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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 rovers95 on September 2, 2010, at 18:42:18
Hey, im currently using dosulepin for depression and anxiety and have been for about 2 months, i was euphoric initially on it which was great but now its working just ok as i've gone up to 150mg. Still sleep is rubbish even w/ seroquel and i get stressed out easily, when i had the initial euphoria this wasn't an issue though.
I appear to have both typical and atypical symptoms and i'm considering ritalin, but any other suggestions would be gratefully received.
thanks
rover
Posted by rovers95 on September 2, 2010, at 18:47:20
In reply to augmenting tricyclic AD's...any ideas???, posted by rovers95 on September 2, 2010, at 18:42:18
> Hey, im currently using dosulepin for depression and anxiety and have been for about 2 months, i was euphoric initially on it which was great but now its working just ok as i've gone up to 150mg. Still sleep is rubbish even w/ seroquel and i get stressed out easily, when i had the initial euphoria this wasn't an issue though.
>
> I appear to have both typical and atypical symptoms and i'm considering ritalin, but any other suggestions would be gratefully received.
>
> thanks
>
> roverI should add that my problem seems to be cholinergic (i have constant twitching and did have hypersalivation, lots of REM sleep etc. before the AD) and i feel i may benefit from ritalin or wellbutrin to counteract this?
And finally i also take ativan to counteract any irritability.
rover
Posted by SLS on September 3, 2010, at 5:26:33
In reply to Re: augmenting tricyclic AD's...any ideas???, posted by rovers95 on September 2, 2010, at 18:47:20
Have you considered performing a quick trial of lithium (300-600mg)? You would know in a week if it is going to be helpful.
The hypersalivation is unusual. With mood disorders, there is often a dysregulation of the autonomic nervous system, but it is usually skewed in the opposite direction, with dry mouth being predominant. However, dysautonomia (where there is sometimes insufficient sympathetic flow) can sometimes push the system in the direction of hypersalivation.
Do you ever get dry mouth?
How about heart rate?
- Scott
Posted by rovers95 on September 3, 2010, at 8:26:22
In reply to Re: augmenting tricyclic AD's...any ideas??? » rovers95, posted by SLS on September 3, 2010, at 5:26:33
> Have you considered performing a quick trial of lithium (300-600mg)? You would know in a week if it is going to be helpful.
>
> The hypersalivation is unusual. With mood disorders, there is often a dysregulation of the autonomic nervous system, but it is usually skewed in the opposite direction, with dry mouth being predominant. However, dysautonomia (where there is sometimes insufficient sympathetic flow) can sometimes push the system in the direction of hypersalivation.
>
> Do you ever get dry mouth?
>
> How about heart rate?
>
>
> - Scottmy hypersalivation and excessive REM sleep (dreams, nightmares etc.)is now under control through the use of dosulepin...i am happy to get dry mouth instead!! will lithium not up my cortisol levels, i was thinking t3 could be preety effective?
cheers
Rover
Posted by SLS on September 3, 2010, at 15:22:10
In reply to Re: augmenting tricyclic AD's...any ideas??? » SLS, posted by rovers95 on September 3, 2010, at 8:26:22
> > Have you considered performing a quick trial of lithium (300-600mg)? You would know in a week if it is going to be helpful.
> >
> > The hypersalivation is unusual. With mood disorders, there is often a dysregulation of the autonomic nervous system, but it is usually skewed in the opposite direction, with dry mouth being predominant. However, dysautonomia (where there is sometimes insufficient sympathetic flow) can sometimes push the system in the direction of hypersalivation.
> >
> > Do you ever get dry mouth?
> >
> > How about heart rate?
> >
> >
> > - Scott
>
> my hypersalivation and excessive REM sleep (dreams, nightmares etc.)is now under control through the use of dosulepin...i am happy to get dry mouth instead!! will lithium not up my cortisol levels, i was thinking t3 could be preety effective?
Lithium and T3 augmentation of tricyclic antidepressants were common strategies to treat depression before Prozac came along (1987). Regardless of what some studies show regarding increased cortisol associated with lithium use, I would not neglect the possibility that there is still potential therapeutic benefits from taking it. Personal theories are sometimes valid. However, there are times when you have to look at empirical or anecdotal evidence.Good luck and keep us up to date.
- Scott
Posted by bleauberry on September 3, 2010, at 19:08:56
In reply to augmenting tricyclic AD's...any ideas???, posted by rovers95 on September 2, 2010, at 18:42:18
Add an ssri to it....zoloft first choice, prozac second choice, effexor third choice. IMO
Posted by Conundrum on September 3, 2010, at 23:13:08
In reply to Re: augmenting tricyclic AD's...any ideas???, posted by bleauberry on September 3, 2010, at 19:08:56
Does anyone know how prozac interacts with the liver and tricyclics?
Posted by SLS on September 4, 2010, at 5:53:21
In reply to Re: prozac TCA interaction? » bleauberry, posted by Conundrum on September 3, 2010, at 23:13:08
> Does anyone know how prozac interacts with the liver and tricyclics?
Prozac is an inhibitor of cytochrome P450 2D6, the same enzyme the body uses to metabolize tricyclics.
- Scott
Posted by rovers95 on September 5, 2010, at 7:51:47
In reply to Re: prozac TCA interaction?, posted by SLS on September 4, 2010, at 5:53:21
Posted by Conundrum on September 5, 2010, at 8:06:27
In reply to Re: prozac TCA interaction?, posted by SLS on September 4, 2010, at 5:53:21
So it would increase TCA levels then?
Posted by SLS on September 5, 2010, at 8:17:56
In reply to Re: prozac TCA interaction? » SLS, posted by Conundrum on September 5, 2010, at 8:06:27
> So it would increase TCA levels then?
Yes. In my experience, I would estimate that desipramine blood levels are doubled when taken in combination with Paxil, another 2D6 inhibitor.
- Scott
Posted by SLS on September 5, 2010, at 8:31:41
In reply to so is low dose zoloft safe with dosulepin? (nm), posted by rovers95 on September 5, 2010, at 7:51:47
I believe so. Zoloft is not as potent a CYP450 2D6 inhibitor as are Prozac and Paxil. Still, you may need to adjust the dosulepin downward somewhat as 2D6 is the primary route of metabolism for this drug. At 50mg of sertraline, you probably won't need to make any adjustment in dosulepin at all.
- Scott
Posted by rovers95 on September 6, 2010, at 8:35:44
In reply to Re: so is low dose zoloft safe with dosulepin? » rovers95, posted by SLS on September 5, 2010, at 8:31:41
> I believe so. Zoloft is not as potent a CYP450 2D6 inhibitor as are Prozac and Paxil. Still, you may need to adjust the dosulepin downward somewhat as 2D6 is the primary route of metabolism for this drug. At 50mg of sertraline, you probably won't need to make any adjustment in dosulepin at all.
>
>
> - ScottGreat....i will give it a try then!
thanks
rover
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