# Cipralex and Anafranil



## stringbean (Dec 31, 2010)

hi all, 
Sorry not been on here for a while but thought i would post and let you know what has been happening.

I was getting very odd effects on cipralex after feeling good on them and reducing to 5mg had a relapse and had to work my way up to 20mg! after the awful side effects i then settled for a couple of weeks and felt okish but then had terrible anxiety. My Dr said he thought i was over medicated and reduced to 10mg which helped for six weeks but then the old ocd started poking me again.

Anyway he has now prescribed me 10mg of Cipralex AND 25mg anafranil but i am concerned. Is this ok to take together?
 I know that i will get an honest reply, does anyone else take this combination?

Thank


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## forgetmenot (Dec 31, 2010)

No i was on cipralex and had to go off it but if you are concerned ask your doctor okay or better yet as pharmacist   I am sure if there were any concerns either would have told you before starting you on it.  You doctor seems to understand what he is doing but your pharmacist is a good person to discuss your medication as well too.  Each person is different so perhaps give it a try and see what happens right  take care


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## Retired (Dec 31, 2010)

Cipralex (Lexapro) Serotonin Dual Action Antidepressant and Anafranil (Tricyclic antidepressant): potential moderate interaction (Medscape Interaction Checker)

Lexapro Oral and Anafranil Oral may interact based on the potential interaction between SSRI'S; SELECTED SNRIS and TRICYCLIC COMPOUNDS

MECHANISM OF ACTION: Selective serotonin reuptake inhibitors and duloxetine and milnacipran impair oxidative hepatic metabolism. These agents may lead to a more rapid down regulation of postsynaptic beta-adrenergic receptors, thus possibly contributing to a faster onset of the antidepressant effect of other agents. 

CLINICAL EFFECTS: Concurrent administration of a selective serotonin reuptake inhibitor, duloxetine or milnacipran with a tricyclic compound or trazodone may result in an increase in serum levels, toxicities, and/or clinical effects of the tricyclic compound or trazodone

PATIENT MANAGEMENT: Patients should be observed for increased adverse effects and clinical effects of tricyclic compounds at the initiation of concurrent therapy with selective serotonin reuptake inhibitors, duloxetine or milnacipran. Plasma concentrations of the tricyclic compound should be monitored and the dosage adjusted accordingly. 

If selective serotonin reuptake inhibitor, duloxetine or milnacipran treatment is discontinued in a patient receiving a tricyclic compound, the dosage of the tricyclic compound may need to be adjusted. 

Have you discussed your concerns with your doctor?


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## stringbean (Dec 31, 2010)

no i havent as he told me to add the anafranil so wasnt that worried but then thought i should make sure so came on here! I have been taking 10mg for a week and just upped to 20mg the last few days (anafranil). Sorry to be so dense but can you advise what that means above in laymans terms as  cannot work out what i should be looking out for?

Thanks in advance

---------- Post added at 05:25 PM ---------- Previous post was at 05:23 PM ----------

Thanks spirit, did you mean you were on cipralex and had to go off it to go on anafranil? if so what worked best for you?

---------- Post added at 05:26 PM ---------- Previous post was at 05:25 PM ----------

oops posted reply on wrong place, thanks for replying did you mean that you were on cipralex and had to come off it to start the anafranil, is so what worked best for you.


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## forgetmenot (Dec 31, 2010)

i went off cipralex because of side effects but no i was put on wellbutrin which has been effective for me without so many side effect  still have some but not as intense  take care


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## Retired (Dec 31, 2010)

> can you advise what that means above in laymans terms as cannot work out what i should be looking out for?



If you begin experiencing adverse reactions, that is, side effects that make you feel uncomfortable such as dery mouth, constipation, dizziness excessive drowsiness, advise your doctor as dosages may have to be adjusted.  Your doctor may order blood tests to adjust the dosage and if the Cipralex is stopped, the dosage fo the Anafranil may have to be adjusted because the Cipralex may have affected how the Anafranil was being absorbed.


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## stringbean (Jan 1, 2011)

*Anafranil query*

Hi all, just wondered if someone can advise.
I was having a hard time with ssris so my dr cut the dose in half and put me on anafranil as well, i took 10mg for a week and although it didnt do much i felt a bit better but then after a week i upped to 20mgs - that night i got a bit anxious i,e. what if i get bad side effects etc but managed to calm myself down, then i went down with the flu
and had to have two days in bed and really felt ok ocd wise and anxiety but yesterday first day up went to work and although felt bad with a cold thought ' blimey i feel okish' then get home and start feeling awful, worried about the drugs, worried that i am going to lose my mind/contol???Today woke after a restless night and its sort of shifted to one minute being in the depths of i am feeling ill and i will never get better to swaying i feel ok and it will get better.

Does anyone think its just me bringing on these symptoms or is it the drugs, so scared as want these to work. :crybaby:


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## David Baxter PhD (Jan 1, 2011)

It rather sounds like you are getting carried away with obsessive worrying. Can you make an appointment with the physician who prescribes your medications to discuss this further?


