Lofepramine? Advice please

[welshdory]

Hello,

My doctor has suggested that I take lofepramine along side my escitralopram to see how I tolerate it, with a view to switching completely to it.

I have tried so many antidepressants, I am beginning to wonder if I will ever find one that suits.

It is for Anxiety and depression. I can't find much info online about this one, so would welcome any experience or advice.

Many thanks

[BlueIris]

I was on lofepramine for a while about 20 years ago. Obviously different people have different opinions, but it worked really well for me and I noticed a huge difference in my depression.

[panic_down_under]

My doctor has suggested that I take lofepramine along side my escitralopram to see how I tolerate it, with a view to switching completely to it.

Is escitalopram working at all and how much are you taking?


It is for Anxiety and depression. I can't find much info online about this one, so would welcome any experience or advice.

Lofepramine is primarily a noradrenaline, aka norepinephrine, reuptake inhibitor that also inhibits serotonin reuptake to a much lesser extent. If SSRIs haven't been effective it is worth a shot.


I have tried so many antidepressants, I am beginning to wonder if I will ever find one that suits.

What have you tried, at what maximum dose, how long were you on that dose and why did you stop taking it?

[welshdory]

It's hard to say if it's working or not. My hubbie was diagnosed with a terminal illness 18mths ago and I became his carer overnight so there is a lot of change and worry in general.

I am currently on 15mg. I have been on 20mg with no significant change.

It is for anxiety, depression and (mild) OCD.

I have had GAD for most of my adult life, depression for the last few years, made worse after my husbands diagnosis.

I have tried citralapram, prozac, venlaflexamine, propranolol.

I am already overweight so keen not to be on anything that might include weight gain. Also as I am a carer for my hubbie and we have children I feel there is a lot of pressure to be as well as possible so change of meds worries me incase I end up with side effects.

[panic_down_under]

It's hard to say if it's working or not. My hubbie was diagnosed with a terminal illness 18mths ago and I became his carer overnight so there is a lot of change and worry in general.

Sorry to hear this. :sad: You're right, acute stress can make it harder to figure out how well a med is working.


I am currently on 15mg. I have been on 20mg with no significant change.

How long were you on 20mg?


I have tried citralapram, prozac, venlaflexamine, propranolol.

Escitalopram and citalopram are essentially the same med, so you've effectively been on 3 SSRIs (venlafaxine is really only a SSRI, not SNRI despite the claim on the packaging) plus a beta-blocker which are usually only marginally effective for anxiety and not depression.


I am already overweight so keen not to be on anything that might include weight gain.

Lofepramine generally doesn't affect weight much, but this is one side-effect which varies greatly depending on individual biology so there are no guarantees. You might find: How to control weight gain when prescribing antidepressants (PDF (https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/0605CP_Article3.pdf)) of interest. It's written for doctors and doesn't mention lofepramine as it isn't marketed in the U.S., but much of the info is still relevant.


Also as I am a carer for my hubbie and we have children I feel there is a lot of pressure to be as well as possible so change of meds worries me incase I end up with side effects.

Unfortunately, side-effects are always a possibility when starting an antidepressant, but they can usually be minimised by starting on a small dose and ramping it up at about weekly intervals by the same small amount. The usual adult starting dose is 70mg twice a day, but I'd ask your GP if you can cut the tablet in half and only take 35mg twice a day for the first week. If you don't want to cut pills lofepramine also comes in a liquid formulation with 5ml containing 70mg so you'd only take 2.5ml twice a day for the first week if the GP agrees.

[welshdory]

Thank you panic down under, you sound very knowledgeable.

It worries me that there's not a lot to Google about this med? Is it not commonly used?.

My doc has suggested if this doesn't work to try agomelatine or buspirion? Any thoughts on these? Thank you

[panic_down_under]

It worries me that there's not a lot to Google about this med? Is it not commonly used?

It is only marketed in the UK, Ireland, Japan and South Africa.


My doc has suggested if this doesn't work to try agomelatine

Agomelatine is a novel AD which acts on melatonin receptors and blocks some serotonin receptors. Like lofepramine it is only available in a handful of countries and hasn't really shown any advantage over older ADs. Weight gain is a potential issue and because it can elevate liver enzymes (https://webarchive.nationalarchives.gov.uk/ukgwa/20141205150130/http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON199558) liver function tests should be done regularly (https://www.gov.uk/drug-safety-update/agomelatine-valdoxan-risk-of-liver-toxicity) and alcohol should be avoided, possibly also paracetamol (aka acetaminophen). It isn't a first line AD, imho.


or buspirion?

In addition to escitalopram, or on its own?

Buspirone is a Generalised Anxiety Disorder specific medication (not an AD) which works well for some, but is about as effective as M&Ms for most and rarely works for panic disorder, PTSD, or the OCD spectrum disorders (or depression), however, when taken with SSRIs or other serotonergic ADs it can increase their effectiveness and reduce the severity of some of their side-effects. It may also resurrect pooped-out ADs to full function.

[welshdory]

Would you say this is a safe and effective AD to be on?.

I'm so scared to experiment with meds when things are so hectic at home.

If this didn't work, what would be a good one to try?

Thanks again

[panic_down_under]

Would you say this is a safe and effective AD to be on?

Lofepramine usually causes fewer issues than most other ADs. Whether it will be effective for you only time will tell. It comes down to individual biology.


If this didn't work, what would be a good one to try?

No AD is intrinsically better/more effective than the others either generally, or for a specific disorder (two for the OCD spectrum disorders may be the exception to this rule), but one or two will likely be for you. Unfortunately, there is still no sure way of determining which ones except by trial and error. :sad:

[welshdory]

Thanks for your reply.

Which 2 for OCD (I suffer with that also).

I'm feeling OK on it so far but only on one dose a day and need to up to twice a day. I'm also still on escitralopram so I suppose things could change when making the switch

[panic_down_under]

Which 2 for OCD (I suffer with that also).

The SSRI fluvoxamine (Luvox) and the TCA clomipramine (Anafranil). I think clomipramine is the better of the two because fluvoxamine interacts with many pharmaceuticals and alternative 'meds' which can complicate things if their are other health issues. However, clomipramine is also one of the most serotonergic ADs and you apparently haven't responded to them in the past.

[welshdory]

Hello I have decided to come off this med, due to intense anxiety and not being able to sleep.

Due to my husbands terminal illness and my caring role (so needing to be the best I can) I am considering staying on escitralopram and asking for something purely to help with the anxiety when it spikes. Any suggestions?

[panic_down_under]

I am considering staying on escitralopram and asking for something purely to help with the anxiety when it spikes. Any suggestions?

If you can get buspirone then adding a small dose, 20-30mg/day might boost the effectiveness of escitalopram. If not there aren't many options. Benzodiazepines should be avoided as they reduce AD effectiveness and exacerbate the underlying brain dysfunction which manifests as anxiety and/or depression. Mirtazapine which is more a sedative than AD might help, plus maybe pregabalin, but neither are first line anti anxiety meds. If your anxiety triggers adrenaline surges then a beta-blocker is worth a shot.