![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Vincent_QC on March 7, 2009, at 7:08:10
Another post for another AD I try right now...Yes, it's my third tries since the begining of 2009.
Witch TCA have the less impact on the heart??? That's my first question...
I'm now on a very low dose of nortriptyline. I suggest to try it to my PDoc after the Clomipramine failure, I was so lazy and tired mentally on the Clomipramine that it was impossible to be less anxious, especially for the SAD and GAD...
Anyway, the nortriptyline give a lot of tachycardia, i'm only at a low dosage of 20mg/day, 10 mg when I wake up in the morning and 10 mg at noon. The first 10 mg seem to be ok...I got some tachycardia around 1 1/2 hours after I take the first dose, my heart pulse rate is around 120...that's high for me, normally i'm around 80 at rest. The second dose around noon make my heart run faster...I monitor my blood pressure and it's ok, 120-130/70-80....but the pulse rate is around 145 at rest.
That's scary me a lot. Is it dangerous to have a such high pulse rate? Do I will have a heart attack or any others problems like a seizure or anything else like this? I also have another strange sensation inside my head (different than the one I had with the Clomipramine), that's in the left temple and happen suddenly every now and then...The pain last 10 seconds and it make me a lot anxious each time I experience it, I do also more panic attacks or have more signs of panic anxiety that's appears for no good reasons...my hands get moist often and I have a reapid heart beat for nothing as well as a kind of over fixation on the side-effects I feel inside my head and normally all of these symptoms start a panic attack... For me, that's seem to worse my panic disorder problem as well as increase my anxiety (social or general).
I also find the Nortryptiline to be a lot activating. I would say it's a good thing for me since I lack a lot of energy, but now I can say it's make me more anxious in general and even if I sleep more at night time and even if i'm more energized at daytime, I always have a BIG drop out of my energy level after noon and I can't resist to jump in my bed again and do a long nap...
I'm only at 20 mg of Nortryptiline, that's a really low dosage, is it possible that all the side-effects are not true and that my panic disorder make me too much hypervigilance about what I feel inside my head and my body ? Is it possible also that these side-effects will dissepear after a couple of days and the calming effect of the Nortryptiline will appear???
Should I stop the Nortryptiline already and wait until monday to call my PDoc and ask to switch to another TCA's ? When I meet him last week, he suggest to me "Surmontil" (trimipramine), it's more sedating but maybe it will be possible to take it as a single dose at bedtime, The PDoc suggest it to me before I argue a little bit about the fact it was too much sedating...and I suggest to him to try the Nortryptiline? Did I made a mistake? Do the Trimipramine is less hard on the heart effects like tachycardia, palpitations and arrhythmias? Maybe it will help me to sleep more well at night, so I will be able to stop the Seroquel for my insomnia?
I have so much questions about TCA's... I have a bad feelings about them in general, especially for the SAD and GAD and the panic disorder, even if they was the gold standard treatments for PAD before the newer SSRI's appear on the market.
That's so complicated to have so many disease at the same time that sometimes I wonder wich ones is the main problem and need to be treat as first. I really think the panic disorder make me too much hypervigilance and let me drop out too fast the different meds I try...so it should be treat at first no? Less anxiety symptoms like moist hands, over sweating and high pulse rate should help me to feel less anxious in social situation or in my life in general no???
Thanks in advance for any answer I will get ;-)
Posted by mav27 on March 7, 2009, at 8:23:08
In reply to Nortriptyline = Tachycardia, posted by Vincent_QC on March 7, 2009, at 7:08:10
My doc told me nortriptyline was the easiest in terms of side effects, it still caused me some slight takychardia though and me me more anxious and sort of agitated.
Posted by Phillipa on March 7, 2009, at 10:57:03
In reply to Re: Nortriptyline = Tachycardia, posted by mav27 on March 7, 2009, at 8:23:08
Vincent I wonder if propanalol ie: inderal might slow the heart rate and lessen the anxiety? Just a thought. Love Phillipa
Posted by Incubusfan on March 7, 2009, at 11:57:32
In reply to Nortriptyline = Tachycardia, posted by Vincent_QC on March 7, 2009, at 7:08:10
Like you, I switched from Clomipramine to Nortriptyline. I couldn't tolerate the Tachycardia I got from it. So far though, at 20mg of Nortriptyline, I have no heart issues, no dry mouth, no sedation. I take it all at bed time.
