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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Keith Talent on November 16, 2004, at 7:03:38
I experienced a nasty fainting/nausea/weakness episode after coming out of the gym. My heart was racing and I'm just wondering if it's dangerous to take both classes of drugs simulataneously. They both reduce inotropic state (to the point of high-output heart failure?). Clomipramine has a prodysrhythmic effect, and my heart was missing beats during the incident.
Busyness/procrastination have prevented me from exercising regularly, so there was a sudden large demand placed on the heart. My dilemna is that both my psychiatrist and me are going away within days.
Should we: ditch the cloimipramine for an SSRI
ditch the beta blocker (and use the TCA to reduce myocardial contractility)
?
I am on other antihypertensive agents (hydrochlorothiazide, irbesartan, lercanidipine).Any advice would be appreciated.
Posted by jujube on November 16, 2004, at 8:37:21
In reply to Clomipramine and a beta blocker?, posted by Keith Talent on November 16, 2004, at 7:03:38
Keith,
I was prescribed a TCA (actually Clomipramine) a couple of weeks ago. At that time I did some research and found information on TCA interactions and what the interaction would result in. The charts indicated that TCA interaction with Beta Blockers such as Propranolol results in the TCA possibly causing greater than expected drops in blood pressure (could explain your fainting/nausea/weakness episode after the gym.
Anyways, there is a whole list of other interactions and what the results could be. Here is the webpage if you want to have a look.
www.holisticonline.com/Remedies/Depression/dep_interactions-TCA.htm
Tamara
> I experienced a nasty fainting/nausea/weakness episode after coming out of the gym. My heart was racing and I'm just wondering if it's dangerous to take both classes of drugs simulataneously. They both reduce inotropic state (to the point of high-output heart failure?). Clomipramine has a prodysrhythmic effect, and my heart was missing beats during the incident.
>
> Busyness/procrastination have prevented me from exercising regularly, so there was a sudden large demand placed on the heart. My dilemna is that both my psychiatrist and me are going away within days.
>
> Should we: ditch the cloimipramine for an SSRI
> ditch the beta blocker (and use the TCA to reduce myocardial contractility)
> ?
> I am on other antihypertensive agents (hydrochlorothiazide, irbesartan, lercanidipine).
>
> Any advice would be appreciated.
>
Posted by Keith Talent on November 16, 2004, at 22:52:24
In reply to Re: Clomipramine and a beta blocker? » Keith Talent, posted by jujube on November 16, 2004, at 8:37:21
Thank you so much, Tamara. This obviously needs further investigation.
Posted by Keith Talent on November 16, 2004, at 23:08:27
In reply to Re: Clomipramine and a beta blocker?, posted by Keith Talent on November 16, 2004, at 22:52:24
The alternatives that I'm faced with are:
1. Drop the clomipramine (even though it's the best antidepressant I've ever had).
2. Drop the atenolol (beta blocker), resulting in my heart rate going back up again to 120 at rest.
If 1., the likely candidates to replace it would be escitalopram, paroxetine, fluoxetine or sertraline. None of them are as good (for me) as clomipramine for my mood.
Does anyone have any experience in taking an SSRI with atomoxetine (Strattera)? I've already found reboxetine (Edronax) to be useless for me personally. This combo would be sort of equivalent to clomipramine, without weakening the heart's contractility and causing dysrhythmias.
Basically, there is definitely a dopaminergic component to my (and a great many other posters here's) depression. What I would like to trial would be an SSRI at a high dose and (dex)methylphenidate to compensate for the SSRI-induced apathy/anergy/amotivation/emotionally-numbing side effects. I've already found that dextroamphetamine worked very well for this, but only for a month, then the effect burnt out. I hope that (dex)methylphenidate would produce a more sustainable benefit because it does not cause release of dopamine (at low brain concentrations) - it only blocks reuptake.
You people here are fantastic and any tidbit of knowledge/experience/advice would be most appreciated.
Posted by jujube on November 17, 2004, at 9:50:43
In reply to Re: Clomipramine and a beta blocker?, posted by Keith Talent on November 16, 2004, at 22:52:24
> Thank you so much, Tamara. This obviously needs further investigation.
>My pleasure. If you don't mind, I have a couple of questions for you (as a new Clomipramine user). First, how long did it take before it started working and you noticed a change? Second, did you notice an increase in motivation, etc. Third, how bad were the side effects at 75 mg (I seem to recall you mentioning in an older post that you were on 75 mg). And, finally, have you experienced memory loss and other cognitive impairments?
Thanks and sorry to highjack your thread with my questions.
Tamara
This is the end of the thread.
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