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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Lonely on August 13, 2004, at 19:14:26
I'm wondering what experiences other board readers have had with antidepressant and ADHD medications in regard to blood pressure.
My husband is on 150 mgs a day of Effexor - Effexor seems to work best at managing his severe depression. We're looking at lowering it to 110 mgs a day w/approval of doc. He also started on Provigil (usually given for narcolepsy which he does NOT have) 5 days ago to help w/ADHD symtoms. He feels it is helping him slightly w/organizing himself at work. Also, possibly slightly supressing his appetite WHICH HE NEEDS!
The problem:
(1) He's had, for many years, very high blood pressure and has several TIAs and there is brain damage. I read that SSRIs and ADHD drugs do raise blood pressure.
(2) He's quite overweight - probably 70 pounds which we know contribute to high BP. However, I think in part because of mental problems he can't/doesn't lose weight. It's hard for him to exercise in a hot climate and 14 hours a day commuting & working & financial issues.
(3) The meds for blood pressure have serious side effects as follows (and we've tried many different types within these classifications:)
Beta Blockers: Severe depression, exhaustion, not much help in lowering BP, difficulty breathing
ACE Inhibitors: Severe choking - apparently the wind pipe doesn't quite close off properly when he swallows. Also depression and kidney disease
Diuretics (including pottassium sparring) Seriously low pottasium levels despite replacement med, large kidney stones, high creatinine levels, cystic kidneys
Calcium Channel Blockers - don't seem to lower BP and his father died very suddenly from these drugs.
I got into a slightly heated discussion with his neurologist this morning when the neurologist refused to give him an Rx for ADHD med (of any kind) due to BP. He NEEDS a med that helps with that problem to help even out his agitation and curb his appetite. Without it he's in a downward spiral and complications continue. Part of the problem right now has become iatrogenic.
What's bothoring me in particular is that the doctor(s) don't seem to see the cause-and-effect process of continuing the BP meds that cause tremendous weight gain and depression followed by more med for depression followed by less activity and higher BP. Anyone else have a similar expereince or other insights?
Posted by King Vultan on August 13, 2004, at 23:45:50
In reply to ADHD SSRI Meds Cause High Blood Pressure (?), posted by Lonely on August 13, 2004, at 19:14:26
I have a couple of suggestions for consideration, probably neither of which his doctors will agree with, but here they are, anyway:
1) The tricyclic AD desipramine is sometimes used for adult ADD and does act as an appetite suppressant for some but not all people (I lost a few pounds on it and am not at all overweight to begin with). It can raise BP at lower dosages but will tend to decrease BP at higher dosages because of its alpha adrenergic blockade. It is considered to be an "activating" antidepressant.
2) The MAOI Parnate is one of the few drugs from the non-stimulant class that has demonstrated efficacy for ADHD. This drug can cause a BP increase in the period of time immediately after taking it, but there is also an overall anti-hypertensive effect because this is an MAOI. Some patients can experience significant drops in BP, which can be a serious drawback for people with normal blood pressure but is not necessarily a bad thing for people whose BP is high to begin with.
This drug also does not tend to induce weight gain as many antidepressants do and may also act as an appetite suppressant for some people (It is stimulating and has a structure very close to that of amphetamine). Of course, this is an MAO inhibitor, with all the associated dietary and OTC drug restrictions. It is an excellent antidepressant, but all things considered, may really be too dangerous a drug to take in your husband's rather problematic situation. I only suggest it because like the desipramine, it can both lower appetite and blood pressure, while having some efficacy for attention disorders.
Todd
Posted by crazychickuk on August 14, 2004, at 6:51:47
ADHD Blood Pressure Meds Cause High BP?
Posted by Lonely on August 13, 2004, at 19:11:46I'm wondering what experiences other board readers have had with antidepressant and ADHD medications in regard to blood pressure.
My husband is on 150 mgs a day of Effexor - Effexor seems to work best at managing his severe depression. We're looking at lowering it to 110 mgs a day w/approval of doc. He also started on Provigil (usually given for narcolepsy which he does NOT have) 5 days ago to help w/ADHD symtoms. He feels it is helping him slightly w/organizing himself at work. Also, possibly slightly supressing his appetite WHICH HE NEEDS!
The problem:
(1) He's had, for many years, very high blood pressure and has several TIAs and there is brain damage. I read that SSRIs and ADHD drugs do raise blood pressure.
(2) He's quite overweight - probably 70 pounds which we know contribute to high BP. However, I think in part because of mental problems he can't/doesn't lose weight. It's hard for him to exercise in a hot climate and 14 hours a day commuting & working & financial issues.
(3) The meds for blood pressure have serious side effects as follows (and we've tried many different types within these classifications:)
Beta Blockers: Severe depression, exhaustion, not much help in lowering BP, difficulty breathing
ACE Inhibitors: Severe choking - apparently the wind pipe doesn't quite close off properly when he swallows. Also depression and kidney disease
Diuretics (including pottassium sparring) Seriously low pottasium levels despite replacement med, large kidney stones, high creatinine levels, cystic kidneys
Calcium Channel Blockers - don't seem to lower BP and his father died very suddenly from these drugs.
I got into a slightly heated discussion with his neurologist this morning when the neurologist refused to give him an Rx for ADHD med (of any kind) due to BP. He NEEDS a med that helps with that problem to help even out his agitation and curb his appetite. Without it he's in a downward spiral and complications continue. Part of the problem right now has become iatrogenic.
What's bothoring me in particular is that the doctor(s) don't seem to see the cause-and-effect process of continuing the BP meds that cause tremendous weight gain and depression followed by more med for depression followed by less activity and higher BP. Anyone else have a similar expereince or other insights?
