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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by mashogr8 on April 25, 2002, at 21:36:43
Does anyone know of a difficulty taking high blood presssure medication along with ADs. I am currently taking Wellbutrin SR (400), Celexa (30) Cytomel(.025) and Synthroid(0125) to try to augment the ADs. Things have been steadily getting worse, nothing was working. I agreed to add lithium (300) and in two weeks I thought there was a hint of improvement. Then my GP placed me on lisonipril for high blood pressure. Within 36 hours, I was so sad and hopeless, right back to where I was before the lithium.
Is it possible for the BP medication to have had such a disastrous effect? Could all the other meds I am on been affected causing the downside?
Thanks for any thoughts anyone has.
Posted by jay on April 29, 2002, at 2:26:48
In reply to Blood Pressure med /ADs and downward plunge, posted by mashogr8 on April 25, 2002, at 21:36:43
Hi...yes I believe it is possible, as BP meds have an opposite effect of antidepressants. Plus, add lithium in there, and more complications. Maybe ask your doctor if you could try a smaller dose of a weaker BP med. There are many to choose from.Best wishes..
Jay
Posted by kid47 on April 30, 2002, at 12:38:30
In reply to Blood Pressure med /ADs and downward plunge, posted by mashogr8 on April 25, 2002, at 21:36:43
Hi. did you have high BP before starting the AD's? Wellbutrin can cause elevated BP. If the Wellb is not helping with depression, you might dc it & see if your BP problem resolves. Ask your doc.
Posted by medlib on April 30, 2002, at 18:34:57
In reply to Blood Pressure med /ADs and downward plunge, posted by mashogr8 on April 25, 2002, at 21:36:43
Hi M.?--
Welcome to PB!; I haven't seen your handle before (which isn't saying a lot, since I haven't been here much lately). I'm posting now because I'm concerned that some of the information you've received is not entirely correct. On this PB board we generate ideas and alternatives, and we share our own med experiences, and, sometimes, our information. We trust that you will consider everything you read here to be opinion, which you will check out at reputable web sites and with qualified medical specialists--before making any med changes.
BP-lowering meds are NOT the opposite of antidepressants. Lisinopril is an ACE inhibitor, a family of BP-lowering meds which has no history of causing or worsening depression. On the contrary, a few scattered anecdotal reports suggest that captopril may have slight antidepressant properties (no studies published yet which confirm this).
Different families of cardiac drugs lower BP by very different physiological mechanisms, so comparisons between families on strength or efficacy are ambiguous. Suffice it to say that it's best to match the med used to the needs of the patient, then adjust the therapeutic response by dosage level.
That said, if your GP knew that you were taking lithium, lisopril probably should not have been his first choice for lowering BP. A number of published case studies (easily available to any MD or pharmacist) have reported that combining lithium with lisinopril (or captopril) has led to lithium toxicity. This isn't an immediate problem for you since your lithium dose is so low--as is, I assume, your lisinopril dose. Lithium is one med whose dosage *must* be monitored by blood levels. It has a relatively narrow therapeutic window; that is, there's not much room between "enough to work well" and "too much to tolerate." A number of things can affect lithium levels in the blood (diuretics, level of iodized salt intake, etc.) and lithium itself affects other systems (it reduces thyroid functioning, for example). It's my impression that lithium, for most people, does a better job of preventing mania than it does alleviating depression. There are other mood stabilizers which may have more of an antidepressant effect--Lamictal, Topamax, Depakote, etc. All meds have side effects, though. If you and your pdoc want you to remain on Lithium, the dosage may need to be increased to reach the optimum therapeutic level; in which case, you will want to change to a different BP med. You might ask your GP about Verapamil, a frequently prescribed calcium channel blocker which has mild antidepressant effects for some.
Since both Wellbutrin and thyroid meds can raise BP, if you've taken each at least a month with NO improvement in symptoms, you might question whether either is worth keeping. Many pdocs have found that augmentation of psych drugs with thyroid meds is not helpful unless there is a preexisting hypothyroid condition.
Bottom line? The med literature suggest that lisinopril is unlikely to have caused your mood decline. If anything, it might have increased the blood levels of lithium which could have *improved* your mood. But, psych meds cause infinitely more variability in individual responses than do all the other classes of meds combined. So, almost anything is possible.
There are many possible permutations and combinations in current drug therapy; it takes quite a bit of patience and persistence to find one that works. Hope something in here helps. If I've managed to create more confusion than clarity, please let me know. We might be able to offer a bit more help if we had a few more details.
Well wishes---medlib
P.S. I lost track of the time--can't stop to proofread this and I'm an abysmal typist. Sorry!
Posted by mashogr8 on May 5, 2002, at 13:18:42
In reply to Re: Blood Pressure med /ADs and downward plunge » mashogr8, posted by medlib on April 30, 2002, at 18:34:57
Thanks all for your replies (I hate being on lithobid, besides the hand tremor,it plays around with keyboard senesitivity and I wind up with extra letters! what a pain, hope I clean them up before I post this).
Anyway, I am very familiar with PB since '98, although I mostly read and absorved information. Occasionally, I tried to present my experiences with depression and medication. Eventually,some form of medication worked for a decent bit of time and I found myself not paying much attention to the computer at all. All good things come to an end and whatever I was on at that time, no longer worked. My meds have been upgraded, dowongraded and sent who knows where. I started poking around this site again,hoping for some good inspiration, but the world had changed even here. There were all these different choices to make and I didn't have the patience to read and decipher what the directions said. Plus now you had to register and give a name. Someone already had my name. I don't exist here either. I gave up.This winter things got desperrate and ECT was mentioned more frequently. It's a route I elect not to take. I probably would die rather than submit to that. Out of desperation,I agreed to take lithium (which I intensely dislike) and then wound up having the lisonipril. Because I crashed mood wise overnight and simultaneously with the start of taking the lisonipril with nothing else as a trigger, the psydr. wanted me to get off BP immediately.
In thinking about your replies, I wonder now if the Wellbutrin SR could in fact, be raising the blood pressure. I see the GP next week -- I'm going to try to pin down when my pressure started getting out of hand. It might just correspond to the start of the Wellbutrin.
I will also bring up your idea of the other V... medication whose name I don't remember and I can't see the post, oh well(sigh).
Agian, thanks for your thoughts and now that I have a new identity and made ti through this board, it might not appear so intimidating and I will be bbback more often.I can't believe how this site has grown -- the number of messages is staggering.
Thank you, Dr. Bob for having the patience to keep working to keep this site active. It is the only site that I would use for information and uspport.
Ma
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