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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by smittay17 on November 17, 2003, at 8:45:59
Ive been on imipramine since 1996 (200mg). My psychiatrist wants me to get on celexa and desipramine to avoid TCA side effects. Since desipramine is a TCA and celexa is an SSRI.
He thinks Imipramine is 3/4 serotonin and 1/4 Norepinephrine.
Can someone please help me out? I'm in the process of changing right now from imipramine to celexa and desipramine...and could really, really use some help
I'm afraid this ratio thing isn't correct cause i'm not feeling too well right now :(
Please if anyone knows can you post?
Thanks,
Erik
Posted by Larry Hoover on November 17, 2003, at 9:43:55
In reply to HELP ME: Whats the ratio of Sero/NE in Imipramine?, posted by smittay17 on November 17, 2003, at 8:45:59
> Ive been on imipramine since 1996 (200mg). My psychiatrist wants me to get on celexa and desipramine to avoid TCA side effects. Since desipramine is a TCA and celexa is an SSRI.
>
> He thinks Imipramine is 3/4 serotonin and 1/4 Norepinephrine.Close enough.
> Can someone please help me out? I'm in the process of changing right now from imipramine to celexa and desipramine...and could really, really use some help
>
> I'm afraid this ratio thing isn't correct cause i'm not feeling too well right now :(
>
> Please if anyone knows can you post?
>
> Thanks,
> ErikHow geeky an answer are you looking for?
http://www.preskorn.com/columns/0003.html
http://jpet.aspetjournals.org/cgi/content/full/283/3/1305
Your new drug combo is much less noradrenergic, in my opinion.
Lar
Posted by smittay17 on November 17, 2003, at 15:05:21
In reply to Re: HELP ME: Whats the ratio of Sero/NE in Imipramine? » smittay17, posted by Larry Hoover on November 17, 2003, at 9:43:55
> > Ive been on imipramine since 1996 (200mg). My psychiatrist wants me to get on celexa and desipramine to avoid TCA side effects. Since desipramine is a TCA and celexa is an SSRI.
> >
> > He thinks Imipramine is 3/4 serotonin and 1/4 Norepinephrine.
>
> Close enough.
>
> > Can someone please help me out? I'm in the process of changing right now from imipramine to celexa and desipramine...and could really, really use some help
> >
> > I'm afraid this ratio thing isn't correct cause i'm not feeling too well right now :(
> >
> > Please if anyone knows can you post?
> >
> > Thanks,
> > Erik
>
> How geeky an answer are you looking for?
>
> http://www.preskorn.com/columns/0003.html
>
> http://jpet.aspetjournals.org/cgi/content/full/283/3/1305
>
> Your new drug combo is much less noradrenergic, in my opinion.
>
> LarLarry
Thanks so much for your help. I have a really horrible problem. My imipramine is causing my tongue to swell to 2X its size (because its s TCA) and causing sleep apnea and i have to wear an oxygen mask to bed and i'm only 28. So the ratio is really around 75% serotonin and 25% NE?
My doc wants me to get on less of a dosage of a TCA so this won't happen. So he suggested to get the NE from 50mg of desipramine (still TCA but not as much) and to get the serotonin from 40mg of celexa.
Do you think this will work? Do you know of a better suggestive combination? I tried just Celexa and couldnt do it, so I obviously need some NE. I tried Remeron and I balooned up (i dont think that would help the Apnea).
Whats the closest thing I could get to that like the Imipramine wihtout the TCA side effects?? I guess i dont understand where the difference between tcas and ssris work. is TCA the pre-synaptic nerve?
Thanks so much for helping me Larry, i'm having a horrible time managing this, no sleep, and working a corporate job...people just don't realize how hard this stuff is! :)
Posted by jamesprice on November 17, 2003, at 22:18:30
In reply to Re: HELP ME: Whats the ratio of Sero/NE in Imipramine?, posted by smittay17 on November 17, 2003, at 15:05:21
I read a study that, out of 4 stars of effect, rated the serotonin levels affected by 2 stars and the norepinephrine levels affected at a rating of 3 stars.