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## stringbean (Jan 1, 2011)

Thanks David, will do but its weekend and bank holiday on monday so thought i would post something here to see if i could get some advice.
Think you are right talking myself into a lot of it and i think combined with the increase of drugs its making it worse. I must say i had very little side effects on the 10mg of anafranil whereas was worried as had so many bad side effects when starting on ssris.


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## David Baxter PhD (Jan 1, 2011)

It's most likely just the flu and worrying.

I started a medication about a year ago and stopped after about 3 days because I had flu-like symptoms which were getting worse (they vstarted on day 1) and that was one of the listed side-effects.

It turned out I had the flu.


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## stringbean (Jan 2, 2011)

Thanks David. I think i mislead the post a bit, wasnt worried that the flu was a side effect. I realised the cold/flu was due to a virus. I was more worried about the swaying from oh god i feel ill(mentally) to i will be ok but do you think it could be to do with the upped dose and the brain chemistry adjusting itself again?


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## David Baxter PhD (Jan 2, 2011)

stringbean said:


> I think i mislead the post a bit, wasnt worried that the flu was a side effect. I realised the cold/flu was due to a virus.


 
No, I understood you. I was simply giving you an example from my personal experience of how easy it is to attribute symptoms to a medication that have nothing to do with the medication.


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## stringbean (Jan 2, 2011)

*anafranil another query*

just wondered if someone could advise if this is normal when upping a dose of this drug.

Take 20mg at night 9pm our time, sleep ok, dont feel over tired etc, but since starting this dose (day 4 at the moment) feel like the most of the day my head isnt really there, bit disconnected and then get waves of oh god i dont feel right, i am not going to get better etc then about 7pm start to feel ok and that its all going to be ok?

Anyone else know what i mean? any advice appreciated


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## David Baxter PhD (Jan 2, 2011)

_{threads merged}_

You may feel some dizziness or lightheadedness with Anafranil, so that could be contributing. Also, although this is not a listed side-effect*[1]*, in my experience when one is adapting to this sort of medication some feelings of derealization or depersonalization may occur: These usually don't last more than a few days.

And of course, the symptoms could also be the direct result of anxiety or excessive worrying about side-effects.

If the symptoms persist, call your doctor and ask him/her for an opinion.

_Added:_

*[1]* Actually, depersonalization is listed as an infrequent side-effect for Anafranil.


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## stringbean (Jan 4, 2011)

hi David, do you know if feeling emotionless is one of the symptoms? i am not really a highly emotional person  but was watching something on tv out of the corner of my eye while on the computer, and the subject would normally make me cry but felt nothing. I am now worried that i am not feeling anything but then i suppose if i am worried i am not feeling anything~ i am feeling??????


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## Andy (Jan 4, 2011)

Sorry I know you were talking to Dr.Baxter, hopefully you don't mind my input. 

Sometimes when you increase a medication at first it can make you feel a little dull. That should go away as you adjust to the new dose and obviously if it doesn't then you need to speak to your doctor because you don't want to feel void of emotion, that defeats the purpose.  If I am correct you are on day 5 or 6? Maybe give it another week or two unless it is to bothersome of course. 

That's just my 2 cents. I hope you get to feeling better with those feelings intact.


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## stringbean (Jan 4, 2011)

bless you, thank you so much. I am having a terrible time today and any advice welcome. Think my ocd has got hold of the symptom side and worrying about the medication as well.
I wake up dreading how i am going to feel which just fuels the ocd and then start going down the route ' oh my god have the kids to look after, what if i am a pshycopath and dont feel anything, I might do something and hurt them' an internal battle ensues and the depersonalisation etc.
But i do think i am expecting miracles as it is only day 6 but yesteday started like this and it ended ok so forever hopeful. Thank you again


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## stringbean (Jan 4, 2011)

*does anyone feel like this? with anafranil (Dr Baxter sorry if i should have merged t*

Hi all, have had a really bad time with ocd and anxiety due to this for on and off a year, this all started when i reduced my dose of meds from 15mg of cipralex to 5mg and all of a sudden the relationship doubts in ocd came back with avengance! i then tried to up my meds but they worked on and off but in the end my anxiety was worse becuase of or despite them! My Dr has spoken to a consultant and he recommended that i try half the dose 10mg cipralex and 25mg of anafranil which i have done. I started with 10mg and of the anafranil as so scared to start on the higher dose and had very little side effects at all but did feel a little better! then after a week upped to 20mg which i have been on for five days! I wake up with a headache and feel like mentally anxious(not physically if that makes sense) thoughts going in and out of my head etc, going to lose control or go crazy. Then about 12noon feel a lot better and start to feel ok and normal phew, then about three start to go down hill and here i am at 7pm on here not knowing what to do! 
I have read that this drug can make you feel worse before you get better, can anyone please advise.


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## David Baxter PhD (Jan 4, 2011)

Threads merged again. Stringbean, you've provided information in this thread which will help other members to reply. Instead of sytarting new threads, just use the "Reply to Thread" feature in this thread.

