![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by KaraS on January 26, 2005, at 14:00:53
I'm becoming increasingly sensitive to norepinephrine. It has made it difficult to take any antidepressants that might really help me with my anergic depression. I just started taking a very small amount of maprotiline to help me sleep (something I used to take for years) and now that too is giving me tachycardia and it's not terribly helpful for sleep anymore. I tried a very small amount of Cymbalta and felt the same way. This is particularly bad since I'm having terrible problems with anxiety now.
The SSRIs are of limited use for me. I need more comprehensive AD agents but then I face the norepinephrine problems (not to mention the dopamine problem as it puts me to sleep).
My last two pdocs have refused to give me beta blockers. Why won't doctors prescribe beta blockers for tachycardia? Or are some of them willing to do this? Are there any other answers here?
K
Posted by Minnie-Haha on January 26, 2005, at 16:23:40
In reply to Why not beta blockers for tachycardia?, posted by KaraS on January 26, 2005, at 14:00:53
This info at Medline says beta blockers can increase depression. Maybe that's why your doc doesn't want to RX?
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202087.html
Posted by emme on January 26, 2005, at 17:08:58
In reply to Why not beta blockers for tachycardia?, posted by KaraS on January 26, 2005, at 14:00:53
Some do. Mine did. Atenolol doesn't cross the blood brain barrier as easily as some of the others and might be a viable choice. Besides, if you tried one and decided it increased your depression, you could stop.
> I'm becoming increasingly sensitive to norepinephrine. It has made it difficult to take any antidepressants that might really help me with my anergic depression. I just started taking a very small amount of maprotiline to help me sleep (something I used to take for years) and now that too is giving me tachycardia and it's not terribly helpful for sleep anymore. I tried a very small amount of Cymbalta and felt the same way. This is particularly bad since I'm having terrible problems with anxiety now.
>
> The SSRIs are of limited use for me. I need more comprehensive AD agents but then I face the norepinephrine problems (not to mention the dopamine problem as it puts me to sleep).
>
> My last two pdocs have refused to give me beta blockers. Why won't doctors prescribe beta blockers for tachycardia? Or are some of them willing to do this? Are there any other answers here?
>
> K
>
>
>
>
>
>
>
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>
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>
Posted by KaraS on January 27, 2005, at 1:10:22
In reply to Re: Why not beta blockers for tachycardia?, posted by Minnie-Haha on January 26, 2005, at 16:23:40
> This info at Medline says beta blockers can increase depression. Maybe that's why your doc doesn't want to RX?
>
> http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202087.html
>
Yes, that's entirely possible although benzos can do the same thing yet pdocs prescribe them regularly.
Posted by KaraS on January 27, 2005, at 1:14:09
In reply to Re: Why not beta blockers for tachycardia? » KaraS, posted by emme on January 26, 2005, at 17:08:58
> Some do. Mine did. Atenolol doesn't cross the blood brain barrier as easily as some of the others and might be a viable choice. Besides, if you tried one and decided it increased your depression, you could stop.
>
>
> > I'm becoming increasingly sensitive to norepinephrine. It has made it difficult to take any antidepressants that might really help me with my anergic depression. I just started taking a very small amount of maprotiline to help me sleep (something I used to take for years) and now that too is giving me tachycardia and it's not terribly helpful for sleep anymore. I tried a very small amount of Cymbalta and felt the same way. This is particularly bad since I'm having terrible problems with anxiety now.
> >
> > The SSRIs are of limited use for me. I need more comprehensive AD agents but then I face the norepinephrine problems (not to mention the dopamine problem as it puts me to sleep).
> >
> > My last two pdocs have refused to give me beta blockers. Why won't doctors prescribe beta blockers for tachycardia? Or are some of them willing to do this? Are there any other answers here?
> >
> > K
> >Thanks. I think that if I could find a doctor willing to prescribe them, then I'd have a few more options left. It might be worth risking the extra depression. (I need to find out for certain whether I have any asthma or not though as beta blockers are contraindicated with this condition.)
Posted by yxibow on January 27, 2005, at 1:59:53
In reply to Why not beta blockers for tachycardia?, posted by KaraS on January 26, 2005, at 14:00:53
> My last two pdocs have refused to give me beta blockers. Why won't doctors prescribe beta blockers for tachycardia? Or are some of them willing to do this? Are there any other answers here?
