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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by ChicagoKat on October 10, 2012, at 19:47:37
About recovery not being a straight line up and getting periodic worsenings. I'm back in the depths. Was it just another blip? Will it get better again, do you think?
KatHere comes the rain again
Falling from the stars
Drenched in my pain again
Becoming who we are
As my memory rests
But never forgets what I've lost
Wake me up when September ends-Green Day
Posted by phillipa on October 10, 2012, at 23:23:06
In reply to How right you were Scott, posted by ChicagoKat on October 10, 2012, at 19:47:37
Kat up & down how frustrating. It will be up from here. Phillipa
Posted by SLS on October 11, 2012, at 5:50:32
In reply to How right you were Scott, posted by ChicagoKat on October 10, 2012, at 19:47:37
> About recovery not being a straight line up and getting periodic worsenings. I'm back in the depths. Was it just another blip? Will it get better again, do you think?
I wouldn't call your most recent improvement a blip. You will probabably improve again, though. Please take note that you are probably not taking a therapeutic dose of amitriptyline yet (125 - 200 mg/day). Things might not "stick" until you do. I question the belief that you can get away with subtherapeutic doses of two drugs when they are combined. This has not been my experience with MAOI + TCA and SRI + TCA combinations.
It is hard to see any light when you are in the midst of darkness.
All in all, I think you should remain optimistic.
- Scott
Posted by ChicagoKat on October 11, 2012, at 12:17:15
In reply to Re: How right you were Scott » ChicagoKat, posted by phillipa on October 10, 2012, at 23:23:06
> Kat up & down how frustrating. It will be up from here. Phillipa
Thanks Phillipa, you are always so kind and understanding, you are such an asset to this forum.
I'm happy to say that I'm feeling a bit better today :) How are you doing these days?
Kat
Posted by ChicagoKat on October 11, 2012, at 12:22:55
In reply to Re: How right you were Scott » ChicagoKat, posted by SLS on October 11, 2012, at 5:50:32
> > About recovery not being a straight line up and getting periodic worsenings. I'm back in the depths. Was it just another blip? Will it get better again, do you think?
>
> I wouldn't call your most recent improvement a blip. You will probabably improve again, though. Please take note that you are probably not taking a therapeutic dose of amitriptyline yet (125 - 200 mg/day). Things might not "stick" until you do. I question the belief that you can get away with subtherapeutic doses of two drugs when they are combined. This has not been my experience with MAOI + TCA and SRI + TCA combinations.
>
> It is hard to see any light when you are in the midst of darkness.
>
> All in all, I think you should remain optimistic.
>
>
> - ScottAs always Scott, I believe you are right. I'm at my target dose of Nardil now, 45mg/day, and thankfully no ataxia. But I'm afraid to go up anymore on my Elavil b/c of my BP problems. I'm not seeing PCP or pdoc til next tuesday.
I'm really thinking adding a stim might help me more than a TCA. I've just never had any luck with any of the TCAs, and I've tried them all. What are your thoughts, Scott?
And thanks for the encouragement. I'm happy to say that I'm feeling better today. :)
Has the Prazosin started to really kick in yet? Are you feeling any better?
Kat
Posted by SLS on October 12, 2012, at 8:46:02
In reply to Re: How right you were Scott » SLS, posted by ChicagoKat on October 11, 2012, at 12:22:55
> > > About recovery not being a straight line up and getting periodic worsenings. I'm back in the depths. Was it just another blip? Will it get better again, do you think?
> >
> > I wouldn't call your most recent improvement a blip. You will probabably improve again, though. Please take note that you are probably not taking a therapeutic dose of amitriptyline yet (125 - 200 mg/day). Things might not "stick" until you do. I question the belief that you can get away with subtherapeutic doses of two drugs when they are combined. This has not been my experience with MAOI + TCA and SRI + TCA combinations.
> >
> > It is hard to see any light when you are in the midst of darkness.
> >
> > All in all, I think you should remain optimistic.
> >
> >
> > - Scott
>
> As always Scott, I believe you are right. I'm at my target dose of Nardil now, 45mg/day, and thankfully no ataxia. But I'm afraid to go up anymore on my Elavil b/c of my BP problems. I'm not seeing PCP or pdoc til next tuesday.
>
> I'm really thinking adding a stim might help me more than a TCA. I've just never had any luck with any of the TCAs, and I've tried them all. What are your thoughts, Scott?
There are no guarantees. You are already in the middle of a trial of amitriptyline and are approaching a therapeutic dosage with it. It might make sense to continue with it. It is unusual that your BP should rise. Your idea of adding a stimulant is a good one, but I don't know your history of reactions to them.It is unusual for one's blood pressure to rise from taking amitriptyline, although it is listed as a possible side effect. However, the frequency at which this happens might be higher when it is combined with Nardil. I don't know. Can you describe in more detail your history of blood pressure problems and how different drugs have affected it? My only concern is serotonin syndrome, which, in my mind, is a possibility with this combination. Of course, you realize that methyphenidate might produce an increase in BP as well, although through a noradrenergic mechanism.