Posted by smittay17 on November 18, 2003, at 9:40:20
In reply to SERO 40% NE 60%, posted by jamesprice on November 17, 2003, at 22:18:30
> I read a study that, out of 4 stars of effect, rated the serotonin levels affected by 2 stars and the norepinephrine levels affected at a rating of 3 stars.
>
>OKAY so if i was on 200mg of Imipramine, (I thought based on the theory i heard it was 75% SERO / 25% NE) so i thought it was 150mg Sero/50 NE.
so you're saying out of 200mg of Imipramine its 40% SERO/60% NE ??
that means i'd have to take 80mg of SERO and 120mg of NE? oh no.
do you have a link to this artivle or anything like it, i really, really appreciate your guys and girls help !!!
Posted by smittay17 on November 19, 2003, at 8:46:27
In reply to Re: SERO 40% NE 60%, posted by smittay17 on November 18, 2003, at 9:40:20
is there somewhere online where it says the ratio of Sero/NE in Imipramine online>?
i have to change my medicine tomorrow and i really, really need to show my doctor this.
he has no clue and i could really use some help? anyone please?
Posted by jamesprice on November 19, 2003, at 11:50:29
In reply to Re: SERO 40% NE 60%, posted by smittay17 on November 18, 2003, at 9:40:20
I don't think that 60% NE 40% SERO really applies.
The study I read rated prozac as 4 stars for SERO but no stars for NE or DOPA.
Effexor rated 4 stars for SERO and NE and maybe even DOPA, can't remember.
Nortriptyline 3 sero 2 NE
Paxil & the other SSRI's all 4 stars SERO 0 stars NE & DOPA
Posted by SLS on November 19, 2003, at 13:39:18
In reply to IS THIS REALLY ACURATE?? Ratio of Sero / NE ??????, posted by smittay17 on November 19, 2003, at 8:46:27
> is there somewhere online where it says the ratio of Sero/NE in Imipramine online>?
>
> i have to change my medicine tomorrow and i really, really need to show my doctor this.
>
> he has no clue and i could really use some help? anyone please?
Here is a website that presents the binding affinities of many drugs. Just use the drop-down menu to find the drugs you are interested in and then review the numbers given for NE and 5-HT transporters. The lower the number, the more it inhibits reuptake. However, be advised that these numbers are being generated using methods that don't always reflect what goes on in the living brain. I would say that nortriptyline would be preferable to desipramine if you are looking for increasing serotonergic activity. Unfortunately, getting the dosage right with nortriptyline can be tricky and sometimes requires blood tests. Most people do well on 75mg.Good luck.
- Scott
Posted by jamesprice on November 19, 2003, at 14:22:18
In reply to Re: IS THIS REALLY ACURATE?? Ratio of Sero / NE ??????, posted by SLS on November 19, 2003, at 13:39:18
You forgot to post the name of the website I believe.
Posted by SLS on November 19, 2003, at 14:31:22
In reply to Re: IS THIS REALLY ACURATE?? Ratio of Sero / NE ??????, posted by jamesprice on November 19, 2003, at 14:22:18
> You forgot to post the name of the website I believe.
Oops. I certainly did!PDSP Drug Database:
Posted by zeugma on November 19, 2003, at 18:43:41
In reply to Re: IS THIS REALLY ACURATE?? Ratio of Sero / NE ??????, posted by SLS on November 19, 2003, at 14:31:22
With imipramine the 5-HT/NE ratio is going to be variable based on differences in the way the drug is metabolized. Some people are slow metabolizers and get more of the serotonergetic parent drug, others will process it quickly and will get more of the NE-specific metabolite. TCA's in general are among the most variably metabolized drugs. That is one reason determining blood levels can be inportant when taking them.
