Psycho-Babble Medication Thread 693850

Shown: posts 1 to 22 of 22. This is the beginning of the thread.

 

Tricyclics - Q for SLS et. al. regarding ...

Posted by michael on October 11, 2006, at 14:45:09

Scott,

I've been meaning to drop you a quick line & ask your opinion - others' opinions welcome too, of course...

I saw you mention trying a tricyclic in another thread, which prompted me to write you here @ PB, [that, & I don't have your home address w/me right now] since I'm about to start my first trial of a tricyclic.

My question is if you might have any recommendations/advice regarding which I should try? I'm just starting my wash out today, after something like 2-3+ months on 60 mg Parnate.

The Parnate seemed to help some for a while, but seems to have faded lately.

To summarize: my diagnosis is dysthymia; my primary symptoms/issues are a general malaise, or feeling ill/flu-ish all of the time, fatigue (always feel run down) and sleeping/tired all the time, difficulty with focus/concentration, and sometimes w/memory, and lack of motivation - even difficulty getting simple tasks started/acccomplished.

From the little I've read/researched about tca's so far, I've been thinking of trying one of the following 3: Desipamine, Nortriptylne, or Protriptyline?

[of course my Pdoc will be involved in the choice too, however he allows me a lot of input - he's a resident, so while he has more education, I - unfortunately - probably have more experience at this point in time! ha ha]

Any input (from Scott, or anyone else) regarding whether one may fit my symptoms better? Or which may have less (or less pronounced) side effects? Or any other factors, experience or advice that I should consider?

Thanks to all.

[Scott - hope you're feeling better, or at least that you will very soon. Thx as always for any thoughts, advice & wisdom you may have to offer.

The above thought applies to the rest of you, too!]


p.s.

Btw, so far, I think my best results were with a combination of wellbutrin (max dose of various formulations) & dexedrine (20 mg bid)... and slightly better still adding 50 mg (I think it was 50) sulpiride.

Oh yeah - kind of a basic question: can stimulants be taken w/TCA's?

 

Re: Tricyclics - Q for SLS et. al. regarding ...

Posted by blueberry on October 11, 2006, at 18:15:59

In reply to Tricyclics - Q for SLS et. al. regarding ..., posted by michael on October 11, 2006, at 14:45:09

Based on your descriptions, my best guess would be to go for desipramine. It's a bit more activating and less sedating than nortriptyline, though either one could be good for you.

I would definitely stay clear of protriptyline...that's just because I tried it once and I was just stunned at how harsh the side effects were, I mean it was nasty stuff, more nasty than I can even find words to describe. Desipramine or nortriptyline are much friendlier.

 

Re: Tricyclics - Q for SLS et. al. regarding ...

Posted by SLS on October 11, 2006, at 18:42:48

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by blueberry on October 11, 2006, at 18:15:59

Hi Michael.

> Based on your descriptions, my best guess would be to go for desipramine. It's a bit more activating and less sedating than nortriptyline, though either one could be good for you.
>
> I would definitely stay clear of protriptyline...that's just because I tried it once and I was just stunned at how harsh the side effects were, I mean it was nasty stuff, more nasty than I can even find words to describe. Desipramine or nortriptyline are much friendlier.


Blueberry said exactly what I was going to say, only sooner, and in fewer words. I found protriptyline to be the most potent of the tricyclics with respect to anticholinergic/pro-noradrenergic side-effects. Another reason to go with the desipramine first is that you don't have to guess at therapeutic windows. You can actually miss the target and take and too much nortriptyline. I happen to be taking nortriptyline 100mg right now because I find it helps a little more with anhedonia. For me, it has more of a mood-brightening effect.

You know, several people have used a combination of amisulpride and selegiline for dysthymia with some success. I would be curious as to how combining Emsam with Abilify might be. In case I fail to think of it later, I thought I might mention it now.


