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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by temoigneur on February 25, 2005, at 23:48:20
After, ridiculous anxiety - being almost driven to suicide numerous times in the past year, I've come upon clomipramine for OCD/Anxiety. It has all but abolished the horrible OCD/Anxiety along with clonazepam, 3mg t.i.d. but I'm tired all the time, I just want to sleep all day; my mind is relatively dull, and I can see sleeping my way into my sixties, if I don't get something that would give me some inertia.
I have little/no ambition, or drive to do very much and as I'm on disability, I can just sleep all day and ponder what life would be like without the disease. But I had a good mind, got my ARCT in piano, I'd like to be a Nurse-Practitioner, but this is impossible being so dull and drowsy.Anyway, is there any conceivable combo Clomipramine + SSRI or bromocriptine that may allow me to retain clinical gains, and start living again. Basically looking for something to give me my energy and creativity without the torment of Anxiety and OCD. Has anyone observed that their anxiety is aggravated by SNRI's or Stimulants.
I cannnot tolerate any stimulants, On Ritalin I displayed bipolar symptoms, Dexadrine made me extremely anxious, as did provigil.
My psychiatrist has noted that noradrenergic medications cause an increase in anxiety for me. Does anything strike anyone that might help with energy, I found all SSRI's to be stimulating, to the point where I couldn't sleep, which is why I'm somewhat interested in some combination of SSRI + Clomipramine. The SSRI's alone helped for 4 months, then did little for my anxiety, but it's hard to compare because While on the SSRI's I was in school, under a great deal of pressure - now on clomipramine I no significant commitments . Thanks so much - also, if you're neurotic and want a prototypical response profile for different medications, I would be happy to submit my experience:)
Ben
Posted by Phillipa on February 26, 2005, at 0:25:06
In reply to Clomipramine 12weeks sedation anhedonia, posted by temoigneur on February 25, 2005, at 23:48:20
Have you tried Luvox? It's for OCD and depression and it didn't aggravate my anxiety. You may need to continue to take meds for anxiety with it though. Fondly, Phillipa
Posted by krybrahaha78 on February 26, 2005, at 2:24:21
In reply to Re: Clomipramine 12weeks sedation anhedonia, posted by Phillipa on February 26, 2005, at 0:25:06
yes luvox is awesome i highly recommend it
Posted by SLS on February 26, 2005, at 7:09:27
In reply to Clomipramine 12weeks sedation anhedonia, posted by temoigneur on February 25, 2005, at 23:48:20
To what degree to you think Klonopin might be contributing to your sedation and anhedonia? How long have you been taking Klonopin? Klonopin can be depressogenic, although some people report that this is a temporary side-effect.
- Scott
Posted by temoigneur on February 26, 2005, at 15:41:41
In reply to Re: Clomipramine 12weeks sedation anhedonia, posted by krybrahaha78 on February 26, 2005, at 2:24:21
> yes luvox is awesome i highly recommend it
Hi Thanks for your resposne, yeah, originally when i tried prozac and luvox I felt wonderful, and they just stopped working after about 4 months, even at the top recommended dose. I have tried virtually every medication, it's amazing I haven't tried clomipramine till now, I did try it on a short term basis earlier, but I started at too high a dosage, and had to come off it.
I'm wondering now if there's anything I might be able to add to clomipramine - to maintain the anti-OCD effects, but decrease sedation.
Posted by ed_uk on February 26, 2005, at 15:50:24
In reply to Re: Clomipramine 12weeks sedation anhedonia, posted by temoigneur on February 26, 2005, at 15:41:41
Hi,
What dose are you on? Any chance of a reduction?
Ed.
Posted by temoigneur on February 27, 2005, at 2:39:35
In reply to Re: Clomipramine 12weeks sedation anhedonia » temoigneur, posted by ed_uk on February 26, 2005, at 15:50:24
> Hi,
>
> What dose are you on? Any chance of a reduction?
>
> Ed.I'm on 200mg clomipramine, 3mg clonazepam, I'm just so sick of it, if I'm not a vegetable the OCD comes right back, I hate it soooooooo much ahhhhh. :)
Posted by banga on February 27, 2005, at 7:54:43
In reply to Re: Clomipramine 12weeks sedation anhedonia, posted by temoigneur on February 27, 2005, at 2:39:35
That is a lot of clomipramine. NO wonder you are exhausted. HOw fast did you titrate up? Did you try and hold on at a lower dose for some weeks to see if it could kick in? Clomipramine helped me with obsessive ruminations well (75mg), but it took four weeks or so to start helping.
I actually did combine a little SSRI and clomipramine, but these were small doses--50 mg clomipramine and 10mg Lexapro. At higher doses I am sure pdocs would be fearful of serotonin syndrome.
So it's possible (though I could imagine some pdocs being sticklers and saying "nope" at even combining low doses), but not at the dose you are on....
Posted by ed_uk on February 27, 2005, at 8:38:43
In reply to Re: Clomipramine 12weeks sedation anhedonia, posted by temoigneur on February 27, 2005, at 2:39:35
Hi,
>200mg clomipramine
Have you tried a dose reduction?
Ed.
Posted by temoigneur on February 27, 2005, at 17:34:01
In reply to Re: Clomipramine 12weeks sedation anhedonia » temoigneur, posted by ed_uk on February 27, 2005, at 8:38:43
> Hi,
>
> >200mg clomipramine
>
> Have you tried a dose reduction?