The answer is probably twofold -- one, your p-doc may feel that he's not experienced enough in the field of cardiology and doesnt want to take a danger or risk of sending you into bradycardia (60bpm or less) and would prefer you see a GP or cardiologist...
... and two is the depression issue mentioned, although propranolol-induced depression I dont believe is severe.
But if you're just trying to solve a heart arrythmia issue, I would see a general practitioner and have them prescribe a cardioselective beta-blocker.
(The field of psychiatry generally prescribes non-cardioselective ones such as propranolol for anxiety because they dont act as strongly and directly at the heart.)
Posted by alienatari on January 27, 2005, at 5:14:10
In reply to Re: Why not beta blockers for tachycardia? » emme, posted by KaraS on January 27, 2005, at 1:14:09
I have sensitive airways (or something like that) and i was able to take beta blockers. I do not have asthma though. But its best to check i guess. Better to be safe than sorry. Personaly i didnt find them much help. But i know of other people that swear by them.
> > Some do. Mine did. Atenolol doesn't cross the blood brain barrier as easily as some of the others and might be a viable choice. Besides, if you tried one and decided it increased your depression, you could stop.
> >
> >
> > > I'm becoming increasingly sensitive to norepinephrine. It has made it difficult to take any antidepressants that might really help me with my anergic depression. I just started taking a very small amount of maprotiline to help me sleep (something I used to take for years) and now that too is giving me tachycardia and it's not terribly helpful for sleep anymore. I tried a very small amount of Cymbalta and felt the same way. This is particularly bad since I'm having terrible problems with anxiety now.
> > >
> > > The SSRIs are of limited use for me. I need more comprehensive AD agents but then I face the norepinephrine problems (not to mention the dopamine problem as it puts me to sleep).
> > >
> > > My last two pdocs have refused to give me beta blockers. Why won't doctors prescribe beta blockers for tachycardia? Or are some of them willing to do this? Are there any other answers here?
> > >
> > > K
> > >
>
> Thanks. I think that if I could find a doctor willing to prescribe them, then I'd have a few more options left. It might be worth risking the extra depression. (I need to find out for certain whether I have any asthma or not though as beta blockers are contraindicated with this condition.)
>
Posted by KaraS on January 27, 2005, at 11:28:02
In reply to Re: Why not beta blockers for tachycardia?, posted by yxibow on January 27, 2005, at 1:59:53
> > My last two pdocs have refused to give me beta blockers. Why won't doctors prescribe beta blockers for tachycardia? Or are some of them willing to do this? Are there any other answers here?
>
> The answer is probably twofold -- one, your p-doc may feel that he's not experienced enough in the field of cardiology and doesnt want to take a danger or risk of sending you into bradycardia (60bpm or less) and would prefer you see a GP or cardiologist...
>
> ... and two is the depression issue mentioned, although propranolol-induced depression I dont believe is severe.
>
> But if you're just trying to solve a heart arrythmia issue, I would see a general practitioner and have them prescribe a cardioselective beta-blocker.
>
> (The field of psychiatry generally prescribes non-cardioselective ones such as propranolol for anxiety because they dont act as strongly and directly at the heart.)
Thanks. That's very helpful.K
Posted by KaraS on January 27, 2005, at 11:30:41
In reply to Re: Why not beta blockers for tachycardia?, posted by alienatari on January 27, 2005, at 5:14:10
> I have sensitive airways (or something like that) and i was able to take beta blockers. I do not have asthma though. But its best to check i guess. Better to be safe than sorry. Personaly i didnt find them much help. But i know of other people that swear by them.
>I guess it depends on what you're using them for. I would just be using them to bring my heart rate down to a more normal rate. I have tried propanolol on a couple of occassions for performance anxiety and it worked well.
k
Posted by emme on January 27, 2005, at 13:20:58
In reply to Why not beta blockers for tachycardia?, posted by KaraS on January 26, 2005, at 14:00:53
Posted by linkadge on January 27, 2005, at 15:43:52
In reply to atenolol is cardioselective (nm) » KaraS, posted by emme on January 27, 2005, at 13:20:58
I read this too, that atenolol does not cross the blood brain barrier.
I think this is nonsence for three reasons:
a) It is sometimes used in agression and
PTSD, where lowering blood pressure alone
does not ameleorate agression/PTSD.b) It is used in migrane, whereas not every
medicine that lowers blood pressure ameliorates
migrane.c) It makes me depressed.
