Imipramine or Clomipramine

[SideFX]

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?



The cognitive/behavioural/mindfulness therapies can also be very effective. They work by the same mechanism as ADs.



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.

Thanks Ian

I am a bit fuzzy bout the buspar, could of been Wellbutrin that made me so angry. I took it with venlafaxine at the time.

I personally find that the CBT and other cognitive therapies are of no use to me....The only thing that has helped has been Pharmacologic and tenacity!!!

I have started trying CBD Oil and don’t know if it’s placebo effect, but it does help...I need to be careful though as my second dose of Pregabalin with Diazipam can knock me out like a tranqulliser dart. I take them 6 hours apart and this has always been the case. It’s as if the peak is delayed for several hours and as I’m coming down of it I can feel it bad.

I was thinking of trying again to taper the Pregabalin, as I’ve tried and failed twice (Your thoughts Ian ?)

I totally agree with you in regards of the vortioxatine, with the M.O. of drop to 5mg and cross taper for 2 weeks with a small dose of imipramine. I so need all of the above to work out for me, as I have so much hanging on it...My work and my livelihood!!!!!

Any further guidance Ta John

[SideFX]

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!

Thanks Pilisa
Yeah it is not a science, albeit the pdocs act like it is, they have no idea how exactly these meds work and that makes it even more difficult...You would have thought that they would follow the family response indicator, however that’s not the case.

As PDU has stated they go with what they’ve used recently and have a toolbox of meds to try...Then when that’s exhausted they are lost and don’t listen to the patient...For gods sake, surely that’s the starting point and not the last resort, which is what had happened in my case...I have asked for it numerous times and put on meds that don’t suit or do nothing !!!!

There is a gene test but I believe it’s very far from accurate and therefore not worth wasting money on...What AD’s has your son been through and is this his first episode ???? Ta John

[panic_down_under]

I am a bit fuzzy bout the buspar, could of been Wellbutrin that made me so angry. I took it with venlafaxine at the time.

Bupropion (Wellbutrin) is a very stimulating AD so would be more likely to trigger anger I would have thought, although it is a listed side-effect of both meds. Not a med most with anxiety can tolerate as it can almost literally have them climbing the walls, but small adjuvant doses to counter AD induced weight gain, or for sexual dysfunction can be useful, however, buspirone is often effective for the latter so the better initial option.

I personally find that the CBT and other cognitive therapies are of no use to me...

Unfortunately, therapy didn't help me either, but I did enjoy the sessions.

I have started trying CBD Oil and don’t know if it’s placebo effect, but it does help...

It can be, however, cannabis isn't as THC has the same deleterious effects on hippocampal neurons as alcohol, BZDs and cortisol.

I need to be careful though as my second dose of Pregabalin with Diazipam can knock me out like a tranqulliser dart. I take them 6 hours apart and this has always been the case. It’s as if the peak is delayed for several hours and as I’m coming down of it I can feel it bad.

Interesting. The amount of diazepam in your system wouldn't vary much across 24 hours. Pregabalin's may if you're a fast metaboliser because of its short half life

I was thinking of trying again to taper the Pregabalin, as I’ve tried and failed twice

The problem can be that short half-life because it can drop out of the system very quickly especially at the lower doses which may set up a roller-coaster effect which many find very disturbing. Upping the diazepam dose may help, but your GP may take some convincing given you're on a largish dose already.

I totally agree with you in regards of the vortioxatine, with the M.O. of drop to 5mg and cross taper for 2 weeks with a small dose of imipramine. I so need all of the above to work out for me, as I have so much hanging on it...My work and my livelihood!!!!!

You need to get your GP's and particularly your psychiatrist's inputs on this too. On paper it should be fine, but these things all come down to YMMV, and they are better placed to foresee any likely pitfalls based on your general well-being and history.

[SideFX]

Bupropion (Wellbutrin) is a very stimulating AD so would be more likely to trigger anger I would have thought, although it is a listed side-effect of both meds. Not a med most with anxiety can tolerate as it can almost literally have them climbing the walls, but small adjuvant doses to counter AD induced weight gain, or for sexual dysfunction can be useful, however, buspirone is often effective for the latter so the better initial option.