Posted by Racer on August 14, 2004, at 9:48:42
In reply to ADHD Blood Pressure Meds Cause High BP?, posted by crazychickuk on August 14, 2004, at 6:51:47
This is the answer I posted to this on the Health board, where this originally appeared.
> The problem:
>
> (1) He's had, for many years, very high blood pressure and has several TIAs and there is brain damage. I read that SSRIs and ADHD drugs do raise blood pressure.
>
There are a lot of anti-depressants which tend to lower BP, such as most of the tricyclics. (MAOIs can lower BP, too, but are associated with hypertensive crisis if strict dietary guidelines aren't adhered to.)
> (2) He's quite overweight - probably 70 pounds which we know contribute to high BP. However, I think in part because of mental problems he can't/doesn't lose weight. It's hard for him to exercise in a hot climate and 14 hours a day commuting & working & financial issues.
>
Give your husband a break on these two issues. First of all, if he's on Effexor, it's playing with his thermoregulatory system. It's hard enough to exercise in a hot climate, but add the existing weight problems, the existing BP trouble, and the effects of the Effexor -- he may even be better off not getting all that ambitious.As for the weight issue itself, *many* antidepressant drugs can cause weight gain. When I was taking a combo of Effexor and Prozac, I put on nearly 60 pounds. When I stopped the meds, though, the first 30 or so came off without me making any changes at all in diet or exercise. (My job was physically demanding, and it was quite demoralizing to be that heavy while I was already getting much more than the recommended amount of exercise just going to work. I had stopped getting on scales at all, because it was too upsetting, until one day I climbed on for some reason and saw that I weighed about 30 pounds less than I had expected. Mind you, I am estimating my highest weight, because I didn't have it in me to get onto a scale while the weight was still going up.)
And just because the doctor says that a medication is "not associated with weight gain" doesn't mean that that's true. The SSRIs, for example, are associated with weight gain in a significant percentage of the people who take them. The earlier studies, though, didn't catch that because it's a later-onset side effect that didn't become apparent in the short term studies that all the doctors read. With the exception of Remeron, which causes more initial weight gain, virtually all the newer drugs that cause weight gain don't show this effect until at least six month after starting.
>
> I got into a slightly heated discussion with his neurologist this morning when the neurologist refused to give him an Rx for ADHD med (of any kind) due to BP. He NEEDS a med that helps with that problem to help even out his agitation and curb his appetite. Without it he's in a downward spiral and complications continue. Part of the problem right now has become iatrogenic.
>
This might not be a good idea -- I know much too little about blood pressure, and mine is a bit too low -- but you might want to ask about Strattera. It's marketed as an ADHD med, but it was first developed as an antidepressant. I was on it for depression for a while, and it seemed to help me. It might be worth asking his doctor about it.Has your husband been diagnosed ADHD by a doctor? How recently has that diagnosis been verified? There's something in the back of my mind, but I don't want to offer it without those two questions answered.
> What's bothoring me in particular is that the doctor(s) don't seem to see the cause-and-effect process of continuing the BP meds that cause tremendous weight gain and depression followed by more med for depression followed by less activity and higher BP. Anyone else have a similar expereince or other insights?
>Again, I didn't know that BP meds caused weight gain -- would seem counter intuitive to me, since hypertension can be linked so closely to obesity. Then again, they got what they got.
(And they may not really know about the weight gain. A few months ago, a mental health professional told me that "anti-depressants don't cause weight gain. it's like with birth control pills -- when you take them, you just don't exercise enough and you eat more." Hello? Didn't that whole birth control pill thing get cleared up in the eighties? And hasn't this chick read as many of the recent professional discussions on the A/D topic as I have with my limited public access? The drug companies don't want the bad press of "the fat pill" and the studies are short term -- it takes years for the doctors to figure out the long term effects of any drug, because they have to have access to some people who have taken it long term. And then, too, some doctors still see obesity as a character flaw.)
Yes, lots of similar experiences on these boards. This is actually a question that would likely get a lot of good info on the main babble board if you post it there. There are some meds being tried along side a/ds that cause weight gain, but I can't remember the names -- maybe topamax was one of them? And there are a few a/d that are more weight neutral for a lot of people.
Best luck.
Posted by Racer on August 14, 2004, at 12:31:11
In reply to Re: ADHD SSRI Meds Cause High Blood Pressure (?), posted by King Vultan on August 13, 2004, at 23:45:50
As usual, I had a possibly atypical reaction to a drug mentioned -- desipramine lowered my blood pressure at any dose. While it might just be me -- idiopathic hypotension being a specialty -- it might still be worth trying -- or at least talking about.
And, while Lonely's husband's doctor may not agree, if you check below under the thread where crazychickuk copied the original post from the Health board, you'll see that my original response -- which I copied there -- started off with TCAs in general as a good place to start looking. Maybe great minds think alike, maybe taking various meds ourselves has taught us something the doctors haven't learned yet -- or maybe I've just gotten an education reading this board and posts from King Vultan?
Posted by King Vultan on August 15, 2004, at 23:18:07
In reply to ADHD SSRI Meds Cause High Blood Pressure (?), posted by Lonely on August 13, 2004, at 19:14:26
You didn't mention if he has tried clonidine--this is an antihypertensive from the alpha-2 agonist class. It is reputed to have some efficacy in treating ADHD also, as it is thought that one of the reasons stimulants work for ADHD is that the norepinephrine they release winds up stimulating alpha-2 adrenergic receptors, among other things. Clonidine stimulates these receptors directly, without all the negatives of the stimulants, and actually reduces norepinephrine release, which will tend to reduce BP. To my way of thinking, this would tend to have a depressive effect on mood as well, which might require antidepressant augmentation or a greater degree thereof for someone already taking an AD.
Todd
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