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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by greywolf on July 25, 2007, at 2:03:01
I've been off the boards here for awhile, in part because one of my last options--Emsam--did absolutely nothing for me. So, in a fit of disappointment and utter stupidity, I went cold turkey for about 2 months and that didn't work out too well. Let's just say that the bipolar ride was eventful enough that even people who never stick their noses into my business took the time to express their concern.
So, my psychiatrist was kind enough to see me on an expedited basis to discuss my limited alternatives. I won't repeat all the details here because I've posted them several times already, but in treatment of depression-dominant BPII and very severe OCD problems, I have been on most of the available meds at therapeutic levels during the last 15 years without significant success. Consequently, my current options are (1) VNS (which I just can't see doing until there's data indicating efficacy significantly greater than placebo); (2) ECT (which I can't do because of my job); and (3) trying the odd med that I haven't been on yet.
I've picked door #3, which happens to be Desipramine. I believe I've been on all of the other "pramines", so I don't have great hopes for this one, but I asked my doctor to be as aggressive as possible regardless of side effects. Much of my treatment has been concerned with finding a pharmaceutical approach that will avoid the fatigue and fogginess that makes it harder for me to get my writing done, but I have finally just said screw it, hit me as hard as you can as fast as you can and I'll just deal with it the best I can.
The plan right now is to take me up to 300mg Desipramine and 300mg Seroquel per day over the next 2 weeks, with Xanax as needed. I'll probably be pretty out of it for several days, and I'd appreciate learning from folks with experience on Desipramine what I'm likely to run into.
Thanks.
Greywolf
Posted by linkadge on July 25, 2007, at 9:48:19
In reply to What to expect on Desipramine, posted by greywolf on July 25, 2007, at 2:03:01
So, I guess you've tried nortryptaline? Nortryptaline/lithium combination appears to be particularly effective in some cases.
Lithium/desipramine may be too.
Desipramine is probably the most stimulating TCA. You might get heart palps on higher doses.
I know a few people who have done well on desipramine, most while in the hospital.
Linkadge
Posted by greywolf on July 25, 2007, at 21:41:04
In reply to Re: What to expect on Desipramine, posted by linkadge on July 25, 2007, at 9:48:19
Thanks much, Linkadge. I am hopeful on the stimulating front because the lethargy regime got old a long time ago.Of the TCAs, I've been on imipramine, clomipramine, doxepin, trazodone (tetra), and mirtazapine (tetra). I have not been on nortryptaline. It was considered many years ago, but I was not a good candidate because I was non-compliant with the blood work requirements. I've since moved on to other doctors, but no one has mentioned nortryptaline even though I've been on plenty of meds requiring blood monitoring.
I'll bring it up at my next visit. If desipramine doesn't work out, I'll suggest the nortryptaline/lithium combo. I've had moderate success with lithium in the past, but my last two psychiatrists haven't been too keen on it (I'm sure the history notes about me wrapping my car around a tree while on lithium and a variety of other meds during my more carefree/careless youth don't help much on that front).
Thanks again.
Greywolf
Posted by linkadge on July 27, 2007, at 12:51:00
In reply to Re: What to expect on Desipramine, posted by greywolf on July 25, 2007, at 21:41:04
You can type in nortryptalie + lithium into a search engine. There have been a few studies I believe on the combination. Most involving post ETC depression relapse prevention. Apparently the combination lead to fewer relapses and more time till relapse.
Both nortryptaline and desipramine are heavy on the noradrenergic side of it. Nortryptaline still has some appreciable affinity for the serotonin uptake pump. Desipramine is even more selective for norepinephrine.
Nortryptaline has a good track record for treatment resistant depression. Some large trials have found it effective for some people who fail SSRI's. This could extend to desipramine.
I think the nortryptaline/lithium combination used augmenting doses of lithium (ie 450-600, so it may still be tollerable if you don't handle high doses well).Take Care.
Linkadge
This is the end of the thread.
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