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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 FourFeathers on January 9, 2010, at 13:51:10
I am considering combining low dose Effexor with a TCA and would like some advice on which one.
I tend to be quite med sensitive and have been on the med merry go round for years. I have tried all of the SSRIs, Effex, Wellb, Strattera, Cymb, Nardil... I have never tried a TCA.
After years of trial and error it has become obvious that I do best with a medication with a decent norep effect (except for cymbalta which just made me flat). Strattera is calming but creates REM behavior issues. I cannot tolerate doses of Effexor above 75mg as it creates increased anxiety and blood pressure.
Unmedicated my bp is borderline (effect of underlying anxiety) and my heart tends to go quickly from 70bpm at rest to 140-160bpm with any exercise (5-10 mins of cardio). Beta blockers slow the heart but create cognitive side effects and terrible constipation. BTW...I am otherwise in good physical shape and not overweight or suffer other health issues.
Of the TCAs, I am currently considering nortriptyline or protriptyline as an augmentation to 37.5mg Effexor. Any advice as to a TCA that would be a logical trial which may also reduce bp and modulate my sympathetic nvervous system?
Thank you in advance.
Posted by mtdewcmu on January 9, 2010, at 22:27:28
In reply to Effexor + TCA - Advice Needed, posted by FourFeathers on January 9, 2010, at 13:51:10
>
> Of the TCAs, I am currently considering nortriptyline or protriptyline as an augmentation to 37.5mg Effexor. Any advice as to a TCA that would be a logical trial which may also reduce bp and modulate my sympathetic nvervous system?
>
> Thank you in advance.
>
>Are you hoping to lower your blood pressure using a TCA? I don't think that makes sense, unless you are just trying to reduce your anxiety. There are better drugs to reduce blood pressure.
The two best TCAs in terms of side effects, based on my research, are nortriptyline and desipramine. Both of them are very selective for norepinephrine.
Posted by FourFeathers on January 10, 2010, at 16:53:20
In reply to Re: Effexor + TCA - Advice Needed, posted by mtdewcmu on January 9, 2010, at 22:27:28
> Are you hoping to lower your blood pressure using a TCA? I don't think that makes sense, unless you are just trying to reduce your anxiety. There are better drugs to reduce blood pressure.
>
> The two best TCAs in terms of side effects, based on my research, are nortriptyline and desipramine. Both of them are very selective for norepinephrine.
No, I am not trying to lower my blood pressure through the use of a TCA. My blood pressure is a direct result of my underlying anxiety disorder and resultant dysthymia. I had read that some TCAs as a side effect actually will LOWER bp rather than raise it through the adrenergic feedback loop modulation. It is this effect that I was curious about.Of Desipramine and Nortriptyline which one is better known for its anxiolytic properties?
Thanks!
Posted by mtdewcmu on January 10, 2010, at 17:47:10
In reply to Re: Effexor + TCA - Advice Needed, posted by FourFeathers on January 10, 2010, at 16:53:20
> Of Desipramine and Nortriptyline which one is better known for its anxiolytic properties?
>
> Thanks!
>I don't have personal experience with either of them, but if I had to guess, probably nortriptyline.
Posted by TriedEveryDrug on January 11, 2010, at 16:23:11
In reply to Effexor + TCA - Advice Needed, posted by FourFeathers on January 9, 2010, at 13:51:10
For a while I took desipramine, probably 50mg with 37.5 Effexor xr.
epocrates shows a major interaction, but my doctor seemed to think it was ok. He said he had people on that combo. (I'm not so sure, I found articles claiming cardiotoxicity w/ that combo)
Anyway, the combo was nice - desipramine helped with my concentration and motivation, the effexor knocked out the side effects I had from the despiramine (anxiety, anger, depression).
I did not continue because I was afraid of the purported toxicity.
Anyway, just my experience.
This is the end of the thread.
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