# Anafranil: Old School Anti-Obsessional... Any experience?



## Kobayashi (Dec 18, 2009)

So my GP has just advised me to stop following the advice of my PDoc as things haven't been going well with the Lexapro and Risperidone he's prescribed.

She (my GP) wants me to continue with the Lexapro and add 25mg of Anafranil at night - give things a week or so and if I tolerate it well I'm to come off the lexapro slowly and increase the Anafranil.

I read mixed reviews of this stuff. Some people LOVE it, others find the side effects too harsh. My Pharmacist told me that its old-school, and is making a come-back as its very effective if you can get through the side effects.

I have pure - O - no compulsions.

Anyone have any experience?

Nicko


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## Daniel (Dec 18, 2009)

BTW, as you may know, it's FDA approved for OCD.


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## Retired (Dec 18, 2009)

Kobayashi said:
			
		

> My Pharmacist told me that its old-school, and is making a come-back



Every physician has a protocol for dealing with various diagnoses based on training and clinical experience.

Sometimes this will include medications that may not be the most recently introduced to market, but are meds with which the physician has extensive experience and uses them to determine a particular patient's response.

Medicine is as much art as it is science, and every physician has his/her preferred treatment strategy.

We should not be unduly influenced b the hype created by the pharmaceutical industry in consumer ads on TV, that seem to promote the idea that if the latest medication is not used, then there is little hope for successful treatment.

While new medications are important and necessary improvements in therapy, we should not consider the latest meds as being a status symbol such as needing to drive the latest model car.

If your physician has found success in working with Anafranil, then feel comfortable in giving it a try, and report your progress in detail so your doctor can evaluate your progress.

It's the only way you and your doctor can make the best choices for your treatment options.


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## David Baxter PhD (Dec 18, 2009)

A good example is the anti-hypertensives (blood pressure medications). Like most people these days, I was started on the new breed of these medications but struggled with various side-effects and by trial and error found one that wasn't too bad, other than occasional problems with postural hypotension and lightheadedness or dizziness. 

Then, in 2007, it appeared that I was having allergic reactions to numerous things and possibly one of those was the anti-hypdertensive I was taking. Given that, by then, I'd tried nearly every type of modern drug for the issue, my doctor put me on a low dose of an older medication (the so-called "water pill"). Not only does that low dose control the blood pressure very well, but I have no side-effects at all. An added bonus is that I went from $80 - $100 per month on the newer medications to a cost of about $16 for a 3 month supply of the current medication.


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## Andy (Dec 18, 2009)

Isn't this like Paxil? Or similar to it? 

If it is, then I can tell you my expereince was nil. It did nothing for me.  My frined used it for awhile and she was really glad to have been put on it. 

If it's not like paxil, then just ignore this, lol I just thought I would tell you a litle story!


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## Daniel (Dec 18, 2009)

> Isn't this like Paxil? Or similar to it?


Anafranil is a tricyclic antidepressant, not a SSRI like Paxil.


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## Andy (Dec 18, 2009)

Yes, I just looked it up, thank-you.  Sounded familiar. So there you go a nice little story about paxil.:blush:

Back to Anafranil...


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## David Baxter PhD (Dec 18, 2009)

STP said:


> So there you go a nice little story about paxil.:blush:



You can never have too many Paxil stories.


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## Andy (Dec 18, 2009)

That's what i was thinking. :think:


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## Kobayashi (Dec 19, 2009)

Thanks for the responses guys.  I'll give it a shot and report my progress.:2thumbs:

Cheers!

KOB


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## Kobayashi (Jan 8, 2010)

So I've been on this stuff for a few days - 25mg.  (I decided to wait until the holidays were over before I started).  I'm still taking 25mg of Cipralex in the am and have stopped the .25mg of risperidone.

Things so far are ok.  Don't really notice any significant difference.  Bit of dry mouth.

The biggest thing is that I'm not sleeping well.  I fall asleep fine, but seem to wake up every hour or so in this kind of twilight sleep state.  Apparently, (according to my wife), I'm having lots of interesting conversations in my sleep too!  I thought this stuff was supposed to be sedating? Strange.  Anyway - I'll report back as things progress.

Cheers!


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## Melon Collie (Jan 8, 2010)

From my personal experience only, I wish to add that if you have ever had suicidal thoughts you should consider something else instead of anafranil.


