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Re: Smoking - Core Symptoms Depression - Selegiline » SLS

Posted by zeugma on October 17, 2005, at 18:45:23

In reply to Re: Smoking - Core Symptoms Depression - Selegiline » rod, posted by SLS on October 16, 2005, at 18:05:13

Actually, in my mind, it is reasonable to combine a derivative of imipramine (clomipramine) with a derivative of amitriptyline (nortriptyline). These two series of drugs are different enough to produce different responses in the same person.>>

Hi Scott,

This is a fascinating point to my mind at least. I have had numerous discussions with my pdoc, the upshot of which, as you have heard, is that nortriptyline and desipramine are essentially identical and that clomipramine is equivalent to a combination of nortriptyline plus SSRI.

I don't think he is being unreasionable in this (he said it was not from a theoretical point of view that the two drugs were almost indistinguishable but in terms of clinical effect) but I am very curious as to how you would differentiate the amitriptyline series from the imipramine series experientially. What would adding an imipramine derivative contribute, in terms of desired effect?

I also tend to think that medications produce some of their effect from our using the perturbations they make in our CNS to productive results. I am watchful for signs of perturbations during med trials, because there are some perturbations (e.g., the slight slowing effect of Provigil) that can be used productively, and others which are not useful at all.

Interestingly, the medications that I tolerate best emotionally and cognitively (not necessarily physically) are those that produce a slowing effect. The first glimmer of therapeutic response I got from nortriptyline was that my mind was slowing down slightly, allowing me to perceive things as less of a blur than usual. I wonder if this is a trait of the amitriptyline series generally, or is an idiosyncratic response.

-z


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