- Scott

 

Re: Tricyclics - Q for SLS et. al. regarding ... SLS

Posted by Phillipa on October 11, 2006, at 20:40:37

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by SLS on October 11, 2006, at 18:42:48

Scott that would be very stimulating wouldn't it? But I guess you want that? Love Phillipa

 

Re: Tricyclics - Q for SLS et. al. regarding ... michael

Posted by Darwin on October 12, 2006, at 13:41:58

In reply to Tricyclics - Q for SLS et. al. regarding ..., posted by michael on October 11, 2006, at 14:45:09

I am also dysthymic with most of the symptoms you describe. I have tried imipramine, desipramine, nortriptyline, doxepin, and amitriptyline.

To my surprise, desipramine was the worst in both effectiveness and side-effects (impotence, urinary retention, rapid heart beat, orthostatic hypotension, poor sleep quality).

Nortriptyline was the best as far as side-effects are concerned but the best overall was amitriptyline. I am currently on amitriptyline and it helps considerably in treating my dysthymia.

Here's my guess on why amitriptyline is helpful in treating my dysthymia but desipramine is not (for me). I think, in many cases, dystyhmia is largely a problem of poor sleep quality. Sleep is not fully restorative thus the chronic low mood and tiredness and amitriptyline is better at restoring sleep quality than desipramine.

Also, amitriptyline hits most of the antidepressant mechanisms:

* norepinephrine reuptake inhibition
* serotonin reuptake inhibition
* alpha-2 receptor antagonism
* 5ht2a recepton antagonism
* cholinergic receptor antagonism

On the other hand, desipramine is primarily a norepinephrine reuptake inhibitor and not much else.

Having said all this I must admit that we are all unique biochemically and I'm sure that there are dysthymics who do better on desipramine than amitriptyline. As they say, YMMV.

Darwin

 

Re: Tricyclics - Q for SLS et. al. regarding ...

Posted by SLS on October 12, 2006, at 16:19:54

In reply to Re: Tricyclics - Q for SLS et. al. regarding ... michael, posted by Darwin on October 12, 2006, at 13:41:58

Amitriptyline does look attractive here. I guess the main thing is whether or not it is tolerated with regard to sedation. The only property listed here that I have not seen literature for is the NE alpha-2 antagonism.

> Also, amitriptyline hits most of the antidepressant mechanisms:
>
> * norepinephrine reuptake inhibition
> * serotonin reuptake inhibition
> * alpha-2 receptor antagonism
> * 5ht2a recepton antagonism
> * cholinergic receptor antagonism


- Scott

 

Re: Tricyclics - Q for SLS et. al. regarding ...

Posted by michael on October 12, 2006, at 18:13:26

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by SLS on October 12, 2006, at 16:19:54

Thanks to all of you who have replied, that's precisely the kind of feedback that I was looking for...

I meet w/my Pdoc this evening, but as I mentioned in my initial post/question, I'm in my wash-out period (only day 2 right now), so I won't have to make any decisions for a while yet...

...so, please feel free to add any further thoughts that might occur -- or feel free to add additional comments if you haven't yet.

Thanks again (a lot!) for the feedback thus far!

 

Re: Tricyclics - Q for SLS et. al. regarding ...

Posted by psychobot5000 on October 12, 2006, at 22:07:35

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by michael on October 12, 2006, at 18:13:26

I would suggest nortriptyline, though many of those are good drugs. It is relatively good on side-effects, and though desipramine may narrowly beat it out on that score, I've seen metaanalyses that suggest nortriptyline may also a more powerful antidepressant.

It is, of course, very similar to amitriptyline, having noradrenaline and serotonin reuptake inhibiton, and hitting the various receptor sites, but has fewer side-effects. A disadvantage of amitriptyline is powerful sedation (from histamine blocking), which nortrip is much better about (my own experiences on those two bear this out). Nortrip is better on cardiac side-effects (less anticholinergic action) and has a more powerful noradrenaline reuptake-inhibiting effect. It also has much more serotonergic effects than desipramine.

