Norpramin (nor-PROM-in, nor-PRAM-in)

Generic name: desipramine (dez-IHP-ra-mean)
Clinical uses: treatment of depression, cocaine withdrawal, bulimia
Class: tricyclic
Chemical formula: C18H22N2
Possible side-effects: sedation, nausea, change in weight, change in libido, hypertension, impotence

To the best of my knowledge, Norpramin is rarely prescribed for depression these days. Doctors do administer tricyclics to patients who do not respond to SSRIs and atypical antidepressants; however, they'll usually start with some other drug first (such as Elavil or Tofranil), in part because Norpramin doesn't have the sedative effect that makes these other tricyclics useful. Nonetheless, a patient might still receive Norpramin if s/he didn't respond to common antidepressants but couldn't tolerate any kind of sedation.

Once upon a time, in my wild and woolly days, I was mentally hospitalized for depression. I've been depressive all my life, and had had a few episodes before that particular hospitalization. I had been on Prozac for a few months before this particular stint in the clink, so they decided that Prozac wasn't doing it for me. They started me on Norpramin.

Now, the thing about the these old-fashioned tricyclic antidepressants is that they require a certain blood concentration to be theraputic. So every couple of days, they did a blood test on me, to determine whether they should bump up my dose.

For the first few dose increases, my blood levels went up. But after that, they plateaued, and even decreased despite further hikes in dosage. They thought I was palming the pills or throwing them up (a commonly seen tactic in such fine institutions). But I took every last one of those pills, for fear that they would start force-feeding them to me, if nothing else.

Eventually they also put me on lithium, which has a synergistic effect on the theraputive action of tricyclics. Man, did lithium suck. My handwriting has always been abysmal, but lithium made it unintelligible.

They got some outside advice on my case, and eventually found out that a small portion of patients (such as yours truly) have a genetic ability to metabolize tricyclics extremely quickly. The problem is that the metabolites are what cause the side effects. So I was being non-theraputically dosed, but had a huge blood concentration of nasty, health-threatening partial metabolites. I had a resting heart rate of 120, and my vision would black out when I stood up quickly. And constipation like you would not believe.

So they gave up on the Norpramin and put me back on Prozac. Kept me on the lithium, though, for no good reason that I could discern. I've never been even vaguely bipolar. But on those meds I stayed for a good several months after I got out.

In the end, all the medicine in the world never helped me. I got better when I decided to get better, and when I learned the coping mechanisms which help me recognize depressive episodes when they occur, and how to keep my life together and reasonably functional until the mood passes.

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