I plan on giving Nortriptyline a trial, and if it doesn't work, then possibly try Desipramine or try one of the SSRIs I've never tried, such as Lexapro or Luvox.
Interesting how we both had trouble with Clomipramine, but Nortriptyline effects us differently. I'm usually pretty sensitive to side effects of meds.
Keep us updated.
- Mike
> Another post for another AD I try right now...Yes, it's my third tries since the begining of 2009.
>
> Witch TCA have the less impact on the heart??? That's my first question...
>
> I'm now on a very low dose of nortriptyline. I suggest to try it to my PDoc after the Clomipramine failure, I was so lazy and tired mentally on the Clomipramine that it was impossible to be less anxious, especially for the SAD and GAD...
>
> Anyway, the nortriptyline give a lot of tachycardia, i'm only at a low dosage of 20mg/day, 10 mg when I wake up in the morning and 10 mg at noon. The first 10 mg seem to be ok...I got some tachycardia around 1 1/2 hours after I take the first dose, my heart pulse rate is around 120...that's high for me, normally i'm around 80 at rest. The second dose around noon make my heart run faster...I monitor my blood pressure and it's ok, 120-130/70-80....but the pulse rate is around 145 at rest.
>
> That's scary me a lot. Is it dangerous to have a such high pulse rate? Do I will have a heart attack or any others problems like a seizure or anything else like this? I also have another strange sensation inside my head (different than the one I had with the Clomipramine), that's in the left temple and happen suddenly every now and then...The pain last 10 seconds and it make me a lot anxious each time I experience it, I do also more panic attacks or have more signs of panic anxiety that's appears for no good reasons...my hands get moist often and I have a reapid heart beat for nothing as well as a kind of over fixation on the side-effects I feel inside my head and normally all of these symptoms start a panic attack... For me, that's seem to worse my panic disorder problem as well as increase my anxiety (social or general).
>
> I also find the Nortryptiline to be a lot activating. I would say it's a good thing for me since I lack a lot of energy, but now I can say it's make me more anxious in general and even if I sleep more at night time and even if i'm more energized at daytime, I always have a BIG drop out of my energy level after noon and I can't resist to jump in my bed again and do a long nap...
>
> I'm only at 20 mg of Nortryptiline, that's a really low dosage, is it possible that all the side-effects are not true and that my panic disorder make me too much hypervigilance about what I feel inside my head and my body ? Is it possible also that these side-effects will dissepear after a couple of days and the calming effect of the Nortryptiline will appear???
>
> Should I stop the Nortryptiline already and wait until monday to call my PDoc and ask to switch to another TCA's ? When I meet him last week, he suggest to me "Surmontil" (trimipramine), it's more sedating but maybe it will be possible to take it as a single dose at bedtime, The PDoc suggest it to me before I argue a little bit about the fact it was too much sedating...and I suggest to him to try the Nortryptiline? Did I made a mistake? Do the Trimipramine is less hard on the heart effects like tachycardia, palpitations and arrhythmias? Maybe it will help me to sleep more well at night, so I will be able to stop the Seroquel for my insomnia?
>
> I have so much questions about TCA's... I have a bad feelings about them in general, especially for the SAD and GAD and the panic disorder, even if they was the gold standard treatments for PAD before the newer SSRI's appear on the market.
>
> That's so complicated to have so many disease at the same time that sometimes I wonder wich ones is the main problem and need to be treat as first. I really think the panic disorder make me too much hypervigilance and let me drop out too fast the different meds I try...so it should be treat at first no? Less anxiety symptoms like moist hands, over sweating and high pulse rate should help me to feel less anxious in social situation or in my life in general no???
>
> Thanks in advance for any answer I will get ;-)
Posted by linkadge on March 7, 2009, at 13:34:07
In reply to Re: Nortriptyline = Tachycardia » Vincent_QC, posted by Incubusfan on March 7, 2009, at 11:57:32
Nortriptyline can certainly cause tachycardia. The extent of this side effect probably depends on your baseline levels of norepinephrine.
It may decrease over time. What exactly is your heart rate?
Posted by Vincent_QC on March 7, 2009, at 15:43:24
In reply to Re: Nortriptyline = Tachycardia, posted by mav27 on March 7, 2009, at 8:23:08
> My doc told me nortriptyline was the easiest in terms of side effects, it still caused me some slight takychardia though and me me more anxious and sort of agitated.
