Posted by SLS on December 18, 2004, at 14:27:47
In reply to Re: Imipramine.... to Scott, posted by ed_uk on December 18, 2004, at 10:35:46
> Perhaps your pdoc is worried that you would develop SS if you increased the dose of Parnate or imipramine. What do you think?
>
> Ed.
I really don't know what his concern is. He would prefer that I use amitriptyline. I don't think it is any less serotonergic than imipramine. I may be wrong. I did have a reaction when I tried to add Nardil to imipramine. It included severe hypotension and cramping of torso muscles. This probably was SS. The thing is, I have been on Parnate + imipramine before.This is my dilemma:
1. Amitriptyline leaves me sedated and feeling miserable, despite continued treatment.
2. With nortriptyline, there is no one dosage that provides improvement. I am one of the minority of people for whom there is no window of efficacy. 75mg is too little and 100mg too much. When I go from 75mg to 100mg, I experience a transient improvement that lasts for a portion of the day before I begin feeling worse again. When I drop from 100mg to 75mg, I experience the same thing. No window.
3. Desipramine does not help me as much as imipramine.
Besides all of this, he wrote the script for Parnate at only 30mg per day. That won't do anything for me. I can take 120mg and still sleep. I wish I would become insomniac on it. Insomnia is usually a good sign for me. The first time I tried Parnate + desipramine, I couldn't sleep for even 5 minutes a night until I was prescribed Halcion and Ativan. I didn't dream at all. I also responded to it. It was the only time I ever experienced a sustained improvement. Of course, the same combination does nothing for me now. I don't even experience REM suppression any more. There is no doubt in my mind that the medication-naive brain is altered by exposure to these drugs, and that these alterations persist.
Crap.
My doctor won't be available for over a week, I can't take the tricyclic that I know does the most for me, and I wasn't prescribed as much Parnate as I would need anyway. I wish I had looked at the prescription before I left the office. I just assumed that he would have me taking 60mg before my next visit in three weeks. 30mg is a waste of time. The only thing I can think to do is switch over to nortriptyline, finesse the dosage, and sneak an extra 10mg of Parnate. It's either that, or do nothing. I can't stand to waste another three weeks and another office visit fee. Nothing has been accomplished.
Crap.
- Scott
poster:SLS
thread:428196
URL: http://www.dr-bob.org/babble/20041217/msgs/431287.html