Posted by smittay17 on November 24, 2003, at 13:10:25
In reply to Re: IS THIS REALLY ACURATE?? Ratio of Sero / NE ??????, posted by zeugma on November 19, 2003, at 18:43:41
> With imipramine the 5-HT/NE ratio is going to be variable based on differences in the way the drug is metabolized. Some people are slow metabolizers and get more of the serotonergetic parent drug, others will process it quickly and will get more of the NE-specific metabolite. TCA's in general are among the most variably metabolized drugs. That is one reason determining blood levels can be inportant when taking them.
Thanks so much for all your help. So in essence, its YOUR body that decides how long it will take to metabolize the drug, its not a given ratio of 3/4 SERO to 1/4 NE in imipramine. so my body could take longer either with serotonin or NE?Is there a blood test i could get from a doctor to determine the amounts of SERO & NE in my blood? who would i go to... a neurologist? WHERE SOULD I GO? Can they really test and see how long it takes your body to break down SERO & NE ?
Thank you so much everyone, its really great having a place where people care and try to help you out- Erik
Posted by zeugma on November 25, 2003, at 22:38:40
In reply to WHERE? BLOOD TEST for ratio of Sero / NE ??????, posted by smittay17 on November 24, 2003, at 13:10:25
There's no test to determine reliably the amounts of monoamines in your CNS. That's one reason psychiatry is the series of shots in the dark that it is.
You can get your blood levels of imipramine taken, and you can in effect determine if you're a slow of or fast metabolizer of the drug. Fast metabolizers have more of the desipramine metabolite leading to a stronger NE effect. Some think the only TCA that has a pronounced 5-HT effect is clomipramine. Personally, I think it comes down to finding a drug that alleviates your symptoms without being too costly in terms of side effects. I'd guess that if a couple of SSRI's don't work, then desipramine or nortriptyline (or Effexor) are rational next moves.
Posted by smittay17 on November 26, 2003, at 14:41:10
In reply to Re: WHERE? BLOOD TEST for ratio of Sero / NE ?????? » smittay17, posted by zeugma on November 25, 2003, at 22:38:40
> There's no test to determine reliably the amounts of monoamines in your CNS. That's one reason psychiatry is the series of shots in the dark that it is.
>
> You can get your blood levels of imipramine taken, and you can in effect determine if you're a slow of or fast metabolizer of the drug. Fast metabolizers have more of the desipramine metabolite leading to a stronger NE effect. Some think the only TCA that has a pronounced 5-HT effect is clomipramine. Personally, I think it comes down to finding a drug that alleviates your symptoms without being too costly in terms of side effects. I'd guess that if a couple of SSRI's don't work, then desipramine or nortriptyline (or Effexor) are rational next moves.Zeugma,
Thank you so much for your input. So I'm trying to get off 200mg of Imipramine (that TOTALLY cured my Panic Disorder for 8 years). As I stated above, I HAVE to get off the Imipramine because it is swelling my tongue and causing sleep apnea, which is leading to no sleep and a weakened immune system.I don't know what is worse... feeling chronically sick, but mentally stable or feeling panic and healthier... its like choosing the lesser of 2 evils.
Zeugma (or anyone else) So you think this is a good idea??... getting on Celexa (SSRI) for Serotonin and Desipramine (TCA) for NE to replace the Imipramine (TCA-which give both SERO & NE)?
My doctor thought it would be a good idea, because moving the SERO over to SSRI'S (Celexa) will give me less of the TCA side effect of Edema (swelling) of the tongue, which is causing my sleep apnea... this is the hardest thing ever! I've been essentially fine since 1996 and now its all panicky again.
What do you think a good "hypothetical dose" of the Celexa and Desipramine would be to mimic the 200mg of Imipramine I have been taking? or would you recommend another drug besides Celexa and Desipramine to change to? I tried Remeron and Effexor in the past before I was put on Imipramine cause they just didn't work (the doc knew the side effects were less, but then opted Imipramine).
My doc suggested Desipramine cause its the breakdown product of Imipramine and then what he claims is the best of the SSRI's- Celexa.