But these are all good drugs, as far as I know. I would also consider clomipramine and doxepin. Still, you sound like you need a catecholaminergic effect, so that would suggest one of the more NA boosting drugs--nortrip and desip.

As for stimulants, as I understand these things, it's possible, but tricky. Your doctor may not approve it because of tricyclic cardiac effects. Still, if you monitor your heart, and there are no major effects on heart-rate or blood pressure from them, small doses of stimulants seem like they would be fine. I have seen them on a list of drugs contraindicated with TCAs, but, as is usually the case, some more experienced doctors are willing to use them with due care. You'd just have to see.

Hope you find something that helps!
Psychbot

 

Re: Tricyclics - Q for SLS et. al. regarding ... SLS

Posted by Darwin on October 13, 2006, at 2:34:06

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by SLS on October 12, 2006, at 16:19:54

Hi Scott,

The following two sites seem to imply that amitriptyline is a somewhat weak NE alpha-2 antagonist:

http://www.gpcr.org/7tm/ligand/Seeman/a2adren1.html

http://www.preskorn.com/columns/9803.html (Table 2)

Clearly, amitriptyline's NE alpha-2 antagonism is too weak to produce an antidepressant effect by itself but perhaps, combined with amitriptyline's many other modes of action, it may slightly elevate amitriptyline's overall antidepressant effectiveness. Then again, maybe not.

Darwin

 

Re: Tricyclics - Q for SLS et. al. regarding ...

Posted by SLS on October 13, 2006, at 8:05:27

In reply to Re: Tricyclics - Q for SLS et. al. regarding ... SLS, posted by Darwin on October 13, 2006, at 2:34:06

> Hi Scott,
>
> The following two sites seem to imply that amitriptyline is a somewhat weak NE alpha-2 antagonist:
>
> http://www.gpcr.org/7tm/ligand/Seeman/a2adren1.html
>
> http://www.preskorn.com/columns/9803.html (Table 2)
>
> Clearly, amitriptyline's NE alpha-2 antagonism is too weak to produce an antidepressant effect by itself but perhaps, combined with amitriptyline's many other modes of action, it may slightly elevate amitriptyline's overall antidepressant effectiveness. Then again, maybe not.


Thanks for the links.

The dissociation constant seems high enough that it might play a role. Amitriptyline was, prior to clomipramine, considered to be the most potent tricyclic antidepressant. I can understand why.


- Scott

 

Re: Tricyclics - Q for SLS et. al. regarding ...

Posted by SFY on October 13, 2006, at 15:18:29

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by psychobot5000 on October 12, 2006, at 22:07:35

> I would suggest nortriptyline, though many of those are good drugs. It is relatively good on side-effects, and though desipramine may narrowly beat it out on that score, I've seen metaanalyses that suggest nortriptyline may also a more powerful antidepressant.

Nortriptyline proved to have one noticeable side effect for me that I've seen little mention of. Namely, sexual dysfunction, specifically weakened and short-lived erections along with some loss of libido. It was barely mentioned in the patient prescription printout I received with just a brief reference under the rare side effect listing and an admonition to call your doctor immediately (which my pdoc didn't understand at all).

 

Re: Tricyclics, side-effects SFY

Posted by psychobot5000 on October 14, 2006, at 11:40:40

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by SFY on October 13, 2006, at 15:18:29

Sexual side-effects are rarely listed, and very common. Meta-analyses seem to show a 40-70% likelihood with major drug classes like MAOis, TCAs, and SSRIs. I doubt that the other TCAs are any better on these side-effects. Amitriptyline and clomipramine I know can cause them.

>
> Nortriptyline proved to have one noticeable side effect for me that I've seen little mention of. Namely, sexual dysfunction, specifically weakened and short-lived erections along with some loss of libido. It was barely mentioned in the patient prescription printout I received with just a brief reference under the rare side effect listing and an admonition to call your doctor immediately (which my pdoc didn't understand at all).

