Lofepramine [Archive] - No More Panic

panic_down_under

21-04-17, 14:52

Hi I have just started on lofepramine for GAD after many failed attempts with SSRI's and SNRI's. I am on day 1 and not really sure how I feel at the moment....

Anyone else had any luck with it??

Lofepramine is a stronger inhibitor of noradrenaline, aka norepinephrine, than serotonin so is a good choice if SSRIs/SNRIs haven't worked. It usually triggers fewer of the ongoing TCA side-effects such as dry-mouth and constipation and is nearly as safe as the SSRIs in overdose.

milliemoo

23-04-17, 17:36

It has made my anxiety a lot worse since starting it!! I am really worried that It won't work for anxiety as it's main use is depression and I am not depressed just severely anxious!! Do TCA's really work for anxiety??

panic_down_under

23-04-17, 23:15

It has made my anxiety a lot worse since starting it!!

This is common with most antidepressants initially, though usually minder with the TCAs than SSRIs/SNRIs. It usually diminishes within a few weeks. Ask your GP to prescribe a small dose of diazepam (Valium) if it gets to be too much.

I am really worried that It won't work for anxiety as it's main use is depression and I am not depressed just severely anxious!! Do TCA's really work for anxiety??

Well they have been keeping me almost totally panic free for over 30 years.

The various anxiety disorders and depression are just different points on a continuum of disorders produced by the same underlying biological deficit, the reduction (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) in hippocampal neurons caused by chronically high brain stress hormone levels, and will respond to the same meds.

I forgot to mention in my previous post that the main problem with lofepramine is its short half-life which means it needs to be taken several times a day. Some don't mind this, but it can be frustrating for others. If it is for you then desipramine (Pamelor) would be a good alternative. It is the active metabolite of lofepramine having similar psychodynamics, with desipramine being slightly more potent, milligram for milligram.

milliemoo

25-04-17, 21:48

I had a pretty good day yesterday but today has been awful, anxiety, feel like I wanted to cry all day but didn't feel depressed but then this evening felt really down and loads of negative thoughts!! Feelings are all over the place! I'm hoping it's just the tablets doing something to my brain lol!! I don't have a problem with twice a day dosing as long as it works! I have so far not had much luck over the last two years, with SSRI's and venlafaxine!!

panic_down_under

25-04-17, 22:33

Feelings are all over the place! I'm hoping it's just the tablets doing something to my brain lol!!

I wouldn't read anything into how lofepramine is affecting your feelings, atm. Antidepressants can be weird meds at the beginning. It pays to just go with the flow. The good news is you have now been on it long enough for plasma levels to have stabilized so things should begin settling down soon.

How much are you taking?

milliemoo

25-04-17, 22:38

I started on 35mg twice a day then went to 70mg twice day but that was too much so I've gone back to the 35mg, was going to let that settle till the weekend then up my dose again.

panic_down_under

26-04-17, 01:49

I started on 35mg twice a day then went to 70mg twice day but that was too much so I've gone back to the 35mg, was going to let that settle till the weekend then up my dose again.

Sounds like a good plan. You could also try taking only an extra half a tablet, i.e. 52.5mg twice a day for 2-3 days before going up to the whole 70mg morning and night.

milliemoo

30-04-17, 20:00

So I'm now on 52.5 in the morning and 70 at night - yesterday I had such a good day but today I've been so anxious again and feeling tearful although don't know why!! One of the things that triggers my anxiety is worrying that the tablets are not going to work! As I said before I have been through so many for the past two years I just get scared that I'll be like this forever 😪

I know deep down that it's too early to tell but after having a good day yesterday today is just a downer. Sorry I'm just venting my frustration. Anyway onwards and upwards and we will see what tomorrow brings.

panic_down_under

30-04-17, 23:34

One of the things that triggers my anxiety is worrying that the tablets are not going to work!

Well, the good news is this will likely resolve once the med begins working. Fortunately, antidepressants don't need belief in them to work. Despite the claims of their critics, they don't rely on the placebo effect.

I know deep down that it's too early to tell but after having a good day yesterday today is just a downer.

Antidepressants typically take 3-12 weeks to kick-in so it is way to early to draw any conclusion about the likely effectiveness of lofepramine.

milliemoo

04-05-17, 16:39

The last few days have not been too bad, so yesterday I increased the dose up to 70mg am and 70mg pm (gone from 52.5mg am - 70mg pm), but since yesterday evening my anxiety has been horrendous.

