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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Incubusfan on February 17, 2009, at 11:40:19
It appears as if I'm rather sensitive to drugs that can affect heart rate. On Parnate, I had brayacardia and hypotension issues. I gave Clomipramine another week, and it elevates my heart rate a great deal, which makes me feel like I'm out of breath, and extremely fatigued/lethargic.
Are any of the tricyclics known to be easy on the old ticker?
Thanks,
- Mike
Posted by mav27 on February 17, 2009, at 12:00:52
In reply to Tricyclic least likely to mess with the heart?, posted by Incubusfan on February 17, 2009, at 11:40:19
Dothiepin/Dosulepin didn't give me heart rate issues like the other tricyclics but i believe it isn't available in the US if that's where you are.
Posted by SLS on February 17, 2009, at 12:30:24
In reply to Re: Tricyclic least likely to mess with the heart? » Incubusfan, posted by mav27 on February 17, 2009, at 12:00:52
Maybe trimipramine.
- Scott
Posted by Incubusfan on February 17, 2009, at 12:46:38
In reply to Re: Tricyclic least likely to mess with the heart?, posted by SLS on February 17, 2009, at 12:30:24
> Maybe trimipramine.
>
>
> - ScottHow about desipramine? I've read the anti-cholinergic properties can contribute to the heart rate issues. Desipramine doesn't seem to have anti-cholinergic issues.
Thanks,
- Mike
BTW, have you hit 300mg yet? Hope you're doing well.
Posted by Phillipa on February 17, 2009, at 13:04:14
In reply to Re: Tricyclic least likely to mess with the heart?, posted by Incubusfan on February 17, 2009, at 12:46:38
When's the time up? Phillipa
Posted by SLS on February 17, 2009, at 14:19:07
In reply to Re: Tricyclic least likely to mess with the heart?, posted by Incubusfan on February 17, 2009, at 12:46:38
> > Maybe trimipramine.
> >
> >
> > - Scott
>
> How about desipramine? I've read the anti-cholinergic properties can contribute to the heart rate issues. Desipramine doesn't seem to have anti-cholinergic issues.Desipramine does have a mild muscarinic cholinergic receptor binding affinity. However, I don't know how important that is to the overall set of side effects.
Anticholinergic effects will certainly contribute to cardiac effects of drugs. However, the NE reuptake inhibition of desipramine is so potent, that most people notice an accelerated heart rate. Remember, there is a balance between sympathetic (NE) and parasympathetic (ACh) autonomic nervous systems. Too much NE or not enough ACh produce very similar symptoms: tachycardia, palpitations, dry mouth, sweating, mydriasis, blurred vision, urinary retention, etc. I found imipramine to be worse, which, of course, makes sense, as it does have the additional anticholinergic properties.
http://www.drugs.com/sfx/desipramine-side-effects.html
Personally, I have no fear of any of the tricyclics except for, perhaps, protriptyline. It is extremely anticholinergic along with NE reuptake inhibition.
> BTW, have you hit 300mg yet? Hope you're doing well.
Thanks for asking. No, I am still stuck at 250mg, and I continue to deteriorate. This was unexpected. I would have thought that being so close to my therapeutic dosage that I would have at least maintained some sort of plateau. Now, I can't help but to have some trepidation that even 300mg won't do it. I still think it's the right drug for me, though. I guess we will know better in 2 weeks.
Take care and be well.
- Scott
Posted by softheprairie on February 17, 2009, at 23:40:21
In reply to Re: Tricyclic least likely to mess with the heart?, posted by Incubusfan on February 17, 2009, at 12:46:38
> How about desipramine?
I take desipramine and had strong heart side effects even when I was on a dose only a third as large as my current one. I got sinus tachicardia (heartrate over 100 beats per minute, but EKG didn't find anything bad about it except that high #); subjectively disturbing/scary heart palpitations, increased anxiety, and profuse sweating of my forehead. A beta blocker (Bystolic/nebivolol) added in response to the desipramine has improved all of those side effects except the sweating, which I can accept.
The desipramine has been so helpful to my depression, and so much better than other things tried, that I sort of want to evangelize about it. I sort of am suprised that it isn't used more. Plus, I get it as a generic.
Posted by Incubusfan on February 18, 2009, at 12:11:49
In reply to Re: Tricyclic least likely to mess with the heart? » Incubusfan, posted by SLS on February 17, 2009, at 14:19:07
>
> Desipramine does have a mild muscarinic cholinergic receptor binding affinity. However, I don't know how important that is to the overall set of side effects.
>
> Anticholinergic effects will certainly contribute to cardiac effects of drugs. However, the NE reuptake inhibition of desipramine is so potent, that most people notice an accelerated heart rate. Remember, there is a balance between sympathetic (NE) and parasympathetic (ACh) autonomic nervous systems. Too much NE or not enough ACh produce very similar symptoms: tachycardia, palpitations, dry mouth, sweating, mydriasis, blurred vision, urinary retention, etc. I found imipramine to be worse, which, of course, makes sense, as it does have the additional anticholinergic properties.
