Posted by Ame Sans Vie on March 17, 2005, at 8:22:22
In reply to Ame, Re: Clomipramine, sedation, anhedonia » Ame Sans Vie, posted by temoigneur on March 10, 2005, at 21:41:49
> Hey Michael how are you doing. Are you in school right now, I remember your french, perhaps you're launched in a carreer.
Hi, Ben! LTNS!
Well, I haven't launched a career utilizing my French, but Parnate has allowed me the confidence to accept an amazing job offer programming an all -new computer system! :-)
> How is your family, mine is good, I'm going to the Anxiety Disorder Conference in Seattle next month, should be informative:)
My family's hanging in there, you know... I'd be very interested to hear how that conference goes!
> I haven't been on the anxiety boards that much recently, so i don't know if you are still in contact, but I have severe anxiety and moderate – heavy OCD.... I was asking you about tramadol while i was trying nardil.
Yes, I remember talking with you quite well! :-)
> I went on Tramadol, but I thing the NRI properties it shares with effexor were making me quite anxious. As explained below, I'm on Clomipramine now, but tricyclics, feel similar to zyprexa to me, it certainly has controlled my OCD well, but I sleep most of the day, and have little/no ambition to do much of anything, I’m numb, and have lost much of my creativity.
Ah, the cruel jokes serotonin reuptake inhibitors play upon us... :-(
> I was wondering, with your knowledge of anxiolytics and drugs, is there anything you might recommend addiing to or as an alternative to clomipramine.I'll certainly try my best . . .
> I wrote this message in Feb. before I saw your post on Parnate, that’s about the only drug available in Canada I haven’t been on. Below I've explained some of the complications I've had with stimulants/SSRI's …
Well you know, I've heard of wonderful success stories involving Parnate used to treat OCD (as well as other comorbid conditions, i.e., depression, other anxiety disorders, eating disorders). I've heard anecdotal evidence to support Nardil's use in treating OCD, but nowhere near enough to convince me that it is truly effective, unlike the case with Parnate (and perhaps Marplan as well).
> After, ridiculous anxiety - being almost driven to suicide numerous times in the past year, I've come upon clomipramine for OCD/Anxiety.
Oh wow, I'm so sorry to hear you've had such a rough year... :-(
> It has all but abolished the horrible OCD/Anxiety along with clonazepam, 3mg t.i.d.
Well, that's a start!
> but I'm tired all the time, I just want to sleep all day; my mind is relatively dull, and I can see sleeping my way into my sixties, if I don't get something that would give me some inertia. I have little/no ambition, or drive to do very much and as I'm on disability, I can just sleep all day and ponder what life would be like without the disease. But I had a good mind, got my ARCT in piano, I'd like to be a Nurse-Practitioner, but this is impossible being so dull and drowsy.
Oh believe me, I can relate, as can many others on this board.
> Anyway, is there any conceivable combo Clomipramine + SSRI or bromocriptine that may allow me to retain clinical gains, and start living again. Basically looking for something to give me my energy and creativity without the torment of Anxiety and OCD.An SSRI would almost certainly exacerbate your lethargy and lack of drive on its own, so I imagine combining one with a relatively selective serotonin reuptake inhibitor like clomipramine would just add to the problem.
Bromocriptine could help things out, though it may not give you your energy back. Dopamine agonists tend to work very well for lack of ambition and anhedonia, but it's the noradrenergic meds that seem to provide the most useful boost in energy.
> Has anyone observed that their anxiety is aggravated by SNRI's or Stimulants. I cannnot tolerate any stimulants, On Ritalin I displayed bipolar symptoms, Dexadrine made me extremely anxious, as did provigil.
I found just the opposite with stimulants -- they made me more sociable and easy-going, even without Klonopin. SNRIs have never helped me at all though, but neither did they ever cause any side effects (which I understand is rare).
> My psychiatrist has noted that noradrenergic medications cause an increase in anxiety for me. Does anything strike you that might help with energy/cognition, I found all SSRI's to be stimulating, to the point where I couldn't sleep, which is why I'm somewhat interested in some combination of SSRI + Clomipramine. The SSRI's alone helped for 4 months, then did little for my anxiety, but it's hard to compare because while on the SSRI's I was in university school, under a good deal of pressure – now on clomipramine, I have no significant commitments.
Hmmm... I really have very few suggestions, but here they go:
1. Augment with low-dose fluoxetine (perhaps least likely of the SSRIs to cause anhedonia/apathy, and it has an indirect dopamine-enhancing effect)
2. A very low dose of Provigil, Dexedrine, etc. (if you can find a dose that is somewhat helpful without many side effects), perhaps combined with either Parlodel, Symmetrel, Mirapex or Requip.
3. A CNS stimulant in a low-moderate dose along with either a beta-blocker (e.g. propranolol, nadolol, atenolol) or alpha-2 agonist (e.g. guanfacine, clonidine) to keep your noradrenergic system from overfiring.
4. A CNS stimulant in a low-moderate dose, perhaps a decrease in your Klonopin dose, and the addition of a more "anti-depressant" benzodiazepine, such as alprazolam or lorazepam.
5. A good sleeping pill that allows you to wake up feeling refreshed (e.g. Imovane, Ambien, Sonata, Lunesta, Restoril).
6. Xyrem, though I'm not sure that it's available in Canada... I imagine a couple doses at night could be great for the fatique you describe, though.
7. Parnate> I came off clomipramine cold turkey three days ago, and I’m starting to get anxious, I feel this forboding brewing, I think I’ll go back on it tonight. Thank’s Michael,, also I understand if your busy, catching up on what your illness has taken from you, and can’t answer.
Sorry it took so long to reply, but I'm just so busy during the days now that I actually *feel* good! :-)
> Ben Je te souhaite toutes reussites avec parnate.~Michael Je te remercie infiniment! :-)
poster:Ame Sans Vie
thread:468293
URL: http://www.dr-bob.org/babble/20050317/msgs/471971.html