Posted by JohnL on December 6, 2000, at 3:17:45
In reply to Need info on Anafranil, posted by Lin on December 5, 2000, at 18:58:37
> I am bipolar/ADD and currently take lithium, zyprexa, and dexadrine. For various reasons, I have been unable to take most ADs. The SSRIs caused mania, Serzone didn't touch my depression, and Effexor caused sexual dysfunction. Tonight, my MD suggested Anafranil. It is one of the only drugs that I know nothing at all about. CAn anyone here enlighten me? Thanks a lot! Lin
Hi Lin,
Anafranil is a serotonergic tricyclic antidepressant notorious for causing sexual dysfunction. I've tried four tricyclics--Nortriptyline, Desipramine, Anafranil, and Protriptyline. Of them all, Nortriptyline and Desipramine have the fewest side effects (mostly dry mouth and constipation). Nortriptyline might be better if insomnia is a problem, since it is slightly sedating. Desipramine might be better if daytime stimulation is desired. As for your depression, one should work if the other doesn't. Desipramine probably has the lowest chance of causing sexual dysfunction. No guarantees though. To further muddy the waters, the tricyclics are more apt to spark mania than other antidepressants. Again though, no guarantees. Just slightly increased odds, that's all.In general either Desipramine or Nortriptyline are easier to handle than Anafranil and are less likely to cause sexual dysfunction. In clinical trials Amitriptyline was discovered to be the only one significantly more effective than any of the others. But its side effect profile is harsher than the others and is not tolerable by many people. Desipramine or Nortriptyline I think are your best choices, not Anafranil. Of the two I think Desipramine would be least likely to cause sexual dysfunction. Some of the tricyclics (including Nortriptyline) have a therapeutic window. Desipramine is one that doesn't. Therefore you could take varying doses without worrying about whether you are inside a window or not.
I'm just thinking out loud. As I do so, I seem to have arrived at the conclusion that Desipramine is the best bet. Considering your sensitivity and sexual dysfunction with ADs, I cannot even imagine why the doc suggested Anafranil.
Johnps...Just more food for thought. In the back of my mind I also thought about Tegretol. It is a mood stabilizer with anti-manic and anti-depressant potential that has a chemical structure very similar to the tricyclic antidepressants. The mild stimulant Adrafinil could be very helpful to you, with few (if any) side effects. It is used for alertness, mental cognition, vigilance, motivation, and antidepression. It goes real well with APs like Zyprexa, and also goes well with Adderall (personal experience). It is a different arena though, since you would have to mailorder it yourself instead of having the doctor prescribe it. Given the higher level of side effects of Anafranil or any other drugs, I really like Adrafinil (not to be confused with Anafranil) as a top choice. Just my experience in personal trials.
poster:JohnL
thread:49993
URL: http://www.dr-bob.org/babble/20001130/msgs/50025.html