My PDoc told me the same thing...He said it was the most easy TCA to use and he use it often on older people because it have less side-effect and no metabolite and it's a more clean TCA...BUT for me I feel the same way that you on it...I already stop the Nortryptiline, I don't want to end up at the hospital for a heart attack...What I Can say is that it's worsing my GAD and make me a lot more agitated and I assume I will never get an proper answer on my SAD problem on a TCA...
Posted by Vincent_QC on March 7, 2009, at 15:46:59
In reply to Re: Nortriptyline = Tachycardia, posted by Phillipa on March 7, 2009, at 10:57:03
> Vincent I wonder if propanalol ie: inderal might slow the heart rate and lessen the anxiety? Just a thought. Love Phillipa
Propanol...you mean a beta bloker...I had this at a high dose last year...we do an experience to see if it will help my SAD....and the answer is no...no improve on it...no hypotension also, it was like taking a placebo for me...But my sister use it 2 or 3 times a year because she's a teacther and when it's time to meet the parents of her students, she feel a lot anxious so she take a small dose of 20mg before she meet them and she say it's working good on her...and she avoid panic attacks...
Posted by Vincent_QC on March 7, 2009, at 15:55:40
In reply to Re: Nortriptyline = Tachycardia » Vincent_QC, posted by Incubusfan on March 7, 2009, at 11:57:32
> Like you, I switched from Clomipramine to Nortriptyline. I couldn't tolerate the Tachycardia I got from it. So far though, at 20mg of Nortriptyline, I have no heart issues, no dry mouth, no sedation. I take it all at bed time.
>
> I plan on giving Nortriptyline a trial, and if it doesn't work, then possibly try Desipramine or try one of the SSRIs I've never tried, such as Lexapro or Luvox.
>
> Interesting how we both had trouble with Clomipramine, but Nortriptyline effects us differently. I'm usually pretty sensitive to side effects of meds.
>
> Keep us updated.
>
> - Mike
>Hi Mike,
Well, The clomipramine experience was not very nice for sure, but at least, I never encounter any heart issue on it... I was just more tired mentally and it was not helping improving my mood and to relieve my SAD or GAD...at 50 mg...The Nortryptiline make my heart racing, that's crazy. Like I Was writing 2 minutes ago, I take my last 10 mg at noon today and I already decide to stop after a really high pulse rate I experienced 1 hour after I take my dose...I had 2 hours of speed heart racing around 160-165...it was crazy and I Was out of breath... I wonder why I can't tolerate well such a low dose of Nortryptiline...20mg seem to be not very high... Now i'm back to 125 for the heart pulse rate and I still feel a lot anxious and i'm tired as hell...
I'm also very sensitive to the side-effects of meds...but this one is worse than the Parnate for me...I prefer to do some hypertension or hypotension than doing high pulse rate that make me a lot anxious, on the panic mood and also very agited...
I do believe the TCA's is not for me...I will give another try maybe for the Surmontil (Trimipramine), since it's seem to be less activating and having a more anxiolitic profile...maybe it will help dealing with my GAD and SAD...and the panic disorder as well...
Anyway, I will keep all of you informed after I will talk to my PDoc monday...
Good luck with the Nortryptiline, I really hope it will working on you!!!
Bye!
Vincent ;-)
Posted by Vincent_QC on March 7, 2009, at 16:01:02
In reply to Re: Nortriptyline = Tachycardia, posted by linkadge on March 7, 2009, at 13:34:07
> Nortriptyline can certainly cause tachycardia. The extent of this side effect probably depends on your baseline levels of norepinephrine.
>
> It may decrease over time. What exactly is your heart rate?
>
>
Hi!
Ok, this afternoon , 1 hour after my 10 mg dose my pulse rare go up to 160-165...it was like this for almost 2 hours...now, after 4 hours it's around 125... My heart pressure is ok...around 120-130/70-80...It may decrease over the time...but I still don't like it at all. I don't want to feel this way for another 3 weeks...I was suppose to increase my dosage at 50 mg next week...forget this...I call the PDoc monday and I will ask to switch to another TCA like Surmontil or do a washout period and be back on the Parnate at a very low dosage since I got also heart issues on the Parnate (Hypertensives crisis and hypotension)...but at least I had an immediate effect on my SAD on it...it's definitly helping to reduce the social anxiety and the need to take benzos drugs...