>
> Ed.High Ed, Banga, I titrated up fairly quickly I think to may up 50 mg every two weeks or so - I was in a horrible state, I can't really remember, but Banga you mentioned 75mg Clomipramine and 10 lexapro? Does this adequately control your obsessions, I'd be so interested to know how it's working. The doctors have done everything but brain surgery, so at this point, even though I left my psychiatrist, I'm hopping the new one will be open. Thank you
Posted by TamaraJ on February 27, 2005, at 19:10:17
In reply to Re: Clomipramine 12weeks sedation anhedonia, posted by temoigneur on February 27, 2005, at 17:34:01
Just to let you know, my pdoc had me taking Clomipramine (50 - 75 mg) concurrently with Celexa (20 mg). I seem to recall someone responding to me when I first started that Clomipramine while continuing with the Celexa that serotonin syndrome was not as much of a concern because Clomipramine has a mechanism that helps prevent such an occurence. I wish I could find the thread. I will have another look. So, maybe combining low dose Clomipramine with low dose Luvox might be effective and plausible. I unfortunately had to stop Clomipramine because it severely aggravated my already low blood pressure, and, at the dose I was able to tolerate, it really wasn't much more effective for me than a SSRI.
Wishing you all the best,
Tamara
Posted by banga on February 27, 2005, at 19:45:53
In reply to Re: Clomipramine 12weeks sedation anhedonia » temoigneur, posted by TamaraJ on February 27, 2005, at 19:10:17
75 mg of clomipramine alone was quite effective for me for getting rid of rumination. But it did take a while to kick in--4-6 weeks I'd say.
When I tried combining lexapro and clomipramine together, they had both already pooped out on me--so I'm not a good barometer for the combo's effectiveness.
When my pdoc wrote out the prescription, I don't think he even mentioned a worry about serotonin syndrome, and he was a very careful guy.
I like the idea of luvox and clomipramine...maybe that would be a good plan. Luvox it seems is more calming than lexapro. WIth 200mg, I am not surprised it feels hellish.
Posted by TamaraJ on February 27, 2005, at 20:26:55
In reply to Re: Clomipramine 12weeks sedation anhedonia, posted by temoigneur on February 27, 2005, at 17:34:01
I found the thread I was referring to in my previous post:
http://www.dr-bob.org/babble/20041103/msgs/411045.html
What I was told is that, apparently, serotonin syndrome is not a worry with Clomipramine (Anafranil) because it serves as it's own antidote via 5-HT2A antagonism.
Tamara
Posted by ed_uk on February 28, 2005, at 8:10:11
In reply to Re: Clomipramine 12weeks sedation anhedonia » temoigneur, posted by TamaraJ on February 27, 2005, at 20:26:55
Hi everyone,
Remember that Luvox interacts with clomipramine. Very large rises in the blood levels of clomipramine can occur if these drugs are combined, this could cause a seizure or cardiac arrhythmias.
Ed.
Posted by banga on February 28, 2005, at 8:33:02
In reply to Re: Clomipramine 12weeks sedation anhedonia, posted by ed_uk on February 28, 2005, at 8:10:11
Could LUvox by chance interact with desipramine too? I don't remember literature saying that, but Since I went to 100mg Luvox, I have experienced orthostatic hypotension, it was not a problem before that....
or does it on its own affect blood pressure?
Posted by ed_uk on February 28, 2005, at 8:48:53
In reply to Re: Clomipramine 12weeks sedation anhedonia, posted by banga on February 28, 2005, at 8:33:02
Hi!
>Could LUvox by chance interact with desipramine too?
Fluvoxamine may produce a small rise in desipramine levels, effectively increasing the dose. Perhaps 75mg desip will be enough now that you're on fluvoxamine. Fluvoxamine occasionally causes orthostasis but desip is a more likely culprit. Stand up slowly!
Ed.
Posted by banga on February 28, 2005, at 9:07:29
In reply to Re: Clomipramine 12weeks sedation anhedonia » banga, posted by ed_uk on February 28, 2005, at 8:48:53
Maybe that's why pdocs don't want to prescribe Luvox too often--have to keep track of 101 possible interactions. I wonder however if I may be one of the rare ones Luvox directly affects blood pressure--I had been on 100 mg desipramine in the beginning ,it had not been a problem.
Maybe I will just not sit down today at all, that way I won't have to deal with the dizzy spells! Hard to drive though standing up....
Posted by ed_uk on February 28, 2005, at 9:15:29
In reply to Re: Luvox and desipramine » ed_uk, posted by banga on February 28, 2005, at 9:07:29
Hi!
>Maybe that's why pdocs don't want to prescribe Luvox too often--have to keep track of 101 possible interactions.
I don't think so, Paxil has lots of interactions. Luvox just hasn't been marketed very effectively!!
>I had been on 100 mg desipramine in the beginning ,it had not been a problem.
But now you're on 100mg desip + fluvoxamine that might be more like taking 125 desipramine w/o fluvoxamine. (That's just a guess btw.)
I think you should consider going back down to 75mg of desipramine for a few days and then increasing again if the diziness improves.
Ed.
Posted by banga on February 28, 2005, at 9:26:17
In reply to Re: Luvox and desipramine » banga, posted by ed_uk on February 28, 2005, at 9:15:29
I guess I did not write that clearly --I am not on 100mg desipramine at the moment, I meant that when I first started it I was on 100mg (and dizziness was not a problem), but soon dropped down to 75mg due to its interaction with Abilify and the Adderall.
I will manage, I assume my body may readjust soo enough. I only worry because I am going abroad and need to be functioning top form..
Posted by banga on February 28, 2005, at 11:37:58
In reply to Re: Luvox and desipramine, posted by banga on February 28, 2005, at 9:26:17
BY the way, do you know whether then desipramine in turn potentiates fluvoxamine? Or does fluvoxamine only inhibit breakdown of TCAs. Couldn't quite understand from the literature...Maybe I could lower the fluvoxamine. It does seem to have already given a calming effect....
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