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Dr. Bob is Robert Hsiung, MD,
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Posted by Lonely on August 12, 2004, at 18:21:17
I'm wondering what experiences other board readers have had with antidepressant and ADHD medications in regard to blood pressure.
My husband is on 150 mgs a day of Effexor - Effexor seems to work best at managing his severe depression. We're looking at lowering it to 110 mgs a day w/approval of doc. He also started on Provigil (usually given for narcolepsy which he does NOT have) 5 days ago to help w/ADHD symtoms. He feels it is helping him slightly w/organizing himself at work. Also, possibly slightly supressing his appetite WHICH HE NEEDS!
The problem:
(1) He's had, for many years, very high blood pressure and has several TIAs and there is brain damage. I read that SSRIs and ADHD drugs do raise blood pressure.
(2) He's quite overweight - probably 70 pounds which we know contribute to high BP. However, I think in part because of mental problems he can't/doesn't lose weight. It's hard for him to exercise in a hot climate and 14 hours a day commuting & working & financial issues.
(3) The meds for blood pressure have serious side effects as follows (and we've tried many different types within these classifications:)
Beta Blockers: Severe depression, exhaustion, not much help in lowering BP, difficulty breathing
ACE Inhibitors: Severe choking - apparently the wind pipe doesn't quite close off properly when he swallows. Also depression and kidney disease
Diuretics (including pottassium sparring) Seriously low pottasium levels despite replacement med, large kidney stones, high creatinine levels, cystic kidneys
Calcium Channel Blockers - don't seem to lower BP and his father died very suddenly from these drugs.
I got into a slightly heated discussion with his neurologist this morning when the neurologist refused to give him an Rx for ADHD med (of any kind) due to BP. He NEEDS a med that helps with that problem to help even out his agitation and curb his appetite. Without it he's in a downward spiral and complications continue. Part of the problem right now has become iatrogenic.
What's bothoring me in particular is that the doctor(s) don't seem to see the cause-and-effect process of continuing the BP meds that cause tremendous weight gain and depression followed by more med for depression followed by less activity and higher BP. Anyone else have a similar expereince or other insights?
Posted by Racer on August 12, 2004, at 23:14:40
In reply to Blood Pressure Raising Side Effects of Psych Meds, posted by Lonely on August 12, 2004, at 18:21:17
> The problem:
>
> (1) He's had, for many years, very high blood pressure and has several TIAs and there is brain damage. I read that SSRIs and ADHD drugs do raise blood pressure.
>
There are a lot of anti-depressants which tend to lower BP, such as most of the tricyclics. (MAOIs can lower BP, too, but are associated with hypertensive crisis if strict dietary guidelines aren't adhered to.)
> (2) He's quite overweight - probably 70 pounds which we know contribute to high BP. However, I think in part because of mental problems he can't/doesn't lose weight. It's hard for him to exercise in a hot climate and 14 hours a day commuting & working & financial issues.
>
Give your husband a break on these two issues. First of all, if he's on Effexor, it's playing with his thermoregulatory system. It's hard enough to exercise in a hot climate, but add the existing weight problems, the existing BP trouble, and the effects of the Effexor -- he may even be better off not getting all that ambitious.As for the weight issue itself, *many* antidepressant drugs can cause weight gain. When I was taking a combo of Effexor and Prozac, I put on nearly 60 pounds. When I stopped the meds, though, the first 30 or so came off without me making any changes at all in diet or exercise. (My job was physically demanding, and it was quite demoralizing to be that heavy while I was already getting much more than the recommended amount of exercise just going to work. I had stopped getting on scales at all, because it was too upsetting, until one day I climbed on for some reason and saw that I weighed about 30 pounds less than I had expected. Mind you, I am estimating my highest weight, because I didn't have it in me to get onto a scale while the weight was still going up.)
And just because the doctor says that a medication is "not associated with weight gain" doesn't mean that that's true. The SSRIs, for example, are associated with weight gain in a significant percentage of the people who take them. The earlier studies, though, didn't catch that because it's a later-onset side effect that didn't become apparent in the short term studies that all the doctors read. With the exception of Remeron, which causes more initial weight gain, virtually all the newer drugs that cause weight gain don't show this effect until at least six month after starting.
>
> I got into a slightly heated discussion with his neurologist this morning when the neurologist refused to give him an Rx for ADHD med (of any kind) due to BP. He NEEDS a med that helps with that problem to help even out his agitation and curb his appetite. Without it he's in a downward spiral and complications continue. Part of the problem right now has become iatrogenic.
>
This might not be a good idea -- I know much too little about blood pressure, and mine is a bit too low -- but you might want to ask about Strattera. It's marketed as an ADHD med, but it was first developed as an antidepressant. I was on it for depression for a while, and it seemed to help me. It might be worth asking his doctor about it.Has your husband been diagnosed ADHD by a doctor? How recently has that diagnosis been verified? There's something in the back of my mind, but I don't want to offer it without those two questions answered.
> What's bothoring me in particular is that the doctor(s) don't seem to see the cause-and-effect process of continuing the BP meds that cause tremendous weight gain and depression followed by more med for depression followed by less activity and higher BP. Anyone else have a similar expereince or other insights?
