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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Vincent_QC on July 3, 2009, at 14:59:27
Hi Everyone...
Another time, I have a hard time with a new med , well new for me but old TCA...I have some questions about the Imipramine. I'm on the week 1 on this med, at only 25mg.
I take it mainly for panic disorder with agoraphobia... since it's my main problem now... the SAD is still there, but the panic attacks take place full time and happen anytimes now, it's the first time of my life who I loose the control over them... I had a rought time when I begin the gym 3 months ago.. but the panic attacks at the gym fade away... but appear again with some testing that I don't want to talk... and also since I start the imipramine...
First of all, I know that the Imipramine have a metabolite, an active one = Desperimine... mean more NE effect... I also know that the Imipramine have a strong a2 antagonist effect...BUT... I try the Clonidine, who is a good a2 agonist, I try it to reduce the panic attacks and lower my blood pressure and I see no difference... even worse, on the Clonidine, that I try on every dosage possible, mean 0,1 in a single dose, 0,2mg single dose, 0.3mg single dose... I see no difference.. I just had more upset stomach, a small decrease of my blood pressure but a higher pulse rate!!! So the problem can be something else than the NE?...I'm wondering what inside the TCA's make them hard for the heart...
I try in the past the Clomipramine, who was ok for the blood pressure but bad for energy level... on the Nortriptiline 20mg, I had high pulse rate... stronger than the effect of the Imipramine...
I wonder if it will be more easy on the Trimipramine (Surmontil)??? For the heart... since I do insomnia at night, it's maybe a good solution for me?
Anyway, panic attacks happen everywhere now... when I drive, at the gym , alone in front of the TV or the computer... they are sometimes trigger by negatives thoughts and sometimes they happen suddenly...
Anyway, I want to know if it's normal to have an increase only of the pulse rate on a LOW dose of Imipramine? What I should excepted when I will increase the dosage (25mg every week)? Did my pulse rate will be higher and higher? Did my body will adapt itself to the med? The side-effects will decrease with time ? What I should except exactly?
Also, is it normal to feel weird on this med? I do more panic attacks since I start it last monday. I have strange sensations on my heads, change in vision, feel out of my body... feel just worse... Is it normal?
I know that all the AD's increase the anxiety at first, so I probably do more panic attacks because I know my pulse rate is higher and I focus on that side-effect... but I mean, i'm only at 25mg... and the goal will be to reach the 150/300mg... I will have my blood test next week to see how I metabolise the med... but anyway, i'm just wondering if it's normal to have a high pulse rate and more panic attakcs?
Any positives feedback will be very welcome... negatives ones also !!! lol ;-)
Thanks again!
Bye!
Vincent ;-)
Posted by chumbawumba on July 3, 2009, at 15:56:46
In reply to Imipramine + higher pulse rate, posted by Vincent_QC on July 3, 2009, at 14:59:27
Yes, I experienced the same effect of increased heart rate at low dose imipramine. Fortunately it didn't get any worse at higher dosages.
Posted by SLS on July 3, 2009, at 16:05:16
In reply to Imipramine + higher pulse rate, posted by Vincent_QC on July 3, 2009, at 14:59:27
Hi.
When I am taking a tricyclic, I do not worry about the elevated heart rates that they can produce. I would say that anything up to 120bpm is reasonable and often lowers over time as one continues to take the drug after a few months. Actually, the heart is not working as hard as you might think. Part of its drive to beat faster is to compensate for the decreased blood pressure caused by imipramine's effect on peripheral NE alpha-1 receptors (antagonist). The heart pumps faster, but with less force being necessary. Many people have been on tricyclics for over 20 years. These drugs are not beating the hell out of your heart.
I would suggest that you just sit back, relax, and let the drug do its work. You will have side effects, which, at first, will be significant, but often reduce in magnitude over time. You still have yet to get to a therapeutic dosage. Keep track of your heart rate, but don't obsess over it.
Actually, if imipramine becomes intolerable or doesn't work, I would opt to go back to nortriptyline at some point with the understanding that the elevated heart rate is normal and to be expected for these drugs. The side effects with nortriptyline are quite a bit milder than with imipramine.
- Scott
Posted by Vincent_QC on July 3, 2009, at 17:29:14
In reply to Re: Imipramine + higher pulse rate » Vincent_QC, posted by SLS on July 3, 2009, at 16:05:16
> Hi.
