Posted by sukarno on March 19, 2010, at 22:35:49
In reply to Re: Starting Pristiq, posted by g_g_g_unit on March 19, 2010, at 21:21:42
"i have a friend who was on an SSRI for four years, and now battles with concentration difficulties,"
I'm thinking we need to bring back the TCAs as first-line therapy as these SSRIs seem to cause too many problems for too many folks. Concentration difficulties, anhedonia, apathy, loss of motivation, etc.
The secondary amines such as nortriptyline and protriptyline have less side effects than tertiary amines (e.g. amitriptyline, clomipramine, imipramine). Lofepramine is said to have even less side effects as it is a third generation TCA, but it is only available in the UK unfortunately.
I've never met anyone on a TCA who felt anhedonic or apathetic. Weight gain and sexual dysfunction are also rare on TCAs. TCAs such as nortriptyline tend to enhance cognitive function and are used to treat ADD when the patient cannot tolerate CNS stimulants or Strattera.
If the dosage is started up slowly and proper precautions are taken such as a pre-treatment ECG/EKG, glucose monitoring, evaluation for structural heart disease/defects, etc, tricyclic antidepressant use is quite safe.
SSRIs themselves also are cardiotoxic as they prolong the QT interval. I think a lot of doctors exaggerate the side effects of TCAs in order to promote the on-patent SSRIs.
There is also a mistaken belief among pdocs that "old drugs don't work" or don't work as well as newer drugs. Hogwash. :-)
poster:sukarno
thread:939241
URL: http://www.dr-bob.org/babble/20100318/msgs/940124.html