I don't think it is cardioselective. The ideal heart medication is cardioselective so every manufacturer claims this.
Linkadge
Posted by KaraS on January 27, 2005, at 23:27:31
In reply to atenolol is cardioselective (nm) » KaraS, posted by emme on January 27, 2005, at 13:20:58
I just read that in one of Ed's posts above. Does that mean that it isn't contraindicated for asthma? Does it also have a tendency to cause or worsen depression?
Posted by KaraS on January 27, 2005, at 23:30:06
In reply to It proposedly does not cross the BBB, posted by linkadge on January 27, 2005, at 15:43:52
> I read this too, that atenolol does not cross the blood brain barrier.
>
> I think this is nonsence for three reasons:
>
> a) It is sometimes used in agression and
> PTSD, where lowering blood pressure alone
> does not ameleorate agression/PTSD.
>
> b) It is used in migrane, whereas not every
> medicine that lowers blood pressure ameliorates
> migrane.
>
> c) It makes me depressed.
>
> I don't think it is cardioselective. The ideal heart medication is cardioselective so every manufacturer claims this.
>
>
> Linkadge
It's hard to know what to believe these days - esp. if it's coming from the big drug companies.
Posted by mrporter1 on January 28, 2005, at 13:40:43
In reply to atenolol is cardioselective (nm) » KaraS, posted by emme on January 27, 2005, at 13:20:58
I take 37.5 mgs of Atenolol(25 am 12.5 pm) for tachycardia. I started with 25 each day and that wasn't enough. But have been taking current dose for 3 years and it has managed major events (>190bpm). However, I just started Cymbalta and am finding that my heart rate has been jumping to about 120 at night if I move a muscle. I spoke with p-doc about it and he assured me that it had nothing to do with Cymbalta. Must just be a grand coincidence! Not sure how I will proceed...
Posted by emme on January 28, 2005, at 23:39:39
In reply to Re: atenolol is cardioselective » emme, posted by KaraS on January 27, 2005, at 23:27:31
> I just read that in one of Ed's posts above. Does that mean that it isn't contraindicated for asthma?
All the drug info I've ever seen for it says it is contraindicated for asthma; there will be some cross-over between receptors with all the beta-blockers.
> Does it also have a tendency to cause or worsen depression?
All the beta blockers have the potential to cause depression. I believe my doctor tried atenolol because it crosses the BB barrier less readily than, say, propranolol. I think it was a good choice to try to avoid potential worsening of depression. If you want to find out more about how much actually makes it across the BB barrier, do a search on "atenolol" and "blood brain barrier". I think I saw one or two on Pubmed where they measured how much crossed the barrier.
But what it all boils down to is that you wouldn't know if it made you more depressed unless you tried it. But you've said the doctors wouldn't prescribe it. What were their reasons? Are you asthmatic? Do you have really low blood pressure? Beta blockers could be contraindicated for a number of reasons.
Posted by KaraS on January 29, 2005, at 2:12:44
In reply to Beta Blockers and Tachycardia, posted by mrporter1 on January 28, 2005, at 13:40:43
> I take 37.5 mgs of Atenolol(25 am 12.5 pm) for tachycardia. I started with 25 each day and that wasn't enough. But have been taking current dose for 3 years and it has managed major events (>190bpm). However, I just started Cymbalta and am finding that my heart rate has been jumping to about 120 at night if I move a muscle. I spoke with p-doc about it and he assured me that it had nothing to do with Cymbalta. Must just be a grand coincidence! Not sure how I will proceed...
Yeah, some coincidence!
Posted by KaraS on January 29, 2005, at 2:15:16
In reply to Re: atenolol is cardioselective » KaraS, posted by emme on January 28, 2005, at 23:39:39
> > I just read that in one of Ed's posts above. Does that mean that it isn't contraindicated for asthma?
>
> All the drug info I've ever seen for it says it is contraindicated for asthma; there will be some cross-over between receptors with all the beta-blockers.
>
> > Does it also have a tendency to cause or worsen depression?
>
> All the beta blockers have the potential to cause depression. I believe my doctor tried atenolol because it crosses the BB barrier less readily than, say, propranolol. I think it was a good choice to try to avoid potential worsening of depression. If you want to find out more about how much actually makes it across the BB barrier, do a search on "atenolol" and "blood brain barrier". I think I saw one or two on Pubmed where they measured how much crossed the barrier.
