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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Racer on June 4, 2004, at 11:48:02
A lot of ADs reduce my already low BP even further, and lead to me falling down a lot from a sudden drop. Does anyone know of any ways to improve this, so that I might be able to go on and stay on one of the drugs that does this to me?
Thanks!
Posted by Ilene on June 4, 2004, at 12:24:17
In reply to Any ideas on reducing AD-related hypotension?, posted by Racer on June 4, 2004, at 11:48:02
> A lot of ADs reduce my already low BP even further, and lead to me falling down a lot from a sudden drop. Does anyone know of any ways to improve this, so that I might be able to go on and stay on one of the drugs that does this to me?
>
> Thanks!I had to reduce my dose of Marplan because of low BP.
I take Florinef for neurally mediated hypotension, and I drink a disgusting potion called E-Lyte that seems to help keep fluid in my body.
http://www.detoxxbox.com/main/products/selectrolyte.htm
I.
Posted by King Vultan on June 4, 2004, at 12:39:26
In reply to Any ideas on reducing AD-related hypotension?, posted by Racer on June 4, 2004, at 11:48:02
> A lot of ADs reduce my already low BP even further, and lead to me falling down a lot from a sudden drop. Does anyone know of any ways to improve this, so that I might be able to go on and stay on one of the drugs that does this to me?
>
> Thanks!
I've posted this link beforehttp://www.currentpsychiatry.com/2002_06/06_02_maoi.asp
and this is the relevant passage near the end in regard to orthostatic hypotension:
"Orthostatic hypotension is the most common early side effect of phenelzine and isocarboxazid. Clinically significant hypotension is best managed via dosage adjustment. If that fails, add Na Cl, 1 to 2 grams bid with increased fluids. If that doesn’t work, administer fludrocortisone, 0.1 to 0.4 mg/d. If that fails, administer d-amphetamine, starting with 2.5 to 5 mg/d, and observe carefully for hypertension."
I am having severe problems myself on the 90 mg/day of Nardil I am taking and have been teetering and coming close to blacking out on several occasions. It's not the typical problem where you feel dizzy after standing up quickly (I experienced that sort of thing on tricyclics), but a situation where I start having problems after sitting for a while and then getting up and walking a distance of perhaps 100-200 feet or just climbing some stairs. I had to crouch down and tilt my head forward after walking into a store last night because my legs were shaking and quivering and about to give out, combined with a definite lack of blood flow to my brain. I am not in bad condition: 5-9, 150 lbs, and jog 15-20 miles a week. I guess I am fortunate in this case for my essential hypertension because the problem would probably be exacerbated if I had a low BP as you do (unmedicated BP is 140/90, unmedicated heart rate is 75; with the Nardil, it is about 100/65, with a heart rate of 60). I do not believe I have a solution for my own problem other than to try to be careful and anticipate the dizziness/weakness attack as best I can in order to take precautionary action (crouching down, grabbing support, etc). Perhaps this might be of some benefit in your situation also.Todd
Posted by Racer on June 4, 2004, at 13:06:47
In reply to Re: Any ideas on reducing AD-related hypotension?, posted by King Vultan on June 4, 2004, at 12:39:26
Thanks. I don't have the usual orthostatic hypotension, either. Sitting in a chair can bring on the dizziness. Standing up in one place (standing in line, etc) can also do it. And that's without any medication causing it. My 'normal' BP is about 90/60, but the lower number tests down into the low 50s pretty regularly, even when I'm a bit tense.
I guess unless a doctor gets pretty aggressive, I'm pretty limited in my AD options, then. Man, that's not what I wanted to hear. But I really do thank you for answering.
You always amaze me, both for your knowledge and generousity in sharing it, and also for your consistently kind tone. You're a real asset to this world.
Posted by Sad Panda on June 4, 2004, at 14:00:29
In reply to Any ideas on reducing AD-related hypotension?, posted by Racer on June 4, 2004, at 11:48:02
> A lot of ADs reduce my already low BP even further, and lead to me falling down a lot from a sudden drop. Does anyone know of any ways to improve this, so that I might be able to go on and stay on one of the drugs that does this to me?
>
> Thanks!
>What AD are you taking at the moment?
Cheers,
Panda.
