Posted by Brainbeard on February 19, 2010, at 6:13:44
In reply to Best first Tricyclic to Try?, posted by bearfan on February 19, 2010, at 3:49:30
I wrote a post that might be helpful to you in this thread (it's the last post in the thread, currently): http://www.dr-bob.org/cgi-bin/pb/mget.pl?post=/babble/20090620/msgs/902389.html#902389
Quoting myself ('->' means: 'metabolizes into [active metabolite]'):
'imipramine (relatively strong, mildly sedative SNRI) -> desipramine (strong NRI). Since desipramine potentially has a half-life of more than hundred hours, and imipramine a half-life of less than 24 hours, the desipramine tends to dominate on higher dosages.
amitriptyline (dirty, sedative, anxiolytic NSRI -> nortriptyline (sedative, anxiolytic NRI)
clomipramine (strong, sedative, anxiolytic SRI and SNRI) -> desmethylclomipramine (NRI). Also with clomipramine, the metabolite has a longer half-life, so on higher dosages the NRI-action is boosted significantly more than the SRI-action. In fact, clomipramine is such a strong SRI that even 10mg is enough to reach the amount of serotonin reuptake inhibition that a typical therapeutic dose of an SSRI delivers (http://archpsyc.ama-assn.org/cgi/content/full/60/4/386).'
It depends a bit on the type of anxiety you have which TCA might work best. If you got OCD of any kind, clomipramine is the drug of choice. If it's more general anxiety, amitriptyline or imipramine might work best. The TCA's are, in my not so humble opinion, superior to the newer antidepressants, but it can be hard to tolerate their side-effects. I like clomipramine a lot, but it makes my eyes extremely, even painfully sensitive to sunlight, which is a real bummer. It also gave me worse sexual side-effects than even Paxil gave me.
Anyway, hope this helps.
Make your day, go TCA!!!
poster:Brainbeard
thread:937358
URL: http://www.dr-bob.org/babble/20100216/msgs/937363.html