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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by SK on March 17, 2005, at 22:24:07
I want to switch from 150 mg of disparmine to 5HTP. Anyone know of the best way to do this?
Posted by SLS on March 17, 2005, at 23:46:59
In reply to withdrawal from desiparmine, posted by SK on March 17, 2005, at 22:24:07
> I want to switch from 150 mg of disparmine to 5HTP. Anyone know of the best way to do this?
You should be able to take them at the same time. However, if for some reason you don't, I would taper the desipramine by decreasing it 25-50mg every 3 days. Desipramine does not produce the same sort of withdrawal syndrome that the serotonergic SRI antidepressants do. Please post again and report how you do with it.
- Scott
Posted by bruin on March 19, 2005, at 23:44:02
In reply to withdrawal from desiparmine, posted by SK on March 17, 2005, at 22:24:07
You should only cut it 5-10% and wait to become stable before cutting again. While TCAs normally don't cause withdrawals as frequently as SSRIs, they still have the potential and the best bet is to proceed prudently to give your central nervous system time to adjust. Maybe it will only take a few days or weeks, but better safe than sorry. Proceeding slowly and letting your body tell you when to make another cut is better than going too fast and then paying the consequences later. I would NOT follow a set schedule and I would NOT make cuts that went over 10%. Just my opinion, but I have seen far too many people go too fast on any number of classes of drugs and pay the price for either their lack of patience or some doctor's complete ignorance. Best of luck.
> I want to switch from 150 mg of disparmine to 5HTP. Anyone know of the best way to do this?
Posted by SLS on March 20, 2005, at 7:11:16
In reply to Re: withdrawal from desiparmine-SK, posted by bruin on March 19, 2005, at 23:44:02
Hi Bruin.
> You should only cut it 5-10% and wait to become stable before cutting again.
* Using this SCHEDULE, how long would it take the average person to discontinue taking 150mg of desipramine?
How long shall one allow themselves to be "stable" before reducing their dosage any further?
How do you define "stable"?
My suggestion to cut by 50-25mg every three days is aggressive. A very prudent set schedule would be to cut by 25mg every three days. This would take 15 days to accomplish. If it were ME, I would do the following:
100mg x 3 days
50mg x 3 days
25mg x 3 days
0mg9 days.
> While TCAs normally don't cause withdrawals as frequently as SSRIs,
Tricyclic and SRIs are definitely different beasts. I treat them differently when I need to discontinue them, something I have had the unfortunate experience to do many, many times over the last 25 years. I think it is well justified to taper a tricyclic more rapidly than an SRI. The only exception might be clomipramine. I was on it only once, and I don't recall too well my experience with it. No "brain zaps" though. A rapid taper of a TCA probably makes sense for most people who want to move on to another medication. Your schedule is almost exactly that which is prescribed for discontinuing a benzodiazepine. This is not at all necessary.
* Your taper schedule for 150mg of desipramine would take between 4 - 8 weeks to accomplish if one were to stay at each dosage for 2 days; 11 - 22 weeks at 3 days. This is unacceptable for a tricyclic.http://www.currentpsychiatry.com/2002_06/06_02_Tricyclics.asp
"Discontinuing tricyclics:
When discontinuing a TCA, taper the dosage no more rapidly than 25 to 50 mg every 2 to 3 days. Abrupt discontinuation can cause cholinergic rebound, with symptoms such as nausea, cramping, headache, vomiting, and sweating. “Rebound hypomania” or “mania” have been reported with abrupt cessation of TCAs,24 especially in patients with bipolar disorder. If the etiology of rebound symptoms is unclear (i.e., medical versus psychiatric), re-administering the discontinued TCA should relieve the symptoms and confirm a diagnosis of discontinuation."
- Scott
Posted by bruin on March 20, 2005, at 9:34:30
In reply to Re: withdrawal from desiparmine-SK » bruin, posted by SLS on March 20, 2005, at 7:11:16
"Tricyclic and SRIs are definitely different beasts. I treat them differently when I need to discontinue them, something I have had the unfortunate experience to do many, many times over the last 25 years. I think it is well justified to taper a tricyclic more rapidly than an SRI. The only exception might be clomipramine. I was on it only once, and I don't recall too well my experience with it. No "brain zaps" though. A rapid taper of a TCA probably makes sense for most people who want to move on to another medication. Your schedule is almost exactly that which is prescribed for discontinuing a benzodiazepine. This is not at all necessary."