Unfortunately, therapy didn't help me either, but I did enjoy the sessions.



It can be, however, cannabis isn't as THC has the same deleterious effects on hippocampal neurons as alcohol, BZDs and cortisol.



Interesting. The amount of diazepam in your system wouldn't vary much across 24 hours. Pregabalin's may if you're a fast metaboliser because of its short half life



The problem can be that short half-life because it can drop out of the system very quickly especially at the lower doses which may set up a roller-coaster effect which many find very disturbing. Upping the diazepam dose may help, but your GP may take some convincing given you're on a largish dose already.



You need to get your GP's and particularly your psychiatrist's inputs on this too. On paper it should be fine, but these things all come down to YMMV, and they are better placed to foresee any likely pitfalls based on your general well-being and history.

Thanks Ian

Would you consider dropping Pregabalin albeit extremely slowly or hang out for the swap to a TCA and hopefully getting more stability before attempting any med reductions ??? I know it’s a big question and one that’s been plaguing me for months and months...You said you thought that Pregabalin and diazipam were probably what we’re giving me the lift, with very little help from brintellix.

Do you mind explaining in greater detail what you were referring too with that response please ???? Ta John

BTW
I’m pretty sure if was Wellbutrin as it fits the pattern and validates what bits I’ve read about the med

[panic_down_under]

Would you consider dropping Pregabalin albeit extremely slowly or hang out for the swap to a TCA and hopefully getting more stability before attempting any med reductions ???

Leave it until after you're stabilised on imipramine as it may help with any anxiety spike at the beginning. Getting onto an effective AD should be the priority. Whatever issues there are with pregabalin and diazepam are probably not going to get any worse over the next month or two given you've been on both for years.

You said you thought that Pregabalin and diazipam were probably what we’re giving me the lift, with very little help from brintellix.

That does seem to be the case from what you've posted, John.

Do you mind explaining in greater detail what you were referring too with that response please ????

About pregabalin and diazepam, vortioxetine, or something else? Sorry, I don't know which response you're referring to.

[SideFX]

Leave it until after you're stabilised on imipramine as it may help with any anxiety spike at the beginning. Getting onto an effective AD should be the priority. Whatever issues there are with pregabalin and diazepam are probably not going to get any worse over the next month or two given you've been on both for years.



That does seem to be the case from what you've posted, John.



About pregabalin and diazepam, vortioxetine, or something else? Sorry, I don't know which response you're referring to.

Sorry Ian

I was referring to more details around your comment that Pregabalin and Diazipam we’re probably providing the lift and vortioxatine wasn’t really doing much if anything, albeit I asked if it’s raising serotonin levels it must be doing something...The vortioxatine however comes with a host of SideFX for me ???

Hope that makes sense and I think your probably correct, in trying to get on an AD that I gel with first...Even though it all scares the crap out of me TBH I have had so many med changes but cannot tolerate the SRI’s any more. So I hope the TCA class is a better fit

Thanks Ian Ta John

[panic_down_under]

I was referring to more details around your comment that Pregabalin and Diazipam we’re probably providing the lift and vortioxatine wasn’t really doing much if anything, albeit I asked if it’s raising serotonin levels it must be doing something...The vortioxatine however comes with a host of SideFX for me ???

Yep, pregabalin, diazepam and mirtazapine based on what you've posted, John. Whatever positive effect vortioxetine may be having seems likely cancelled by the impact of the side-effects on your psyche. In your first post you wrote that you're almost constantly on the verge of panic. Whatever issues there may be with the other three they are pretty consistent in their performance which suggests it's the AD pulling you down. What is your take?

[SideFX]

Yep, pregabalin, diazepam and mirtazapine based on what you've posted, John. Whatever positive effect vortioxetine may be having seems likely cancelled by the impact of the side-effects on your psyche. In your first post you wrote that you're almost constantly on the verge of panic. Whatever issues there may be with the other three they are pretty consistent in their performance which suggests it's the AD pulling you down. What is your take?

