Posted by bleauberry on July 19, 2009, at 13:48:04
The following is based on patient descriptions and ratings at askapatient.com. There will be some built-in bias in any specific sample population, so I was more curious of trends than actual numbers. MAOIs in this list, but Parnate and Nardil scored in the 4's.
On a 1 - 5 scale, patients rated their meds. Most common antidepressants have an average rating of 3.1 to 3.8. Ranking from best to worst were:
Parnate 4.2
Nardil 4.1
Desipramine 3.8
Zoloft 3.4
Prozac 3.4
Nortriptyline 3.4
Lexapro 3.3
Luvox 3.3
Paxil 3.1
Effexor 3.1
Remeron 3.1Back to the title of this thread.
A closer examination of Nortriptyline was performed, separating the ratings of patients who tried it for depression alone, anxiety/panic alone, or both together. Patients using Nort for Fibromyalgia, migraines, pain, and other conditions were weeded out to focus on depression/anxiety/panic. Nortriptyline's scores in those categories:Depression alone 3.3
Anxiety/Panic alone 4.1
Depression and Anxiety together 4.2Patients who had depression without anxiety had an average chance of success with Nort compared to other ADs, with a score of 3.3 which was better than Effexor or Remeron.
Patients who had just anxiety/panic did surprisingly well with Nort, better than most of the commonly prescribed meds for anxiety/panic, with a score of 4.1.
Patients who had depression with anxiety at the same time did the best at 4.2, which is right in line with MAOIs.
When was the last time anyone heard of a doctor prescribing Nortriptyline for anxiety/panic? Paying attention to the trends of patient side effect comments, Nort appeared to be significantly easier to tolerate than SSRIs and I do not recall seeing sexual dysfunction mentioned even once.
As with all meds there were a few cases of outright failures where patients commented it was the worst med ever. Others, best med ever.
An interesting sidenote is how old-timer Desipramine performed better than any common med by a good margin, second only to Nardil and Parnate.
I became interested in this because I have been on a very low dose of Nort for a short time. Lyme aches and pains improved 90% beginning day 2, anxiety/panic/social nervousness/social withdrawal/waking nervousness/fearfulness/paranoia kind of stuff is a mere whimper compared to what it was in such a short time. I was surprised to see how many people found Nort a great med for anxiety/panic in addition to depression, but most especially for those with both conditions.
Anyway, I had two reasons for doing all the calculations and posting this:
1. For the potential benefit of those patients who are having difficulty in the anxiety/panic area and not happy with their SSRI/benzo/antipsychotic experiences for whatever reasons.
2. To present a reminder that options exist which are not commonly prescribed, but are time-tested, cheap, and in many cases better tolerated. There is a promising world outside the arena of the "newer better" meds.
poster:bleauberry
thread:907493
URL: http://www.dr-bob.org/babble/20090709/msgs/907493.html