Posted by Incubusfan on March 7, 2009, at 17:43:42
In reply to Re: Nortriptyline = Tachycardia » Incubusfan, posted by Vincent_QC on March 7, 2009, at 15:55:40
>
> Hi Mike,
> Well, The clomipramine experience was not very nice for sure, but at least, I never encounter any heart issue on it... I was just more tired mentally and it was not helping improving my mood and to relieve my SAD or GAD...at 50 mg...
>
> The Nortryptiline make my heart racing, that's crazy. Like I Was writing 2 minutes ago, I take my last 10 mg at noon today and I already decide to stop after a really high pulse rate I experienced 1 hour after I take my dose...I had 2 hours of speed heart racing around 160-165...it was crazy and I Was out of breath... I wonder why I can't tolerate well such a low dose of Nortryptiline...20mg seem to be not very high... Now i'm back to 125 for the heart pulse rate and I still feel a lot anxious and i'm tired as hell...
>
> I'm also very sensitive to the side-effects of meds...but this one is worse than the Parnate for me...I prefer to do some hypertension or hypotension than doing high pulse rate that make me a lot anxious, on the panic mood and also very agited...
>
> I do believe the TCA's is not for me...I will give another try maybe for the Surmontil (Trimipramine), since it's seem to be less activating and having a more anxiolitic profile...maybe it will help dealing with my GAD and SAD...and the panic disorder as well...
>
> Anyway, I will keep all of you informed after I will talk to my PDoc monday...
>
> Good luck with the Nortryptiline, I really hope it will working on you!!!
>
> Bye!
>
> Vincent ;-)Before you quit, try taking your full dose before bed time(2 hours before you go to bed), this works best for me for the side effects of meds(heart rate, sedation, etc). Just a recommendation.
I don't think Trimipramine is available in the US... hey we get some drugs you don't, and you Canadians get some of your own :) I wish we had your UHC though... :(
Posted by linkadge on March 7, 2009, at 19:21:23
In reply to Re: Nortriptyline = Tachycardia » linkadge, posted by Vincent_QC on March 7, 2009, at 16:01:02
Get off of it. Your pulse rate is too high.
Linkadge
Posted by mav27 on March 8, 2009, at 0:38:23
In reply to Re: Nortriptyline = Tachycardia » mav27, posted by Vincent_QC on March 7, 2009, at 15:43:24
> > My doc told me nortriptyline was the easiest in terms of side effects, it still caused me some slight takychardia though and me me more anxious and sort of agitated.
>
>
> My PDoc told me the same thing...He said it was the most easy TCA to use and he use it often on older people because it have less side-effect and no metabolite and it's a more clean TCA...BUT for me I feel the same way that you on it...I already stop the Nortryptiline, I don't want to end up at the hospital for a heart attack...What I Can say is that it's worsing my GAD and make me a lot more agitated and I assume I will never get an proper answer on my SAD problem on a TCA...
>Yeah i'm on imipramine at the moment but a low dose because of the usual tricks the TCA does on the heart. It's not being useful for my SAD but is for my lack of energy which i wasn't able to get with the ssri's or snri or even reboxetine. SO i'm going to ask my doc about staying on the small amount of imipramine and adding a weaker ssri like luvox to it as the ssri's have helped with my SAD but i don't like the side effetcs of them at high dose. I was actually having success on just lexapro but i had no energy to want to get out and do anything and was sleeping around 15 hours a day.
Posted by Vincent_QC on March 8, 2009, at 10:10:32
In reply to Re: Nortriptyline = Tachycardia » Vincent_QC, posted by mav27 on March 8, 2009, at 0:38:23
> Yeah i'm on imipramine at the moment but a low dose because of the usual tricks the TCA does on the heart. It's not being useful for my SAD but is for my lack of energy which i wasn't able to get with the ssri's or snri or even reboxetine. SO i'm going to ask my doc about staying on the small amount of imipramine and adding a weaker ssri like luvox to it as the ssri's have helped with my SAD but i don't like the side effetcs of them at high dose. I was actually having success on just lexapro but i had no energy to want to get out and do anything and was sleeping around 15 hours a day.