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## Kobayashi (Jan 8, 2010)

How long after you started anafranil did you experience a problem with this?


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## David Baxter PhD (Jan 8, 2010)

Melon Collie said:


> From my personal experience only, I wish to add that if you have ever had suicidal thoughts you should consider something else instead of anafranil.





Kobayashi said:


> How long after you started anafranil did you experience a problem with this?



I also wonder why you make that statement, Melon Collie, and why you believe the anafranil was at fault.

Some similar concerns were expressed about SSRIs a few years ago but the evidence is rather convincing that it is not the medications _per se_ that are the cause of suicidal thinking but rather a combination of the depression the medications are used to treat and limited or inaccurate information given to patients about how the medications work (i.e., poorly informed expectations about the medications).


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## Kobayashi (Jan 8, 2010)

Here's my take on it:

When I first became ill with OCD - I didn't even know what was wrong with me.  I did have thoughts of self-harm, although looking back, they really weren't suicidal thoughts.  (I didn't have a plan, I had no desire to actually do anything like hurt myself) - It was just the OCD rearing its ugly head and making me think that I wanted to do the unthinkable - I was afterall stressed to the max.  I still get these thoughts, but I know that they are just obsessions and they aren't real.

The first med they put me on was Citalopram - an SSRI.  I had some intense start-up issues with this med, that actually increased the volume and frequency of my OCD thoughts.  It was awful.  I don't know why SSRI's etc can do this to some people.  When they switched me to Cipralex, I experienced the same thing - and yes some of the thoughts I had could be construed as "suicidal" - But I know now that they were just thought processes gone awry as my brain was adapting to the new med.  My Doc told me this and that I had to "push through" the thoughts.  (A prescription of ativan also helped to get me through the start up side effects).  My Doc only gave me 20 of them and I didn't need to use them all.

Just my 2 cents.


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## David Baxter PhD (Jan 8, 2010)

There is also some evidence that an apparent increase in suicidal thinking may come early in treatment with antidepressant medication as a result of an increase in psychological and physical energy. Thus, it's not a direct side-effect of the medication but rather the individual reacting to part of what the medication is supposed to do.

In other words, physicians and therapists certainly need to monitor depressed patients when they first start taking medications, but indeed all depressed patients should be monitored for suicidal ideation whether they are taking medication or not. What this really underscores is the critical importance of close monitoring early in treatment and followup evaluations within a week or two of initiating treatment with antidepressants.


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## Melon Collie (Jan 8, 2010)

Sorry.  I felt as soon as I posted that I should either change my wording or elaborate on my post.  My intention is to help prevent anyone else going through what I did.  

In addition to the dry mouth that you experienced I also felt a strange sensation of being unable to cry when I was sad.  I think Anafranil is an excellent medication and I hope it works well for you.

I don't think that it's to blame and I don't think it causes suicidal thinking but I do think it is dangerous in the hands of a person that is intent on self-harm.   

Another option to switching, if you feel like taking more that you are supposed to, is give the meds to your wife and she gives you a daily dose.  My husband had mine under lock and key for about a year before they switched me over to prozac.


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## Kobayashi (Jan 8, 2010)

Good points.  I think it all depends on the individual and their unique circumstances with these meds.  I was just browsing another Psych forum and saw several posts form people who attribute anafranil to actually saving their lives when they were in the depths of depression and more specifically from the torments of OCD.  

These forums are great for getting a "broad spectrum" view on the overall advantages and disadvantages of medications.  I try to take what people say with a grain of salt before jumping to the conclusion that I'll get the same side effects or all of a sudden end up with some nasty condition called "Hot Dog Fingers".  Its a tough thing to do though as we are all looking for answers.


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## Kobayashi (Jan 12, 2010)

So I'm almost a week into taking 25mg of anafranil.  Past few days have been rough.  Increased anxiety and increased OCD (pure-O).  I'm still on the 25mg of cipralex too.  Just not feeling myself.  Had to pop .5 mg of ativan last night.  haven't used that for a while.  I'm hoping that this is just start up side effects - similar to what I went through when starting cipralex.  Definitely not feeling any better yet - that's for sure.  I'm going to give this a few more days - not sure at what point I pull the plug if its not giving me the desired results.