>
> When I am taking a tricyclic, I do not worry about the elevated heart rates that they can produce. I would say that anything up to 120bpm is reasonable and often lowers over time as one continues to take the drug after a few months."Ok, so that's totally normal to have a pulse rate of 110 and more on a small dose of 25mg of Imipramine? And I can excepted that it will be lowering over the time, even if I increase the dosage?"
Actually, the heart is not working as hard as you might think. Part of its drive to beat faster is to compensate for the decreased blood pressure caused by imipramine's effect on peripheral NE alpha-1 receptors (antagonist). The heart pumps faster, but with less force being necessary. Many people have been on tricyclics for over 20 years. These drugs are not beating the hell out of your heart.
>"OK, I understand that part also... I don't know what happen but since my BAD Parnate experience, I only focus on my heart... something that I never experienced before the Parnate. My heart was always normal... I think that it's common for peoples who do panic disorder to focus on body sensations like this no??? Is that mean that I can continue to go to the gym without taking care of my pulse rate? Since almost all my panic attacks start when I feel that my heart pump really fast, what can I do to stop that process? I can't do a CBT just for my heart focusing!!! lol"
> I would suggest that you just sit back, relax, and let the drug do its work. You will have side effects, which, at first, will be significant, but often reduce in magnitude over time. You still have yet to get to a therapeutic dosage. Keep track of your heart rate, but don't obsess over it.
>Ok, so I should monitered the heart how many times by day? Also, is it possible that "coffee" increase the pulse rate making the effect of the Imipramine on my heart worse? Also, when you mean "reduce in magnitude over time", if I increase the dosage by 25mg each week, that's mean that I will not reach the minimum goal of 150mg/day before 1 1/2 months... Does it mean that I will feel BAD for 1 1/2 months and more???
You know, I can deal with panic attacks who occur at the gym or in the street... but when I drive my car, I Can't deal with that... I don't want to kill someone else because I do a panic attack... I don't care about myself as much as I care about the others...
I understand also that all the TCA's increase the NE level at first and that the down regulation of the NE take some time to happen...but how many time I should excepted to feel more anxious and do more panic attacks? ... "
> Actually, if imipramine becomes intolerable or doesn't work, I would opt to go back to nortriptyline at some point with the understanding that the elevated heart rate is normal and to be expected for these drugs.The side effects with nortriptyline are quite a bit milder than with imipramine.
"Hummm and for the strange side-effects like feeling out of my body, dizness and feeling weird sensation in my head... is it normal???
I'm not sure that i'm interrested to return to the Nortriptyline cause it was worse than the Imipramine for the pulse rate... above 120, sometimes 140... at rest... and only at 20mg... I understand that the high pulse rate is not dangerous... but that's the kind of sensation I can't tolerate... a small increase of the pulse rate, mean around 90-100 is ok for me.. I can deal with that... but more than 120? Not sure..."
>
>
> - Scott"Did you ever try the Trimipramine??? Just curious... since I have insomnia... and begin again to take some seroquel at bedtime to be able to sleep, maybe it will be an interresting option for me... since the Trimipramine is the more sedating TCA...I Will avoid blending 2 kinds of meds... since the Seroquel can also increase the blood pressure sometimes...""
Anyway thanks for your answer Scott ! I will continue the imipramine, but take it at bedtime... will maybe avoid some focus on my pulse rate while I sleep !!! ;-)
I just hope the weird feelings I have right now will decrease over the time...and not increase with the dose increasement!!! ;-)
Posted by Vincent_QC on July 3, 2009, at 17:45:23
In reply to Re: Imipramine + higher pulse rate, posted by chumbawumba on July 3, 2009, at 15:56:46
> Yes, I experienced the same effect of increased heart rate at low dose imipramine. Fortunately it didn't get any worse at higher dosages.
Ok thanks!!! And did you had any other side-effects? Like feeling weird...out of your body... goosebumps on the head...and feeling isolated, not at all sociable and lazy? That's what I experience since monday and I can told you that I don't like that... And also, each time you increase the dosage, did you had worse side-effects that last for a long time???
I know, I ask a lot of questions... but I just want to be sure I do the good choice... since I really need to get ride of those panic attacks and the panic disorder... no other meds succeed to make it possible, just the Paxil, who work 4 years and stop working for no reason after...
That's strange how the things happen. At first, I was diagnosticed with panic disorder + agoraphobia and panic attacks... with time, Doctors and PDoc change their minds and told me it was social anxiety disorder... and with the time, I ended up with tons of comorbidities (body dismorphic, bulemia, GAD, lack of motivation and energy... call dys???? don'T know the word in englosh sorry...) and an addiction to the benzo drugs... that I continue to use even if they don't work relly well.. even 4 mg of Rivotril can stop me doing panic attacks or prevent them...
