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Thread: Imipramine or Clomipramine

  1. #11
    Join Date
    Jul 2016
    Posts
    519

    Re: Imipramine or Clomipramine

    Hi PDU

    I have seen the psych this morning and she has agreed to changing to Clomipramine. The schedule she has given me is as follows: I am currently on 125mg of Nort.

    Sunday
    Nortriptyline 3 tabs (75mg)

    Tuesday
    Nortriptyline 1 tab (25mg)

    Wednesday
    Clomipramine 1 tab (25mg)

    Thursday
    Clomipramine 2 tabs (50mg)

    Sunday
    Clomipramine 3 tabs (75mg)

    I have asked if I could spend a week at each level with the Clomipramine, so 25mg one week, 50mg week two etc.

    Do you think slowing down the increase in Clomipramine is necessary or do you think because I am taking the Nortriptyline it would be better to ramp it up over a week.

    I hate medication changes and my anxiety is already high just thinking about it. Sorry for all the questions. Thank you again for all the information you have shared with me. I know I should be asking the psych some of these questions, but the psych is a bit of a scatterbrain, she asked me what medications I'm on when I go in, and then says 'oh, I have so many patients I can't remember what everyone is on'. So I would probably trust your judgement more than hers. The only reason I am staying with her is because she is linked to the hospital where I was admitted at the end of last year.
    Thanks PDU.
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  2. #12
    Join Date
    Jan 2017
    Posts
    1,997

    Re: Imipramine or Clomipramine

    Quote Originally Posted by Mermaid16 View Post
    I have asked if I could spend a week at each level with the Clomipramine, so 25mg one week, 50mg week two etc.

    Do you think slowing down the increase in Clomipramine is necessary or do you think because I am taking the Nortriptyline it would be better to ramp it up over a week.
    While I would have suggested a different approach, I prefer your psychiatrist's faster switching method to limit any withdrawal symptoms than your slower pace, however, they may not be that severe anyway as the TCAs are usually easier to quit than the SSRIs and SNRIs.

    I know I should be asking the psych some of these questions, but the psych is a bit of a scatterbrain, she asked me what medications I'm on when I go in, and then says 'oh, I have so many patients I can't remember what everyone is on'.
    This is what patients' records are for, to be quickly read between patients!! Sigh!! One of the things I've observed about doctoring generally, and psychiatry in particular is critical thinking skills don't seem to be a basic requirement.

  3. #13
    Join Date
    Jul 2016
    Posts
    519

    Re: Imipramine or Clomipramine

    Hi PDU! Just curious as to how you would do the swap over as you mentioned you would have gone for a different approach. I have read somewhere to reduce Nort down to 25mg and then start the Clom and I have also read a study where patients were taking 150mg Clom and 50mg of Nort (which I will not be doing), but obviously they can be taken together, as I think I will still have the Nort in my systems when I start the Clom. Thanks PDU. You are a 'fountain of knowledge'.
    __________________
    The other side of every fear is FREEDOM

  4. #14
    Join Date
    Jan 2017
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    1,997

    Re: Imipramine or Clomipramine

    Quote Originally Posted by Mermaid16 View Post
    Hi PDU! Just curious as to how you would do the swap over as you mentioned you would have gone for a different approach.
    I think cross-tapering is a better strategy. But your doctor should be the arbiter.

  5. #15
    Join Date
    Jul 2016
    Posts
    519

    Re: Imipramine or Clomipramine

    Not doing too well with my taper so far. Only dropped one tablet last night instead of 2 (started on 125, so only dropped down to 100). Probably just my mind playing tricks on me, but I am actually worried that I will lose my mind by dropping this med so quickly. Doesn't it put your brain into all kinds of chaos. Have psych appoint tomorrow to see what she thinks. I want to do it quickly, but I'm really scared of what may happen. So far today have just felt a little off, but nothing major.