>Again, I didn't know that BP meds caused weight gain -- would seem counter intuitive to me, since hypertension can be linked so closely to obesity. Then again, they got what they got.
(And they may not really know about the weight gain. A few months ago, a mental health professional told me that "anti-depressants don't cause weight gain. it's like with birth control pills -- when you take them, you just don't exercise enough and you eat more." Hello? Didn't that whole birth control pill thing get cleared up in the eighties? And hasn't this chick read as many of the recent professional discussions on the A/D topic as I have with my limited public access? The drug companies don't want the bad press of "the fat pill" and the studies are short term -- it takes years for the doctors to figure out the long term effects of any drug, because they have to have access to some people who have taken it long term. And then, too, some doctors still see obesity as a character flaw.)
Yes, lots of similar experiences on these boards. This is actually a question that would likely get a lot of good info on the main babble board if you post it there. There are some meds being tried along side a/ds that cause weight gain, but I can't remember the names -- maybe topamax was one of them? And there are a few a/d that are more weight neutral for a lot of people.
Best luck.
Posted by Dr. Bob on August 17, 2004, at 4:34:15
In reply to Blood Pressure Raising Side Effects of Psych Meds, posted by Lonely on August 12, 2004, at 18:21:17
[testing]
Posted by Clancy on August 17, 2004, at 14:33:00
In reply to Blood Pressure Raising Side Effects of Psych Meds, posted by Lonely on August 12, 2004, at 18:21:17
Couple of suggestions if I may. First and foremost. Acupunture is an effective treatment for high BP. Mass General( the great white mecca)in Boston recently did a study which by now should have hit the peer review journals. They showed that the protocol they used ( but would not share prior to publication) controlled high BP for 6 mos to a year WITHOUT ANY DRUGS. My acupunturist who I was seeing for two bone on bone knees just added a few extra spots that he knew about and walla - I went from highs of 180/110 back to more normal ranges (120/80) with highs held to 140/90 . Then the second piece I changed(and yes you need to check with your docs and others about this but be careful cause most docs know NOTHING re healthy alternatives) as odd as this sounds was adding BOTH calcium and magnesium supplements ( nothing high I always start with lowest possible dosage). While both are necessary (We are just now finding how important calcium is to everything our body does) the magnesium is the more important if you can only talk your doc into one. Beware of the Calcium blockers - long term they do as much or more damage to the heart as the thing they're supossedly treating. Dr.Whitaker(Whitaker Wellness center) is a good resource to read on some of this. He has all the right alleopathic (Western Medicine) credentials but realizes we need to pay attention to the whole system. My BP now is 116/65. We also used this combo to treat my Mom who had been on all the different BP medicines over the years and had suffered horrendous side effects one at a time from them. She just died recently (at 87) and for the last 2-3 years her BP was normal just using the calcium and magnesium supplements and the supps mentioned below.
You may also want to talk to your doctor about a couple other simple ideas. Re the depression Selium(never more than 200mcg!) and sun believe it not can make a big difference -BUT how these fit with the drugs your husband is on I don't know. Be careful ( tho if not working for him and he comes off of them at some point - this might be worth a try.)
Finally three other possiblities (both recomended to me by MD's many years ago and double checked with lots of research). The first falls into what I call the no harm no foul category. It is Rutin which is a bioflavanoid. At one time 60+ years ago it was a FDA approved drug but they turned it into an over the counter supplement 50+ years ago. Bioflavanoids since then have been shown to be strong antioxidants. What Rutin specifically does is strenghtens the wall of the blood vessels. When I was a kid I used to get hemorraghes in my eye and our family doc is the one that told me get Rutin. Took it for a year - never had problem again. We also used it over the last couple years for my mom who had a problem with Stasis ulcers in her legs. Once on Rutin and Arginine (next one I'll tell you about) we went three years w/o a stasis ulcer until last year when she was in rehab hospital for 2 months and they wouldn't give her the supplements. Ok - arginine - this one you really do have to check with your doc. Never more than 1000 mg a day AND ALWAYS should be starting much lower. Arginine is an amino acid ( building block of body). It strenghtens the cardiovascular system. It also affects the stickiness of your blood corpusels (sp) so reduces clotting (different mechanism from aspirin or warfin tho) The last useful substance is also an amino acid - carnitine. Again it strengthens the cardiovascular system. It is very good for diabetics cause it will help their liver process proteins and fats which are actually more of problem for them than sugar ( Dad & sister were severe diabetics). BUT PLEASE NOTE - carnitine can affect insulin levels AND affect the amount of insulin you take if you are a diabetic. PLEASE 1. check with your Doc and 2. check out the research to see if it would help or be appropriate for your situation. It is a very powerful amino acid even tho sold OTC - and medically had been used to treat quite a number of serious metabolic disorders.
Hope some of this helps. If nothing else -please try the acupunturist - it is not voodoo medicine there are a number of very rigourous scientific studies done over the last thirty years that shows it works. Good luck. I know how tough it is to always be putting out fires.
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