Any feedback is appreciated.


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## Melon Collie (Jan 12, 2010)

I wish I could remember my start up side effects, if I had any.  But it's been twenty years since I went off of it and I just can't remember.  Sorry, I'm no help.

I was also prescribed Zoloft and now Prozac.  Maybe one of these may be worth trying if you have to stop the Anafranil?


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## Kobayashi (Jan 14, 2010)

Seeing my GP today.  Haven't been feeling much better.  I'm wondering if I need an increase in dosage, or perhaps there is too much going on with both cipralex and anafranil.  Feeling agitated, blue, foggy.  It's likely just start up side effects...But going through this ain't fun


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## David Baxter PhD (Jan 14, 2010)

Kobayashi said:


> Seeing my GP today.  Haven't been feeling much better.  I'm wondering if I need an increase in dosage, or perhaps there is too much going on with both cipralex and anafranil.  Feeling agitated, blue, foggy.  It's likely just start up side effects...But going through this ain't fun



I think it's been long enough now (if memory serves, it's been more than a week now, right?) that you may want to ask your doctor about a change, given the side-effects you've been experiencing. In any case, make sure your doctor is aware of how you've been feeling on the current medications.

If your doctor does decide to go with a change of medications, ask him/her about Luvox (fluvoxamine), which is an SSRI that is known to have better anti-obsessional properties than most. It should be an easy transition from Cipralex to Luvox.

Note: If you do switch to Luvox, be aware that there is some evidence that the generic is not as effective as the brand name. There's no harm in trying the cheaper generic first if you don't have some sort of drug plan but if you do have a good drug plan it might be worth asking your doctor to specify the brand name on the prescription.


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## Kobayashi (Jan 14, 2010)

Thanks Doc - Its been 7 days now at 25mg of Anafranil.  I take it at night. Take my 25mg of cipralex in the am.  First few days it had a calming effect.  I've definitely noticed in the past few days that I'm having increased rumination and feeling generally depressed.  I dhould mention that I felt this way when starting cipralex as well.  I did manage to push through and after a week or so felt much better.  Is that something that could be happening here?  I've read that some people can have increased anxiety etc when starting up TCA's.


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## David Baxter PhD (Jan 14, 2010)

My general feeling is that if you're not seeing a diminishing of the side-effects after 5-7 days, it's probably not just an adaptation effect but rather a side-effect that's not going to go away.

Your doctor may want you to try another week, given your history with Cipralex, but if it seems to be getting worse rather than better I wouldn't be optimistic. Certainly raise the issue with your doctor and see what s/he has to say about it, but I would recommend that you at least ask about Luvox.


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## Kobayashi (Jan 14, 2010)

Will do.  thanks for your input.  As a side note I did great on Cipralex for approx 7 months, with very little OCD and non-existent anxiety.  It helped a great deal while doing CBT.  I started to feel physical anxiety settle in along with OCD in increasing amounts so they upped my cipralex dosage and added risperidone.  Risperidone helped a bit, but it didn't last.  Hoping to find a med as part of the solution here soon.

---------- Post added at 03:44 PM ---------- Previous post was at 01:19 PM ----------

Went to see my GP.  She want's me to stay the course for a few more days with the anafranil.  I see her again in a week.  If I continue to feel crummy, I was told to stop the anafranil and we'll look at Luvox as an option.  She just wants to ensure that we aren't missing a potential window of opportunity with the anafranil.


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## David Baxter PhD (Jan 14, 2010)

Sounds like a plan. Good luck, Kobayashi.


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## amastie (Jan 15, 2010)

David Baxter said:


> .. Not only does that low dose control the blood pressure very well, but I have no side-effects at all. An added bonus is that I went from $80 - $100 per month on the newer medications to a cost of about $16 for a 3 month supply of the current medication.


Good one!  :2thumbs:

---------- Post added at 01:18 AM ---------- Previous post was at 01:13 AM ----------




Kobayashi said:


> ..As a side note I did great on Cipralex for approx 7 months, with very little OCD and non-existent anxiety.  It helped a great deal while doing CBT...


I tried Lexapro - the name for it in Australia - (at least I think I have) but it didn't seem to help me.  After someone else mentioned how much it helped her, I'm gong to talk to my psych about it again, or at least something in the same family.  It would be great to take less Xanax, which is the only med (apart from Valium in the past) which works for me.  I've been on so many and nothing else has ever had a long-term benefit.