>
> But what it all boils down to is that you wouldn't know if it made you more depressed unless you tried it. But you've said the doctors wouldn't prescribe it. What were their reasons? Are you asthmatic? Do you have really low blood pressure? Beta blockers could be contraindicated for a number of reasons.NO, I had no signs of asthma and they hadn't even taken my blood pressure when they said no. They both gave me the impression that it just wasn't done. I think the truth is that they were uncomfortable prescribing a medication they think is outside of their specialty or expertise.
Posted by emme on January 29, 2005, at 9:53:13
In reply to Re: atenolol is cardioselective » emme, posted by KaraS on January 29, 2005, at 2:15:16
> > > I just read that in one of Ed's posts above. Does that mean that it isn't contraindicated for asthma?
> >
> > All the drug info I've ever seen for it says it is contraindicated for asthma; there will be some cross-over between receptors with all the beta-blockers.
> >
> > > Does it also have a tendency to cause or worsen depression?
> >
> > All the beta blockers have the potential to cause depression. I believe my doctor tried atenolol because it crosses the BB barrier less readily than, say, propranolol. I think it was a good choice to try to avoid potential worsening of depression. If you want to find out more about how much actually makes it across the BB barrier, do a search on "atenolol" and "blood brain barrier". I think I saw one or two on Pubmed where they measured how much crossed the barrier.
> >
> > But what it all boils down to is that you wouldn't know if it made you more depressed unless you tried it. But you've said the doctors wouldn't prescribe it. What were their reasons? Are you asthmatic? Do you have really low blood pressure? Beta blockers could be contraindicated for a number of reasons.
>
> NO, I had no signs of asthma and they hadn't even taken my blood pressure when they said no. They both gave me the impression that it just wasn't done. I think the truth is that they were uncomfortable prescribing a medication they think is outside of their specialty or expertise.Okay, so if there's no obvious physical reason for you to not be able to try a beta blocker, then then you can try going in armed with information in order to open a discussion. A search on "anxiety beta blockers" will bring up a number of references to beta blockers as a treatment for anxiety, especially for social phobia. Not that social phobia is your issue, but it might show them that there's precedent for their use in psychiatry. I think I was my pdoc's guinea pig. She suggested atenolol after she'd seen something in the literature about propranolol being used to expedite response to ADs.
I took a quick look on Pubmed and NIMH for starters.
Giving you a general sense that it's not done isn't a very satisfying explanation for deciding a medication isn't appropriate. If they have a valid objection, then they should state explicitly what that is.
http://www.nimh.nih.gov/publicat/adfacts.cfm?styleN=two
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9622045
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15014622
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12408422
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10832377
Posted by KaraS on January 29, 2005, at 15:47:58
In reply to Re: atenolol is cardioselective » KaraS, posted by emme on January 29, 2005, at 9:53:13
> > > > I just read that in one of Ed's posts above. Does that mean that it isn't contraindicated for asthma?
> > >
> > > All the drug info I've ever seen for it says it is contraindicated for asthma; there will be some cross-over between receptors with all the beta-blockers.
> > >
> > > > Does it also have a tendency to cause or worsen depression?
> > >
> > > All the beta blockers have the potential to cause depression. I believe my doctor tried atenolol because it crosses the BB barrier less readily than, say, propranolol. I think it was a good choice to try to avoid potential worsening of depression. If you want to find out more about how much actually makes it across the BB barrier, do a search on "atenolol" and "blood brain barrier". I think I saw one or two on Pubmed where they measured how much crossed the barrier.
> > >
> > > But what it all boils down to is that you wouldn't know if it made you more depressed unless you tried it. But you've said the doctors wouldn't prescribe it. What were their reasons? Are you asthmatic? Do you have really low blood pressure? Beta blockers could be contraindicated for a number of reasons.
> >
> > NO, I had no signs of asthma and they hadn't even taken my blood pressure when they said no. They both gave me the impression that it just wasn't done. I think the truth is that they were uncomfortable prescribing a medication they think is outside of their specialty or expertise.
