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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 75. This is the beginning of the thread.
Posted by med-amorphosis on May 17, 2010, at 14:11:37
Some sources say that imipramine is 'gold standard' for TRD and is unsurpassed when tested against newer antidepressants. Please share any experiences with it. Especially if uv used it with an MAOI. All comments wellcome. Thanks.
My current regime is:
90mg isocarboxazid (Marplan).
210mg lofepramine.
4mg clonazepam (Klonopin).
1.5g L-Tryptophan - now ditched coz of excessive hypersomnia.Obviosly I would be swapping the imipramine for the lofepramine.
Conditions:
Depression (currently severe).
Severe Social Phobia, probably APD.
On-going long-term hypersomnia.
Posted by ed_uk2010 on May 17, 2010, at 14:50:01
In reply to Imipramine really that good?, posted by med-amorphosis on May 17, 2010, at 14:11:37
> My current regime is:
> 90mg isocarboxazid (Marplan).
> 210mg lofepramine.
> 4mg clonazepam (Klonopin).
> 1.5g L-Tryptophan - now ditched coz of excessive hypersomnia.Imipramine cannot be combined with MAOIs because it inhibits the reuptake of serotonin. The combination could cause severe toxicity. Lofepramine is different because it is essentially a noradrenergic antidepressant.
If you want to try imipramine you'd need to come of lofepramine and isocarboxazid first. You could start imipramine once you had been completely off isocarboxazid for three weeks.
Posted by SLS on May 17, 2010, at 14:57:24
In reply to Imipramine really that good?, posted by med-amorphosis on May 17, 2010, at 14:11:37
> Some sources say that imipramine is 'gold standard' for TRD and is unsurpassed when tested against newer antidepressants. Please share any experiences with it. Especially if uv used it with an MAOI. All comments wellcome. Thanks.
>
> My current regime is:
> 90mg isocarboxazid (Marplan).
> 210mg lofepramine.
> 4mg clonazepam (Klonopin).
> 1.5g L-Tryptophan - now ditched coz of excessive hypersomnia.
I would say that imipramine demonstrates a greater success rate than desipramine.When combined with an MAOI, imipramine might have a greater potential to produce serotonin toxicity when compared to lofepramine. I think lofepramine is a prodrug that is converted to desipramine in the body. Desipramine is selective enough for NE that it be safer with an MAOI. I experience a degree of serotonin syndrome when I combine imipramine with Nardil.
How did you come to take 90mg of Marplan? Are you convinced that it helps you more than 60mg? I am in the process of titrating Marplan. However, I doubt that my doctor will go any higher than 60mg.
Thanks.
- Scott
Posted by SLS on May 17, 2010, at 14:59:27
In reply to Re: Imipramine really that good?, posted by ed_uk2010 on May 17, 2010, at 14:50:01
Hi Ed.
You are remarkable.
The Psycho-Babble community is lucky to have you.
- Scott
Posted by med-amorphosis on May 17, 2010, at 15:11:22
In reply to Re: Imipramine really that good?, posted by ed_uk2010 on May 17, 2010, at 14:50:01
> > My current regime is:
> > 90mg isocarboxazid (Marplan).
> > 210mg lofepramine.
> > 4mg clonazepam (Klonopin).
> > 1.5g L-Tryptophan - now ditched coz of excessive hypersomnia.
>
> Imipramine cannot be combined with MAOIs because it inhibits the reuptake of serotonin. The combination could cause severe toxicity. Lofepramine is different because it is essentially a noradrenergic antidepressant.
>
> If you want to try imipramine you'd need to come of lofepramine and isocarboxazid first. You could start imipramine once you had been completely off isocarboxazid for three weeks.So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI, as well as amitryptyline? I was slightly shocked too, but Hes very experienced. Anyway, imipramine is greatly more potent as an NRI than SRI, esp as its broken down to desipramine anyway. No?
Posted by med-amorphosis on May 17, 2010, at 15:18:22
In reply to Re: Imipramine really that good? » med-amorphosis, posted by SLS on May 17, 2010, at 14:57:24
> I would say that imipramine demonstrates a greater success rate than desipramine.