I just wonder if my body needs 200mg of Desipramine instead of 200mg of Imipramine. I hope not. My goal was to get on 40-60mg of Celexa and 50-100mg of Desipramine (therefore cutting the 200mg of TCA down to 50-100mg of TCA).
Does this sound plausible anyone? I really, really appreciate all your help. Its so scary now that i'm married and have a corporate job to be going through this, whereas before i was in college in 1996 and was able to take time off. I really appreciate this and any other suggestions or help anyone could offer. Or if someone knows of a good Psychiatrist/Neurologist North of Boston that takes HMO Blue and is open :)
Thanks,
Erik
smittay1975@hotmail.com
Posted by zeugma on November 26, 2003, at 17:34:20
In reply to MY REMEDY 4 PANIC DISORDER/NEED DOC N of BOSTON ?, posted by smittay17 on November 26, 2003, at 14:41:10
There seem to be two crucial elements here:
1) What is causing the edema of the tongue (which is truly an awful, and dangerous, side effect)
2) What element of imipramine's effect is HELPING you.
If 200 mg desipramine helps you, without causing edema, then you'd be set. But I don't know why desipramine would be less likely to cause edema than imipramine (though it does tend to be the best TCA in terms of S/E according to many).
There's an alarming post a little ways down on this board, about someone on a combo of two TCA's plus an opiate drug suffering from a terrible edema of the neck (scroll down till you see "Oedema.") So there's some reason to want to steer clear of TCA's.
A suggestion: Instead of Celexa + desipramine, maybe you could mention Celexa + Strattera to your doc. Strattera is an ADHD med, but similar to desipramine pharmacologically, and since it's not a TCA it might not have this propensity for causing edema.Good luck.
Posted by jamesprice on November 28, 2003, at 21:20:33
In reply to Re: MY REMEDY 4 PANIC DISORDER/NEED DOC N of BOSTON ?, posted by zeugma on November 26, 2003, at 17:34:20
My feeling is that I regret that you are having to drop a medication that has helped you so much. I have been trying for 10 years to find the right combination. Imipramine really helped me but it seemed to wear off after awhile.
Nortriptyline felt almost identical to imipramine. Maybe it would do the trick. Although the SSRI's of course generally have less side effects than the TCAs so it may be a good thing to give them a try first.
Why has your doctor not chosen Lexapro instead of Celexa? Although for me personally I think Celexa did more goode tha Lexapro.
JP
Posted by smittay17 on November 30, 2003, at 15:27:01
In reply to Re: MY REMEDY 4 PANIC DISORDER/NEED DOC N of BOSTON ?, posted by zeugma on November 26, 2003, at 17:34:20
> If 200 mg desipramine helps you, without causing edema, then you'd be set. But I don't know why desipramine would be less likely to cause edema than imipramine (though it does tend to be the best TCA in terms of S/E according to many).Z,
I think i only need to be on 50mg of Desipramine, not 200mg like Imipramine. Because Imipramine is 3/4 Serotonin and 1/4 NE and breaks down to Desipramine (and Desipramine is JUST NE).So hopefully I wouldn't need to take 200mg of Desipramine because its all NE which is 1/4 of the 200mg of Imipramine I was fine on, so I'm trying 50mg Desipramine (3/4 less TCA side effects) and 60mg of Celexa.
As for the Strattera, I'll have to check that out! I heard of it briefly and if it offers the NE without using a TCA, maybe that will work.
Now does a ton of SERO cure Panic? it must, because im upping my celexa and it works and my Imipramine 200mg was 150mg SERO. I always thought it was the NE...I'll keep you all updated as I go along and again thank you so so so much for your advice and help! this place and people are a God-send :)
Erik
Posted by zeugma on November 30, 2003, at 16:04:22
In reply to Re: MY REMEDY 4 PANIC DISORDER/NEED DOC N of BOSTON ?, posted by smittay17 on November 30, 2003, at 15:27:01
This is the end of the thread.
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