>
>Hi ;-)
I totally agree with you...the SSRI's make you tired, and tehd to make people lazy and lack any energy or motivation, it's why I always hated them.I never get a proper answer on any SSRI's, SRNI's, as well as wellbutrin or Remeron or Trazodone...I never try the Reboxetine cause it's not avaible in the Canada, but I assume it's purely acting on the NE so I guess more heart problems on it.
The main problem is that I never had any heart problem before. I was put on a lot of combos...the last ones was Lexapro, who don't do anything for my anxiety or SAD BTW, with Ritalin...The Ritalin fail to give more energy and more motivation to me so we change the Ritalin for the Wellbutrin at 300 mg...nothing...it was worse...
For The Luvox, since I never get an answer from a SSRI, I still don't see the utility to try it...I know that in somes countries it's approved for SAD...but well a lot of others SSRI'S like Paxil or Zoloft are approved by the FDA for this and they don't work on me. They just worse my depression and make my anxiety more hard to support...
I don't think all the TCA's have this strong effect on the heart. They can give hypotension orthostatic, like the MAOI's but the faste heart pulse is something linked to the more selective for the NE action (Nortryptiline, Despiramine), Imipramine don't hit a lot the NE, as far as know...
Well anyway I never get a high hope on the TCA's and I now understand why my Family Doctor, who is also a specialist for anxiety and depression problems never try them on me...he told me often they was not usefull for SAD or GAD...and their efficacity on the panic disorder was weak...
Today i'm off any AD'S...no more Nortryptiline...I hope the PDoc will not already in vacation for 2 weeks...IF so, I Will have do be at least 14 days without any meds to help me, with the exception of the innefective Valium...
I really think I will just do a washout period and be back again on a slow dose of Parnate...at least it's hard on my heart also but I see some improve for my SAD...something I never had on any others meds...
At this stage, I dont care about my daytime energy of my motivation, all I want is to be relieve of my anxiety (social or general)...One problem at the time, I will work more on the energy and motivation level after the main problem will be stabilized...
Have a nice day !!!
Bye!
Vincent ;-)
Posted by Vincent_QC on March 8, 2009, at 10:15:00
In reply to Re: Nortriptyline = Tachycardia, posted by linkadge on March 7, 2009, at 19:21:23
> Get off of it. Your pulse rate is too high.
>
> LinkadgeHi Linkadge!
It's already done...I'm off of it since yesterday. I really don't need to be more agited or to feel like I will die of a heart attack, that's just worsing my anxiety (social, general or panic disorder)...I still don't understant why I cant use it and why I got high pulse rate like this at a so small dose...
Anyway thanks for your advise and take care of you !!!
Bye!
Vincent ;-)
Posted by Vincent_QC on March 8, 2009, at 10:27:59
In reply to Re: Nortriptyline = Tachycardia, posted by Incubusfan on March 7, 2009, at 17:43:42
>
> Before you quit, try taking your full dose before bed time(2 hours before you go to bed), this works best for me for the side effects of meds(heart rate, sedation, etc). Just a recommendation.
>
> I don't think Trimipramine is available in the US... hey we get some drugs you don't, and you Canadians get some of your own :) I wish we had your UHC though... :(
>Hi !
To be honnest, I take my first 10 mg of Nort before bedtime, the day my PDoc prescribed it to me and I had the worse night since a while, I remember I wake up in the middle of the night and I had a real fast heart beat rate...and I was not able to sleep at all... The morning after, I take the other 10mg dose and my heart start to race again but a lot more than at night...So the night after I don't take my 10 mg dose before bedtime, I Wait in the morning, the first dose was ok, I was able to feel my heart racing faster than usual but it was tolerable...nothing to make me more anxious...The second dose around noon was crazy...after 1 or 1/2 hours I got this really fast heart beat that was crazy as hell...but after 1 hour it was ok...so I forgot this and say to myself it will be like this only the first couple of days... The third day was horrible, first dose in the morning was ok, the second dose was a disaster, the 160-165 pulse rate was too much for me... I Can't imagine feeling like this all the time, even increase my dosage to 50mg...forget it!!! I don't want to play with my life again...it's worsing my SAD and my GAD as well as my panic disorder so I don't know why I will stay on it and continue this med...Yeahm in the Canada we have some meds that you don't have in the States...but I think the States have more meds avaible on the market than the Canada...the good thing is that in the Canada, we have a lot of generic meds who cost nothing...or just a little bit if you compare with the States, where the meds are a lot more expensive and often not generic and patented for years and years to comes...That's the best of both world I guess...
