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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by DStupid on November 30, 2007, at 21:53:04
I have low tolerance for psychiatric meds insofar as my heart is concerned, and I tried -- but couldn't tolerate for more than a month -- Dexedrine (a stimulant), Ritalin (same), Pamelor (a TCA), Norpramin (a TCA), Wellbutrin (a combo). I was able to tolerate Lexapro but it pooped out after a year. I'm currently taking Klonopin (.5 mg) and Xanax (.5 mg) for general well being, and I take Toprol XL, a beta blocker (25 mg), for concentration. My dad, a retired scientist, told me today that I needed to get off the benzos (which I did in the past without a problem) and to start taking serious stuff, "to change my personality." My principal problem is a defective executive functioning -- spotting problems and resolving them -- in all spheres of my life which require solving problems on a daily basis. I never grasp the big picture.
When I was taking Dexedrine, however, I was bright and quick; when on Ritalin, methodical; when on Pamelor, I actually saw the big picture, and when on Norpramine, I was a good writer and organizer. I couldn't tolerate any of them due to rapid pulse, angina, palpitations, reduced ejection rate. I took them separately, and couldn't tolerate them even at the lowest dosage. When I was on Lexapro, I was relatively happy, but I still didn't see the big picture and could not solve ordinary problems.
Sorry for a long post. If there are any heart-conscious/suffering people out there on psych meds, do post your experience, please.
Separate question: do the rules here allow posting of links to uploaded medical e-books? Through extensive searches of medical student web sites, I've assembled a bunch of good books.
Posted by linkadge on November 30, 2007, at 22:59:31
In reply to Heart Trouble Patient Looking for AD or Similar, posted by DStupid on November 30, 2007, at 21:53:04
You may want to stay away from noradrenergic medications. You may ask your doctor to look at augmentation with a dopamine agonist (?).
You could try a low dose of lexapro, if it provided any benifit, and perhaps augment with some mirapex?
You might gain the some of the desired dopaminergically mediated mood effects of drugs like ritalin, without the cardiovascular conessequences of noradrenergic stimulation.
I don't think that dopamine agonists (in general) have serious adverse cardiac effects.
Linkadge
Posted by DStupid on November 30, 2007, at 23:08:55
In reply to Re: Heart Trouble Patient Looking for AD or Similar, posted by linkadge on November 30, 2007, at 22:59:31
Thank you. Excluding noradrenergic medications would take me out of all TCAs and all MAOIs. Right?
I tried Ritalin and even at low dose of 10 mg. daily, I felt terribly after about two weeks: heart racing, heaviness in the chest. Yesterday, I had a test at my job and I took one Ritalin. It helped me a lot, but by the end of the day, I felt bad. Not super bad, but bad enough that I don't want to take it again, except in special cases when I have to do the best I can to stay in my job.
Posted by clipper40 on December 1, 2007, at 0:44:53
In reply to Heart Trouble Patient Looking for AD or Similar, posted by DStupid on November 30, 2007, at 21:53:04
What about taking noradrenergic medications with a beta blocker (especially a more cardio-specific one like atenolol)? Has your doctor ever suggested this? I have to take atenolol with noradrenergics as I just can't tolerate the effects on my heart without it.
Posted by yxibow on December 1, 2007, at 3:14:04
In reply to Re: Heart Trouble Patient Looking for AD or Simila » DStupid, posted by clipper40 on December 1, 2007, at 0:44:53
> What about taking noradrenergic medications with a beta blocker (especially a more cardio-specific one like atenolol)? Has your doctor ever suggested this? I have to take atenolol with noradrenergics as I just can't tolerate the effects on my heart without it.
>
>
Metoprolol would probably be even better and clonidine or guanfacine as a PRN backup medication just in case.Its interesting you bring up the subject because my doctor has an interest in transplant psychiatry -- there are a lot of depression issues, waiting lists, the trauma of the whole procedure, and mixing medications with transplant drugs.
