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Thread: Imipramine, have I made the right choice?

  1. #21
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    Re: Imipramine, have I made the right choice?

    Many thanks for that reply and information which I have just skimmed through now but will read in detail tomorrow.
    And sorry PDU, I realized afterwards that I had referred to Imipramine instead of Trimipramine - can I borrow your D'oh!

  2. #22
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    Re: Imipramine, have I made the right choice?

    Quick update. My dosage was increased to 50mg yesterday. So far no more issues and I have been sleeping quite well. I have noticed I seem to experience more highs and lows emotionally than I have ever on ssris.

  3. #23
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    Re: Imipramine, have I made the right choice?

    Quote Originally Posted by Dazzlar13 View Post
    Quick update. My dosage was increased to 50mg yesterday. So far no more issues and I have been sleeping quite well.
    The TCAs tend to produce milder initial side-effects than the SSRIs/SNRIs, however, they tend to have more ongoing ones, mostly dry-mouth and constipation which can be managed. Insomnia is also much less likely with TCAs than SSRIs/SNRIs because TCAs are mild to powerful antihistamines.

    I have noticed I seem to experience more highs and lows emotionally than I have ever on ssris.
    It is early days and you're on a low dose so I wouldn't read too much into this. Some of it could also be a rebound from sertraline if it had dampened emotions.
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  4. #24
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    Re: Imipramine, have I made the right choice?

    I have a six month baby at home but I have just noticed I feel much happier generally than I have in a long time. But if I see something sad on TV for instance it just seems to have more of an effect on me. I do put it down to the emotional blunting from sertraline and duloxetine earlier.

    I have noticed I have more vivid dreams also.

    I see the recommend dose is 125mg and my doctor is only increasing it 25 mg every 2 weeks and I'm a big guy as well coming in at 260lbs. It's going to take a while before I get the full effect.

  5. #25
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    Re: Imipramine, have I made the right choice?

    Quote Originally Posted by Dazzlar13 View Post
    I do put it down to the emotional blunting from sertraline and duloxetine earlier.
    Possibly. Some ADs may have that affect on some people. Switching to another AD will usually resolve the issue, however, some prefer the blunting.

    I have noticed I have more vivid dreams also.
    I suspect the dreams don't actually change. That they are just as vivid most of the time, but ADs may lighten REM sleep enough for them to intrude into conscious awareness. I used to have some beauties on imipramine. The full DeMille extravagances in widescreen Technicolor with surround sound...well if DeMille was on crack, some were really weird! Haven't taken it for over 25 years, but I still miss them.

    I see the recommend dose is 125mg and my doctor is only increasing it 25 mg every 2 weeks and I'm a big guy as well coming in at 260lbs. It's going to take a while before I get the full effect.
    Patience is a virtue and that applies double where ADs are concerned. Better to go slow to minimize the initial side-effects than to rush it. The usual effective dose range is 100-200mg, but a few may need more. I was on 350mg for a while.

    Body weight doesn't matter much. Antidepressants have no direct effect on anxiety, or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly, and they take time to bud, grow and mature. For a more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF) and How antidepressant drugs act.
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  6. #26
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    Re: Imipramine, have I made the right choice?

    Apologies I haven't posted for a while. I've have been really busy. Thought I would post a quick update. So I have felt a lot better than I did when I was on sertraline, the panic attacks have gone but the general anxiety and my temper are bubbling away underneath. Although I have not felt as good as when I responded to citalopram.

    I would like to increase the dosage but the doctor who prescribed it is adamant 100mg is the maximum dose for imipramine, should I ask for a second opinion? I don't want to keep changing meds..

  7. #27
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    Re: Imipramine, have I made the right choice?

    Quote Originally Posted by Dazzlar13 View Post
    I would like to increase the dosage but the doctor who prescribed it is adamant 100mg is the maximum dose for imipramine,
    Which is why it comes in tablets up to 150mg! The usual starting dose for depression in healthy adults is 75mg with a maximum recommended dose is 200mg as an outpatient, 300mg under medical supervision in hospital (see British National Formulary: imipramine). I took 350mg for many months without issue and was on 300mg for years. I suggest you take doses above 100mg in 2-3 divided doses.

    should I ask for a second opinion?
    Definitely
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  8. #28
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    Re: Imipramine, have I made the right choice?