>
> Okay, so if there's no obvious physical reason for you to not be able to try a beta blocker, then then you can try going in armed with information in order to open a discussion. A search on "anxiety beta blockers" will bring up a number of references to beta blockers as a treatment for anxiety, especially for social phobia. Not that social phobia is your issue, but it might show them that there's precedent for their use in psychiatry. I think I was my pdoc's guinea pig. She suggested atenolol after she'd seen something in the literature about propranolol being used to expedite response to ADs.
>
> I took a quick look on Pubmed and NIMH for starters.
>
> Giving you a general sense that it's not done isn't a very satisfying explanation for deciding a medication isn't appropriate. If they have a valid objection, then they should state explicitly what that is.
>
> http://www.nimh.nih.gov/publicat/adfacts.cfm?styleN=two
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9622045
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15014622
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12408422
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10832377
>
Thanks so much Emme,I've bookmarked this post. It gives me new options.
Take care,
Kara
Posted by KaraS on January 30, 2005, at 14:00:09
In reply to Re: atenolol is cardioselective » KaraS, posted by emme on January 29, 2005, at 9:53:13
> > > > I just read that in one of Ed's posts above. Does that mean that it isn't contraindicated for asthma?
> > >
> > > All the drug info I've ever seen for it says it is contraindicated for asthma; there will be some cross-over between receptors with all the beta-blockers.
> > >
> > > > Does it also have a tendency to cause or worsen depression?
> > >
> > > All the beta blockers have the potential to cause depression. I believe my doctor tried atenolol because it crosses the BB barrier less readily than, say, propranolol. I think it was a good choice to try to avoid potential worsening of depression. If you want to find out more about how much actually makes it across the BB barrier, do a search on "atenolol" and "blood brain barrier". I think I saw one or two on Pubmed where they measured how much crossed the barrier.
> > >
> > > But what it all boils down to is that you wouldn't know if it made you more depressed unless you tried it. But you've said the doctors wouldn't prescribe it. What were their reasons? Are you asthmatic? Do you have really low blood pressure? Beta blockers could be contraindicated for a number of reasons.
> >
> > NO, I had no signs of asthma and they hadn't even taken my blood pressure when they said no. They both gave me the impression that it just wasn't done. I think the truth is that they were uncomfortable prescribing a medication they think is outside of their specialty or expertise.
>
> Okay, so if there's no obvious physical reason for you to not be able to try a beta blocker, then then you can try going in armed with information in order to open a discussion. A search on "anxiety beta blockers" will bring up a number of references to beta blockers as a treatment for anxiety, especially for social phobia. Not that social phobia is your issue, but it might show them that there's precedent for their use in psychiatry. I think I was my pdoc's guinea pig. She suggested atenolol after she'd seen something in the literature about propranolol being used to expedite response to ADs.
>
> I took a quick look on Pubmed and NIMH for starters.
>
> Giving you a general sense that it's not done isn't a very satisfying explanation for deciding a medication isn't appropriate. If they have a valid objection, then they should state explicitly what that is.
>
> http://www.nimh.nih.gov/publicat/adfacts.cfm?styleN=two
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9622045
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15014622
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12408422
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10832377
>
Actually I did a little more research and there is still a chance of it causing depression - just not as much chance as if you took a nonselective beta blocker. Did you notice any increased depression when you took it?
Posted by emme on January 30, 2005, at 15:36:25
In reply to Re: atenolol is cardioselective » emme, posted by KaraS on January 30, 2005, at 14:00:09
> Actually I did a little more research and there is still a chance of it causing depression -Yes, depression is listed as a potential s/e for all beta blockers.
> just not as much chance as if you took a nonselective beta blocker.
Not so. Selectivity has to do with whether it blocks beta-1 receptors (selective) or both beta-1 and beta-2 receptors (nonselective). Beta-1 receptors are primarily cardiac. Beta2-receptors are are located on a number of tissues including bronchial and gastrointestinal. I haven't read anything on exactly how strict the selectivity is, but it does say to use atenolol with caution if one has asthma.
CNS effects, such as depression, are more likely if the drug crosses the blood-brain barrier readily. This is different from whether the drug is selective. Lipophilic = crosses readily. Hydrophilic = not so readily. 'Course no filtering system is absolutely perfect and apparently some people get depressed on atenolol (which is hydrophilic).
It just so happens that of the beta-blockers mentioned here most often, atenolol is both cardioselective *and* hydrophilic, and propranolol and pindolol are both nonselective and lipophilic.
