Posted by King Vultan on June 2, 2004, at 13:15:16
In reply to Re: tolerance to desipramine impotence and tachycardia » King Vultan, posted by Chairman_MAO on June 2, 2004, at 9:26:07
> Thanks for the thorough response. I am now encouraged to persevere with the desipramine for a month to see what happens. Just out of curiosity, what was the dose of desipramine needed to get you into the therapeutic range, and why did you leave desipramine behind? How effective was it for you?
>
It gets a little complicated because I was actually on both Wellbutrin and desipramine when I had the 207 ng/ml reading and was taking a lower dosage of desipramine than I would have been taking by itself because of Wellbutrin's powerful CYP-450 2D6 inhibition. In this case, I was taking 150 mg/day of Wellbutrin SR and 100 mg/day of desipramine.A few months earlier, I had taken the desipramine by itself at 150 mg/day. We checked the blood plasma level, and it was 89 ng/ml. We figured that adding another 50 mg/day would probably get me into the therapeutic range of 125-300 ng/ml, and while I did go up to 200 mg/day for a few weeks, we did not actually check the blood plasma level at that dosage, as by that time, I had decided to go on to the Vivactil.
As for why I left it behind, I found it very beneficial and constructive, but it was not quite the silver bullet I was looking for. In retrospect, it's probably the 2nd best antidepressant I've taken and reminds me in several ways of the Nardil I'm currently taking.
> Regarding your BP problem on Nardil: I've heard that high-dose Parnate is less likely to have this problem because of its intrinsic sympathomimetic effects. Whether this is mediated by Parnate itself or its metabolites I do not know. Could adding Ritalin or an amphetamine compensate for the BP decrease?
Yes, I have read that Parnate has less of a hypotensive effect, probably due to the stimulant-like effects you allude to. I have seen amphetamine recommended to help mitigate these types of effects with MAOIs, but I have never actually taken a stimulant and would prefer not to go down that road if possible. I am trialing a different alpha blocker that I take for a minor prostate condition because my feeling is that the doxazosin I've been on has been exacerbating the orthostatic hypotension problems. Beyond all this, I would consider trying Parnate if the Nardil winds up proving inadequate, but the Nardil has been so beneficial so far, particularly with my social phobia, that I want to see what more I can accomplish while on it.Todd
poster:King Vultan
thread:352932
URL: http://www.dr-bob.org/babble/20040602/msgs/353055.html