My main issue is being alone, but as I home school my daughter its not usually a problem but yesterday she asked if she could go out with her friends over the weekend, well this has spiraled my anxiety. I'm just getting so fed up with this anxiety and worrying that the tablets are not going to work..... Today marks two weeks of being on lofepramine, and only just getting up to the correct dose!! I know I have to be patient but patience is something I seem to be lacking at the moment.

Sorry for the rant, but its nice having somewhere to just write my thoughts down as a release!!

panic_down_under

04-05-17, 23:04

My main issue is being alone, but as I home school my daughter its not usually a problem but yesterday she asked if she could go out with her friends over the weekend, well this has spiraled my anxiety.

I wonder whether this was the main factor in the anxiety spike, not the lofepramine dose increase.

Today marks two weeks of being on lofepramine, and only just getting up to the correct dose!! I know I have to be patient but patience is something I seem to be lacking at the moment.

The long delay between first taking antidepressants and getting a response is the biggest problem with these meds. Unfortunately, there is no way of speeding up the process. The new brain cells which produce the therapeutic response take time to bud, grow and mature. :(

milliemoo

05-05-17, 09:36

Thank you for your response. I know deep down I have to wait for the therapeutic response to kick in, I just feel so anxious at the moment! I have never had or been prescribed diazepam so I don't have anything to help me through the first few weeks. I am just relying on the fact that these tablets WILL work and I just have to be patient. I am trying to write a journal each day and challenge my negative thoughts but sometimes this makes me feel worse..

Do you think the being tearful bit is just the side effects? I've never had this before?

panic_down_under

05-05-17, 13:15

I just feel so anxious at the moment! I have never had or been prescribed diazepam so I don't have anything to help me through the first few weeks.

Well, it's not too late to ask your GP to prescribe a small dose of diazepam.

Do you think the being tearful bit is just the side effects? I've never had this before?

Possibly, but it could just be a combination of the med, anxiety and frustration.

milliemoo

08-05-17, 17:23

Can the lofepramine make my anxiety still seem so bad?? I feel worse now than when I started the meds 2.5 weeks ago? Friday and today have been awful? Should it have settled down by now?

panic_down_under

08-05-17, 23:23

Can the lofepramine make my anxiety still seem so bad?? I feel worse now than when I started the meds 2.5 weeks ago? Friday and today have been awful? Should it have settled down by now?

Antidepressants can make anxiety worse at the beginning because of the initial surge in serotonin activity. Despite Dr Google's claims that serotonin is a "feel good" neurotransmitter, it is anything but as you're discovering (actually neurotransmitters have no intrinsic properties, their actions are determined by the receptors they bind with). The brain will usually adapt within a few weeks by reducing serotonin synthesis and expression and anxiety levels then drop back to baseline for a while until the med kicks-in.

Unfortunately, there is no way of speeding things up, but a benzodiazepine would help when things get particularly difficult.

milliemoo

13-05-17, 11:34

hi ya
What do you mean by - The brain will usually adapt within a few weeks by reducing serotonin synthesis and expression and anxiety levels then drop back to baseline for a while until the med kicks-in.

The last couple of days - I feel like I've had abit more energyand sleeping a bit better - yesterday was a good day, but today not so!! I hope I am going in the right direction

panic_down_under

13-05-17, 13:02

What do you mean by - The brain will usually adapt within a few weeks by reducing serotonin synthesis and expression and anxiety levels then drop back to baseline for a while until the med kicks-in.

Ignore this. I apparently didn't have my brain in gear when I wrote it because lofepramine has only a minor affect on serotonin reuptake. :doh:

It will however, significantly boost noradrenaline/norepinephrine (NA) activity initially which can also heighten anxiety levels. But, as with SSRIs and serotonin, after a week or two the brain adapts by down-regulating NA synthesis and expression and the additional anxiety should begin to drop back to around pretreatment severity, i.e. baseline. But getting it below baseline takes longer as that comes from the growth of new hippocampal brain cells, and the strengthening of interconnections between brain regions. As with most antidepressants, this typically takes 3-12 weeks.

The last couple of days - I feel like I've had abit more energyand sleeping a bit better - yesterday was a good day, but today not so!! I hope I am going in the right direction

It is still to early to draw any conclusions. It is not uncommon to have bad days following good. I'm sure that was the case before you began taking the med. Anxiety levels tend to wax and wane rather than remain constant for any length of time.

milliemoo

13-05-17, 13:43

Thanks, I can't believe the difference between yesterday and today! Just feeling quite low and lethargic but anxious at the same time.

panic_down_under

13-05-17, 22:35

Thanks, I can't believe the difference between yesterday and today! Just feeling quite low and lethargic but anxious at the same time.