>
> When combined with an MAOI, imipramine might have a greater potential to produce serotonin toxicity when compared to lofepramine. I think lofepramine is a prodrug that is converted to desipramine in the body. Desipramine is selective enough for NE that it be safer with an MAOI. I experience a degree of serotonin syndrome when I combine imipramine with Nardil.
>
> How did you come to take 90mg of Marplan? Are you convinced that it helps you more than 60mg? I am in the process of titrating Marplan. However, I doubt that my doctor will go any higher than 60mg.
>
> Thanks.
>
>
> - ScottNot even MDMA produces serotonin syndrome with my meds. Its quite pleasant. Surprisingly. Anyway.
At 60mg my previous pdoc suggested upping Marplan to 80mg seeing as I had no side effects. I then took myself to 90. Its a far less toxic-feeling drug than Nardil. But then Nardil does so much more.
Posted by bearfan on May 17, 2010, at 15:24:15
In reply to Imipramine really that good?, posted by med-amorphosis on May 17, 2010, at 14:11:37
I'm trying a trial with it, and it takes about 9 days for steady state and to feel any effects. It does seem slightly stronger than a activating SSRI, although its not really all that much better. Were talking if you get 65% efficacy on an SSRI then maybe 70% with Imipramine (if you can tolerate some of its annoying side effects).
Posted by SLS on May 17, 2010, at 15:30:02
In reply to Re: Imipramine really that good? » ed_uk2010, posted by med-amorphosis on May 17, 2010, at 15:11:22
> So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI,
Perhaps he has experience with it. However, if he is relying on "theoretical" safety, I must reiterate that I have had a SS reaction to imipramine in combination with Nardil on two occassions. I experienced severe hypotension, hyperreflexia, and rigidity.
The potencies of imipramine to inhibit the reuptake of serotonin and norepinephrine are about the same.
- Scott
Posted by Phillipa on May 17, 2010, at 15:36:58
In reply to Re: Imipramine really that good?, posted by SLS on May 17, 2010, at 15:30:02
Best to be careful not something to take chances with. Phillipa
Posted by ed_uk2010 on May 17, 2010, at 15:38:39
In reply to Re: Imipramine really that good? » ed_uk2010, posted by med-amorphosis on May 17, 2010, at 15:11:22
>So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI, as well as amitriptyline?
I must say that I am very surprised.
>Anyway, imipramine is greatly more potent as an NRI than SRI, esp as its broken down to desipramine anyway. No?
Imipramine itself acts as a moderate SRI and a NRI. Desipramine is an NRI. I would be very concerned about combining imipramine with any of the MAOIs. Fatalaties have been reported.
eg. Imipramine added to the MAOI tranylcypromine (Parnate)...
http://www.ncbi.nlm.nih.gov/pubmed/12927331
Posted by ed_uk2010 on May 17, 2010, at 15:41:24
In reply to Re: Imipramine really that good? » SLS, posted by med-amorphosis on May 17, 2010, at 15:18:22
>Not even MDMA produces serotonin syndrome with my meds. Its quite pleasant.
Now that does sound risky. Take care of yourself.
Posted by ed_uk2010 on May 17, 2010, at 15:41:56
In reply to Re: Imipramine really that good? » ed_uk2010, posted by SLS on May 17, 2010, at 14:59:27
Thanks Scott :)
Posted by Bob on May 17, 2010, at 17:33:29
In reply to Re: Imipramine really that good? » med-amorphosis, posted by SLS on May 17, 2010, at 14:57:24
>
> When combined with an MAOI, imipramine might have a greater potential to produce serotonin toxicity when compared to lofepramine. I think lofepramine is a prodrug that is converted to desipramine in the body. Desipramine is selective enough for NE that it be safer with an MAOI. I experience a degree of serotonin syndrome when I combine imipramine with Nardil.
>>
> Thanks.
>
>
> - Scott
Scott -What exactly do you feel when you experience "a degree of serotonin syndrome"? I'm not sure I would know what that feels like.
Bob
Posted by Bob on May 17, 2010, at 17:43:07
In reply to Re: Imipramine really that good?, posted by SLS on May 17, 2010, at 15:30:02
>
> The potencies of imipramine to inhibit the reuptake of serotonin and norepinephrine are about the same.