 

Re: Tricyclics, side-effects (also)

Posted by psychobot5000 on October 14, 2006, at 11:45:59

In reply to Re: Tricyclics, side-effects SFY, posted by psychobot5000 on October 14, 2006, at 11:40:40

...From what I've read, clomipramine seems to be the worst of TCAs, possibly because of serotonergic action, with amitriptyline and imipramine, because of their long track-records, also being well known to cause it.

The only tricyclics that seem to be without (negative) sexual side effects are the cousins amineptine and tianeptine.

 

Re: Tricyclics, side-effects (also)

Posted by michael on October 14, 2006, at 21:50:14

In reply to Re: Tricyclics, side-effects (also), posted by psychobot5000 on October 14, 2006, at 11:45:59

> ...From what I've read, clomipramine seems to be the worst of TCAs, possibly because of serotonergic action, with amitriptyline and imipramine, because of their long track-records, also being well known to cause it.
>
> The only tricyclics that seem to be without (negative) sexual side effects are the cousins amineptine and tianeptine.


Yeah, I WISH that amineptine was an option!

michael

 

Re: Tricyclics - Q for SLS et. al. regarding ...

Posted by michael on October 20, 2006, at 12:20:07

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by michael on October 12, 2006, at 18:13:26

> Thanks to all of you who have replied, that's precisely the kind of feedback that I was looking for...
>
> I meet w/my Pdoc this evening, but as I mentioned in my initial post/question, I'm in my wash-out period (only day 2 right now), so I won't have to make any decisions for a while yet...
>
> ...so, please feel free to add any further thoughts that might occur -- or feel free to add additional comments if you haven't yet.
>
> Thanks again (a lot!) for the feedback thus far!


Hello again,

As I mentioned above, I met w/my pdoc... We discussed the options, & I summarized the discussion in this thread, as well as gave him a copy of some of the posts in the thread.

He said that based on some rsch that he had done, he was thinking of imipramine or amitriptyline, and leaning toward imipramine.

So... any thoughts on imipramine for my case?

I had originally been leaning toward desipramine, myself... But after the feedback here, and my pdoc's input thus far, I guess that I'm kind of leaning toward amitriptyline at the moment.

Having said that, however, I have to say that I haven't done any reading/rsch on imipramine as of yet... (will try to do some of that later today).

So... I would greatly appreciate any thoughts on the relative merits / promise of the options currently on the table - which I guess would seem to be imipramine and amitriptyline... and possibly desipramine.

In addition to effectiveness for my symptoms (noted in my first post in this thread), any thoughts/feedback regarding the relative side effects? Sedation and sexual side effects come to mind first, though I know TCA's have others as well.

Thanks again for all of the input thus far - and I look forward to hopefully reading more!

Very Appreciatively,

michael

 

Re: Tricyclics - Q for SLS et. al. regarding ...

Posted by michael on October 23, 2006, at 2:07:40

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by michael on October 20, 2006, at 12:20:07

Hello All,

...dont' mean to be impatient, but just wanted to make a quick post to keep this thread current (i.e.: give it one of those "new" flags)

...and see if there might be any further thoughts / comments out there on my last (previous) post & questions in this thread.


As always, thanks again for everyone's input.
michael

 

Re: TCA's - Q for SLS et. al. -- LAST CALL --

Posted by michael on October 25, 2006, at 20:53:50

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by michael on October 23, 2006, at 2:07:40

> Hello All,
>
> ...dont' mean to be impatient, but just wanted to make a quick post to keep this thread current (i.e.: give it one of those "new" flags)
>
> ...and see if there might be any further thoughts / comments out there on my last (previous) post & questions in this thread.
>
>
> As always, thanks again for everyone's input.
> michael

Hello again -

Just a last call for any input on this...

I see my pdoc tomorrow evening (Thursday, 10-26), & need to try to decide which TCA I should try...
[probably amitriptyline or imipramine - possibly desipramine]

RE: amitriptyline vs. imipramine...

