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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by bulldog2 on April 24, 2010, at 13:55:05
Went to my primary physician for another issue but her exam showed an elavated heart rate of 84 beats per minute. I'm on 50 mg of clomipramine. Does this mean I'm at the end of the road dose wise? I mean the next dose increase to 75 mg of clomipramine would probably take me over 100 beats per minute. I think anything over 100 beats per minute is considered dnagerous. Any thoughts or suggestions?
Posted by SLS on April 24, 2010, at 14:18:17
In reply to Clomipramine and Tachycaridia?, posted by bulldog2 on April 24, 2010, at 13:55:05
> Went to my primary physician for another issue but her exam showed an elavated heart rate of 84 beats per minute. I'm on 50 mg of clomipramine. Does this mean I'm at the end of the road dose wise? I mean the next dose increase to 75 mg of clomipramine would probably take me over 100 beats per minute. I think anything over 100 beats per minute is considered dnagerous. Any thoughts or suggestions?
I found a resting rate of 90 bpm to be an acceptable compromise when I was responding to Parnate and desipramine. That was a personal decision. The heart will beat faster, but its load per beat will be reduced because of the vasodilation caused by NE alpha-1 receptor blockade. I found that my HR moderated somewhat with continued treatment.
- Scott
Posted by bulldog2 on April 24, 2010, at 14:29:23
In reply to Re: Clomipramine and Tachycaridia? » bulldog2, posted by SLS on April 24, 2010, at 14:18:17
> > Went to my primary physician for another issue but her exam showed an elavated heart rate of 84 beats per minute. I'm on 50 mg of clomipramine. Does this mean I'm at the end of the road dose wise? I mean the next dose increase to 75 mg of clomipramine would probably take me over 100 beats per minute. I think anything over 100 beats per minute is considered dnagerous. Any thoughts or suggestions?
>
> I found a resting rate of 90 bpm to be an acceptable compromise when I was responding to Parnate and desipramine. That was a personal decision. The heart will beat faster, but its load per beat will be reduced because of the vasodilation caused by NE alpha-1 receptor blockade. I found that my HR moderated somewhat with continued treatment.
>
>
> - ScottI will accept the 84 beats per minute. But I assume an increase to 75 mg will throw me over 100 beats per minute. So do I augment as I do not have a complete remission on 50 mg? What would be your next step for atypical depression?
Posted by SLS on April 24, 2010, at 15:33:43
In reply to Re: Clomipramine and Tachycaridia? To Scott » SLS, posted by bulldog2 on April 24, 2010, at 14:29:23
> > > Went to my primary physician for another issue but her exam showed an elavated heart rate of 84 beats per minute. I'm on 50 mg of clomipramine. Does this mean I'm at the end of the road dose wise? I mean the next dose increase to 75 mg of clomipramine would probably take me over 100 beats per minute. I think anything over 100 beats per minute is considered dnagerous. Any thoughts or suggestions?
> >
> > I found a resting rate of 90 bpm to be an acceptable compromise when I was responding to Parnate and desipramine. That was a personal decision. The heart will beat faster, but its load per beat will be reduced because of the vasodilation caused by NE alpha-1 receptor blockade. I found that my HR moderated somewhat with continued treatment.
> >
> >
> > - Scott
>
> I will accept the 84 beats per minute. But I assume an increase to 75 mg will throw me over 100 beats per minute. So do I augment as I do not have a complete remission on 50 mg? What would be your next step for atypical depression?
I don't remember there being much difference in my HR as I raised the dosage of desipramine beyond 50mg. Tachycardia is defined as having a resting rate in excess of 100 bpm, although I wonder how that number was arrived at. I think you should inform the prescribing physician of your condition and let him help you decide what to do next. I wouldn't worry about it, but your doctor might. I have observed some people on PB discontinue tricyclics because of increased HR. I wonder how many of them would have continued treatment if their doctors had explained to them that increased HR was an expected side effect.I never performed an intensive search of medical literature about the long-term effects on cardiac function of the tricyclics when taken appropriately. Of course, you will find plenty of literature describing their effects in acute overdose. I guess I don't worry too much about it because people have been taking these drugs for so long. You can always get a EKG to screen for heart block.
