Posted by SLS on August 16, 2008, at 13:36:14
In reply to Re: Nortriptyline vs. Desipramine » SLS, posted by Bob on August 16, 2008, at 12:22:58
> > > Why does Nortriptyline seem to be a more popular choice of AD than Desipramine, considering that the latter might be considered a slightly cleaner or more pure norephinephrine enhancer than Nortriptyline? There are recommendations for combining Nortriptyline with SSRI's, but I haven't really seen the same for Desipramine.
> > Sometimes "dirty" is better. Unlike desipramine, nortriptyline blocks 5-HT2a/c receptors in addition to being a modest 5-HT reuptake inhibitor. I find nortriptyline to be a more pleasant drug than desipramine. Desipramine is certainly a good drug, and many people will respond to it and not respond to nortriptyline.
> When you say that sometimes dirtier is better, are you referring to a definable attribute, or just an unpredictable response for some people with certain drugs? In other words, does the dirtiness have some specific effect that people desire? My main concern here is the possibility of developing intractable sedation with Nortriptyline.
"Dirty" is a popular term to call a drug that exerts effects in addition to its therapeutic activity. They are usually undesirable side effects. So, regarding the 5-HT2a/c blockade, this is not yet fully understood to be a beneficial property, even though I feel strongly that it is. Desipramine is "clean" because it just inhibits the reuptake of norepinephrine.If you have never tried nortriptyline before, it might be soporiphic (sleep-inducing) in the beginnig. I would consider it a startup side effect because it usually disappears.
- Scott
poster:SLS
thread:846648
URL: http://www.dr-bob.org/babble/20080814/msgs/846692.html