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Thread: Imipramine or Clomipramine

  1. #21
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    Re: Imipramine or Clomipramine

    Quote Originally Posted by SideFX View Post
    I have read that buspar can be a solution to SSRI induced bruxism...However that would mean me moving from Mirtazipine to buspar and that still doesnít resolve my overall problem of not reaching remission...
    You can take buspirone with mirtazapine, assuming you can get it at all. It might even boost vortioxetine effectiveness, althought it is itself a weak serotonin 5-HT1a receptor partial agonist.

    The Pdoc is talking of lowering the Mirtazipine, not increasing it and as you will know at higher doses it can become more activating.
    It does become less sedating as the dose increases. I'm not sure you could call that more activating, although it can trigger strong paradoxical reactions in some.

    I just feel this current combo of meds is causing me more problems, whilst helping me focus to work...However after over 2 years I would have expected to be fully recovered. Would you agree ???
    If the combo was working well I would have expected better results within 4-6 months.

    It causes my skin to burn real bad and not in patches, but all over. And the docs wouldnít believe me, which has been very frustrating I can tell you.
    Neuropathy and a host of other nerve and skin conditions are <> listed side-effects. Your doctors are clearly of the mushroom school of 'bedside manner', i.e. keep their patients in the dark and feed them male bovine manure...or ignorant!

    If doctors were simply honest with their patients support groups would have much less traffic!

    I have also tried to research moving from an SSRI to a TCA and there is virtually nothing out there. However thereís lots of stuff on moving the other way...
    I take the view that if it works okay going one way it will likely work well in the reverse direction too.
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  2. #22

    Re: Imipramine or Clomipramine

    Quote Originally Posted by panic_down_under View Post
    You can take buspirone with mirtazapine, assuming you can get it at all. It might even boost vortioxetine effectiveness, althought it is itself a weak serotonin 5-HT1a receptor partial agonist.



    It does become less sedating as the dose increases. I'm not sure you could call that more activating, although it can trigger strong paradoxical reactions in some.



    If the combo was working well I would have expected better results within 4-6 months.



    Neuropathy and a host of other nerve and skin conditions are <> listed side-effects. Your doctors are clearly of the mushroom school of 'bedside manner', i.e. keep their patients in the dark and feed them male bovine manure...or ignorant!

    If doctors were simply honest with their patients support groups would have much less traffic!



    I take the view that if it works okay going one way it will likely work well in the reverse direction too.
    Thanks for validating that Neuropathy and skin reactions are indeed med side effects and my only way of controlling that right now is by taking Pregabalin, which is for Neuropathy and pain. So without that I would have no way tolerated the Brintellix, which continues to cause it...I thought if I force my body to accept it it would resolve itself

    However it is still a lingering side effect and doesnít lift my depression fully, nor my anxiety. So Iím pressing on until a suitable time when I may feel in a position to take that leap of faith to imipramine.

    My concern is that the Neuropathy becomes permanent and wonít fade once I switch to a TCA med...Iíve asked my GP the question and also the bruxism and she will not commit herself or even say there is a good chance (Talk about sitting on the fence) But the truth is they have no idea of what these meds do and I only wish every psychiatrist had to take a therapeutic dose of the meds they prescribe and then I would feel they are in a position to validate some of their claims.

    One last ask please ian...When I was put on quetiapine I would get vibrations in my legs and body and feel disoriented upon waking...This has faded, but still plagues me after more than 2 years. Again I have spoke to my Pdoc, who is completely disinterested...I feel I did something to my dopamine receptors for sure...Any thoughts with your med knowledge ???? Thanks John

  3. #23
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    Re: Imipramine or Clomipramine

    Quote Originally Posted by SideFX View Post
    I thought if I force my body to accept it it would resolve itself
    Unfortunately, that isn't how these things work. If a side-effect continue to persist beyond when the med kicks-in then it will likely continue as long as you're on it though some degree of tolerance may slowly develop.