Any history of CV disease?
- Scott
Posted by hopefullynow on April 24, 2010, at 15:40:09
In reply to Re: Clomipramine and Tachycaridia? To Scott » SLS, posted by bulldog2 on April 24, 2010, at 14:29:23
Hy Bulldog, i'm on clomipramine right now at 75 mg for 3 days, previously being at 50 mg.I noticed the slightly increased heart rate at 80-85 bpm when i increased the dose from 25 to 50.After this next step in dosage, i noticed that my heart rate stabilized as i sad at 80-85.So, i think that it will remain in this range.I also do phisically things and i noticed that involving in strenous workouts, say at 80% of my power the bpm increased to 160-180 bpm, which i think is in normal range, so I beleive only the resting rate will rise.
Posted by floatingbridge on April 24, 2010, at 15:58:33
In reply to Re: Clomipramine and Tachycaridia?, posted by hopefullynow on April 24, 2010, at 15:40:09
Bulldog, I'm thinking that maybe the increase geometry (for lack of a better word) might not take you as high as you think.
I once showed up at a physical w/ a hr of 90--really rare and unheard of for me. My point here is that I didn't really feel it. I suggest discussing w/ your doc before abandoning. Could you go to 75 and back out if unhealthy or intolerable?
good luck
Posted by bulldog2 on April 24, 2010, at 16:00:43
In reply to Re: Clomipramine and Tachycaridia?, posted by hopefullynow on April 24, 2010, at 15:40:09
> Hy Bulldog, i'm on clomipramine right now at 75 mg for 3 days, previously being at 50 mg.I noticed the slightly increased heart rate at 80-85 bpm when i increased the dose from 25 to 50.After this next step in dosage, i noticed that my heart rate stabilized as i sad at 80-85.So, i think that it will remain in this range.I also do phisically things and i noticed that involving in strenous workouts, say at 80% of my power the bpm increased to 160-180 bpm, which i think is in normal range, so I beleive only the resting rate will rise.
Well that sounds promising. Maybe at 84 I have some room for one more dose increase to 75 mg. I guess anything under 100 is acceptable. But as per Scott's suggestion will talk to prescribing physician about this.
By the way how are you doing on the clomipramine?
Posted by ed_uk2010 on April 24, 2010, at 16:34:47
In reply to Re: Clomipramine and Tachycaridia? » hopefullynow, posted by bulldog2 on April 24, 2010, at 16:00:43
My heart rate was often over 100 bpm on tricyclics. It didn't cause any major problems as far as I am aware.
Posted by bulldog2 on April 24, 2010, at 17:22:17
In reply to Re: Clomipramine and Tachycaridia?, posted by floatingbridge on April 24, 2010, at 15:58:33
> Bulldog, I'm thinking that maybe the increase geometry (for lack of a better word) might not take you as high as you think.
>
> I once showed up at a physical w/ a hr of 90--really rare and unheard of for me. My point here is that I didn't really feel it. I suggest discussing w/ your doc before abandoning. Could you go to 75 and back out if unhealthy or intolerable?
>
> good luckHi Floating
Hope you are doing well. I am only on 50 mg of clomipramine. My rhb went from my normal 70's to 84 when I went from 25 mg to 50 mg on the clomipramine. But it sounds like I would stay under 100 rhb if I made a move to 75 mg on the clomipramine. The results of others sounds promising. But I will stay at 50 mg until I see the p-doc.