>
> http://www.drugs.com/sfx/desipramine-side-effects.html
>
> Personally, I have no fear of any of the tricyclics except for, perhaps, protriptyline. It is extremely anticholinergic along with NE reuptake inhibition.>
> Thanks for asking. No, I am still stuck at 250mg, and I continue to deteriorate. This was unexpected. I would have thought that being so close to my therapeutic dosage that I would have at least maintained some sort of plateau. Now, I can't help but to have some trepidation that even 300mg won't do it. I still think it's the right drug for me, though. I guess we will know better in 2 weeks.
>
> Take care and be well.
>
>
> - Scott
Spoke to my pdoc yesterday, he seems to like Noritriptyline the best in terms of side effects.When asked if any tricyclics will not mess with the heart, he basically said no,and then exactly what you said Scott in terms of the systems involved with affected heart rate.
The summer will be a better time for me to test side effect heavy meds, as I'll be able to lie in bed without consequence, if need be. For the moment, I'll be taking 4mg of Trilafon.
I'm going to ask my doctor about trying Wellbutrin SR at 300MG next week(No insurance, and the XL generic is apparently garbage).
Thanks!
- Mike
Posted by SLS on February 18, 2009, at 12:41:17
In reply to Re: Tricyclic least likely to mess with the heart?, posted by Incubusfan on February 18, 2009, at 12:11:49
Hi.
Nortriptyline is an interesting drug, and I agree with your doctor that it feels like a milder drug with regard to side effects. Among other things, nortriptyline acts as an antagonist at serotonin 5-HT2a receptors. This is a property shared with the atypical neuroleptic antipsychotics. It might be the thing that helps treat the negative (depression-like) symptoms of schizophrenia. I think it adds to the mood brightening effect of nortriptyline.
Good luck.
- Scott
************************************************> > Desipramine does have a mild muscarinic cholinergic receptor binding affinity. However, I don't know how important that is to the overall set of side effects.
> >
> > Anticholinergic effects will certainly contribute to cardiac effects of drugs. However, the NE reuptake inhibition of desipramine is so potent, that most people notice an accelerated heart rate. Remember, there is a balance between sympathetic (NE) and parasympathetic (ACh) autonomic nervous systems. Too much NE or not enough ACh produce very similar symptoms: tachycardia, palpitations, dry mouth, sweating, mydriasis, blurred vision, urinary retention, etc. I found imipramine to be worse, which, of course, makes sense, as it does have the additional anticholinergic properties.
> >
> > http://www.drugs.com/sfx/desipramine-side-effects.html
> >
> > Personally, I have no fear of any of the tricyclics except for, perhaps, protriptyline. It is extremely anticholinergic along with NE reuptake inhibition.
>
> >
> > Thanks for asking. No, I am still stuck at 250mg, and I continue to deteriorate. This was unexpected. I would have thought that being so close to my therapeutic dosage that I would have at least maintained some sort of plateau. Now, I can't help but to have some trepidation that even 300mg won't do it. I still think it's the right drug for me, though. I guess we will know better in 2 weeks.
> >
> > Take care and be well.
> >
> >
> > - Scott
>
>
> Spoke to my pdoc yesterday, he seems to like Noritriptyline the best in terms of side effects.
>
> When asked if any tricyclics will not mess with the heart, he basically said no,and then exactly what you said Scott in terms of the systems involved with affected heart rate.
>
> The summer will be a better time for me to test side effect heavy meds, as I'll be able to lie in bed without consequence, if need be. For the moment, I'll be taking 4mg of Trilafon.
>
> I'm going to ask my doctor about trying Wellbutrin SR at 300MG next week(No insurance, and the XL generic is apparently garbage).
>
> Thanks!
>
> - Mike
>
Posted by psychobot5000 on February 20, 2009, at 22:33:54
In reply to Re: Tricyclic least likely to mess with the heart?, posted by SLS on February 18, 2009, at 12:41:17
> Hi.
>
> Nortriptyline is an interesting drug, and I agree with your doctor that it feels like a milder drug with regard to side effects. Among other things, nortriptyline acts as an antagonist at serotonin 5-HT2a receptors. This is a property shared with the atypical neuroleptic antipsychotics. It might be the thing that helps treat the negative (depression-like) symptoms of schizophrenia. I think it adds to the mood brightening effect of nortriptyline.
>
> Good luck.
>
>
> - Scott
>I agree with everything Scott said. I would merely add that Nortriptyline gave me tachycardia (around 100bpm resting, up from 70-80). I don't think it's particularly known for doing that, but it would seem to be a possibility.
Posted by SLS on February 21, 2009, at 6:22:45
In reply to Re: Tricyclic least likely to mess with the heart?, posted by psychobot5000 on February 20, 2009, at 22:33:54
> I would merely add that Nortriptyline gave me tachycardia (around 100bpm resting,
That's about where it put me also.
Desipramine is no worse than this once you've been on it for awhile. I am currently at 98bpm with some coffee down my gut.
- Scott
Posted by Incubusfan on February 21, 2009, at 18:34:00
In reply to Re: Tricyclic least likely to mess with the heart?, posted by psychobot5000 on February 20, 2009, at 22:33:54
I suppose I may be more sensitive to this, as my normal resting heart rate is in the 40s. Clomipramine brought it up to the 70s, which was very high for me.
Genetics and partly good physical condition cause a low heart rate for me.
This is the end of the thread.
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