    My concern is that the Neuropathy becomes permanent and wonít fade once I switch to a TCA med...Iíve asked my GP the question and also the bruxism and she will not commit herself or even say there is a good chance (Talk about sitting on the fence)
    She was probably right to do so as there is not much data to go on. My gut feeling is that it will resolve as soon as you stop taking vortioxetine, but I can't guarantee it. Nerves are tricky.

    When I was put on quetiapine I would get vibrations in my legs and body and feel disoriented upon waking...This has faded, but still plagues me after more than 2 years. Again I have spoke to my Pdoc, who is completely disinterested...I feel I did something to my dopamine receptors for sure...
    The receptors themselves, no. Receptors (and transporters) are simple protein molecules which have limited half-lives, minutes to a few days depending on where they are in the brain (or elsewhere in the nervous system) and how often they are activated. My guess is that your current problem relates to the mirtazapine. There's not a lot of difference in the receptors they both target, although mirtazapine is an even weaker binder to dopamine D1 and D2 receptors than quetiapine:

    Mirtazapine: H1: 1.6 Ki, 5-HT2a: 69.0 Ki, D1: 4100 Ki, D2: 1000 Ki,
    Quetiapine : H1: 6.9 Ki, 5-HT2a: 118. Ki, D1: 712. Ki, D2: 500.0 Ki
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  4. #24

    Re: Imipramine or Clomipramine

    Quote Originally Posted by panic_down_under View Post
    Unfortunately, that isn't how these things work. If a side-effect continue to persist beyond when the med kicks-in then it will likely continue as long as you're on it though some degree of tolerance may slowly develop.



    She was probably right to do so as there is not much data to go on. My gut feeling is that it will resolve as soon as you stop taking vortioxetine, but I can't guarantee it. Nerves are tricky.



    The receptors themselves, no. Receptors (and transporters) are simple protein molecules which have limited half-lives, minutes to a few days depending on where they are in the brain (or elsewhere in the nervous system) and how often they are activated. My guess is that your current problem relates to the mirtazapine. There's not a lot of difference in the receptors they both target, although mirtazapine is an even weaker binder to dopamine D1 and D2 receptors than quetiapine:

    Mirtazapine: H1: 1.6 Ki, 5-HT2a: 69.0 Ki, D1: 4100 Ki, D2: 1000 Ki,
    Quetiapine : H1: 6.9 Ki, 5-HT2a: 118. Ki, D1: 712. Ki, D2: 500.0 Ki
    Thanks Ian that puts my mind to rest regarding the receptors and that no permanent damage could be caused...Still doesnít explain the reaction and itís continued effects, albeit to a lesser degree

    Can I pick your brains about Pregabalin, as Iíve read so many horror stories about its addictive and tolerance effects ??? Also it can be associated with causing depression and anxiety????

    My roadmap hopefully is to swap out the Brintellix for imipramine and hopefully gel well with the TCA...Then when I hopefully feel stable enough. Taper Pregabalin first then Diazipam and think about the Mirtazipine (Which is acting mostly as an antihistamine) plus my tolerance to it is very high after 10 years use.

    I would so love to go back to a mono therapeutic solution...Right now I can only wish for it and plan the right time to take that risk.

    Iíve searched on brintellix and itís a real mixed bag of being fantastic, to its the worst med Iíve ever taken. Plus as it kinda overlaps as busper - I donít get why Iíve got bruxism from it, as busper is a known med to resolve bruxism????

    Your thoughts please (I really need to get out of this poly drugged situation) Ta John

  5. #25
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    Re: Imipramine or Clomipramine

    Quote Originally Posted by SideFX View Post
    Still doesnít explain the reaction and itís continued effects, albeit to a lesser degree
    I think it's coming from the mirtazapine, John. It targets most of the same receptors as quetiapine to similar degrees.

    Can I pick your brains about Pregabalin, as Iíve read so many horror stories about its addictive and tolerance effects ??? Also it can be associated with causing depression and anxiety????
    There's a lot of evidence for it triggering depression, anxiety to a lesser extent. Imho, the only advantage pregabalin (and gabapentin) have over BZDs is that they don't inhibit neurogenesis and there is some evidence they speed up the maturation of new neurons a little although they don't seem to increase their numbers. I put pregabalin well down the list of meds to try for anxiety. I don't think there is any place for gabapentin now that pregabalin generics are available, mostly because of the way its bioavailability drops rapidly as the dose increases. You end up taking a lot more drug for little extra activity.