    Have only been on med about 6 months all together, with 3 of them being at 125mg, before that 100mg.
    Last edited by Mermaid16; 07-08-17 at 06:44.
    __________________
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  6. #16
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    Jan 2017
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    1,997

    Re: Imipramine or Clomipramine

    Quote Originally Posted by Mermaid16 View Post
    Not doing too well with my taper so far. Only dropped one tablet last night instead of 2 (started on 125, so only dropped down to 100). Probably just my mind playing tricks on me,
    Almost certainly. Nortriptyline has an average half-life of 25 hours, range 16-90 hours, so withdrawal symptoms don't usually begin immediately.

    but I am actually worried that I will lose my mind by dropping this med so quickly. Doesn't it put your brain into all kinds of chaos.
    Withdrawal symptoms are usually physical, not psychological. Plus TCAs tend to produce less severe symptoms than the SSRIs and SNRIs.

  7. #17
    Join Date
    Jul 2016
    Posts
    519

    Re: Imipramine or Clomipramine

    Thought I would keep updating, incase someone is in a similar situation to me at some stage. My taper has had an extra day added to it. So is now:

    Tuesday
    Nort 1 tablet

    Wedn
    Nort 1 tablet

    Thursday
    Clom 1 tablet

    Friday
    Clom 1 tablet

    Saturday
    Clom 2 tablets

    Sunday
    Clom 2 tablets

    Monday
    Clom 2 tablets

    Tuesday
    Clom 2 tablets

    Wednesday
    Clom 3 tablets

    Had another psych appointment today, where we nutted out a plan for the week ahead. Plus we put a safety plan into place in case it all goes to shit. She has written up admission papers, so if it does go to shit over the weekend I can go into hospital. Anxiety seems a little higher today. I take Clonazepam at 8.00am and 2.00pm and could really feel the anxiety ramping up before the 2.00pm dose. Also have I think a tension headache of some sort. Feeling a little yuck. Will be glad when work is over. Will try and keep updating for others that are starting on Clomipramine.
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  8. #18
    Join Date
    Nov 2016
    Posts
    1,044

    Re: Imipramine or Clomipramine

    Hi Mermaid and PDU,

    I have been prescribed Nortriptyline (10MG) as an add on to my celexa. I currently taken that in conjunction with my daily clonazepam (which I want to get off of). Is it normal for psychiatrists to add on this medicine for anxiety while taking an SSRI. Now i'm anxious to start a new medication. I'm afraid it's going to cause increased anxiety. Any thoughts on this drug combination?

  9. #19
    Join Date
    Jul 2016
    Posts
    519

    Re: Imipramine or Clomipramine

    Hi Ethansmom

    I have read about Nortriptyline being an add on to other meds. I was taking Nortriptyline while I was tapering off sertraline, so you can definately take it with other meds. I don't remember any added anxiety when I started the Nort. My anxiety did improve, but not enough to get off the clonazepam, which is why I am now changing to Clomi. I am hoping that it will do enough for my anxiety and depression so that I can get off the Clonazepam. I was taking 125mg of Nort so was on a much bigger dose. I would think that you would hardly notice the Nort at 10mg and would doubt you would have any anxiety. Nort did raise my heart rate. I use to sit at about 50 or 60 resting, whereas now my resting is around 80. I do think this relates to the dose though so again you probably woudn't notice anything. I did get postural hypertension at the start, so just take is slow to start with. This did end up going after a week or so and again was at a higher dose. I was started on it while I was in hospital (so I increased quite quickly from memory). Try not to be scared, it is only a small dose. I have tapered down to 25mg and took my last tablet of them last night. Tonight I take my first dose of Clomi 25mg, so know that it is scary, but we have to do it to try and get better. If you have any questions about it, feel free to ask.
    __________________
    The other side of every fear is FREEDOM

  10. #20

    Re: Imipramine or Clomipramine

    Hello,
    I just wanted to give you my experience with clomipramine. I was started on this by a psychiatrist when I was 15 due to sudden onset of severe panic disorder - not OCD. I have been on it (on various doses between 50mg and 150mg) ever since - I am now 27. Although I still have bad phases of severe anxiety (and some obsessive thoughts regarding death) generally, I would say this drug saved my life.
    My mum also started experiencing panic attacks a few years back and has been on a low dose of clomipramine which has helped her.
    It's quite a rare drug these days apparently but I can really say it has helped me, as much as I believe any med would. I haven't suffered any serious bouts of depression since before being prescribed it either.
    Only major side effects are bad dry mouth and drowsiness but the dry mouth goes away and the drowsiness is manageable!

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