>
>
> - ScottSo would it be reasonable to say that imipramine is sort of like a tricyclic version of milnacipran, or vice versa? Not that there exactly the same, but both of them are similar in their approximately even reuptake of serotonin and norepinephrine.
I'm trying to create such a balance with nortriptyline and citalopram, but am not sure what dose combination might do that.
Posted by med-amorphosis on May 17, 2010, at 17:56:23
In reply to Re: Imipramine really that good?, posted by SLS on May 17, 2010, at 15:30:02
> > So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI,
>
> Perhaps he has experience with it. However, if he is relying on "theoretical" safety, I must reiterate that I have had a SS reaction to imipramine in combination with Nardil on two occassions.He leads a whole team of psychopharms. And I'm not on Nardil. Im on Marplan- a VERY different drug. I've used both long term.
> I experienced severe hypotension, hyperreflexia, and rigidity.
Sounds more like fits/convulsions to me...Lots of drugs can cause them- even wellbutrin on its own.
> The potencies of imipramine to inhibit the reuptake of serotonin and norepinephrine are about the same.Thanks. Sounds about right, but I need to find some hard fact about this drug i think.
> - Scott
p.s. no disrespect intended
Posted by med-amorphosis on May 17, 2010, at 17:58:21
In reply to Re: Imipramine really that good?, posted by Phillipa on May 17, 2010, at 15:36:58
> Best to be careful not something to take chances with. Phillipa
So your saying I shouldn't trust my pdoc? Then who do I trust?
Posted by med-amorphosis on May 17, 2010, at 18:05:23
In reply to Re: Imipramine really that good?, posted by ed_uk2010 on May 17, 2010, at 15:38:39
> >So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI, as well as amitriptyline?
>
> I must say that I am very surprised.
>
> >Anyway, imipramine is greatly more potent as an NRI than SRI, esp as its broken down to desipramine anyway. No?
>
> Imipramine itself acts as a moderate SRI and a NRI. Desipramine is an NRI. I would be very concerned about combining imipramine with any of the MAOIs. Fatalaties have been reported.
>
> eg. Imipramine added to the MAOI tranylcypromine (Parnate)...
>
> http://www.ncbi.nlm.nih.gov/pubmed/12927331
>
>
>
>
>
>But im taking Marplan not Parnate. Very different drug. Thats the problem with MAOIs- they are now looked upon as one group of similar drugs, like SSRIs. BUT, MAOIs are totally unique to each other. None are the same, or even similar. Trust me. I've found I can get away with allmost anything with Marplan, unlike Nardil. Pizza? YES! Cheese strait from the block? YES! Could I do this on Nardil? NO!
Posted by SLS on May 17, 2010, at 18:30:27
In reply to Re: Imipramine really that good? » SLS, posted by med-amorphosis on May 17, 2010, at 17:56:23
> > > So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI,
> > Perhaps he has experience with it. However, if he is relying on "theoretical" safety, I must reiterate that I have had a SS reaction to imipramine in combination with Nardil on two occassions.
> He leads a whole team of psychopharms.
It is good that you trust your doctor.
> And I'm not on Nardil. Im on Marplan- a VERY different drug.
Well, I would still consider the possibility that there is some overlap between MAO inhibitors regarding biological effects. That being said, I did not have the problem with Parnate that I had with Nardil when I added imipramine to it.
> > I experienced severe hypotension, hyperreflexia, and rigidity.
> Sounds more like fits/convulsions to meWhy do you say this? How is what I described similar to "fits/convulsions"?
> > The potencies of imipramine to inhibit the reuptake of serotonin and norepinephrine are about the same.
> Thanks. Sounds about right, but I need to find some hard fact about this
drug i think.I think this site will prove useful to you:
http://pdsp.med.unc.edu/indexR.html
- Scott
Posted by SLS on May 17, 2010, at 18:51:15
In reply to Re: Imipramine really that good? » SLS, posted by Bob on May 17, 2010, at 17:33:29
> What exactly do you feel when you experience "a degree of serotonin syndrome"? I'm not sure I would know what that feels like.
