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Re: Depressed/agitated/wired - soft bipolar? » ed_uk

Posted by 4WD on January 18, 2006, at 21:51:36

In reply to Re: Depressed/agitated/wired - soft bipolar? » 4WD, posted by ed_uk on January 18, 2006, at 9:38:10

> Hi Marsha
>
> >When I was on imipramine in 1986-87, I was taking 50mg t.i.d. And doing well (except for pretty bad side effects). Is it possible that such a low dose would help without such bad SEs?
>
> 10mg is very unlikely to help - it's a good starting dose though. Starting TCAs at low doses reduces the severity of the side effects. You won't necessarily need 150mg/day though, some people are helped by lower doses eg. 75mg.
>
> >Do you know why SSRIs are so much more likely to cause anxiety than TCAs?
>
> Part of the problem is that people tend to take high(ish) doses of SSRIs right from the start eg. 20mg Prozac. People usually start TCAs at a low dose and work their way up to a therapeutic dose gradually.
>
> >I thought serotonin was supposed to the "calming" neurotransmitter.
>
> SSRIs consistently produce an initial increase in anxiety. After several weeks treatment, an anti-anxiety effect is often observed, especially in patients with OCD or panic disorder. Some find the SSRIs always aggravate their anxiety though - this is especially common in bipolar disorder, but is *not* 'diagnostic' of bipolar disorder.
>
> Regards
>
> Ed

Ed, thank you so much! I have been trying to find answers to those questions for years and no one has ever been able to explain it to me. I guess the trick is to manage the depression somehow while you work your way up to a therapeutic dosage. If I remember correctly i was started on 100mg of imipramine and pushed up to 150 in a couple of weeks.

So I guess you are saying that if I had started on a lower dosage and gone up much more gradually the side effects would never have been as intense?

No SSRI except low dose (37.5) Effexor has ever had an axiolytic effect for me, no matter how long I took it. I'm glad to know this is not a definitive indicator of bipolar. I really don't want to be rapid cycling bipolar/mixed states because it is apparently one of the hardest Dxs to treat. I'd rather just think I'm "allergic" to SSRIs and SNRI and Wellbutrin. Of course that only leaves the TCAs or MAOIs.

Don't you want to quit pharmacy school and be a pdoc? I'd come to England for treatment...

Marsha


What area of England btw?


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