-I'm a little nervous @ the sedation - is it six of one, half a dozen w/the other? Or is one more notorious for sedation?

-Other side effects - does one have better/worse reputation than the other...?

-Does one seem more appropriate for my symptoms than the other? (see first post in this thread for a quick description of my symptoms)

-Any other things I should consider &/or try to rsch before talking to my pdoc?

Thanks for any further input, and for all the feedback to date...

...wish me luck, here we go again -

michael

 

Re: Tricyclics - ... Darwin

Posted by michael on October 25, 2006, at 23:50:19

In reply to Re: Tricyclics - Q for SLS et. al. regarding ... michael, posted by Darwin on October 12, 2006, at 13:41:58

> I am also dysthymic with most of the symptoms you describe. I have tried imipramine, desipramine, nortriptyline, doxepin, and amitriptyline.
>
> To my surprise, desipramine was the worst in both effectiveness and side-effects (impotence, urinary retention, rapid heart beat, orthostatic hypotension, poor sleep quality).
>
> Nortriptyline was the best as far as side-effects are concerned but the best overall was amitriptyline. I am currently on amitriptyline and it helps considerably in treating my dysthymia.
>
> Here's my guess on why amitriptyline is helpful in treating my dysthymia but desipramine is not (for me). I think, in many cases, dystyhmia is largely a problem of poor sleep quality. Sleep is not fully restorative thus the chronic low mood and tiredness and amitriptyline is better at restoring sleep quality than desipramine.
>
> Also, amitriptyline hits most of the antidepressant mechanisms:
>
> * norepinephrine reuptake inhibition
> * serotonin reuptake inhibition
> * alpha-2 receptor antagonism
> * 5ht2a recepton antagonism
> * cholinergic receptor antagonism
>
> On the other hand, desipramine is primarily a norepinephrine reuptake inhibitor and not much else.
>
> Having said all this I must admit that we are all unique biochemically and I'm sure that there are dysthymics who do better on desipramine than amitriptyline. As they say, YMMV.
>
> Darwin
>
>
>
>

Darwin,

Thanks very much for sharing your experience.

From the above, I take it that you like amitriptyline better than imipramine - at least in your experience? It looks like those are probably the two that I'll be choosing from...

Given the fatigue issues, you dont' find that amitriptyline's sedative side effects are a problem? Or are they similar to imipramine's, and therefore irrelevant in choosing between the two?

Btw, do you take the amitriptyline at night - to "take advantage" of the sedative effect? [as opposed to taking it in the morning & being sleepy during the day?] My pdoc mentioned that idea, which makes sense - but I'm just skeptical that PM dosing will take care of the sedative side effects...

In any case, I'd be interested in your opinion, should you have a chance to read & reply to this before I meet w/my pdoc tomorrow evening [10-26].

Thanks again for your previous feedback.

michael

 

Re: ...Q for SLS et. al. regarding ... SLS

Posted by michael on October 30, 2006, at 16:33:12

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by SLS on October 11, 2006, at 18:42:48

> Hi Michael.

> ...You know, several people have used a combination of amisulpride and selegiline for dysthymia with some success. I would be curious as to how combining Emsam with Abilify might be. In case I fail to think of it later, I thought I might mention it now.
>
>
> - Scott
>


Hey Scott,

Thanks for helping me out... going to start imipramine in a day or two. I'm pretty skeptical, but still a bit hopeful. I figure if it does help, at least with this attitude, I'll know that it's not a placebo effect.

In any case, I wanted to get your thoughts on another topic - for future reference.

Above you mention Abilify - I was just curious what your thoughts/opinions/observations might be regarding Abilify vs. Sulpiride (low dose - 50 mg - 150 mg / day)?

Sounds as if Abilify might tend to be more stimulating/activating?