Posted by Racer on June 4, 2004, at 16:22:55
In reply to Re: Any ideas on reducing AD-related hypotension? » Racer, posted by Sad Panda on June 4, 2004, at 14:00:29
None. So far, I haven't been able to tolerate any of them this time around. They've all just been unbearable and we've had to stop them before they'd have had a chance to work. (To be accurate, I just tried three days of Prozac and have to stop it because of the agitation. Misery + apathy + agitation = the new Black Box warning, you know? I'm feeling like I want to punish myself for not being able to keep trying, and feeling like I can't go on living anymore, but haven't been able to come up with a plan because it's too much trouble to come up with one. The addition of Prozac's agitation to that made finding a plan a PRIORITY, so it seems a lot safer just to stop it. Especially since we tried it last fall already, and this just got worse, with no improvements in sight.)
I am taking 100mg Provigil, though, which I started to combat the profound constipation after a Remeron trial. It helped a lot with my mood, although it didn't lift it, it relieved the frantic feeling that comes with depression for me. So, I'll continue that.
Please don't ask me what I've tried: my failure with Prozac means that the SSRIs are all out (although they've never worked all that well for me, anyway); Wellbutrin is contraindicated because the doctor considers me too high a seizure risk; Effexor is out because while it helped before, it was a partial response that didn't last all that long and came with too many side effects for me to consider trying it again; the TCAs I've tried have either been too sedating and not very effective (nortriptyline) or made me fall down (various, including desiprimine); and I haven't tried MAOIs for what seem pretty compelling reasons to me. (Including the fact that every time I think about trying them, the biggest incentive is that a week's worth can be fatal, and so I know they'd be effective in ending my suffering, you know?)
Guess I answered the unasked question anyway, huh? Do you know of anything that can stabilize my BP so that we could try the desiprimine again?
Posted by Racer on June 4, 2004, at 16:56:33
In reply to Re: Any ideas on reducing AD-related hypotension? » Sad Panda, posted by Racer on June 4, 2004, at 16:22:55
I have no plan at this time. I have no plan to make a plan. I am doing what I can to protect myself from making a plan. I neither want nor desire the police to ensure my safety. My husband knows the way to the psych services ER, and will take me if I need to be there.
I cross my heart promise.
Posted by King Vultan on June 4, 2004, at 17:02:39
In reply to Re: Any ideas on reducing AD-related hypotension? » King Vultan, posted by Racer on June 4, 2004, at 13:06:47
Posted by Racer on June 4, 2004, at 18:21:10
In reply to Re: Thanks for your kind words (nm) » Racer, posted by King Vultan on June 4, 2004, at 17:02:39
Posted by Sad Panda on June 6, 2004, at 4:10:46
In reply to Re: Any ideas on reducing AD-related hypotension? » Sad Panda, posted by Racer on June 4, 2004, at 16:22:55
> None. So far, I haven't been able to tolerate any of them this time around. They've all just been unbearable and we've had to stop them before they'd have had a chance to work. (To be accurate, I just tried three days of Prozac and have to stop it because of the agitation. Misery + apathy + agitation = the new Black Box warning, you know? I'm feeling like I want to punish myself for not being able to keep trying, and feeling like I can't go on living anymore, but haven't been able to come up with a plan because it's too much trouble to come up with one. The addition of Prozac's agitation to that made finding a plan a PRIORITY, so it seems a lot safer just to stop it. Especially since we tried it last fall already, and this just got worse, with no improvements in sight.)
>
> I am taking 100mg Provigil, though, which I started to combat the profound constipation after a Remeron trial. It helped a lot with my mood, although it didn't lift it, it relieved the frantic feeling that comes with depression for me. So, I'll continue that.
>
> Please don't ask me what I've tried: my failure with Prozac means that the SSRIs are all out (although they've never worked all that well for me, anyway); Wellbutrin is contraindicated because the doctor considers me too high a seizure risk; Effexor is out because while it helped before, it was a partial response that didn't last all that long and came with too many side effects for me to consider trying it again; the TCAs I've tried have either been too sedating and not very effective (nortriptyline) or made me fall down (various, including desiprimine); and I haven't tried MAOIs for what seem pretty compelling reasons to me. (Including the fact that every time I think about trying them, the biggest incentive is that a week's worth can be fatal, and so I know they'd be effective in ending my suffering, you know?)
>
> Guess I answered the unasked question anyway, huh? Do you know of anything that can stabilize my BP so that we could try the desiprimine again?
>
>
>Have you got underlying reason for hypotension or do you just suffer excessively from orthostatic hypotension when taking TCA's? There is plenty of ways to lift your blood pressure, but you would want to do that with your doc, are you taking anything at all at the moment?
Cheers,
Panda.
