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Amitriptyline experiences and Mirtazapine thoughts

Posted by Mtom on August 2, 2020, at 11:42:42

In reply to Would like to hear all Amitriptyline experiences, posted by Mtom on August 1, 2020, at 11:38:43

Thanks. Adding more food for thought (this is long, sorry):

I forgot that TCAs can prolong cardiac QT interval and sometimes cause other cardiovascular irregularities. I take Hydroxychloroquine (for Lupus, not Covid!) which can also prolong QT interval. Although interestingly, this was not generally considered a common adverse effect until it became widely publicized in regards to trials of HCQ for Covid. However those where prolonged QT interval was observed seem to have also included Azithromycin which can also prolong QT interval. (As an aside, as QT prolongation seems to be a rather uncommon, even rare, event with Lupus and Rheumatoid Arthritis patients on long-term hydroxychloroquine therapy, I wonder if not only the combination with Azithromycin but also the fact that these drugs were mostly administered to the most severely ill COVID patients who were often either elderly or had comorbidities associated with CVD and may have also been experiencing additional heart damage due to the illness might have contributed to a much higher occurrence of QT prolongation than is commonly seen in Lupus and RA patients on HCQ).

Anyway, sorry for the digression, back to antidepressants. Mirtazapine can also potentially prolong QT interval (risk compared to TCAs unknown?), and as I was on Hydroxychloroquine (for 20 years) when I started Mirt, my doctor did an EKG just before, and several months after starting Mirt all was fine.

However TCAs also are documented to potentially cause other detrimental cardiovascular effects.

The study I linked in my OP did not include Nortriptyline as one of the 21 antidepressants reviewed. Im guessing this is because there were insufficient studies comparing it to other ADs. Ive been trying to research it, and some articles state it is generally better tolerated than Amitriptyline (as pointed out by SLS above). However many hits show it being used for neuroleptic pain, rather than depression. One article noted that older research had found it less effective than Amitriptyline for depression.

I have found Mirtazapine more tolerable than SSRIs, at least at low doses, and with some efficacy although inconsistent, better weeks alternating with worse weeks. When I increased my dose hoping to achieve better efficacy, anxiety (and some other side effects) increased (similar to SSRIs although somewhat less intense) and I had to decrease dose. I attributed this to increased norepinephrine activity associated with higher doses of Mirt. But I had also still been taking Escitalopram, though at very low doses, and it like other SSRIs increased my anxiety, which was partially offset by lower doses of Mirt. I have recently weaned off Esc and am thinking that perhaps this will allow me to increase Mirt to a more consistently therapeutic dose with less chance of anxiety exacerbation?

Although that study showed Amitriptyline as the most effective AD, reading about all its adverse effects is giving me second thoughts....




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