Posted by Phillipa on April 24, 2010, at 18:15:39
In reply to Re: Clomipramine and Tachycaridia? » floatingbridge, posted by bulldog2 on April 24, 2010, at 17:22:17
Bulldog knowing you and other factors I'd get an EKG first before the increase for safety's sake. And do let the doc know where you are now. Love Phillipa
Posted by ed_uk2010 on April 24, 2010, at 19:56:27
In reply to Re: Clomipramine and Tachycaridia? » bulldog2, posted by Phillipa on April 24, 2010, at 18:15:39
> Bulldog knowing you and other factors I'd get an EKG first before the increase for safety's sake. And do let the doc know where you are now. Love Phillipa
TCAs usually cause sinus tachycardia, which does not seem to be a problem for most people.
If someone had underlying heart disease, I would be concerned about sinus tachycardia. I would also be concerned in the elderly, who often have latent coronary artery disease. In young people with no medical problems, I would not be particularly worried (unless the tachycardia was either severe or symptomatic).
The cardiac toxicity of TCAs in overdose is a completely different issue. This is mainly due to their activity at ion channels in the cardiac conduction system. The tachycardia, on the other hand, it mainly caused by.....
1. The anti-cholinergic effect
2. The NE reuptake inhibition
3. Occasionally, a reflex increase due to hypotension
Posted by hopefullynow on April 24, 2010, at 23:55:37
In reply to Re: Clomipramine and Tachycaridia? » hopefullynow, posted by bulldog2 on April 24, 2010, at 16:00:43
> By the way how are you doing on the clomipramine?
Hy Bulldog, thanks for asking!I'm doing really well on clomi, i'm beginning to regain my old and forgotten feelings.I have a lot of good energy, the good one - focused and calm .I amaze myself how i commit in doing things that I thought that made no sense for me being in an anhedonic state for so long.Now I live in a town near the mountains and here all the activities are phisical and I found the joy to involve in a lot of things in my yard besides my workouts.I feel more like "out", I have a new desire to enjoy nature and not to stare 10 h / day reading PBabble archives :).Clomipramine had/have an profound effect on my affect, it is the only ad which done miracles for me.It gave my life back, for now somehow crippled from so many years of suffering.I can't beleive that I didn't stick with clomi, years ago because it's side effects like dry mouth and initial sedation.So far so good, I take it for three weeks and i passed over the initial "3 days blip" which was a pattern for my initial response to various AD's and combos in the past.So for me, the ticket for severe anhedonia, anxiety and depression was an Anafranil.
I have to add that clomi is the foundation on my combo, besides it, i'm on 30 mg of Remeron and 10 mg buspirone for a better serotonergic transmission.Remeron helps a lot with the slight anxiety from clomi and thru his antagonism it knoks down the bad serotonergic receptors.Alone, Anafranil gives me a partial remission.
How are you on clomi, besides elevated heart rate, do you feel an ad response?Can you sleep well on it?Have you noticed an increase in appetite while on it?Best regards!
Posted by floatingbridge on April 25, 2010, at 0:22:13
In reply to Re: Clomipramine and Tachycaridia?, posted by hopefullynow on April 24, 2010, at 23:55:37
Hopefullynow, great to hear!
Posted by bulldog2 on April 25, 2010, at 9:30:40
In reply to Re: Clomipramine and Tachycaridia?, posted by hopefullynow on April 24, 2010, at 23:55:37
> > By the way how are you doing on the clomipramine?
>
> Hy Bulldog, thanks for asking!I'm doing really well on clomi, i'm beginning to regain my old and forgotten feelings.I have a lot of good energy, the good one - focused and calm .I amaze myself how i commit in doing things that I thought that made no sense for me being in an anhedonic state for so long.Now I live in a town near the mountains and here all the activities are phisical and I found the joy to involve in a lot of things in my yard besides my workouts.I feel more like "out", I have a new desire to enjoy nature and not to stare 10 h / day reading PBabble archives :).Clomipramine had/have an profound effect on my affect, it is the only ad which done miracles for me.It gave my life back, for now somehow crippled from so many years of suffering.I can't beleive that I didn't stick with clomi, years ago because it's side effects like dry mouth and initial sedation.So far so good, I take it for three weeks and i passed over the initial "3 days blip" which was a pattern for my initial response to various AD's and combos in the past.So for me, the ticket for severe anhedonia, anxiety and depression was an Anafranil.