Posted by Racer on June 6, 2004, at 8:37:12
In reply to Re: Any ideas on reducing AD-related hypotension? » Racer, posted by Sad Panda on June 6, 2004, at 4:10:46
Dunno if you can say there's an underlying reason, but my BP is normally fairly low, even without meds, and even without meds I have to be careful standing up from sitting or crouching, or even standing still for long periods. On the TCAs I've tried, that's multiplied a lot: I'll get the greyness and fall down without a whole lot of warning, even if I'm actually moving at the time; and I will sometimes start to pass out while sitting in a chair with my feet on the ottoman. (Sorry, just had a mental image of a fellow in Turkish garb, on his hands and knees in front of a chair, with someone's feet up on him. But I'm glad I amuse myself.)
No, not taking anything for the BP, since it is in normal range most of the time. It really only becomes a problem when you add drugs to it. Pdoc is talking about MAOIs as the only thing left to try, but aren't they even worse for hypotensive reactions? So, one way or another the hypotension has to be addressed, and I'd prefer to try the TCAs again, first, if that's the case. Do you know anything about how it can be treated?
Thanks.
Posted by Sad Panda on June 6, 2004, at 10:23:50
In reply to Re: Underlying reason for hypotension? » Sad Panda, posted by Racer on June 6, 2004, at 8:37:12
> Dunno if you can say there's an underlying reason, but my BP is normally fairly low, even without meds, and even without meds I have to be careful standing up from sitting or crouching, or even standing still for long periods. On the TCAs I've tried, that's multiplied a lot: I'll get the greyness and fall down without a whole lot of warning, even if I'm actually moving at the time; and I will sometimes start to pass out while sitting in a chair with my feet on the ottoman. (Sorry, just had a mental image of a fellow in Turkish garb, on his hands and knees in front of a chair, with someone's feet up on him. But I'm glad I amuse myself.)
>
> No, not taking anything for the BP, since it is in normal range most of the time. It really only becomes a problem when you add drugs to it. Pdoc is talking about MAOIs as the only thing left to try, but aren't they even worse for hypotensive reactions? So, one way or another the hypotension has to be addressed, and I'd prefer to try the TCAs again, first, if that's the case. Do you know anything about how it can be treated?
>
> Thanks.
>
>I'm not familiar with treatments of low blood pressure, plenty of drugs can raise it, i.e.: epinephrine, or it could be as simple for you as increasing your salt intake.
With blood pressure & MAOI's, Parnate would be the choice for you as it can raise blood pressure, while Nardil & Marplan nearly always lower it.
Have you tried Strattera? What happened with Effexor? These two would raise blood pressure as they raise NE without A-1 blockade which causes orthostatic hypotension. Strattera would be very similar to the Desipramine without the low blood pressure problem.
Cheers,
Panda.
Posted by Racer on June 6, 2004, at 14:06:21
In reply to Re: Underlying reason for hypotension? » Racer, posted by Sad Panda on June 6, 2004, at 10:23:50
Sorry, I'm at the point of giving all this up, so your questions are kinda hard for me to read right now, but I do thank you for putting up with me and continuing to offer your knowledge.
I've tried Strattera. It didn't seem to make any difference, beyond being part of a cocktail that led to a lot of other problems for me. (Now, though, I think that the Zoloft caused the problems, so I'd consider trying the Strattera again -- except that, again, the depression didn't seem to improve any one that combo.)
Effexor wasn't very effective, although with the addition of Prozac it was OK enough that I was able to function better, as long as there was no pressure of any sort on me. In other words, it wasn't very effective for me. It also caused the standard problems: weight gain of not quite half my starting body weight, constipation, that 'brain zap' feeling, sweating, way too vivid dreams, and some wild fluctuations of my blood sugar (as measured by my husband's glucometer, not based solely on symptoms of hypoglycemia). The relief it offered lasted a bit more than a year, then it lost even that. Since it took so long to wean off, and I was so sick during most of that time, it really doesn't seem worth it to try again.
I *would* be willing to try desipramine again, if the hypotension could be controlled. My pdoc, though, says that since I couldn't tolerate it before (because of the hypotension), the only thing left to try is an MAOI. (Aren't they even worse for hypotension?) That's why I'm asking about anything anyone knows about hypotension. I figure, if he's planning to offer something that causes the same problem that's kept me from taking another drug, he's probably got some idea of mitigating the hypotension. And, if that's the case, he may as well try the desipramine again, before giving me access to a much more reliable means of suicide.
Then again, since I'm the one with the Serious Mental Illness, and he's the one with the medical degree, he's obviously in the best position to make that decision. (Yeah, OK, I'm pretty upset with his treatment of me at the moment. And that sarcasm isn't fair to him. It still feels kinda nice to let some of it out.)
Thank you, Sad Panda. I really appreciate your input.
This is the end of the thread.
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