Imipramine or Clomipramine

[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