> I have to add that clomi is the foundation on my combo, besides it, i'm on 30 mg of Remeron and 10 mg buspirone for a better serotonergic transmission.Remeron helps a lot with the slight anxiety from clomi and thru his antagonism it knoks down the bad serotonergic receptors.Alone, Anafranil gives me a partial remission.
>
>
> How are you on clomi, besides elevated heart rate, do you feel an ad response?Can you sleep well on it?Have you noticed an increase in appetite while on it?
>
> Best regards!Mood is better and actually no increase in appetite. If anything getting my binge eating under control. Have a desire to do more physical things but sciatica is still active after a winter of snow shoveling. So I do require pain meds to do activities. If the p-doc gives me the go ahead I would like to go up to 75 mg which will be the top for me.However having just starting 50 mg I think I still have progress to be made at that dose and let my body get used to that dose.
Posted by hopefullynow on April 25, 2010, at 9:31:45
In reply to Re: Clomipramine and Tachycaridia? » hopefullynow, posted by floatingbridge on April 25, 2010, at 0:22:13
Thanks F/B!
Of course, I have some days when i still feel puzzled and anxious, days when I still feel that anhedonia blah and cannot do anything.These days I try to fight a little for the sake of following ones which i hope will still bring me the normalcy i have attained.I'm early in treatment so is room for better, I have to rebuild my personal life, social interfering, friends, aspirations.All the best !
Posted by conundrum on April 25, 2010, at 12:41:03
In reply to Re: Clomipramine and Tachycaridia?, posted by hopefullynow on April 24, 2010, at 23:55:37
Nice, I'm looking for something for anhedonia and the TCAs keep looking better and better. Not to knit pick but i think remeron and buspar are actually decreasing serotonergic transmittion rather than increasing it. Remeron is blocking those "bad" receptors and buspar tells the brain to stop producing as much serotonin for a little while and both increase noradrenaline and dopamine release.
Posted by bulldog2 on April 25, 2010, at 13:45:26
In reply to Re: Clomipramine and Tachycaridia? » hopefullynow, posted by conundrum on April 25, 2010, at 12:41:03
> Nice, I'm looking for something for anhedonia and the TCAs keep looking better and better. Not to knit pick but i think remeron and buspar are actually decreasing serotonergic transmittion rather than increasing it. Remeron is blocking those "bad" receptors and buspar tells the brain to stop producing as much serotonin for a little while and both increase noradrenaline and dopamine release.
If you like the effects of serotonin than clomipramine is the way to go.At only 50 mg it has a calming effect reminiscent of an ssri. Also add in a moderately strong ne effect and you have a well balanced ad. At 50 mg I find the sides very tolerable. I realize that some have to go up to 200 mg where I guess the sides could be bad.But there is evidence that tcas might work as well at low doses as high doses. If clomipramine is to much serotonin than you have imipramine which is a very balanced se and ne ad.
I guess see if they work for you at 100 mg or under where sides might be very tolerable.
Posted by hopefullynow on April 26, 2010, at 0:41:47
In reply to Re: Clomipramine and Tachycaridia? » hopefullynow, posted by bulldog2 on April 25, 2010, at 9:30:40
Hy Bulldog,
I'm glad that your mood is better and you don't experience serious side effects from clomipramine!Regarding the back pain I also hope that it will cease eventually without increasing dosage above 50 mg.I feel that clomi's analgesic properties are dose dependant, I also have back pain and other injuries and every time when i raise the dose the pain tolerance increases.If you tolerate so well Anafranil, why don't exeperiment with higher dosages above 75 mg?I think that clomipramine's properties and as a bonus its analgesic properties - all in a pill deserves a full trial.Kind regards! ;)
> > > By the way how are you doing on the clomipramine?