The symptoms of serotonin syndrome vary greatly between individuals and the drugs being used. I experienced severe hypotension, mild hyperreflexia, and moderate muscle rigidity when I combined Nardil with imipramine. However, when I combined Parnate with Effexor, in addition to muscle rigidity and ataxia, I became incoherent (altered mental status) and spoke complete gibberish. However, my body temperature was not elevated during any episode, and I did not experience anxiety.
http://uuhsc.utah.edu/poison/healthpros/utox/vol4_no4.pdf
- Scott
Posted by linkadge on May 17, 2010, at 19:34:18
In reply to Re: Imipramine really that good? » Bob, posted by SLS on May 17, 2010, at 18:51:15
Amitriptyline has been combined with MAOI's supposedly without consequence. You will want to watch with the tryptophan though, thats a tripple whammy serotonin boost.
In some studies, long term amitriptyline administration upregulates the serotonin transporter and reduces serotonin levels (hence its antimigrane effect)?
The TCA's inhibit monoamine oxidase themselves (to some extent). Vise versa, parnate inhibits monoamine reuptake. Some degree of overlap is probably ok.
Linkadge
Posted by SLS on May 17, 2010, at 19:46:10
In reply to Re: Imipramine really that good?, posted by linkadge on May 17, 2010, at 19:34:18
> Amitriptyline has been combined with MAOI's supposedly without consequence.
I was treated at Columbia Presbyterian with a combination of Nardil 45mg and amitriptyline 150mg without sequalae. I do wonder, though, if this dosage of Nardil was too low to produce sufficient MAO inhibition to produce a reaction. 45mg is usually too low for me to respond to. These same doctors refused to combine imipramine with Nardil. I am not sure what their concern was.
- Scott
Posted by gman22 on May 17, 2010, at 19:49:23
In reply to Imipramine really that good?, posted by med-amorphosis on May 17, 2010, at 14:11:37
Imipramine was discovered by accident. One can infer that there was no experimental bias in evaluating it's effectiveness, as opposed to the way that drugs are developed today. They were giving the drug to psych patients and found out it made psychotic patients worse, but depressed patients much better. It does hit a lot of receptors and have some side effects, but it is very effective when given at proper dosages. It is considered very safe and doesn't lose effectiveness like SSRI's can over the years.
It helped me immensely.
Posted by med-amorphosis on May 18, 2010, at 5:40:33
In reply to Re: Imipramine really that good? » med-amorphosis, posted by SLS on May 17, 2010, at 18:30:27
> > > > So why has my pdoc included it in the list of TCAs he 'will' consider adding to my MAOI,
>
> > > Perhaps he has experience with it. However, if he is relying on "theoretical" safety, I must reiterate that I have had a SS reaction to imipramine in combination with Nardil on two occassions.
>
> > He leads a whole team of psychopharms.
>
> It is good that you trust your doctor.
>
> > And I'm not on Nardil. Im on Marplan- a VERY different drug.
>
> Well, I would still consider the possibility that there is some overlap between MAO inhibitors regarding biological effects. That being said, I did not have the problem with Parnate that I had with Nardil when I added imipramine to it.
>
> > > I experienced severe hypotension, hyperreflexia, and rigidity.
>
> > Sounds more like fits/convulsions to me
>
> Why do you say this? How is what I described similar to "fits/convulsions"?Only because when my pdoc gave me Optimax the SS warnings he gave to look out for were somewhat different. I see him again today. I'll check whith him what the 1st signs are again. I've only had one SS episode when I stupidly took MDEA along with my Nardil. Feeling cold with hot sweats im sure is one symptom. I feel that mildy whenever I've started an SSRI too. But everyone different so I dont discount your claim. Just how it sounds to me thats all :)
> I think this site will prove useful to you:
>
> http://pdsp.med.unc.edu/indexR.html
>
>
> - ScottThanks Scott
Posted by med-amorphosis on May 18, 2010, at 5:48:41
In reply to Re: Imipramine really that good? » SLS, posted by med-amorphosis on May 18, 2010, at 5:40:33
> I've only had one SS episode when I stupidly took MDEA along with my Nardil.Actually my mistake. It was MDEA combined with paroxetine.
Posted by med-amorphosis on May 18, 2010, at 5:53:58
In reply to Re: Imipramine really that good?, posted by gman22 on May 17, 2010, at 19:49:23
Theres a glimmer of hope! Thanks gman22. Off to docs. I'll let you all know the outcome later.
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