No offense, but your experience here means little to nothing simply because everybody's biochemistry and histories are different and because you got off easily doesn't mean the next will. In terms of moving on to another medication, if that is the goal then that changes things. However, if you are going off for good then it is better safe than sorry. You mentioned my "schedule". I don't have one. I thought I was clear on that one. Whether it is quick or long isn't important.
" Using this SCHEDULE, how long would it take the average person to discontinue taking 150mg of desipramine?
>
> How long shall one allow themselves to be "stable" before reducing their dosage any further?
>
> How do you define "stable"?"Stable is when withdrawal symptoms have abated to the point that you feel quasinormal again. Depeding on a person's history I would wait anywhere from a few days to a few weeks. The specific drug also makes a difference.
"http://www.currentpsychiatry.com/2002_06/06_02_Tricyclics.asp"
Siting something that is a pawn to big pharma doesn't really hold water for me. THen again, if you have completely bought into the notion of psychiatry then I don't think we will ever agree on anything.
Here is the thing. If the person is switching to another drug then I'd probably side with you because it is my opinion that they are losing the point and probably the battle, but I'll leave it at that. However, if they are ridding themselves of these neurotoxins for good then setting a "schedule" is foolhardy and a recipe for pain and suffering. I know more than anyone the compulsion to rid one's self of these drugs, but prudence and patience will always pay dividends whether it is a TCA, an SSRI, an MAOI, AP, or whatever. You simply can't assess over the internet someone's history or have an idea about their biochemistry and how it reacts under these situations over the internet. Giving them a schedule is wreckless IMO. Hence, all I do is try to emphasize the importance of going slow and suggest some things that are good for restoring health to the CNS and trying to fix whatever damage these drugs did. Take care
> Hi Bruin.
>
> > You should only cut it 5-10% and wait to become stable before cutting again.
>
> * Using this SCHEDULE, how long would it take the average person to discontinue taking 150mg of desipramine?
>
> How long shall one allow themselves to be "stable" before reducing their dosage any further?
>
> How do you define "stable"?
>
> My suggestion to cut by 50-25mg every three days is aggressive. A very prudent set schedule would be to cut by 25mg every three days. This would take 15 days to accomplish. If it were ME, I would do the following:
>
> 100mg x 3 days
> 50mg x 3 days
> 25mg x 3 days
> 0mg
>
> 9 days.
>
> > While TCAs normally don't cause withdrawals as frequently as SSRIs,
>
> Tricyclic and SRIs are definitely different beasts. I treat them differently when I need to discontinue them, something I have had the unfortunate experience to do many, many times over the last 25 years. I think it is well justified to taper a tricyclic more rapidly than an SRI. The only exception might be clomipramine. I was on it only once, and I don't recall too well my experience with it. No "brain zaps" though. A rapid taper of a TCA probably makes sense for most people who want to move on to another medication. Your schedule is almost exactly that which is prescribed for discontinuing a benzodiazepine. This is not at all necessary.
>
>
> * Your taper schedule for 150mg of desipramine would take between 4 - 8 weeks to accomplish if one were to stay at each dosage for 2 days; 11 - 22 weeks at 3 days. This is unacceptable for a tricyclic.
>
>
>
> http://www.currentpsychiatry.com/2002_06/06_02_Tricyclics.asp
>
> "Discontinuing tricyclics:
>
> When discontinuing a TCA, taper the dosage no more rapidly than 25 to 50 mg every 2 to 3 days. Abrupt discontinuation can cause cholinergic rebound, with symptoms such as nausea, cramping, headache, vomiting, and sweating. “Rebound hypomania” or “mania” have been reported with abrupt cessation of TCAs,24 especially in patients with bipolar disorder. If the etiology of rebound symptoms is unclear (i.e., medical versus psychiatric), re-administering the discontinued TCA should relieve the symptoms and confirm a diagnosis of discontinuation."
>
>
> - Scott
>
Posted by Dr. Bob on March 22, 2005, at 19:48:48
In reply to Re: withdrawal from desiparmine-SK, posted by bruin on March 20, 2005, at 9:34:30
> your experience here means little to nothing
Please don't post anything that could lead others to feel put down. Or change your posting name without following the steps in the FAQ. The last time you were blocked, it was for 9 weeks, so this time it's for 27.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#namesFollow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
This is the end of the thread.
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