    Quote Originally Posted by panic_down_under View Post
    Which is why it comes in tablets up to 150mg! The usual starting dose for depression in healthy adults is 75mg with a maximum recommended dose is 200mg as an outpatient, 300mg under medical supervision in hospital (see British National Formulary: imipramine). I took 350mg for many months without issue and was on 300mg for years. I suggest you take doses above 100mg in 2-3 divided doses.



    Definitely
    I had a telephone consultation earlier and the doctor I spoke to advised she can put the dosage up to 150mg until I 'stabilise' then they bring me back to 100mg. She told me they are not trained with imipramine as it's an old drug, the secondary care team would do that. Looking at my record the only one I haven't tried shes familiar with is venlaflaxine. I didn't do great on duloxetine, so I was wary of trying it. So I agreed to go to 150mg of imipramine and then asked if I'm happy in 6 weeks would she speak to the secondary care team. She was happy to try this.

    The imipramine has helped just not enough and the side effects have been minimal. The only one that's bugging me is the dry mouth. Better than having no sex drive and anorgasmia when I am actually in the mood.
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  9. #29
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    Re: Imipramine, have I made the right choice?

    Quote Originally Posted by Dazzlar13 View Post
    I had a telephone consultation earlier and the doctor I spoke to advised she can put the dosage up to 150mg until I 'stabilise' then they bring me back to 100mg. She told me they are not trained with imipramine as it's an old drug,
    This is why they have dosing guides such as the Formulary! They only need to know how to read the Queen's <expletive> English! Sigh.

    I haven't tried shes familiar with is venlaflaxine. I didn't do great on duloxetine, so I was wary of trying it.
    Not a fan of venlafaxine. Despite what it says on the tin, it is only a SSRI and while it might work it has a number of potential risks so you might as well try a few plain old SSRIs to see if they'll work first.

    What was the problem with duloxetine? It is usually not a bad AD once stabilized on it, but the initial side-effects can be rough, as can weaning off it although venlafaxine is often worse.

    The imipramine has helped just not enough and the side effects have been minimal. The only one that's bugging me is the dry mouth.
    This does tend to ease over time, although this isn't a guarantee. There are things you can do to minimise it and Biotene make a range of gels, toothpastes and mouthwashes to ease the discomfort. There may be other brand too. Your chemist should be able to advise you on what is available, although they may be cheaper from Amazon and Ebay.

    Better than having no sex drive and anorgasmia when I am actually in the mood.
    Long may that continue, though it is still a possibility. Sexual dysfunction tends to be less of a problem with TCAs than SSRIs/SNRIs, but it can still arise. If it does you may find my tips useful.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  10. #30
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    Re: Imipramine, have I made the right choice?

    Quote Originally Posted by panic_down_under View Post
    This is why they have dosing guides such as the Formulary! They only need to know how to read the Queen's <expletive> English! Sigh.



    Not a fan of venlafaxine. Despite what it says on the tin, it is only a SSRI and while it might work it has a number of potential risks so you might as well try a few plain old SSRIs to see if they'll work first.

    What was the problem with duloxetine? It is usually not a bad AD once stabilized on it, but the initial side-effects can be rough, as can weaning off it although venlafaxine is often worse.



    This does tend to ease over time, although this isn't a guarantee. There are things you can do to minimise it and Biotene make a range of gels, toothpastes and mouthwashes to ease the discomfort. There may be other brand too. Your chemist should be able to advise you on what is available, although they may be cheaper from Amazon and Ebay.



    Long may that continue, though it is still a possibility. Sexual dysfunction tends to be less of a problem with TCAs than SSRIs/SNRIs, but it can still arise. If it does you may find my tips useful.
    Apparently according to the doctor I spoke to they follow the NICE guidelines.

    I can't remember so well when I was on duloxetine, if I remember correctly I spoke to a doctor that said it sounded like it was making me depressed however I was going through a hard time at work and had a bereavement around that time. I do remember being spaced out and lethargic as hell a lot on it plus the usual sexual dysfunction and emotional blunting. I think if they won't budge on the 150mg imipramine it might be worth trying it again, since a lot of those stressors I've had at the time are resolved.
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