> And thanks for the encouragement. I'm happy to say that I'm feeling better today. :)
This is indeed encouraging.
> Has the Prazosin started to really kick in yet? Are you feeling any better?
Yes, it started kicking-in yesterday, and is even better today (so far). Finessing the dosage has been problematic in the past, probably because prasosin has such a short half-life. I was a little over my therapeutic window at 8 mg/day. I am hoping that 6 mg/day will be optimal and consistent. This dosage is lower than I would have anticipated. I will be taking it 2 mg t.i.d. Perhaps I need less now that I am also taking minocycline.
Thanks for caring.
:-)
- Scott
Posted by ChicagoKat on October 12, 2012, at 13:26:55
In reply to Re: How right you were Scott » ChicagoKat, posted by SLS on October 12, 2012, at 8:46:02
> > > > About recovery not being a straight line up and getting periodic worsenings. I'm back in the depths. Was it just another blip? Will it get better again, do you think?
> > >
> > > I wouldn't call your most recent improvement a blip. You will probabably improve again, though. Please take note that you are probably not taking a therapeutic dose of amitriptyline yet (125 - 200 mg/day). Things might not "stick" until you do. I question the belief that you can get away with subtherapeutic doses of two drugs when they are combined. This has not been my experience with MAOI + TCA and SRI + TCA combinations.
> > >
> > > It is hard to see any light when you are in the midst of darkness.
> > >
> > > All in all, I think you should remain optimistic.
> > >
> > >
> > > - Scott
> >
> > As always Scott, I believe you are right. I'm at my target dose of Nardil now, 45mg/day, and thankfully no ataxia. But I'm afraid to go up anymore on my Elavil b/c of my BP problems. I'm not seeing PCP or pdoc til next tuesday.
> >
> > I'm really thinking adding a stim might help me more than a TCA. I've just never had any luck with any of the TCAs, and I've tried them all. What are your thoughts, Scott?
>
>
> There are no guarantees. You are already in the middle of a trial of amitriptyline and are approaching a therapeutic dosage with it. It might make sense to continue with it. It is unusual that your BP should rise. Your idea of adding a stimulant is a good one, but I don't know your history of reactions to them.
>
> It is unusual for one's blood pressure to rise from taking amitriptyline, although it is listed as a possible side effect. However, the frequency at which this happens might be higher when it is combined with Nardil. I don't know. Can you describe in more detail your history of blood pressure problems and how different drugs have affected it? My only concern is serotonin syndrome, which, in my mind, is a possibility with this combination. Of course, you realize that methyphenidate might produce an increase in BP as well, although through a noradrenergic mechanism.
>
> > And thanks for the encouragement. I'm happy to say that I'm feeling better today. :)
>
> This is indeed encouraging.
>
> > Has the Prazosin started to really kick in yet? Are you feeling any better?
>
> Yes, it started kicking-in yesterday, and is even better today (so far). Finessing the dosage has been problematic in the past, probably because prasosin has such a short half-life. I was a little over my therapeutic window at 8 mg/day. I am hoping that 6 mg/day will be optimal and consistent. This dosage is lower than I would have anticipated. I will be taking it 2 mg t.i.d. Perhaps I need less now that I am also taking minocycline.
>
> Thanks for caring.
>
> :-)
>
>
> - ScottScott, my history with HTN is a complex one. It can be very labile, and I can have very strange reactions to meds also. For instance, when I was first put on Vyvanse, rather than a feared-for worsening of my BP, I actually got HYPOtension!! So low that some days I had to stay in bed. We finally figured out that I was having a very weird interaction of the Vyvanse with Trazodone which I was taking at the time for sleep. As soon as I stopped the Trazodone, my BP went back to normal.
My BP has gotten better over the past few days; maybe Nardil's intrinsic hypotensive effects are starting to kick in. But I'm not gonna increase my Elavil til I talk with both my PCP and my pdoc on Tuesday.
Out of curiosity, what do you think of a combo of my low-dose Nardil, with low-dose Elavil (merely to help me sleep), with low-dose Ritalin added in? Ritalin REALLY helps me, much more than any other stim, I've found. Problem was it gave me anxiety. But the Nardil has the anxiety well-controlled, so I thought maybe I could add low-dose Ritalin. I must admit, I did go ahead and try it several days ago at just 10mg, and I felt great. BP did increase just a little bit (to about 150/90), but certainly not to the point where it could not be controlled with antihypertensives. Would appreciate your thoughts on this combo.
