Can I temper cardiac effects of imipramine with Toprol ?

Hello there, just back after a little over a year on Effexor for moderate chronic endogenous depression. I originally got on it in order to straighten out cardiac irregularities.(tachycardia,premature beats.)I had been on maintainence doses of imipramine for over 25 yrs. and it controlled all of my symptoms perfectly. But, after 40, it seemed to really start to beat up on the cardiovascular system. Six months into Effexor my cardiovascular problems had actually become more severe. 50mg. of Toprol per day was prescribed and after a period of a few months it straightened out everything...heart rate, premature beats, even blood pressure. Problem was, Effexor is a vile little drug, it made me hover somewhere inbetween a comfortable numbness. No tears, but no enjoyment either, just numb. Physically, especially from the waist down.... EVERYTHING NUMB!!! It also has other annoying nueurological and gastrointestinal side effects that are very compromising. The reason I call it "vile" is because it's long term action and some side effects take time to creep up and slowly destroy most of your mood. "Insidious" is a better word. This is probably a good drug if your bed-ridden and senile. SSRI's are out...they clean out my tract faster than bottles of citrate of magnesia, not to mention the swirling dizzyness, total destruction of libido. No sir, it's only imipramine for me, 3 weeks and I'm alive again. Something "non-selective" in that little red pill cures me better than anything.
    Now for the problem, I'm only putting down a scant 60mg of imipramine per day...and it's bashing the depressive symptoms to smitherines. Heart rate is up avg. 92 bpm. @ rest. BP avg 129/90.
Would increasing the Toprol supress the action of the imipramine, giving me the best of both worlds...normal heart rate, BP, with no depression...??? Sure I have Doctor's here....they're all guessing, just like me....suggestions..???

[Roger Gould, M.D.]

You are on a low dose of Toprol, and increasing your dose slowly and carefully monitoring the cardiovascular effect is a reasonable course of action.  A very small percentage of people (less than 5%) report some depression with Toprol, but that should not be a problem for you because of the imipramine.

[JoesBrain]

I was really looking for an answer to a different question. I seem to be stabilizing myself on only 50mg. of imipramine. But even at this low amount it is pushing my cardiovascular system, even though I am already on 50mg. of Toprol. I'm particularly concerned more so about the tachycardia. After months of therapy (on imipramine) it gradually begins to disturb conduction causing lots of PVC's. My question is....In a battle to slow the heart down ....if the dosages are tweaked just right ....will the beta-blocker buffer the cardio-cranking effects of the TCA..imipramine.??? Or, in a scenario that I want to stay on imipramine, are there other cardiovascular agents that can buffer these side effects..???

[JoesBrain]

Comment By: JoesBrain on Thursday, May 03, 2001


       I was really looking for an answer to a different question. I seem to be stabilizing myself on only 50mg. of imipramine. But even at this
       low amount it is pushing my cardiovascular system, even though I am already on 50mg. of Toprol. I'm particularly concerned more so
       about the tachycardia. After months of therapy (on imipramine) it gradually begins to disturb conduction causing lots of PVC's. My
       question is....In a battle to slow the heart down ....if the dosages are tweaked just right ....will the beta-blocker buffer the cardio-cranking
       effects of the TCA..imipramine.??? Or, in a scenario that I want to stay on imipramine, are there other cardiovascular agents that can buffer
       these side effects..???