don't know if it causes less or more anxiety than Wellbutrin.
Posted by ed_uk on February 15, 2005, at 10:29:09
In reply to Re: desipramine... » ed_uk, posted by banga on February 15, 2005, at 10:04:35
Hi B :-)
>I have this wierd thing happen to my tongue. It doesn't seem to fit between my teeth anymore!
You had a mild dystonic reaction.
>Gives me scary images of the olden psych ward days, where schizophrenia patients had to walk with a shuffle and deal with tongue protrusion
Some still do, especially those on depot anti-psychotics!
>I just am so desperate to get functioning
Lol, I know what you mean. Sometimes I just want to try everything at once in the hope that a least one of the meds will help, it creates problems in the long run though :-(
>desipramine, I don't know if it causes less or more anxiety than Wellbutrin
My impression is that desipramine seems to be less likely to cause anxiety than Wellbutrin. Some people find that desipramine prevents panic atttacks.
Ed.
Posted by banga on February 15, 2005, at 16:26:38
In reply to Re: desipramine... » banga, posted by ed_uk on February 15, 2005, at 10:29:09
Desipramine rules, I tell you!
But truly I think I am on the right track. I thought so this summer with geodon, anafranil (though I am sure it had poooped out long ago), lexapro and amantadine. But not only did this combo stop working, I felt SO foggy on this combo and lacked energy and stamina.
Now with desipramine and a stimulant as a base, I just need to work on the anxiety.
Posted by ed_uk on February 16, 2005, at 8:04:57
In reply to Re: desipramine..., posted by banga on February 15, 2005, at 16:26:38
Hi!
Please will you babblemail me your email address, I'd like to ask you a question- nothing important, just something I'm curious about.
Ed.
Posted by Maxime on February 16, 2005, at 21:02:45
In reply to Re: desipramine..., posted by banga on February 15, 2005, at 16:26:38
Do you have ADD? Or do you need the adderall to work with the desipramine? I'm curious because I have a bottle of desipramine that I am suppose to be taking but I haven't yet. And I now that adderall has been taken away ....
Maxime
> Desipramine rules, I tell you!
>
> But truly I think I am on the right track. I thought so this summer with geodon, anafranil (though I am sure it had poooped out long ago), lexapro and amantadine. But not only did this combo stop working, I felt SO foggy on this combo and lacked energy and stamina.
>
> Now with desipramine and a stimulant as a base, I just need to work on the anxiety.
Posted by banga on February 17, 2005, at 0:17:03
In reply to Re: desipramine... » banga, posted by Maxime on February 16, 2005, at 21:02:45
I do not officially have a diagnosis of ADHD, but 3 clinicians independently raised the question, I have many of the symptoms in my history, esp. if you look at the newer expanded definitions.... (inattentive type--I don't have a hyperactive bone in my body, though some impulsivity)
Desipramine did help with clarity and attention. Adderall upped it even more; if for some reason I couldn't/chose not to take a stimulant, I think a higher dose of desipramine could still do a lot for me....the anxiety and insomnia I initially had wore off the second week.
Posted by gromit on February 18, 2005, at 0:02:04
In reply to Re: desipramine... » banga, posted by Maxime on February 16, 2005, at 21:02:45
I found that while desipramine didn't help my mood a whole lot it did help me focus better.
This is the end of the thread.
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