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## Kobayashi (Jan 15, 2010)

Eech!  Ok - I'm done with Anafranil.  Feeling even worse.  Now depression has set in...horrible OCD thoughts on the rise.  This ain't good.  Now I get to deal with a double dose of AD withdrawal too.  (Hopefully it isn't that bad as the dose was low and I was on on it briefly).  My instincts are telling me now that this stuff isn't for me.  Too bad - I had high hopes for it.  I'm moving on and will ask to try Luvox next.  Got to love the medication merry-go-round...


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## Kobayashi (Feb 5, 2010)

Ok - So I went back to my Doc today.  I've been having these strange cycles on cipralex.  Two weeks of "ok" and feeling relatively good, followed by a predictable crash into high anxiety and increased OCD.  So I mentioned the Fluvoxamine and she's agreed to give it a shot.  She's prescribed the brand name, not the generic.  So - now I need to taper from Cipralex to the Luvox.  I'm currently at 25mg of the Cip and she wants me to add 50mg of the luvox at bedtime for two weeks and see how things go.  She didn't seem sure if this was a proper tapering schedule, but didn't seem concerned about serotogenic reactions.  

I'm off to Mexico for a week over the March break, and part of me is wanting to wait till I get back to start this change.  Not sure what I'm afraid of - maybe that it will make me worse or something.
Anyone have any insight as to what I might expect with the switchover?

Kob.



David Baxter said:


> My general feeling is that if you're not seeing a diminishing of the side-effects after 5-7 days, it's probably not just an adaptation effect but rather a side-effect that's not going to go away.
> 
> Your doctor may want you to try another week, given your history with Cipralex, but if it seems to be getting worse rather than better I wouldn't be optimistic. Certainly raise the issue with your doctor and see what s/he has to say about it, but I would recommend that you at least ask about Luvox.


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## David Baxter PhD (Feb 5, 2010)

Most people will find it's a pretty smooth transition. In wouldn't expect anything drastic other than a gradual improvement in OCD symptoms over time. You may not notice a profound effect until you're up to 100 mg or greater, though.


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## Kobayashi (Feb 5, 2010)

David Baxter said:


> Most people will find it's a pretty smooth transition. In wouldn't expect anything drastic other than a gradual improvement in OCD symptoms over time. You may not notice a profound effect until you're up to 100 mg or greater, though.



Thanks Doc.  Do you think the cross-taper is ok?  50mg of Luvox AND 25mg of Cipralex?


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## David Baxter PhD (Feb 5, 2010)

I think your doctor is being conservative but that's often a good thing in medicine. 

The risk of any major problems following her instructions is very low, I would say, based on my experience with clients who have made similar transitions.


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## Kobayashi (Feb 17, 2010)

So its been a week on a combination of 20mg cipralex and 50mg Luvox.  I swear - for the first 5 days I felt calmer, less anxious and my intrusive thoughts were slightly diminished.  I know that's unusually quick, but I definitely felt a difference.  Today is day 7.  The past day or two has not been great.  I feel like I've slipped back to where I was prior to starting...anxious, depressed and increased rumination.  I wonder if I could do with bumping up the Luvox?  Problem is, I can't get in to see my Doc until March 1st.  Would it do any harm to increase the luvox say by 25mg?  I have plenty on hand.  I know we shouldn't do these things without Drs consent, but I want to see if this med can give me some benefit by a slight increase.  I know my Doc's plan was to increase the luvox if I tolerated it well.  I've had pretty much zero side effects, except a bit of fatigue and that things have been very "delayed" in the bedroom.  That's likely due to having both cipralex and luvox in my system.  Something I'm willing to live with for now....

Kob.


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## David Baxter PhD (Feb 17, 2010)

Cipralex and Luvox are both SSRIs. I assume your doctor planned to reduce the Cipralex when the Luvox was to be increased.

I think you need to call your doctor's office, either to ask the question or to see if you can move up the appointment.


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## Kobayashi (Feb 17, 2010)

Yes - the plan is to reduce the cipralex, by 5mg increments over time.  Not sure how much the Luvox would be increased.  I tried to move up the appt, but unfortunately I can't get in until March 1st.  I have already reduced the cipralex by 5mg.