Okay, I'll shut up now. :) I hope I wasn't too incoherent.
> Did you notice any increased depression when you took it?
I really don't think so. YMMV. I was just thinking that sometime soon I might stop taking it for several days just to see what happens since I'm not taking anything outrageously acitvating at the moment.
Posted by KaraS on January 30, 2005, at 16:22:24
In reply to Re: atenolol is cardioselective » KaraS, posted by emme on January 30, 2005, at 15:36:25
>
> > Actually I did a little more research and there is still a chance of it causing depression -
>
> Yes, depression is listed as a potential s/e for all beta blockers.
>
> > just not as much chance as if you took a nonselective beta blocker.
>
> Not so. Selectivity has to do with whether it blocks beta-1 receptors (selective) or both beta-1 and beta-2 receptors (nonselective). Beta-1 receptors are primarily cardiac. Beta2-receptors are are located on a number of tissues including bronchial and gastrointestinal. I haven't read anything on exactly how strict the selectivity is, but it does say to use atenolol with caution if one has asthma.
>
> CNS effects, such as depression, are more likely if the drug crosses the blood-brain barrier readily. This is different from whether the drug is selective. Lipophilic = crosses readily. Hydrophilic = not so readily. 'Course no filtering system is absolutely perfect and apparently some people get depressed on atenolol (which is hydrophilic).
>
> It just so happens that of the beta-blockers mentioned here most often, atenolol is both cardioselective *and* hydrophilic, and propranolol and pindolol are both nonselective and lipophilic.
>
> Okay, I'll shut up now. :) I hope I wasn't too incoherent.
>
> > Did you notice any increased depression when you took it?
>
> I really don't think so. YMMV. I was just thinking that sometime soon I might stop taking it for several days just to see what happens since I'm not taking anything outrageously acitvating at the moment.
Emme,Wow! I'm impressed. You sure do know your beta-blockers. Thanks for all of that great information. I'm going to bookmark it for future reference.
Are you having any success with memantine or is it too soon to tell yet?
Kara
Posted by emme on January 30, 2005, at 17:07:48
In reply to Re: atenolol is cardioselective » emme, posted by KaraS on January 30, 2005, at 16:22:24
> >
> > > Actually I did a little more research and there is still a chance of it causing depression -
> >
> > Yes, depression is listed as a potential s/e for all beta blockers.
> >
> > > just not as much chance as if you took a nonselective beta blocker.
> >
> > Not so. Selectivity has to do with whether it blocks beta-1 receptors (selective) or both beta-1 and beta-2 receptors (nonselective). Beta-1 receptors are primarily cardiac. Beta2-receptors are are located on a number of tissues including bronchial and gastrointestinal. I haven't read anything on exactly how strict the selectivity is, but it does say to use atenolol with caution if one has asthma.
> >
> > CNS effects, such as depression, are more likely if the drug crosses the blood-brain barrier readily. This is different from whether the drug is selective. Lipophilic = crosses readily. Hydrophilic = not so readily. 'Course no filtering system is absolutely perfect and apparently some people get depressed on atenolol (which is hydrophilic).
> >
> > It just so happens that of the beta-blockers mentioned here most often, atenolol is both cardioselective *and* hydrophilic, and propranolol and pindolol are both nonselective and lipophilic.
> >
> > Okay, I'll shut up now. :) I hope I wasn't too incoherent.
> >
> > > Did you notice any increased depression when you took it?
> >
> > I really don't think so. YMMV. I was just thinking that sometime soon I might stop taking it for several days just to see what happens since I'm not taking anything outrageously acitvating at the moment.
>
>
> Emme,
>
> Wow! I'm impressed. You sure do know your beta-blockers.Thanks. I can actually remember beta-1 and beta-2. I don't even pretend to keep the serotonin receptors straight. :) My knowledge of pharmacology is not superb.
> Are you having any success with memantine or is it too soon to tell yet?
Yes, it's doing something. It's helped the depression and I'm less apathetic. But I feel vaguely depersonalized all the time, like I'm a stranger in my body. I feel detached from my emotions. And I'm tired. I'm waiting to see if this will subside. It does beat the heavy depression. If you're thinking about trying it, don't let what I've written here scare you off because YMMV. Word is that my pdoc is seeing some positive results in her patients.
em
Posted by KaraS on January 30, 2005, at 20:06:20
In reply to Re: atenolol is cardioselective » KaraS, posted by emme on January 30, 2005, at 17:07:48
> > >
> > > > Actually I did a little more research and there is still a chance of it causing depression -
> > >
> > > Yes, depression is listed as a potential s/e for all beta blockers.
