Posted by undopaminergic on April 17, 2008, at 21:26:14
In reply to SSRI's vs. TCA's, posted by addinbc on April 14, 2008, at 20:06:24
Small doses of amisulpride or sulpiride generally have few side effects, and they are more likely to stimulate than to induce lethargy. They are only slighly effective against anxiety, but for extra anxiolytic effect, benzodiazepines like alprazolam or diazepam could be added. Unfortunately, if you're in the US or Canada, you would have to order amisulpride and sulpiride over the Internet (they aren't FDA-approved).
Since you don't tolerate Wellbutrin, you may not tolerate modafinil, methylphenidate or amphetamine, but they may be worth trying. In particular, they almost certainly won't make you lethargic or fatigued, and they often have slight to moderate mood-elevating effects.
Selegiline and rasagiline are well tolerated, but they may not have sufficient antidepressive effects. They can at least sometimes potentiate sulpiride, amisulpride and methylphenidate. Also, they may render phenylalanine (an amino acid) effective as an anidepressant - in this case, some pyridoxine (vitamin B6) probably should be added.
The TCAs, except clomipramine, which is very SSRI-like, may always be worth trying. Their side effect profiles differ from that of SSRIs, and some people do tolerate them better.
Of course, MAOIs are often effective, but doctors usually don't like to prescribe them. In general, tranylcypromine is the least likely to cause intolerable lethargy and weight gain. Isocarboxazid seems to have fewer side-effects than phenelzine, but phenelzine is apparently effective in some cases where tranylcypromine fails. Also, you have to avoid certain foods and drugs that may cause life-threatening hypertensive effects when taken with MAOIs. Furthermore, all serotonergic agents should be avoided with MAOIs, as there is a serious risk of serotonin syndrome.
poster:undopaminergic
thread:823321
URL: http://www.dr-bob.org/babble/20080412/msgs/823914.html