At this stage I don't think the med is doing much, good, or bad, but when it happens kick-in mostly begins in one of two ways. It might come on all at once, you wake into a bright new day without anxiety. Or it may be a case of a good hour, or day followed by several worse ones, with the good gradually becoming more frequent until it becomes 24/7. The third way, a gradual linear improvement over a week, or so is less common.

milliemoo

13-05-17, 23:24

Thank you for your reassurance. I am trying to put in place the CBT that I was taught. In the hope this medication will be the one for me! When previous medication has worked it has been an hour here and there then improvement over weeks but that was when I was really bad with OCD. This time is not as bad but has just lasted two years, and struggled to find medication to work. Fingers crossed the TCA will work for me.

panic_down_under

14-05-17, 03:10

In the hope this medication will be the one for me! When previous medication has worked it has been an hour here and there then improvement over weeks but that was when I was really bad with OCD. This time is not as bad but has just lasted two years, and struggled to find medication to work. Fingers crossed the TCA will work for me.

There is a good chance lofepramine will be effective. If it isn't then the TCA clomipramine (Anafranil) might be a good alternative given OCD is a part of your disorder. Clomipramine is one of the two antidepressants with the best OCD track record. The SSRI fluvoxamine (Luvox) is the other, but imho clomipramine is the better med. Plus, if other SSRIs haven't worked for you then fluvoxamine probably won't either.

milliemoo

15-05-17, 23:11

panic_down_under

16-05-17, 01:37

Absolutely crap day today, my anxiety has been off the scale! When it gets this high the intrusive thoughts start kicking in, which is not nice! Just feel like I should feel a slight bit better by now (I know it's only been 3.5 weeks and I need to give it longer but my logical brain doesn't work when I'm anxious) I just feels like my ability to cope is reducing!

All you can do is take it one day at a time. It is what it is. No amount of thinking about it will make a positive contribution, indeed ruminating almost always makes things worse.

Distraction helps. As soon as a intrusive thought begins go and do something which will occupy your mind. Going for a walk can also be beneficial, even if it's just up and down your street. Not only is it good for general health, but it can trigger the same brain changes as antidepressant do, albeit on a lesser scale.

milliemoo

16-05-17, 08:53

panic_down_under

16-05-17, 13:49

I'm am going back to my gp today and going to askfor something else I really don't think the lofepramine is me me. I am now suffering with depression and now don't want to leave the house - which has never been an issue-

It's your call, but I wouldn't be making it based on just one bad day.

what are your thoughts on imipramine?

It worked well for me, but it has a similar mode of action as the SSRIs and SNRIs which apparently haven't worked for you in the past.

Imho, desipramine should also be considered. It is the active metabolite of lofepramine and like the parent compound is primarily a noradrenaline reuptake inhibitor, however, it is also a fairly potent inhibitor of serotonin reuptake.

milliemoo

21-05-17, 11:41

By the time I'd got to my GP on Tuesday I had calmed down a bit, she agreed that it was perhaps too soon to change meds. We have agreed to leave it a little while longer although she did give me a prescription to increase my dose if I wanted to.

I feel very weird at the moment, like in between being anxious and very lethergaic. I have been in the full dose 70/70 for just under 3 weeks now. Mornings and evening seems a bit better but afternoons I'm am still quite anxious. I hate this waiting game, just holding on to the hope this is the one and respite is just round the corner.

panic_down_under

21-05-17, 13:45

I have been in the full dose 70/70 for just under 3 weeks now. Mornings and evening seems a bit better but afternoons I'm am still quite anxious. I hate this waiting game, just holding on to the hope this is the one and respite is just round the corner.

The long 3-12 week wait between first taking an antidepressant and getting a response is one of the biggest problems with these meds. Unfortunately, there is no way of speeding up the process.

milliemoo

28-05-17, 12:21

I had such a good day yesterday! Anxiety was minimal and things that usually bother me didn't, however I woke up this morning feeling very anxious again 😥 I suppose 1 day of feeling fairly normal is better than none!! Onwards and upwards I hope!

milliemoo

29-05-17, 10:55

panic_down_under

29-05-17, 12:49

I increased my dose to 105mg in the morning and 70mg at night. Could this be why my anxiety has skyrocketed again?? It's been 7 days now since the increase and although I've had a good day Saturday, I feel all panicky now.

It is common for anxiety levels to spike after antidepressant dose increases. They usually drop back within a couple of weeks.

So I've now done 2 weeks at 70mg a days 3 at 70/70 a day and a week at 105/70. Any advice would be beneficial!!

At 6 weeks you're now in the zone when antidepressants often start kicking-in, though the dose increase may have set this back a little.