I think perhaps one of those, along with a stimulant might be a helpful combination for me. A stimulant alone doesn't get me all of the way "there," but stimulants definitely make the biggest impact for me...

They don't really make me feel "stimulated" (I can take my 20mg of dex and easily take a nap - though I try not to, since that's kind of "wasting" the stimulant, to my mind, since they're so short-acting).

But they definitely lift the veil, so to speak, for me - or clear the fog, etc.

Anyway, just wondering if you might have any thoughts on the relative potentials, or pros & cons, of Abilify vs. Sulpiride.

Good luck w/Emsam - I hope you can get the red tape straightend out, and that it turns out to be your unexpected "Silver Bullet"!

michael

 

Re: ...Q for SLS et. al. regarding ...

Posted by SLS on October 31, 2006, at 8:36:41

In reply to Re: ...Q for SLS et. al. regarding ... SLS, posted by michael on October 30, 2006, at 16:33:12

> > ...You know, several people have used a combination of amisulpride and selegiline for dysthymia with some success. I would be curious as to how combining Emsam with Abilify might be. In case I fail to think of it later, I thought I might mention it now.

> Above you mention Abilify - I was just curious what your thoughts/opinions/observations might be regarding Abilify vs. Sulpiride (low dose - 50 mg - 150 mg / day)?

It's hard to say. One explanation behind the antidepressant effect of sulpiride is its preferential antagonism of presynaptic autorecteptors, leading to an increase in the production and release of dopamine. Its affinity is less than dopamine, and thus does not affect postsynaptic receptors at low dosages. Abilify works differently. Its affinity is considerably higher than dopamine. Some of its energizing effect might be due to its tendency to stimulate postsynaptic receptors when levels of dopamine are low. However, it also stimulates 5-HT1a receptors and blocks 5-HT2a receptors, the combination of which could also contribute to an antidepressant effect.

> Sounds as if Abilify might tend to be more stimulating/activating?

I think this is certainly true early in treatment. I have known people to become somewhat manic on Abilify.

> Anyway, just wondering if you might have any thoughts on the relative potentials, or pros & cons, of Abilify vs. Sulpiride.

One negative aspect of sulpiride (and amisulpride) is its tendency to raise prolactin levels. This doesn't occur in everyone, and is probably not as much of a problem at the lower dosages, but you might want to test for prolactin if you decide to go with sulpiride. I would start at 50mg. With Abilify, you might experience anxiety and insomnia or akathisia-like side effects during the first week or two of treatment. This usually dissipates, but I have seen it suggested to use propranalol or lorazepam temporarily during this period to make things easier if necessary. I would go straight to 10mg.

I have seen amisulpride + Adderal + selegiline work nicely for dysthymia. I imagine sulpiride could just as easily be substituted for the amisulpride. I would leave out the selegiline at first.

> Good luck w/Emsam - I hope you can get the red tape straightend out, and that it turns out to be your unexpected "Silver Bullet"!

Thanks. I am expecting nothing more than a matrix of patches of red skin, but I guess it doesn't make sense to pass-over this drug. You just never know. Actually, it might possibly make me dysphoric. I think the parent drug (selegiline) is a NE reuptake inhibitor. Some NE drugs make me feel worse.


- Scott

 

Re: ...Q for SLS et. al. regarding ... SLS

Posted by michael on October 31, 2006, at 20:58:51

In reply to Re: ...Q for SLS et. al. regarding ..., posted by SLS on October 31, 2006, at 8:36:41