    My roadmap hopefully is to swap out the Brintellix for imipramine and hopefully gel well with the TCA...Then when I hopefully feel stable enough. Taper Pregabalin first then Diazipam and think about the Mirtazipine (Which is acting mostly as an antihistamine) plus my tolerance to it is very high after 10 years use.
    This is a reasonable plan.

    Iíve searched on brintellix and itís a real mixed bag of being fantastic, to its the worst med Iíve ever taken.
    To be fair you'll find the same for every psyche med, and many other meds too. It isn't really a commentary about the med as such, but about how the med meshes with individual biology. No AD is intrinsically any better than another, but some may be for an individual. The hard part is determining which ones work best as trial and error is the only conclusive test.

    Plus as it kinda overlaps as busper - I donít get why Iíve got bruxism from it, as busper is a known med to resolve bruxism????
    Vortioxetine is a much weaker 5-HT1a receptor agonist than buspirone. I suspect it it is too weak to have any real therapeutic benefit which might be why the med hasn't been the success the developers hoped for. Vilazodone (Viibryd) which another of the new combined SSRI+5-HT1a agonists hasn't really taken off either despite being a more potent 5-HT1a agonist. Far better imo to take an ordinary SSRI and add buspirone to it if necessary at a high enough dose to make a difference. I really don't understand why doctors switch patients from another SSRI to vortioxetine without first supplementing the current med with buspirone first given how much easier this usually is on the patient.
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  6. #26

    Re: Imipramine or Clomipramine

    Quote Originally Posted by panic_down_under View Post
    I think it's coming from the mirtazapine, John. It targets most of the same receptors as quetiapine to similar degrees.



    There's a lot of evidence for it triggering depression, anxiety to a lesser extent. Imho, the only advantage pregabalin (and gabapentin) have over BZDs is that they don't inhibit neurogenesis and there is some evidence they speed up the maturation of new neurons a little although they don't seem to increase their numbers. I put pregabalin well down the list of meds to try for anxiety. I don't think there is any place for gabapentin now that pregabalin generics are available, mostly because of the way its bioavailability drops rapidly as the dose increases. You end up taking a lot more drug for little extra activity.



    This is a reasonable plan.



    To be fair you'll find the same for every psyche med, and many other meds too. It isn't really a commentary about the med as such, but about how the med meshes with individual biology. No AD is intrinsically any better than another, but some may be for an individual. The hard part is determining which ones work best as trial and error is the only conclusive test.



    Vortioxetine is a much weaker 5-HT1a receptor agonist than buspirone. I suspect it it is too weak to have any real therapeutic benefit which might be why the med hasn't been the success the developers hoped for. Vilazodone (Viibryd) which another of the new combined SSRI+5-HT1a agonists hasn't really taken off either despite being a more potent 5-HT1a agonist. Far better imo to take an ordinary SSRI and add buspirone to it if necessary at a high enough dose to make a difference. I really don't understand why doctors switch patients from another SSRI to vortioxetine without first supplementing the current med with buspirone first given how much easier this usually is on the patient.
    Again thanks for the greater insight to these meds.
    I must agree that Pregabalin doesnít work any better at higher doses and taken along with Diazipam can and do potentiate the sedative effects, which isnít tackling the problem, just making you really really sleepy as it peaks after around 2/3 hours.


    Iím sure I tried buspar during my 2010 meltdown and it just made me so so angry, I had to stop it straight away.

    I just donít feel the vortioxatine is doing its thing and Iíve tried to force my body to accept it, which has led to a greater tolorance to its SideFX but Iím still in a funk and with denial that depression can be resolved by meds from my Pdoc, has left me tired and exhausted...All I want is my mojo back and I feel thatís a matter of finding the right med again !!!!

    As you have stated itís a clinical state and therefore requires a clinical solution and that is the right med at the right dose.