For a little while, the SAD was the main problem... I had only situationnal panic attacks (public speach at the university)... but when I was in a public space, walking on the streets or in a shopping center, I was feeling really bad, but without doing panic attacks... I was just feeling watched by everyone and judge...
Now, it's seem that I don't care about what the peoples think about me... the problem move to the panic disorder again... strange no? ...
That's seem that the more comobordities you have, and the less chance you have to find the good med or combo of meds to help you...
After trying tons of off-label drugs (Mirapex, Clonidine, Beta blocker, Neurontin, Lyrica, all the newer anti-psychotics, Topamax...), and all the older MAOI's or the newer stuff, even the Pristiq, it's seem that nothing can help really...
They always claim that doing a CBT is the more effective treatment... but doing a CBT when your mental state is not under control is really hard... it's like working for nothing...
Anyway, i'm out of subject again...
Thanks again and if you want, share more of your Imipramine experience with me and also why you use it... if it was effective or not... and the kind of side-efects you had on it... maybe it will help me to reduce my stress in regard of this med...
Posted by chumbawumba on July 3, 2009, at 18:04:22
In reply to Re: Imipramine + higher pulse rate » chumbawumba, posted by Vincent_QC on July 3, 2009, at 17:45:23
At first I felt quite weird. Kind of a pins and needles feeling. My feet felt of like they were electrified or something. That wore off quickly.
I found it to be very effective in the short term. Less so long term. Also my experience was every time my doctor upped the dose I felt the improvement immediately as opposed to having to wait several weeks like with Prozac.
Posted by Phillipa on July 3, 2009, at 19:53:37
In reply to Re: Imipramine + higher pulse rate, posted by chumbawumba on July 3, 2009, at 18:04:22
Vincent sounds positive for you. Phillipa
Posted by Vincent_QC on July 4, 2009, at 6:36:25
In reply to Re: Imipramine + higher pulse rate, posted by Phillipa on July 3, 2009, at 19:53:37
> Vincent sounds positive for you. Phillipa
Well, not so positive... since for now I can't deal with the increase of the NE... I just stop it... the fast heart beat start panic attacks on me, even if this effect fade-away with time, I can't deal with it for now...
I just move on again and will ask the Doc for my number one idea, the Sabril (GabaT ... have the same kind of effect than the "Gabatril" in the USA = GabaErgic effect), not avaible in the USA...
I will see the results... if panic disorder decrease with that stuff, I will maybe ask to have an AD with it...like the Luvox or the Celexa... since the SSRI are very easy to take for me... no side-effects... exception of the lack of motivation and energy ... but I suppose I have those kind of side-effects on the SSRI cause I take some benzo drugs since a too long time now...
Posted by chumbawumba on July 4, 2009, at 14:18:28
In reply to Re: Imipramine + higher pulse rate » Phillipa, posted by Vincent_QC on July 4, 2009, at 6:36:25
> Well, not so positive... since for now I can't deal with the increase of the NE... I just stop it... the fast heart beat start panic attacks on me, even if this effect fade-away with time, I can't deal with it for now...
>When I complained about the heart rate increase to my doctor, he gave me propropanol, a beta blocker. It will return your heart rate to normal and if you are prone to anxiety, some people find it helpful for that as well. The only downside I experienced was that it was difficult to raise my heart rate with aerobic exercise. It made it so I felt more tired and out of shape than was warranted by my actual fitness.
Posted by Phillipa on July 4, 2009, at 23:56:48
In reply to Re: Imipramine + higher pulse rate, posted by chumbawumba on July 4, 2009, at 14:18:28
Same thing happened to me when 25mg of lopressor given to me with ssri first for anxiety with benzos. Reason for lopressor is that with thyroid disorder inderal is contraindicated. Phillipa
Posted by linkadge on July 5, 2009, at 18:52:15
In reply to Re: Imipramine + higher pulse rate » SLS, posted by Vincent_QC on July 3, 2009, at 17:29:14
I know where you are coming from. The only drugs which have had a major impact on my depression is the norepinephrine active ones. At the same time, these affect my heart as you mention.
Its funny, I had a very similar reaction to parnate. As I got up to about 40mg I started to have a major flux in blood pressure and heart rate after each dose. I was not eating any banned foods. I when to the clinic and they told me to stop. Its funny because it just started to work around the time my BP when up like that.
