Lofepramine

[milliemoo]

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??

[panic_down_under]

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]

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]

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 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]

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]

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]

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]

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.

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]

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]

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.