> >
> > Hy Bulldog, thanks for asking!I'm doing really well on clomi, i'm beginning to regain my old and forgotten feelings.I have a lot of good energy, the good one - focused and calm .I amaze myself how i commit in doing things that I thought that made no sense for me being in an anhedonic state for so long.Now I live in a town near the mountains and here all the activities are phisical and I found the joy to involve in a lot of things in my yard besides my workouts.I feel more like "out", I have a new desire to enjoy nature and not to stare 10 h / day reading PBabble archives :).Clomipramine had/have an profound effect on my affect, it is the only ad which done miracles for me.It gave my life back, for now somehow crippled from so many years of suffering.I can't beleive that I didn't stick with clomi, years ago because it's side effects like dry mouth and initial sedation.So far so good, I take it for three weeks and i passed over the initial "3 days blip" which was a pattern for my initial response to various AD's and combos in the past.So for me, the ticket for severe anhedonia, anxiety and depression was an Anafranil.
> > I have to add that clomi is the foundation on my combo, besides it, i'm on 30 mg of Remeron and 10 mg buspirone for a better serotonergic transmission.Remeron helps a lot with the slight anxiety from clomi and thru his antagonism it knoks down the bad serotonergic receptors.Alone, Anafranil gives me a partial remission.
> >
> >
> > How are you on clomi, besides elevated heart rate, do you feel an ad response?Can you sleep well on it?Have you noticed an increase in appetite while on it?
> >
> > Best regards!
>
> Mood is better and actually no increase in appetite. If anything getting my binge eating under control. Have a desire to do more physical things but sciatica is still active after a winter of snow shoveling. So I do require pain meds to do activities. If the p-doc gives me the go ahead I would like to go up to 75 mg which will be the top for me.However having just starting 50 mg I think I still have progress to be made at that dose and let my body get used to that dose.
Posted by hopefullynow on April 26, 2010, at 1:10:39
In reply to Re: Clomipramine and Tachycaridia? » hopefullynow, posted by conundrum on April 25, 2010, at 12:41:03
Conundrum,
Thanks for clarifying me about Remeron and Buspar.I thought Remeron have antagonizes 5ht and 3 recepors which supposedly have an negative impact on mood (dark moods, anxiety)and indirect desinhibits DA and NE, plus its NE alpha 2 antagonism which also raises and increase sensitiviness to NE.Regarding Buspar, thru its 5ht-1a partial receptor antagonism,I thought it disinhibits the serotonin neuron not being dependent on serotonin levels, slowing the neuronal impulse flow and repleting the sensitized neuron and 5ht stores.
Posted by conundrum on April 26, 2010, at 11:39:41
In reply to Re: Clomipramine and Tachycaridia?, posted by hopefullynow on April 26, 2010, at 1:10:39
Yeh everything you said sounded right. I dunno if antagonizing 5 HT3 is bad or not. Someone posted about a new antidepressant in the neurotransmitters section that is a 5 HT3 antagonist. Someone suggested that decreasing dopamine in some areas could help prevent OCD.
Posted by bulldog2 on April 26, 2010, at 12:31:29
In reply to Re: Clomipramine and Tachycaridia? » hopefullynow, posted by conundrum on April 26, 2010, at 11:39:41
> Yeh everything you said sounded right. I dunno if antagonizing 5 HT3 is bad or not. Someone posted about a new antidepressant in the neurotransmitters section that is a 5 HT3 antagonist. Someone suggested that decreasing dopamine in some areas could help prevent OCD.
Need an agonist also for d2 and d3? Clomipramine raises prolactin so maybe a dopamine agonist or a stim would bring prolactin down. You really need a certain amount dopamine.
Also I'm not sure how clomipramine is on 5htc2. An antagonist there is a good thing.
Posted by floatingbridge on April 29, 2010, at 18:16:30
In reply to Clomipramine and Tachycaridia?, posted by bulldog2 on April 24, 2010, at 13:55:05
Jeez, my resting heart rate was 90 (!) yesterday at pcp. I had no idea.
This is the end of the thread.
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