I'm so glad to hear you are doing better! May it continue for a long time!! :)
Kat
Posted by alchemy on October 12, 2012, at 16:30:44
In reply to Re: How right you were Scott » SLS, posted by ChicagoKat on October 12, 2012, at 13:26:55
Hi Kat :) I'm going to start the Parnate journey sometime this week. Thanks for all of your encouragement.
Scott - I am confused about the blood pressure things I read about MOAIs. I am going to start Parnate (lied to my dr. about being off Wellbutrin 2 weeks, I am still tapering but only at 50mg)
Thanks
If they cause low blood pressure, why are we suppose to avoid foods because they will cause high blood pressure? If parnate is stimulating, how can there be a stimulating effect along with low blood pressure?
My blood pressure is always on the low side. Does that make parnate and/or the "scary" foods more or less of a risk?
Posted by SLS on October 12, 2012, at 23:16:35
In reply to Re: How right you were Scott, posted by alchemy on October 12, 2012, at 16:30:44
> Hi Kat :) I'm going to start the Parnate journey sometime this week. Thanks for all of your encouragement.
>
> Scott - I am confused about the blood pressure things I read about MOAIs. I am going to start Parnate (lied to my dr. about being off Wellbutrin 2 weeks, I am still tapering but only at 50mg)I once added Wellbutrin to ongoing Parnate treatment. The combination is generally safe, although I cannot personally vouch for adding Parnate to an ongoing Wellbutrin treatment.
> If they cause low blood pressure, why are we suppose to avoid foods because they will cause high blood pressure?
The two effects operate via different mechanisms. Actually, scientists do not completely understand how MAOIs produce hypotension.
http://www.dr-bob.org/babble/20040423/msgs/339682.html
The tyramine pressor effect (hypertension) is more easily understood. Tyramine is not a neurotransmitter, nor does it bind to neurotransmitter receptors. When excess amounts of dietary tyramine enters the nerve cell, it displaces norepinephrine (NE) from synaptic vesicles and releases this NE into the synapse, thereby stimulating post-synaptic receptors and causing a rise in blood pressure. In effect, tyramine is kicking NE out of the cell. This released NE then stimulates receptors along blood vessels to produce vasoconstriction.
It seems that the acute tyramine pressor effect (cheese reaction) is stronger than the hypotensive effects of the MAOI.
> If parnate is stimulating, how can there be a stimulating effect along with low blood pressure?
Unfortunately, there are instances wherein Parnate alone causes hypertensive reactions and limits its usage.
> My blood pressure is always on the low side. Does that make parnate and/or the "scary" foods more or less of a risk?
I don't know. My guess is that it really doesn't matter too much.
The information I use may not be the most current. Perhaps someone can update us.
- Scott
Posted by ChicagoKat on October 13, 2012, at 15:21:53
In reply to Re: How right you were Scott » alchemy, posted by SLS on October 12, 2012, at 23:16:35
> > Hi Kat :) I'm going to start the Parnate journey sometime this week. Thanks for all of your encouragement.
> >
> > Scott - I am confused about the blood pressure things I read about MOAIs. I am going to start Parnate (lied to my dr. about being off Wellbutrin 2 weeks, I am still tapering but only at 50mg)
>
> I once added Wellbutrin to ongoing Parnate treatment. The combination is generally safe, although I cannot personally vouch for adding Parnate to an ongoing Wellbutrin treatment.
>
> > If they cause low blood pressure, why are we suppose to avoid foods because they will cause high blood pressure?
>
> The two effects operate via different mechanisms. Actually, scientists do not completely understand how MAOIs produce hypotension.
>
> http://www.dr-bob.org/babble/20040423/msgs/339682.html
>
> The tyramine pressor effect (hypertension) is more easily understood. Tyramine is not a neurotransmitter, nor does it bind to neurotransmitter receptors. When excess amounts of dietary tyramine enters the nerve cell, it displaces norepinephrine (NE) from synaptic vesicles and releases this NE into the synapse, thereby stimulating post-synaptic receptors and causing a rise in blood pressure. In effect, tyramine is kicking NE out of the cell. This released NE then stimulates receptors along blood vessels to produce vasoconstriction.
>
> It seems that the acute tyramine pressor effect (cheese reaction) is stronger than the hypotensive effects of the MAOI.
>
> > If parnate is stimulating, how can there be a stimulating effect along with low blood pressure?
>
> Unfortunately, there are instances wherein Parnate alone causes hypertensive reactions and limits its usage.
>
> > My blood pressure is always on the low side. Does that make parnate and/or the "scary" foods more or less of a risk?
>
> I don't know. My guess is that it really doesn't matter too much.
>
> The information I use may not be the most current. Perhaps someone can update us.
>
>
> - Scott
>
>
Nope, Scott, IMO you nailed it.And Alchemy, good luck with the Parnate. I truly hope it really helps you :)
Kat
This is the end of the thread.
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