![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Meltingpot on May 17, 2009, at 11:25:34
Hello,
I've now been taking clomipramine for about 12 weeks. Have been taking 150mg of clomipramine for the past 5 weeks.
Although my anxiety has decreased, I just feel so tired all of the time. I can hardly get up a flight of stairs without having to stop.
My experience with antidepressants is that if they are working properly, you get an increase in motivation and energy and less anxiety. I therefore don't think this clomipramine is working that well for me.
Last time I went to see my psychiatrist she was discussusing amitryptaline as a possible future option but I was just wondering if anyone on this board has any experience with both these drugs?
I also read the below on this board. Now as clomipramine is supposed to be more hard hitting on 5HT receptors than amitryptaline then does this mean that I've got even less chance of amitriptyline working for me.
> Also, amitriptyline hits most of the antidepressant mechanisms:
>
> * norepinephrine reuptake inhibition
> * serotonin reuptake inhibition
> * alpha-2 receptor antagonism
> * 5ht2a recepton antagonism
> * cholinergic receptor antagonism
Thanks for any advice or experiences in advance.
Denise
Posted by desolationrower on May 25, 2009, at 0:15:36
In reply to Clomipramine vs Amitryptaline, posted by Meltingpot on May 17, 2009, at 11:25:34
fatigue might be coming from the strong serotonertig effect of the clomipramine. Still, the older TCAs are more side effects than the secondary ones.
-d/r
Posted by Meltingpot on May 31, 2009, at 13:20:42
In reply to Re: Clomipramine vs Amitryptaline, posted by desolationrower on May 25, 2009, at 0:15:36
.
Posted by zzzz7 on June 22, 2009, at 6:14:23
In reply to Clomipramine vs Amitryptaline, posted by Meltingpot on May 17, 2009, at 11:25:34
It hits the H1 receptor really hard. Also anticholinergic effects are strong.
It's a great anti-depressant. There is, of course, a difference between fatigue and depression. (Fwiw, amil. is pretty sedating, as well, usually even more so than is clom.)
I had the kind of fatigue you describe on clom. I was taking 400mg, though. I stuck with it because it worked so well for me against my depression.
If you can't live with the fatigue, you might try adding something to it, maybe an SSRI at a tiny low dose and dialing down the TCA slowly and dialing up the SSRI slowly. E.g. you might try adding 5mg Celexa to it, and go to 20mg Celexa slowly while going down to 50mg clomipramine.
Posted by Meltingpot on July 12, 2009, at 11:44:22
In reply to Re: Clomipramine vs Amitryptaline, posted by zzzz7 on June 22, 2009, at 6:14:23
Hi zzzz7,
Thanks for your response.
I'm interested in the fact that you took 400mg. Did it take 400mg for you to have a response to the Clomiprime?
The reason I ask is that I found no benefit from increasing the dose of clomipramine from 150mg to 200mg so, after discussing this with my psychiatrist, have decided to drop back down to 150mg and add something else.
Now you have got me wondering if 400mg would have been better.
Kind Regards.....Denise
Posted by Brainbeard on July 29, 2009, at 15:45:38
In reply to Clomipramine vs Amitryptaline, posted by Meltingpot on May 17, 2009, at 11:25:34
Hi,
I've been on both clomipramine and amitriptyline, but the latter only in very small doses, which work for chronic pain. Clomipramine as a stand alone med was a great antidepressant for me, but it caused a kind of sensitivity to sunlight that hurt my eyes, which was too much for me. I then combined it with fluvoxamine (Luvox), which raises clomipramine levels about tenfold while lowering the levels of its noradrenergic metabolite. I took 150mg of Luvox and just 10mg of clomipramine and it worked amazingly well. I did have bouts of tiredness, though, but I felt great so I wasn't bothered about it.
400mg of clomipramine is an unusually high dose. The normal maximum dose is 250mg for outpatients and 300mg for inpatients! For many people, 400mg could be deadly ad would at least be dangerous. Only when you have a pretty quick liver would you be able to handle such a high dose well. Clomipramine inhibits its own metabolism, which is why its blood levels become exponentially higher from doses of 250mg and above, which is why 300mg is the maximum recommended dose.
Amitriptyline would be a poor choice if you don't wanna be sedated: it's one of the most sedating TCA's with a very strong affinity for the H1-receptor.
If you want a more activating TCA with less sedation, I can recommend imipramine. Imipramine is a very good SNRI, but its serotonin reuptake inhibition is not as strong as clomipramine (it ranges somewhere between fluvoxamine and citalopram (Celexa), actually). It is an activating antidepressant for me at just 25mg, although you would probably need more if you use it as a stand alone drug. Its active metabolite is desipramine, which is a very potent NRI. Imipramine is even used for ADD, which tells something. It has a much lower affinity for the H1-receptor than amitriptyline and clomipramine.
Oh, it does raise my pulse strongly, but that gets better over time. Can also raise blood pressure, though lower it as well on higher doses.Hope this helps some.
This is the end of the thread.
Psycho-Babble Neurotransmitters | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.