Posted by clipper40 on December 1, 2007, at 6:17:27
In reply to Re: Heart Trouble Patient Looking for AD or Simila » clipper40, posted by yxibow on December 1, 2007, at 3:14:04
I don't know anything about metropolol. Why is that one better?
Posted by DStupid on December 1, 2007, at 9:52:53
In reply to Re: Heart Trouble Patient Looking for AD or Simila » yxibow, posted by clipper40 on December 1, 2007, at 6:17:27
<< I don't know anything about metropolol. Why is that one better>>
I'm already taking Toprol XL, which is metropolol. It's considered to be better because it's a selective beta blocker, meaning it slows down your pulse without lowering your blood pressure significantly at the same time, as opposed to Coreg (carvedilol) which combines both an alpha blocker and a beta blocker, and lowers both your pulse and the blood pressure.
Posted by Racer on December 1, 2007, at 11:03:16
In reply to Re: Heart Trouble Patient Looking for AD or Simila » linkadge, posted by DStupid on November 30, 2007, at 23:08:55
Yes, avoiding noradrenergic medications pretty well wipes out two classes of antidepressant for you -- the TCAs and the MAOIs. It also pretty well scotches Wellbutrin, and a few other, newer antidepressants.
I'm not an expert in the cardiovascular effects of these drugs, but two things leapt out at me from your first post:
1. If you had success on Lexapro, but it pooped out, have you considered trying another SSRI? I'm thinking Zoloft, since it tends to be a little more activating, which might help with some of your motivational issues. I'm also thinking Zoloft because it had the fewest side effects for me when I took it.
2. Your father's comments struck me as unkind. Even if you think they're deserved, they still seemed unkind. Have you considered getting into therapy? It can be very helpful, including helpful in learning ways to compensate for natural tendencies -- in your case, missing the bigger picture. It may be that addressing the depression through medication and addressing the tighter focus through therapy would give you the best results.
I hope that helps.
Posted by DStupid on December 1, 2007, at 12:44:44
In reply to Re: Heart Trouble Patient Looking for AD or Simila, posted by Racer on December 1, 2007, at 11:03:16
Thank you, Racer. I'm motivated and active, it's just that in whatever I'm doing I'm not achieving anything. One supervisor once told me that the best thing I could do was to do nothing.
Now that I'm in my early 40s, I'm no longer angry at my dad's comments about myself; in fact, I accept them on faith because everyone who knows him is telling me that he is incredibly perceptive and I should listen to him. He's disappointed that, in spite of the tremendous efforts and personal sacrifices he made to put me through a graduate school and get me employed at a great company for over ten years, I've learned little, am deficient in basic social and living skills, and am generally functioning at a level below that of an average person. He weeps often and is on Xanax/Klonopin/Lexapro because of me. His cardiologist and neurologist both diagnosed him as being over stressed. And I'm the cause of that stress.
Long-term therapy would help me, but I don't have mental-health coverage to pay for it.
If I don't find something stronger than Zoloft, I'd try it, thank you for suggesting it, yet I need something stronger acting to show my dad and myself that I'm improving. It's very hard for me to see my dad cry because of me.
Posted by Racer on December 1, 2007, at 13:23:22
In reply to Re: Heart Trouble Patient Looking for AD or Simila » Racer, posted by DStupid on December 1, 2007, at 12:44:44
>
> Long-term therapy would help me, but I don't have mental-health coverage to pay for it.It's certainly an investment, and it's hard to come up with the money, but there are options for lower cost therapy out there. And if the medications alone are not fixing what ails you, it might be worth it to invest in yourself by getting into therapy despite the cost.
Of course, it's easy to say that, and a lot harder to do it. Believe me -- I was uninsured for a decade, I *know* how hard it is to hear people say, "Just pay out of pocket, it's worth it..." Sure -- it's worth it, but if it's a question between rent/mortgage, electricity, food, telephone, or therapy -- and it often is -- therapy is the one that drops off the list in a hurry. On the other hand, most urban areas will have some lower cost alternatives for therapy, and it's worth looking into them. Many agencies have interns who can be helpful. They won't have the experience of a therapist who's been in practice for a long time, but they still have skills that can be helpful, and they're supervised by someone who does have experience. Many therapists out there will adjust their fees for some clients without coverage. Other therapists will allow you to pay over time, which is the least helpful, but still better than nothing. There are options out there, for many people who don't have coverage.
