Posted by Brainbeard on October 2, 2010, at 13:06:13
Looking back, I wonder how I got here, but I did: I've arrived at a staggering 187.5-225mg of clomipramine (brand Anafranil actually, for those who care) combined with 50mg fLUVOXamine. It's like climbing a mountain, and it's getting harder to breathe. I experienced some depersonalization that was probably due to (ab)using marijuana - it's a pity that our national pride has become so insanely strong, containing way too much tetrahydracannabinol and way too little cannabidiol - but that's a different thread altogether.
While on a holiday on one of the Dutch wadden-islands, I got back my blood levels after persistent telephonic inquiries: 267 / 184 microgram (?) per milliliter for clomipramine and desmethylclomipramine, respectively. Desmethylcl. is the noradrenergic metabolite. These blood values are theoretically near-perfect: if you look here: http://www.medscape.com/druginfo/monograph?cid=med&drugid=1305&drugname=Clomipramine+Oral&monotype=monograph&secid=9 (second search result, at least at the date of starting this thread), you can see that 'optimal therapeutic response may be obtained in' folks 'with plasma clomipramine concentrations ranging from 100250 ng/mL and plasma desmethylclomipramine concentrations ranging from 230550 ng/mL'.
I had backed down from 225 to 187.5mg because of the depersonalization, but with these near-perfect blood levels I quickly went back to 225mg.
Now I've become ill with the flu, and I'm suffering from pretty bad anxiety. This may be due to having used and discontinued Concerta (methylphenidate) recently. Anxiety hits me hard at work - I work as a call center agent for the Dutch tax telephone. But it also creeps on me as a dread for having to writhe myself through the small and endless tunnels of time.
And then there's the tremor. Shaking hands, shaking legs.. What body part do I have that is not trembling? I feel insecure when walking steps.
And... The weird, raving dreams at night.. I feel exhausted when waking up. I wake up early, and fight to get some extra sleep.. Like back in the days with Paxil..
Because of the flu and the anxiety I have cut back to 187.5mg. I wonder if it is necessary at all to go as high as 225mg, as per my psychiatrist wishes. Or is start-up anxiety a token of approaching relief, as is often the case with the SSRI's?
I do know that if I take Concerta and Ritalin, I leave anxiety far behind. But I also experience hypomanic impulsiveness, egoism and banality.
Would adding Abilify (aripiprazole) be an idea? Plus mirtazapine (Remeron) for better sleep and perhaps less anorgasmia? I so hope that Abilify could turn me into a mean chore-busting machine.
I'm not quite there yet, folks. I had hoped for quicker and dramatic results with clomipramine, but alas.. Maybe someday. Hope I don't die before that day.
And really, I KNOW that Christ Jesus is the ultimate medicine (for those who wondered).
Current meds: clomipramine 225mg, fluvoxamine (Luvox) 50mg, amitriptyline 10mg, bethanechol 25-50mg.
PRN: oxazepam 5-10mg
poster:Brainbeard
thread:964485
URL: http://www.dr-bob.org/babble/20100926/msgs/964485.html