Linkadge
Posted by linkadge on July 5, 2009, at 18:56:38
In reply to Re: Imipramine + higher pulse rate » chumbawumba, posted by Phillipa on July 4, 2009, at 23:56:48
You might try a low dose of say nortriptyline with an SSRI. This combo may help panic better without the cardiac or apathetic effects of SSRIs or TCA's.
Lexapro + nortriptyline would seem to be a good combo.
You could add some atenolol if needed.
Linkadge
Posted by Vincent_QC on July 6, 2009, at 8:44:09
In reply to Re: Imipramine + higher pulse rate, posted by linkadge on July 5, 2009, at 18:56:38
> You might try a low dose of say nortriptyline with an SSRI. This combo may help panic better without the cardiac or apathetic effects of SSRIs or TCA's.
>
> Lexapro + nortriptyline would seem to be a good combo.
>
> You could add some atenolol if needed.
>
> Linkadge
>
>Hi Linkadge!
Thanks for your imput ;-)What I find funny is that the newer SRNI's don't affect my heart, even if they have a minimal NE effect... I don't try the Cymbalta, who have a more strong NE activity than the Effexor... but I try the Effexor-XR at 450 mg... make me really weird... acting strangely and change my personnality... and I try the Pristiq, who was the same thing...with more insomnia, but I never feel an increase of my blood pressure or my pulse rate on them ...Strange no? More strange... I take my blood pressure often on the Pristis and I had a real good STABLE blood pressure and a normal pulse rate!!! I really don't understand why...
I guess the problem with the older AD's is that they hit too many neurons at the same times, the a1, a2 effect is a disaster on me...well with the TCA's at least... but what I find strange is that I try in the past the REMERON, who have a strong action on the a1 and a2 receptors and I never had any heart problems with it!!! Even at 60mg day...
Maybe I need some chemical courses... but I don't understand at all what can be my problem... but one kind of receptor in my brain make my heart race at the speed of light... but I still try to find the one who cause the problem...
Someone who is on good shape , mean no smooking, gym and a normal life with a work and a good and healthy foods diet will have less problem taking an older AD's like the TCA's or the MAOI's...
My Parnate experience traumatized me for the rest of my life... I think it make me realise that it will be possible for me to DIE from a heart attack... i'm 33 yo now, not 20 yo... and having high blood pressure or low blood pressure constantly make me just over paranoi with my heart... since then (last december) I never succeed to get ride off this fear... I try... you can't even know how hard I try to remove this experience from my memory... but it's impossible...
That's why I wanted to start the gym, to get more healthy and in shape... but the gym turning into a terrible experience at fisrt with panic attacks occuring while I was exercise... I continue to go to the gym and the panic attacks stop after 1 month or so... but I'm not able to exercises like I want because I feel tired rapidly and I have a lot of dizness (probably comming from my benzo intakes)...
The Panic attack problem start again, now it's almost everywhere... When I drive the car especially... at the gym also.. and alone in my house... even sometime I wake up at night and do a panic attack... That's a real difficult process to stop... I know some panic attacks are trigger with negatives throughts about having a panic attack while I drive the car for example... but the other panic attacks I have are not trigger by something... they happen suddenly and often...
Now I do around 10-15 panic attacks a day... that's making me very tired, very anxious also becauase I always think I have a problem with my heart, even if I had a EGK in february who show nothing wrong with my heart... and I feel like I loose the control over my anxiety... for the first time of my life...
Anyway, since that Parnate experience, my panic attacks problem never stop... whatever the MG of Rivotril or Valium I take, I do panic attacks... nothing can prevent them to occur... I read again my small book about the fear of having fear, I pratice the abdominal breathing technic... I do to try some relaxation technics as well... but nothing change...
My try on the Imipramine (Tofranil) was probably the worse thing to do for now because i'm in a panic attack mood... and everyone know that all the AD's will increase the anxiety at first, even at a low dose... sometimes just thinking about the fact that you take a med can make you starting a panic attack... you know what I mean??? You take a pill and 10 minute after you begin to feel the anxiety increasing... starting the panic attack mood...
I don't know why I don't go with my number one idea when I meet my Doctor last week... The Sabril (GabaErgic... a real one, not tlike the Neurontin or the Gabapentin)...
So today I will have to call my Doctor cause yesterday was a really bad day for me...