Hi Ian

I do feel on the edge and the slightest bump hurts me, a bit like driving a car with flat tyres, you feel every bump in the road and it’s magnified....Albeit I do experience degrees of diurnal variation, some days more so than others and as I said early on I seem to have the ability to focus, with less cog fog than previous meds.

However this comes at a price of skin burning sensations, hot flashes, palps, shortness of breath, fatigue, guilt, depression, bruxism and so on...I obviously have built some tolerance to these effects, but after nearly 2 plus years, I should be in full remission and that’s my take on it.

I therefore need to navigate my way through this poly drugged path and try to mitigate as much as possible any additional risk of med changes. Cause this combo is not the right path and I’m sure of that...What I’m not sure of is which med and where to start a new journey. Sorry if this all sounds a bit airy fairy and flakey, but I’m hoping to try and put someone in my shoes.

The risks as I said are very high in my opinion and is this a true quality of life NO NO NO !!!!

I’ve told my GP and Pdoc that the bruxism has me biting my tongue and that hurts, added to which my jaw and teeth still hurt and feel sore. But are they offering any solutions again NO NO NO. I don’t count the advise of reducing Mirtazipine to resolve the bruxism...That’s crap and the only proven method of resolving bruxism is to add buspar, or withdraw the offending med !!!! That’s fact.

I am gonna ask my GP if she can arrange a second opinion. Not a diagnosis, I don’t need that - I mean a proper psychiatric look at my meds and offer some way forward and I don’t mean adding stupid AP meds or Mood Stabilisers. I need an AD that fits me like Peroxatine and venlafaxine have in the past.

Sorry for the rant Ian Ta John

[panic_down_under]

I am gonna ask my GP if she can arrange a second opinion. Not a diagnosis, I don’t need that - I mean a proper psychiatric look at my meds and offer some way forward and I don’t mean adding stupid AP meds or Mood Stabilisers. I need an AD that fits me like Peroxatine and venlafaxine have in the past.

A good idea, imho. But if you're expecting a definitive answer of "this med is *the* one" you probably won't get it, or at least you shouldn't. Imipramine may, or not be the right AD for you, and this is just as true of all the others. Unfortunately, the only reliable method of finding the best AD fit is by trial and error. And part of that is not automatically ruling anything out such as the MAOIs as some of your doctors apparently have. However, it is reasonable to put meds with issues such as most SNRIs, antipsychotics and antiepileptics toward the bottom of the list.

[SideFX]

A good idea, imho. But if you're expecting a definitive answer of "this med is *the* one" you probably won't get it, or at least you shouldn't. Imipramine may, or not be the right AD for you, and this is just as true of all the others. Unfortunately, the only reliable method of finding the best AD fit is by trial and error. And part of that is not automatically ruling anything out such as the MAOIs as some of your doctors apparently have. However, it is reasonable to put meds with issues such as most SNRIs, antipsychotics and antiepileptics toward the bottom of the list.

Thanks Ian

I totally get that there are no guarantees that any particular med may or may not suit each individual and that’s a trial and error process...But it is surely the doctors obligation and goal to get the patient back to feeling how they used too !!!

And I feel my doctors are all being to passive and particularly my Pdoc who doesn’t believe that meds are the answer and keeps trying to play the phycologist with me...I don’t need that I need someone who has the goal of getting my life back and not sitting on the fence, with no suggestions. It’s me that’s driving the bus and it should be them.

They should be saying okay we should try this and if that doesn’t work then that and have a medication plan, at least for the next couple of stages and as you say all AD’s must be explored before resorting to any off label uses of other meds. And I need a fresh pair of eyes to look at things and listen to me.

This morning was so bad I could have easily turned the lights out for good...What I don’t understand is this time round I’ve cried so so much, however no previous episode has triggered that in me, which makes me feel something has definitely changed but what ??? Any ideas Ian and why do I react so badly to SSRI/SNRI meds ???

I’m losing hope because the doctors just ain’t seeing the gravity of the situation I’m in !!!!

Thanks Ian