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## David Baxter PhD (Feb 17, 2010)

Try calling the doctor's office then for advice. I think the doctor is going to want to decrease the Cipralex further before increasing the Luvox.


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## Kobayashi (Feb 17, 2010)

Darn it.  She's on vacation until the end of Feb, backup is only available at the emerg.  Wish I could find some sort of a cross tapering schedule for these meds.


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## David Baxter PhD (Feb 17, 2010)

Given that your doctor is already trying to taper, you could ask your pharmacist for advice on how to proceed. Does your doctor not have a backup who could answer your questions?

We really cannot give you advice on this here, for legal and ethical reasons, not to mention liability. All I can say is that it's likely not a good idea to unilaterally increase the Luvox without a further decrease in Cipralex, unless your doctor has some reason for wanting you on a higher combined dose right now.


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## Kobayashi (Feb 17, 2010)

Maybe I should just leave things till she gets back.  Trouble is - I really felt an initial positive benefit from the luvox.  I have some ativan which she prescribed for the transition.  I've been taking it very sparingly - .5mg every other day for the past few days.


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## David Baxter PhD (Feb 17, 2010)

I understand. I don't think there's much doubt that you're going to want to increase the Luvox but you don't want an SSRI overdose to complicate your life (Luvox and Cipralex are both SSRI medications).

On the other hand, March 1 is still 6 weeks away. My guess is that if you consulted her backup doctor you would be given advice on the next step to transition from Cipralex to Luvox. That's the route I would take if it were me.


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## Kobayashi (Feb 17, 2010)

Spoke to my Pharm today.  He said that if I wanted to increase it, I'd likely need to go down to 10mg of the cip and up the luvox to 75mg.  I've read on a few other forums that Luvox is one of those typical SSRI's that can cause increased agitation and anxiety when first taking it.  I'm wondering if this is what is happening to me.  Hard to tell because of the combo with the cip.  Hopefully things settle down in the next few days.  I'm going to try and push through this one and use ativan sparingly as required.  When I started cipralex I felt something similar for the first week or so, this is very reminiscent.  Maybe its a good sign.  I think I'll stick with the dose as prescribed until the 1st unless things get really out of hand....


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## Kobayashi (Feb 22, 2010)

Hey All..

So here's where I am so far.  The high anxiety I was experiencing subsided slightly over the weekend.  Actually managed to get some skiing in with the kids.  As of Saturday I was 12 days on Luvox at 50mg and have cut my Ciprlex down to 15mg.  The next step according to my Pharmacist is to go down to 10mg of Cipralex and up the Luvox to 75mg.  So I did this last night and have felt a slight increase in anxiety again today.  Not sure If I got my timing right on this transition...I'm scheduled for a weeks vacation on Mexico in early March.  I'm hopeful that things settle down before then.


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## stringbean (Dec 21, 2010)

hi there its been a long time for me as been on ocd uk forum as well but find this site better re the meds info. I also have the same problem as Kob(hope you dont mind me calling you that) I have great results with cipralex for a few weeks then crash again for a few weeks.
My Doctor lowered it from 20mg to 10mg and again felt great for a month but then bam and now i am trying to top it up with 10mg of anafranil to see if that works? Trouble is i feel like my nerves are shattered on meds or off them and feel like i am having a breakdown, i keep hoping tomoroow will be better.


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## Kobayashi (Dec 23, 2010)

Hi There.

Unfortunately, I haven't yet found a solution.  My latest regimen that I've been following for about 6 months is 100mg of Luvox and .5mg of risperidone.  I also use ativan.  I'm the same as you - I'll feel great for a month, then feel bad for a month.  Its a predictable cycle.  I'm wondering if there is some cyclothymeia involved.




stringbean said:


> hi there its been a long time for me as been on ocd uk forum as well but find this site better re the meds info. I also have the same problem as Kob(hope you dont mind me calling you that) I have great results with cipralex for a few weeks then crash again for a few weeks.
> My Doctor lowered it from 20mg to 10mg and again felt great for a month but then bam and now i am trying to top it up with 10mg of anafranil to see if that works? Trouble is i feel like my nerves are shattered on meds or off them and feel like i am having a breakdown, i keep hoping tomoroow will be better.


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