> > > ...You know, several people have used a combination of amisulpride and selegiline for dysthymia with some success. I would be curious as to how combining Emsam with Abilify might be. In case I fail to think of it later, I thought I might mention it now.
>
> > Above you mention Abilify - I was just curious what your thoughts/opinions/observations might be regarding Abilify vs. Sulpiride (low dose - 50 mg - 150 mg / day)?
>
> It's hard to say. One explanation behind the antidepressant effect of sulpiride is its preferential antagonism of presynaptic autorecteptors, leading to an increase in the production and release of dopamine. Its affinity is less than dopamine, and thus does not affect postsynaptic receptors at low dosages. Abilify works differently. Its affinity is considerably higher than dopamine. Some of its energizing effect might be due to its tendency to stimulate postsynaptic receptors when levels of dopamine are low. However, it also stimulates 5-HT1a receptors and blocks 5-HT2a receptors, the combination of which could also contribute to an antidepressant effect.
>
> > Sounds as if Abilify might tend to be more stimulating/activating?
>
> I think this is certainly true early in treatment. I have known people to become somewhat manic on Abilify.
>
> > Anyway, just wondering if you might have any thoughts on the relative potentials, or pros & cons, of Abilify vs. Sulpiride.
>
> One negative aspect of sulpiride (and amisulpride) is its tendency to raise prolactin levels. This doesn't occur in everyone, and is probably not as much of a problem at the lower dosages, but you might want to test for prolactin if you decide to go with sulpiride. I would start at 50mg. With Abilify, you might experience anxiety and insomnia or akathisia-like side effects during the first week or two of treatment. This usually dissipates, but I have seen it suggested to use propranalol or lorazepam temporarily during this period to make things easier if necessary. I would go straight to 10mg.
>
> I have seen amisulpride + Adderal + selegiline work nicely for dysthymia. I imagine sulpiride could just as easily be substituted for the amisulpride. I would leave out the selegiline at first.
>
> > Good luck w/Emsam - I hope you can get the red tape straightend out, and that it turns out to be your unexpected "Silver Bullet"!
>
> Thanks. I am expecting nothing more than a matrix of patches of red skin, but I guess it doesn't make sense to pass-over this drug. You just never know. Actually, it might possibly make me dysphoric. I think the parent drug (selegiline) is a NE reuptake inhibitor. Some NE drugs make me feel worse.
>
>
> - Scott

Good luck Scott! As I've seen is the case with many others here, I'm pulling for you!

Depending on how this imipramine trial goes... I may pursue something along the lines of your suggestions above.

Frankly, I think those hold more promise for me than the TCA route, but I'm already on that trail for now... & perhaps more importantly, trying this, and the other suggestions that my pdoc has made over the last year, I think that he's now more comfortable taking my input pretty seriously, and starting to consider more seriously some of the ideas/suggestions/requests that I've been proposing. ...though I've been very careful not to be pushy about it!

It's been a long term investment - going over a year now - but I think that since I've been willing to cooperate & try his ideas, he's come to trust me somewhat ...that, and from our discussions, he know that I know what I'm talking about (at least to some degree).

In any case, as I've indicated before, I think this is just going to be a couple months of suffering through TCA side effects... Though one never knows until one tries...

But should the TCA not pan out, I'm optimistic about giving something along the lines of what you've suggested a try. Specifically, some combo(s) of the following:

sulpiride / abilify
emsam
stimulant

... who knows. I guess they're just as likely to be a bust as anything else that's seemed promising in theory, but never quite lives up to the hoped for potential...

Any way, I hope you can stick out the Emsam for a while, & that it can help you to find some relief! I'm sure that you'll keep us posted... And fwiw, I'll be pulling for you, & thinking of you!

Thanks again - very sincerely - for all of the time & effort that you expended on my behalf (answering questions, offering advice, etc.) over the years!

michael

 

imipramine

Posted by elanor roosevelt on November 2, 2006, at 8:59:59

In reply to Re: ...Q for SLS et. al. regarding ... SLS, posted by michael on October 31, 2006, at 20:58:51

Michael
Please keep me posted on the imipramine.
Seems from what I read hear that the path is ssri's to maoi's to tricyclics.
the parnate is strange
i am functional but sad and getting sociophobic
also i stare into space
bye bye parnate
i will discuss with my meds doc
had a bad session with him last time
the kind that takes you 2 days to "get"

good luck and thanks for directing me to this thread


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