I think you should also contact the doctor about your experiences with Anafranil. Asking other people about side-effects can only get you so far; all we can do is say "it's possible" or "it's not very likely" or "yes, that's a known common side-effect" but none of that takes into account your personal medical history and how you have reacted to other medications. Your doctors will know these things; we don't.


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## stringbean (Jan 4, 2011)

ok will do, its just difficult as you cannot get hold of a Dr in the UK when you need one and sometimes these sites are a bit of a lifeline! You sort of hope that someone is going through the same thing(sad I know) but i have just read on a search engine that Anafranil combined with ssri can double - tenfold the effects and also that you can expect the depression or anxiety disorder to get worse on this drug before it gets better! Great, I am not taking as much tonight will half the dose, dont think i can face the after effect.


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## AmZ (Jan 4, 2011)

Hi Stringbean...

Definitely is one of the doctor. Make sure to ask. And like is always highly recommended in all cases, don't change the dose of the medication/s without speaking to your doctor about it beforehand. 

I know that I am good at dishing out advice to others and not doing the same myself, but take it from me, it's the best thing you can do and probably the _only_ thing you should do ideally. 

Wishing you better.

All the best


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## David Baxter PhD (Jan 4, 2011)

stringbean said:


> i have just read on a search engine that Anafranil combined with ssri can double - tenfold the effects and also that you can expect the depression or anxiety disorder to get worse on this drug before it gets better!


 
Be very careful. Where did you read this and how valid is that information? Most of what is on the 'net about medications is utter trash and nonsense.


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## stringbean (Jan 4, 2011)

thanks Amz, and Dr Baxter. I did look on the website by the makers and although it wasnt as blunt it did say increase in symptoms in depression or anxiety disorder at the begining of treatment and also that combination can make the potency 2 to 10fold. But will speak to my Dr tomorrow, thanks for your help


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## David Baxter PhD (Jan 4, 2011)

That would generally apply to people just starting medication, though, if at all. You're already taking medications; this is just a change in dose.


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## Retired (Jan 4, 2011)

The question of potential for interaction between and SSRI and a Tricyclic, specifically Anafranil was addressd in post #3 of this thread with follow up comments in post #6.  As was stated there is moderate potential for interaction depending on the combination of compounds that might be prescribed.  The physician should be of this and would likely order blood tests to monitor the situation.

The interaction takes place in the liver, where the SSRI might impair the metabolic process of the tricyclic.


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## stringbean (Jan 6, 2011)

oh right, I have only just started the anafranil on Monday 20th December til 31st December  (10mg)  so that was for   and it wasnt until i upped to 20mg which i have been on for six days that i had problems and have been on that dose a week. I suppose really i have only been on them for less than three weeks.


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## forgetmenot (Jan 6, 2011)

you don't change your dose with out your doctors approval  it will send your levels all over the place  Call whoever it was that ordered these meds for you and explain what is happening.  If you cannot get a hold of your doctor then talk another doctor covering.   Please do not tamper with your med dosages it will only interfer with the doctors ability to help you   hugs


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## stringbean (Jan 6, 2011)

Thanks spirit, my Dr wanted to start me on 25mg but because of my history with side effects we compromised on 10mg and then was to up them but due to the tablets only coming in 10,20 and 50mg had to go straight to 20mg. I managed to speak to a Dr yesterday and they said to take 10mg one day and 20mg the next for a week or two. Unfortunately as they are capsules that's all i can do and hope for the best.

thanks for all your support


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## forgetmenot (Jan 6, 2011)

Glad you spoke with your doctor  let us know how the meds work out okay


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## stringbean (Jan 6, 2011)

Thanks Spirit, will say the mental anxiety is still very high and feel on the verge of loss of control but know thats just me worrying! I am just going to relax tonight with a glass of wine, they say it can make you more drowsy but prepared for an early night.

Your support is very much appreciated, i hope to report that i am feeling much better very soon


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## stringbean (Jan 13, 2011)

just a quick update. I am now up to 20mg (woo hoo) and have been for a few days and although i still feel the same i.e. periods of mental anxiety and feel like i am on the edge of losing it, i think i can recognize it as part of the general anxiety specture. I also had an appointment with a cbt person last week and told me that General anxiety can run hand in hand with ocd so appeased abit. Also have a appointment with a psychiatrist in two weeks so going to get up to the 25mg the dr recommended me to and hopefully speak to him then re long term treatment and prognosis. At least j know i am doing all i can and I WILL GET BETTER !!


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## Retired (Jan 13, 2011)

*Re: Anafranil query*



> i am doing all i can and I WILL GET BETTER !!



Thanks for the update, and do keep us posted on your progress.


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## stringbean (Jan 19, 2011)

another update. 
I have had two brilliant days where its all been improving but today a bit of a set back. I have now upped to 25mg and its been ok but today the third day have had the same effects i had when i started it or upped from 10 to 20mg. Feel like my hearing and sight is very sensitive and in a meeting to day at work i was panicking and could only concentrate on these factors - sure its to do with the brain sorting out again the chemistry but did allow myself to go down the obsession route of oh no i am going crazy! 
But I WILL GET BETTER - watch this space


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