> > >
> > > > just not as much chance as if you took a nonselective beta blocker.
> > >
> > > Not so. Selectivity has to do with whether it blocks beta-1 receptors (selective) or both beta-1 and beta-2 receptors (nonselective). Beta-1 receptors are primarily cardiac. Beta2-receptors are are located on a number of tissues including bronchial and gastrointestinal. I haven't read anything on exactly how strict the selectivity is, but it does say to use atenolol with caution if one has asthma.
> > >
> > > CNS effects, such as depression, are more likely if the drug crosses the blood-brain barrier readily. This is different from whether the drug is selective. Lipophilic = crosses readily. Hydrophilic = not so readily. 'Course no filtering system is absolutely perfect and apparently some people get depressed on atenolol (which is hydrophilic).
> > >
> > > It just so happens that of the beta-blockers mentioned here most often, atenolol is both cardioselective *and* hydrophilic, and propranolol and pindolol are both nonselective and lipophilic.
> > >
> > > Okay, I'll shut up now. :) I hope I wasn't too incoherent.
> > >
> > > > Did you notice any increased depression when you took it?
> > >
> > > I really don't think so. YMMV. I was just thinking that sometime soon I might stop taking it for several days just to see what happens since I'm not taking anything outrageously acitvating at the moment.
> >
> >
> > Emme,
> >
> > Wow! I'm impressed. You sure do know your beta-blockers.
>
> Thanks. I can actually remember beta-1 and beta-2. I don't even pretend to keep the serotonin receptors straight. :) My knowledge of pharmacology is not superb.
>
> > Are you having any success with memantine or is it too soon to tell yet?
>
> Yes, it's doing something. It's helped the depression and I'm less apathetic. But I feel vaguely depersonalized all the time, like I'm a stranger in my body. I feel detached from my emotions. And I'm tired. I'm waiting to see if this will subside. It does beat the heavy depression. If you're thinking about trying it, don't let what I've written here scare you off because YMMV. Word is that my pdoc is seeing some positive results in her patients.
>
> em
Em,
Anything is better than the deepest depression. I'd forgotten how low I could go when not on medication. The depersonalization is a strange side effect. I think I had that somewhat with the tricyclics years ago and it did go away. Have your pdoc's other patients had that side effect?
Memantine is definitely on my list of things to try. I was thinking more of using it as an augmentor but you're using it alone, right?
Have you tried MAOIs at all or are those on your list somewhere?K
Posted by emme on January 30, 2005, at 21:32:22
In reply to Re: atenolol is cardioselective » emme, posted by KaraS on January 30, 2005, at 20:06:20
> > > Are you having any success with memantine or is it too soon to tell yet?
> >
> > Yes, it's doing something. It's helped the depression and I'm less apathetic. But I feel vaguely depersonalized all the time, like I'm a stranger in my body. I feel detached from my emotions. And I'm tired. I'm waiting to see if this will subside. It does beat the heavy depression. If you're thinking about trying it, don't let what I've written here scare you off because YMMV. Word is that my pdoc is seeing some positive results in her patients.
> >
> > em
>
>
> Em,
> Anything is better than the deepest depression. I'd forgotten how low I could go when not on medication. The depersonalization is a strange side effect. I think I had that somewhat with the tricyclics years ago and it did go away.That's good. I'll be patient a little longer and see if it fades out.
> Have your pdoc's other patients had that side effect?
Dunno. I haven't had a chance to ask her yet.
> Memantine is definitely on my list of things to try. I was thinking more of using it as an augmentor but you're using it alone, right?
Nope. I take Lamictal, a dash of atenolol, and xanax as needed.
> Have you tried MAOIs at all or are those on your list somewhere?
I tried selegiline (5-10 mg). It gave me some excellent days. But I think it also fueled ups and downs because I had a lot of viscious crashes while on it. I ruled out Nardil and Parnate because I'm unwilling to take on the diet. It's not a big deal for many people, but there would be a lot of issues with my vegetarian lifestyle and it means a lot to have at least that aspect of my life left intact.
Did you have good success with tricylics?
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