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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by BlueM on April 12, 2010, at 18:49:31
I was on 200 mg of Imipramine and was taken off due to rapid heart beat (resting hart rate of 110) I was on 50 mg of zoloft and that made me very anxious so I cut myself back to 25 mg - I started feeling very paranoid so started taking 50 mg of Imiprame again and immediatly felt a little better. Switched to a psychatrist to discuss my options and he determined that I'd try Nardil since during the late 80's I had a good response to it. My problem is he said I have to be off zoloft and imipramine for 4 weeks before he'll give me the Nardil - I'm almost at 2 weeks now and just feel like a raw nerve - I can't even concentrate at work and feel very vulnerable and sad. Does anyone have any suggestions on how to get through the next 2 1/2 weeks?
Posted by Lou Pilder on April 12, 2010, at 20:06:41
In reply to Off all meds and feeling pretty bad, posted by BlueM on April 12, 2010, at 18:49:31
> I was on 200 mg of Imipramine and was taken off due to rapid heart beat (resting hart rate of 110) I was on 50 mg of zoloft and that made me very anxious so I cut myself back to 25 mg - I started feeling very paranoid so started taking 50 mg of Imiprame again and immediatly felt a little better. Switched to a psychatrist to discuss my options and he determined that I'd try Nardil since during the late 80's I had a good response to it. My problem is he said I have to be off zoloft and imipramine for 4 weeks before he'll give me the Nardil - I'm almost at 2 weeks now and just feel like a raw nerve - I can't even concentrate at work and feel very vulnerable and sad. Does anyone have any suggestions on how to get through the next 2 1/2 weeks?
BlueM,
You wrote,[...on..Imipramine..Zoloft..anxious..paranoid..anyone have any suggestions...next 2 1/2 weeks...].
What you are descibinbg could be the classic symptoms of the withdrawaling from drugs.
There are things that I think one can do to get through the withdrawal.
Lou
Posted by Phillipa on April 12, 2010, at 20:26:18
In reply to Lou's response-eynhrwnbyzdadst » BlueM, posted by Lou Pilder on April 12, 2010, at 20:06:41
Blue M thought it was a two week washout period before starting an Maoi? Phillipa
Posted by gman22 on April 12, 2010, at 20:55:25
In reply to Off all meds and feeling pretty bad, posted by BlueM on April 12, 2010, at 18:49:31
ask the doctor if you can take amitriptyline or nortriptyline in the mean time. they usually help right away with most symptoms (especially anxiety) and both of these are proven safe to take with Maoi's. They actually reduce the chances of hypertensive reaction.
Posted by Lou Pilder on April 12, 2010, at 21:15:12
In reply to Re: Off all meds and feeling pretty bad, posted by gman22 on April 12, 2010, at 20:55:25
> ask the doctor if you can take amitriptyline or nortriptyline in the mean time. they usually help right away with most symptoms (especially anxiety) and both of these are proven safe to take with Maoi's. They actually reduce the chances of hypertensive reaction.
gman22,
You wrote,[...proven safe to take with Maoi's...]
Couuld you post here a link to an article that substantiates that? If you could, then I could have the opportunity to respond accordingly.
Lou
Posted by BlueM on April 13, 2010, at 4:54:10
In reply to Re: Lou's response-eynhrwnbyzdadst, posted by Phillipa on April 12, 2010, at 20:26:18
> Blue M thought it was a two week washout period before starting an Maoi? Phillipa
Everything I've read here says two week washout, but he said 4 weeks. I have days where not only do I not want to go to work, but also don't even care if I get fired - almost like I wish they would so I could just go away. All I want to do is sleep, but I really don't sleep that well.
Posted by SLS on April 13, 2010, at 7:31:06
In reply to Lou's request » gman22, posted by Lou Pilder on April 12, 2010, at 21:15:12
> > ask the doctor if you can take amitriptyline or nortriptyline in the mean time. they usually help right away with most symptoms (especially anxiety) and both of these are proven safe to take with Maoi's. They actually reduce the chances of hypertensive reaction.
> gman22,
You wrote,[...proven safe to take with Maoi's...]
Couuld you post here a link to an article that substantiates that? If you could, then I could have the opportunity to respond accordingly.
Lou
Ok.
- Scott
----------------------------------------------
http://www.ncbi.nlm.nih.gov/pubmed/727903Arch Gen Psychiatry. 1978 May;35(5):639-42.
A comparison of electroconvulsive therapy and combined phenelzine-amitriptyline in refractory depression.Davidson J, McLeod M, Law-Yone B, Linnoila M.