I do a 1:30 hours long panic attack, my parents almost call the 911... I faint for the first time while I was doing a panic attack... had numbess of my legs, my left arm, all around my mouth... was not able to breath at all, my pupils of the eyes was dilated to the maximum... I was not able to stay on my feet... normally while I do a panic attack I can stay on my feet...I just remember that at one point I shout to my dad to call the 911... and I wake up 30 minutes later, I was laying on the kitchen floor with a washcloth of cold water on my face... I take a 3 mg dose of Rivotril and the waves of panic attacks stop 1 hour after... I was so tired that I go in the bed and sleep alomst 2 hours in a row... at night I was just a total mess... just thinking about the panic attack and I wanted to go outside the house, drive the car to go to my friend house and I do another big panic attack while I was driving the car... I had to stop the car at the right of the road, put the 4 lights on, and wait there... 30 minutes... before I was able to continue my road... I do another one while I was driving the car to return at my home at the end of the evening...
Those panic attacks are now out of control... they are the worse thing I live in my life...
Anyway... that's the story... I put so much efforts into CBT therapies and in changing my negatives thoughts into positives thoughts that it make me think that I just loose my time... Reverse this state of mind will be very hard... I clearly need a med to help me, but fear of trying a new one... those panic attacks are frightening !!!
For the Lexapro, I find it's the worse SSRI on the world. That kind of stuff make you depress, it's not even good for anxiety or anything else, you just think about sleeping and eating... I try it with some Ritalin at the time to have more energy and with also some Wellbutrin, both show no improve on me...
The only one SSRI who work on me was the Paxil but it loose it's power after 4 years on it...
I don't try the Luvox... that's the only one I don't try... but I remember that I had a very bad experience with the Prozac, at 30 mg it started on me a panic disorder problem, it was not a pro social drug for me... the Zoloft do nothing, just worsing my weight gain and make me lazy... and the Celexa, who is the same thing than the Lexapro but with a more dirty profile, do nothing on me... The SSRI's tend to make me more depress, more anxious and make me eat like a pig... mean weight gain, mean more body dismorphic problem, mean worse self-esteem, mean worse social phobia, mean more panic disorder with agoraphobia in general... it's all linked to my body image as you can see... and the fear of dying of a heart attack...
Anyway, that's a long answer for nothing...
Will call my Doctor soon and leave a message to him and wait for his phone call...
I need also to change my Benzos... the Valium and Rivotril don't work good on me... Will maybe go with some Ativan, who take a lot of time to start but will be more stable on me... Will avoid the Xanax since I had a hard time last summer to stop it...
Maybe adding a mood stabiliser will help? Some Lamictal or something more old?... don't know... i'm sure the Doctor will say "One step at the time"...
So that's it!
Thanks again ;-)
Posted by Phillipa on July 6, 2009, at 20:32:54
In reply to Re: Imipramine + higher pulse rate » linkadge, posted by Vincent_QC on July 6, 2009, at 8:44:09
Vincent wow you sure did have a horrible day. Is today any better and what did the doc say? Love Phillipa
Posted by Vincent_QC on July 8, 2009, at 6:15:05
In reply to Re: Imipramine + higher pulse rate » Vincent_QC, posted by Phillipa on July 6, 2009, at 20:32:54
> Vincent wow you sure did have a horrible day. Is today any better and what did the doc say? Love Phillipa
Not really... HAd to go to the emergency to have a heart check up... and everything is ok... so what I experience is purely psychological...
I begin the Sabril med (GabaErgic)... feel weird on it on the first dose... had major panic attack on it... I guess you will give to me a sugar pill and I will do a major panic attack because I Will became over focusing on my body sensations...and will wait for side-effects... so when I feel a small thing strange in my head or my body the pulse rate start racing as hell and the panic attack occur...
Thats a hard process to stop.. will work hard on it...
Will return to the Imipramine tonight... Will take it at bedtime with some Seroquel to put me asleep!!! I will avoid the daytime dosage and panic attack because of the meds intake...
I guess the imipramine don't have strong side-effects and everything I feel was just in my head...
Sometimes I wonder why I can't control this problem... since I had it under control for years...
Anyway.. for now... Imipramine... 50mg at bedtime... if something bad occur it's the emergency directly... since I know my heart is ok and nothing appear in my EGK test... I think I will be ok now...
Will hope!!!
Posted by Phillipa on July 8, 2009, at 19:21:40
In reply to Re: Imipramine + higher pulse rate » Phillipa, posted by Vincent_QC on July 8, 2009, at 6:15:05
Vincent glad you checked out your heart. Love Phillipa
This is the end of the thread.
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