Posted by Phoenix1 on June 21, 2008, at 12:10:37
In reply to Re: Clomipramine vs. Nardil » Phoenix1, posted by Crotale on June 19, 2008, at 23:19:05
> Ah. Why (if I may ask) did you keep increasing it after, as you say, things hit the fan?*Sorry, I should have been mire ckear on this. I went up to 90mg, had bad orhostatic hypotension, then reduced to 75mg.
>
> I'm confused; I thought the PRES was the result of too-rapid discontinuation of Nardil. (I sympathize; I had a terrible time when I had to go off Nardil extremely rapidly.)
>*I agree, I think the PRES was indirectly caused by Nardil withdrawal. Pdoc strongly disagrees, but then it's probably a CYA thing. The problem is that if he were to agree that the discontinuation caused it, I would have a good chance of being allowed to re-start it, which is what I want.
> Well, anyway, it sucks that you got misdiagnosed with "conversion disorder." That's just the sort of thing doctors do to psych patients.*Yup, the first ER treated me with total contempt and prejudice the minute I told them I was on an MAOI for depression. They dismissed my suggestion that I was having a hypertensive crisis. I even told them the standard treatment was chlorpromazine or nifedipine, but no action... Is it an unwritten rule that psych patients get a lower standard of care in the ER?
> It seems to me that it wasn't the Nardil but too-rapid discontinuation of the Nardil that caused the PRES....*Exactly! Man I wish the docs would see this is the case.
> How bad was the hypertensive crisis? (That is, how high was BP?)
*190/110 on admission. When I told them it was a hypertensive crisis, the doc said "I see blood pressures like this all day."
> I found that with the sedation from TCAs also. (The sedative effect is mainly, I think, because they are antihistamines.) I had better luck with secondary-amine TCAs (desipramine, nortriptyline, etc.) -- less sedating and less anticholinergic side effects (constipation, dry mouth, etc.) -- although I ended up having to go off desipramine b/c of a seizure (unfortunately, because it was working rather well for me).
> If it is effective, a different TCA might work as well with milder side fx...just a thought. Best of luck to you.
*Thanks for the suggestion. I'll ask about desipramine. I found nortriptylline intensely sedating.
Phoenix
poster:Phoenix1
thread:835192
URL: http://www.dr-bob.org/babble/20080617/msgs/835784.html