AbstractCombined monoamine oxidase (MAO) inhibitor-tricyclic antidepressant therapy and electroconvulsive therapy (ECT) were compared in a population of refractory depressive patients. Seventeen patients were randomly assigned to either of the treatment groups, and an independent observer was used to rate overall progress. Between four and ten ECTs or a combination of phenelzine and amitriptyline were administered. Assays for MAO activity and plasma levels of amitriptyline and nortriptyline were performed. In both psychotic and neurotic depression, ECT was superior. When depression was accompanied by character disorder, the response was generally poor. Adequate levels of MAO inhibition were obtained, but tricyclic antidepressant levels were low. Electroconvulsive therapy is still considered to be the treatment of choice for severe depression, whereas the combination of low doses of phenelzine and amitriptyline are ineffective. This treatment modality needs further investigation.
---------------------------------------
http://www.ncbi.nlm.nih.gov/pubmed/7484185
"Acta Psiquiatr Psicol Am Lat. 1994 Dec;40(4):314-20.
[Combined therapy with tricyclic and MAOI antidepressants in the treatment of resistant major depression][Article in Spanish]
Rosan TA, Mesones HL, Brengio F.
AbstractThis paper shows the results of associating tricyclic and MAOI antidepressants in the treatment of resistant major depression. Forty five patients from private practice with diagnosis of major depression according to DSM III R criteria, with negative response to separate tricyclic or MAOI treatment, were given both types associated. They improved without dangerous side effects."
Posted by SLS on April 13, 2010, at 7:34:27
In reply to Cymbalta- dose related fatigue? or adjunct meds? » Lou Pilder, posted by SLS on April 13, 2010, at 7:31:06
Right post - wrong subject line.
- Scott
Posted by manic666 on April 13, 2010, at 13:23:02
In reply to Off all meds and feeling pretty bad - Oops. Sorry., posted by SLS on April 13, 2010, at 7:34:27
what about 5htp if you are med free// someone corect me if im wrong
Posted by bleauberry on April 13, 2010, at 16:27:00
In reply to Off all meds and feeling pretty bad, posted by BlueM on April 12, 2010, at 18:49:31
> Does anyone have any suggestions on how to get through the next 2 1/2 weeks?
If your doc is ok with mixing TCAs and MAOIs...some are, many not...ask for a very low dose of nortriptyline. It might help a tad, just barely enough to make things more bearable.
You can break up your days into 30 minute segments. Each 30 minute chunk is a marathon that you are determined to win. Nothing else matters. At work, don't look ahead at projects of the day, it can be too overwhelming. Instead, focus on what is right in front of you right now. Nothing else matters. Stay as busy as possible. All these techniques are designed to be distractions.
It can be deadly to begin nardil without the full washout period. Even if not deadly, you could have scary reactions that would blow the whole nardil thing out of the water. You don't want to do that. So hard as it is, getting through the next two weeks clean is the key to your future.
It is so hard. Believe me, I know. Two weeks will be behind you sooner than you think. Just try to stay focused on the goal and try to stay distracted from how lousy you feel.
Posted by BlueM on April 13, 2010, at 18:33:26
In reply to Re: Off all meds and feeling pretty bad, posted by bleauberry on April 13, 2010, at 16:27:00
Hi bleauberry thanks for the words - I have been able to get through work ok but absolutely crash when I get home - I feel sick to my stomach, headache, and have actually lost 10 lbs in less than 2 weeks - the 10 lbs is not necessarily a bad thing, but I wasn't trying. If I could just turn my thoughts in my head off - I'd probably be fine - but the thoughts are making me exhausted - I have to try and keep them under control, but they keep coming up - I'm just exhausted. Thanks again for your post.
Posted by bulldog2 on April 14, 2010, at 15:11:16
In reply to Off all meds and feeling pretty bad, posted by BlueM on April 12, 2010, at 18:49:31
> I was on 200 mg of Imipramine and was taken off due to rapid heart beat (resting hart rate of 110) I was on 50 mg of zoloft and that made me very anxious so I cut myself back to 25 mg - I started feeling very paranoid so started taking 50 mg of Imiprame again and immediatly felt a little better. Switched to a psychatrist to discuss my options and he determined that I'd try Nardil since during the late 80's I had a good response to it. My problem is he said I have to be off zoloft and imipramine for 4 weeks before he'll give me the Nardil - I'm almost at 2 weeks now and just feel like a raw nerve - I can't even concentrate at work and feel very vulnerable and sad. Does anyone have any suggestions on how to get through the next 2 1/2 weeks?
I've always heard two weeks? Maybe talk to him and discuss the four weeks. Maybe he'll compromise on three weeks. Good luck!
Posted by manic666 on April 15, 2010, at 4:21:46
In reply to Re: Off all meds and feeling pretty bad, posted by bulldog2 on April 14, 2010, at 15:11:16
yes you can sway them //my english doc wanted me to wash out, on a swap from 1 ssri to another ssri// isaid ,you want me to go through withdrawl an start up //when a simple taper is the thing//he agreed in the end, so your guy may agree on a shorter wash out
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