Also, in some cases insurance companies will pay for things declared "medically necessary," although that would require your doctor to work with you on appealing the exclusion.
>
> If I don't find something stronger than Zoloft, I'd try it, thank you for suggesting it, yet I need something stronger acting to show my dad and myself that I'm improving. It's very hard for me to see my dad cry because of me.Two things jumped out at me from this paragraph: the idea that SSRIs are somehow "weaker" than alternatives, and your belief that your father cries and takes medication because of you. I'll take the last one first, because I won't say much about it: You are not responsible for your father's emotions. I mean that in both senses: your father's emotions are not caused by you, and it's not your job to fix them. I obviously don't know the history here, but I do know that whatever the history, he is a grown man with responsibility for his own feelings. Just as you are a grown man with responsibility for your own emotions. I would much prefer to see you say that you want to improve your functioning for your own sake, rather than saying you want to satisfy your father's needs. Trust me -- I get into that with my mother, and it doesn't go anywhere good. Our parents are who they are, and nothing we do is going to change them. The only thing we can do is work towards coming to peace with our relationships with them.
As for the part about the medications, it's misleading to say that some are "stronger" than others. Some have more selective actions, some have broader actions, but all anti-depressants are about equally effective. (This board tends to attract those who have not had an easy time of it with medications, which often gives a skewed picture.) The only question is which one works best FOR YOU. If Zoloft is effective for you, it's as strong as any other drug. Because of the cardiac effects you've experienced in the past, you're probably locked out of both TCAs and MAOIs, as well as Wellbutrin -- that leaves SSRIs and a few other, newer drugs for you to try. Since the SSRIs are the safest and have the fewest side effects, they're a good place to start. Even though all the SSRIs work by inhibiting serotonin reuptake, they are all somewhat different. Whether any given SSRI will be effective for you is a matter of trial and error, but since you said Lexapro was helpful for a year, it's likely another SSRI would also be helpful for you -- it's a question of which one. Paxil might have cardiac effects for you, Celexa is very similar to Lexapro and might be a very good choice, Prozac can trigger agitation, and Luvox is the least selective for serotonin, as well as the most sedating. That leaves Zoloft, although I'm biased on that score: Zoloft was the most tolerable of the SSRIs for me, fewest side effects, least emotional blunting, etc. Then again, I couldn't handle Lexapro -- at 10mg, I just stopped talking. I sat in the corner, and just stared at the wall, crying now and again, but otherwise pretty much immobilized.
Good luck, whatever you choose to do.
Posted by stargazer2 on December 2, 2007, at 13:54:44
In reply to Heart Trouble Patient Looking for AD or Similar, posted by DStupid on November 30, 2007, at 21:53:04
Dstupid, as far as the meds go, Racer is right on. You can't say one is stronger than another. Sometimes the strongest ones turn out to be the least effective. I had very good effects from Celexa with vertually no side effects. Supposedly it works alot like Lexapro.
Also, your father's issues only tell me he probably has depression and may have always had this, so I wouldn't feel that I am the cause of it. He sounds less supportive of you than someone who is mentally balanced would. He might be disappointed in you but if he were not depressed, he would not take your failures so personally and could be more supportive of your issues.
He does not sound like he can be in a support role, so I agree that therapy would be a good step to helping deal with your issues. My mother always tried to give me advice but it was always the wrong advice for me. She made me feel like the depression was caused by something I did and this wasn't helpful for me to hear, especially from someone who I knew had a history of emotional instability heself.
Do you live with your father? Is your mother alive? Sometimes as much as they want to help. they may not be capable of doing this very well.
As far as the medical ebooks go, you can post this question to Dr Bob at the admin site rather than here at the site for all drug questions. The site is divided up by topic and those sites are at the bottom of this page.
Stargazer
This is the end of the thread.
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