    Iíve also read that you can stop Brintellix abruptly at 10mg oh yeah and I believe that a med altering brain chemistry can just be stopped like that (No way) your thoughts please Ian ???

    The passive approach of my doctors has been the reason Iíve not hit the right med and my exhaustion at switching meds a couple of years ago...But I know if I donít then I will end up going down the road my father did. He took his life in 93 !!!! Thank you Ian I appreciate your knowledge and continued support Ta John

  7. #27
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    Re: Imipramine or Clomipramine

    My son has been on vortioxetine for about 3 moths at 20mg daily and it's made no difference at all..he's also on quetiapine 400mg and 1mg lorazepam twice daily. He's been on loads of other ADs and been hospitalised twice.

    One psychiatrist told him that TCAs worked better in men but that opinion wasn't shared by other psychs.

    It's all a lottery, John but I wish you all the very best with your recovery. It helps so much to be proactive and to challenge the psychs every inch of the way if you are not happy with their prescribing.

  8. #28

    Re: Imipramine or Clomipramine

    Quote Originally Posted by pulisa View Post
    My son has been on vortioxetine for about 3 moths at 20mg daily and it's made no difference at all..he's also on quetiapine 400mg and 1mg lorazepam twice daily. He's been on loads of other ADs and been hospitalised twice.

    One psychiatrist told him that TCAs worked better in men but that opinion wasn't shared by other psychs.

    It's all a lottery, John but I wish you all the very best with your recovery. It helps so much to be proactive and to challenge the psychs every inch of the way if you are not happy with their prescribing.
    Thanks Pulisa...I totally agree itís like playing Russian roulette to spin the barrel, pull the trigger and hope for the best...Iíve never really dabbled with TCAís however I know I cannot tolerate SRI meds any more, as the SideFX just hurt...So Iíve ended up taking one med to try and dampen the effects of another and led to a poly drugged situation.

    But still no remission...I wish your son the best and a speedy recovery. I got lucky first time with Peroxatine which was lovely and then again with Venlafaxine, again led me back to my old self. So I know meds work and Iíve seen it with my mum.

    Itís just hard going through each trial and then to start over again, itís very tough

    Thank you John

  9. #29
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    Re: Imipramine or Clomipramine

    Quote Originally Posted by SideFX View Post
    Iím sure I tried buspar during my 2010 meltdown and it just made me so so angry, I had to stop it straight away.
    Anger/hostility is a listed side-effect, but I haven't heard of anyone experiencing this until now. Most have no side-effects...or response. Did you take it on its own, or with an AD?

    As you have stated itís a clinical state and therefore requires a clinical solution and that is the right med at the right dose.
    The cognitive/behavioural/mindfulness therapies can also be very effective. They work by the same mechanism as ADs.

    Iíve also read that you can stop Brintellix abruptly at 10mg oh yeah and I believe that a med altering brain chemistry can just be stopped like that (No way)
    I'd drop the dose to 5mg for 14 days and then quit, if that is the way you want to do it. Alternatively you could talk to your GP about adding 25-50mg imipramine at week 2.
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  10. #30
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    Re: Imipramine or Clomipramine

    Quote Originally Posted by SideFX View Post
    Thanks Pulisa...I totally agree it’s like playing Russian roulette to spin the barrel, pull the trigger and hope for the best...I’ve never really dabbled with TCA’s however I know I cannot tolerate SRI meds any more, as the SideFX just hurt...So I’ve ended up taking one med to try and dampen the effects of another and led to a poly drugged situation.

    But still no remission...I wish your son the best and a speedy recovery. I got lucky first time with Peroxatine which was lovely and then again with Venlafaxine, again led me back to my old self. So I know meds work and I’ve seen it with my mum.

    It’s just hard going through each trial and then to start over again, it’s very tough

    Thank you John
    Psychiatrists use these drugs like broad spectrum antibiotics. It would be great if in the future a brain scan could prescribe the right med at the right dose and do away with human guesswork altogether but I doubt whether this would be in our lifetimes!! You've had success with some ADs-as has your Mum and psychs are quite hot on family history on these meds-so there is every hope that you will find the right combo in time..but the "in time" bit is always the hard bit to tolerate!

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