Well, thanks for you help... I will see what my PDoc will told me tomorrow, if I can reach him on the phone...
Have a nice day!
VIncent ;-)
Posted by mav27 on March 8, 2009, at 11:10:42
In reply to Re: Nortriptyline = Tachycardia » mav27, posted by Vincent_QC on March 8, 2009, at 10:10:32
> Hi ;-)
> I totally agree with you...the SSRI's make you tired, and tehd to make people lazy and lack any energy or motivation, it's why I always hated them.
>
> I never get a proper answer on any SSRI's, SRNI's, as well as wellbutrin or Remeron or Trazodone...I never try the Reboxetine cause it's not avaible in the Canada, but I assume it's purely acting on the NE so I guess more heart problems on it.
>
> The main problem is that I never had any heart problem before. I was put on a lot of combos...the last ones was Lexapro, who don't do anything for my anxiety or SAD BTW, with Ritalin...The Ritalin fail to give more energy and more motivation to me so we change the Ritalin for the Wellbutrin at 300 mg...nothing...it was worse...
>
> For The Luvox, since I never get an answer from a SSRI, I still don't see the utility to try it...I know that in somes countries it's approved for SAD...but well a lot of others SSRI'S like Paxil or Zoloft are approved by the FDA for this and they don't work on me. They just worse my depression and make my anxiety more hard to support...
>
> I don't think all the TCA's have this strong effect on the heart. They can give hypotension orthostatic, like the MAOI's but the faste heart pulse is something linked to the more selective for the NE action (Nortryptiline, Despiramine), Imipramine don't hit a lot the NE, as far as know...
>
> Well anyway I never get a high hope on the TCA's and I now understand why my Family Doctor, who is also a specialist for anxiety and depression problems never try them on me...he told me often they was not usefull for SAD or GAD...and their efficacity on the panic disorder was weak...
>
> Today i'm off any AD'S...no more Nortryptiline...I hope the PDoc will not already in vacation for 2 weeks...IF so, I Will have do be at least 14 days without any meds to help me, with the exception of the innefective Valium...
>
> I really think I will just do a washout period and be back again on a slow dose of Parnate...at least it's hard on my heart also but I see some improve for my SAD...something I never had on any others meds...
>
> At this stage, I dont care about my daytime energy of my motivation, all I want is to be relieve of my anxiety (social or general)...One problem at the time, I will work more on the energy and motivation level after the main problem will be stabilized...
>
> Have a nice day !!!
>
> Bye!
>
> Vincent ;-)Yeah i've been going around in circles in regards to that last part, i improve my social anxiety but i never have the energy to go out and be near people anyway, but if i find something that improves my energy i can then get out of the house but my anxiety makes it improssible to talk to people or even be around them in some cases.
Reboxteine was an interesting one, even though it's purely a NE drug it gave me a very relaxing feeling, was quite nice. The trade off which also made me stop it was it caused very bad impotense as well as pain in that area which seems to be a rare side effect but you can trust me to get the rare ones.
nardil and clonazepam was a great combo but the hypotension from the nardil (and parnate as well) made it impossible for me to stay on them.
Posted by linkadge on March 8, 2009, at 11:37:29
In reply to Re: Nortriptyline = Tachycardia » linkadge, posted by Vincent_QC on March 8, 2009, at 10:15:00
Nortriptyline is a powerful inhibitor of norepinephrine reuptake. They still havn't really discovered drugs which targed monoamines in the CNS. As a result, drugs like nortriptyline result in increases in cardiac NE. The effect on BP and heart rate is probably dependant on one's genetic disposition. While TCA's tend to increase pulse in almost everybody, the extent of which probably depends on baseline cardiac NE lvels.
You could try a more balanced TCA such as imipramine. Clomipramine is more slective for serotonin and nortriptyine more selective for NE.
Other than that, I assume you have tried the SSRI's(?)
Some people add a beta blocker to a TCA, but I think thats just getting too dirty, and possibly still unsafe.
Linkadge
Posted by mav27 on March 8, 2009, at 11:52:48
In reply to Re: Nortriptyline = Tachycardia » Vincent_QC, posted by linkadge on March 8, 2009, at 11:37:29
>
> You could try a more balanced TCA such as imipramine. Clomipramine is more slective for serotonin and nortriptyine more selective for NE.
>
> Other than that, I assume you have tried the SSRI's(?)
>
> Some people add a beta blocker to a TCA, but I think thats just getting too dirty, and possibly still unsafe.
>
> Linkadge
>I used a beta blocker with the imipramine to see if it would lower my pulse when standing, unfortunatly it led to me starting to faint like when in on MAOI's. With the imipramine i have bradycardia when laying down and tachycadia when standing. SO annoying
Posted by desolationrower on March 9, 2009, at 1:49:32
In reply to Re: Nortriptyline = Tachycardia » linkadge, posted by mav27 on March 8, 2009, at 11:52:48
did you ever get around to trying parnate+nortriptaline?
-d/r
Posted by Vincent_QC on March 9, 2009, at 8:44:13
In reply to Re: Nortriptyline = Tachycardia » Vincent_QC, posted by linkadge on March 8, 2009, at 11:37:29
> Nortriptyline is a powerful inhibitor of norepinephrine reuptake. They still havn't really discovered drugs which targed monoamines in the CNS. As a result, drugs like nortriptyline result in increases in cardiac NE. The effect on BP and heart rate is probably dependant on one's genetic disposition. While TCA's tend to increase pulse in almost everybody, the extent of which probably depends on baseline cardiac NE lvels.
>
> You could try a more balanced TCA such as imipramine. Clomipramine is more slective for serotonin and nortriptyine more selective for NE.
>
> Other than that, I assume you have tried the SSRI's(?)
>
> Some people add a beta blocker to a TCA, but I think thats just getting too dirty, and possibly still unsafe.
>
> Linkadge
>Hi !
You're probably right about that. It's probably also linked to the genetic as well because in my familly, my dad have to take huge dose of Avapro (irbesartan) to treat hypertension and he is in a good physical condition, a lot active for is age...My sister, who is on Cymbalta, who is also a Ne reuptake, have some cardiac effects as well, high blood pressure and high pulse rate, around 100-110...If I add to this the fact that i'm almost innactive since more than 2 years, that I eat not very well (not a lot and it's often just carbs), the fact that I smoke one pack of cigs a day, that I do insomnia at night, maybe all of this can make my heart more sensitive to the NE effect of the more powerfull AD's who hit the NE...
A more well balanced TCA like Trimipramine or Doxepin seem more interresting, I know they are more sedative but take at bedtime, they will not cause agitation on me and worse at least my GAD or my panic disorder problems...
For the weight gain, I know I have to be more active and I need to move more at daytime, but being active when you have no energy and no motivation at all is really hard...
So that's it...maybe I will also ask to try something like Vigabatrin (Sabril) and wait a little bit before I begin another AD...switching of meds often like I do since last october make my brains a little bit f*ck*d up I think. They need a break and I need a break also...
Since nothing seem to reduce my SAD problem, I will ended up at the same place and in the same state that I Was 2 years go...And for the SSRI's and SRNI's or others meds like Trazodone, Remeron, Wellbutrin, Ritalin, Propanol (Inderal), Neurotin, Lyrica...I try all of them with the exception of the weak SSRI Luvox, who seem to be the worst of them, being award of this by my new PDoc who really don't like it and certainly don't want to prescribe it to me anyway since he find it not usefull in GAD or SAD, even in depression...
That's it, I call right now to leave a message to the PDoc, I hope he will not be in vacation already for 2 weeks...
I will give some news more later!
Thanks everyone for your help!
Bye!
Vincent ;-)
Posted by hansi555 on March 12, 2009, at 1:58:23
In reply to Re: Nortriptyline = Tachycardia, posted by mav27 on March 7, 2009, at 8:23:08
> My doc told me nortriptyline was the easiest in terms of side effects, it still caused me some slight takychardia though and me me more anxious and sort of agitated.
I am on 105 mg Nortrip now. No problems w the heart or other psysical problems apart from being a bit more tired when going up in dosage.
But I do find my self more agitated, easy to get angry.But Nortrip for me is way better in terms of SE - I more or less only get some tolerable dry mouth.
Lexapro gave me all of those typical serotonic SE like nausea, loss of appetite, anxiousness when starting up the med or chanching dose.
This is the end of the thread.
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