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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by sdb on November 21, 2007, at 5:52:36
I've seen people more and more prescribing TCA's again. What's the best TCA in your opinion for depression, anxiety etc. and what's the worst concerning side effects?
warm regards
sdb
Posted by Phillipa on November 21, 2007, at 12:03:22
In reply to TCA's, the best one for you ?, posted by sdb on November 21, 2007, at 5:52:36
sdb why do you think that is? Is it that people poop out on SSRI's and then have to change? Phillipa
Posted by Phil on November 21, 2007, at 12:28:06
In reply to TCA's, the best one for you ?, posted by sdb on November 21, 2007, at 5:52:36
Amitriptyline has very harsh side effects--I took it for 5 years. One good thing about it, I never slept better in my whole life.
You might want to consider Nortriptyline. Desipramine may be too activating.
Posted by linkadge on November 21, 2007, at 14:25:37
In reply to Re: TCA's, the best one for you ? » sdb, posted by Phil on November 21, 2007, at 12:28:06
Yeah, TCA's are making a comeback.
I only tried doxapin, and clomipramine.
They are both wild rides, but I kindof liked doxapin a little better.
Linkadge
Posted by cactus on November 21, 2007, at 16:57:33
In reply to Re: TCA's, the best one for you ? » sdb, posted by Phil on November 21, 2007, at 12:28:06
> Amitriptyline has very harsh side effects--I took it for 5 years. One good thing about it, I never slept better in my whole life.
>
> You might want to consider Nortriptyline. Desipramine may be too activating.I was just told by my sleep specialist to take Amitriptyline because I don't tolerate SSRI's very well. It's for hypnogogic and hypnopompic hallucinations and sleep paralysis which have come back with a vengence since I stopped zoloft for depression. I'm sick of taking drugs that are so harsh on my body. I'm glad I found this post because I don't think I'll take it now. He told me to go get it from my GP
Posted by mav27 on November 21, 2007, at 17:17:28
In reply to TCA's, the best one for you ?, posted by sdb on November 21, 2007, at 5:52:36
I found imipramine to be quite nice, it seemed to have a decent balance to it between effectiveness and side effects. personally i didn't find the side efffects of TCA's to be all that bad, id happpily tak them over ssri side effects any day.
Nortriptyline made me aggitated a lot so i had to give it up and it wasn't really working well for my anxiety anyway. Dothiapin was the more subtle one but i don't thik is available in the US, it's sort of in between nortryptiline and amitripyline(the one that makes you sleep for ever)
Posted by tecknohed on November 21, 2007, at 18:50:47
In reply to TCA's, the best one for you ?, posted by sdb on November 21, 2007, at 5:52:36
Lofepramine definitely! Gone back to it several times. A good (not too strong) NRI effect with a very mild SRI effect too, which is why I think its a better mood enhancer than the newer non-tricyclic NRIs. No sedation at all (for me). If you can't get lofepramine then desipramine would be very similar I imagine - its lofepramine's primary metabolite. Not the best anxiolytic med, unless your anxiety is more fatigue &/or anticipatory related.
Posted by tecknohed on November 21, 2007, at 21:07:17
In reply to TCA's, the best one for you ?, posted by sdb on November 21, 2007, at 5:52:36
Imipramine sounds like one powerfull antidepressant, even said to have opiate & dopaminergic activity: http://en.wikipedia.org/wiki/Imipramine
Posted by stargazer2 on November 21, 2007, at 22:46:18
In reply to Re: TCA's, the best one for you ? » sdb, posted by tecknohed on November 21, 2007, at 21:07:17
Was on this TCA with Nardil for a few weeks, wasn't sure what it was doing other than causing a total lack of saliva, so I backed off it from 75 to 50 and then I totally stopped it. My pdoc will have a fit, he already did when I went from 75 to 50 without his knowledge, but stopping it has had absolutely no effect and I was really bothered by the dry mouth, so as far as I can tell it was not doing a thing or very little.
The Nardil is doing most of everything positive, so I would say Nortriptylline did not do much for me.
My pdoc should be happy because I was the one to show him an article that said TCA's can be given safely with MAO's, else he would never have tried it himself. The things I have convinced him to try have really added to his knowledge of what can be done despite the warnings not to.
Is anyone taking a TCA with Nardil and getting some good effects? Which one and what effects?
Stargazer
Posted by linkadge on November 22, 2007, at 11:54:40
In reply to Re: TCA's, the best one for you ?/ Nortriptylline, posted by stargazer2 on November 21, 2007, at 22:46:18
I think that SLS (an longtime member of this board who doesn't post so much anymore), found relief with a nardil + nortryptaline combination.
He was very TRD, but did well with this combination.
Posted by stargazer2 on November 22, 2007, at 12:23:04
In reply to Re: TCA's, the best one for you ?/ Nortriptylline » stargazer2, posted by linkadge on November 22, 2007, at 11:54:40
Link, actually I knew this and grabbed onto his formula since I had heard it was helping him and he has a reputation as a med wizard. No 2 of us are alike though, but at least we can try when another has a success. So I'm only on Nardil and deplin right now, feels pretty good to know what is doing what.
Thanks...Stargazer
Posted by sdb on November 22, 2007, at 12:55:00
In reply to Re: TCA's, the best one for you ? » sdb, posted by tecknohed on November 21, 2007, at 21:07:17
thanks for your replies everybody.
according to its pharmacokinetic profile someone could take tca's once daily at the evening (correct me, if am wrong). There are also long lasting versions of tofranil (tofranil pm), imipramine
http://www.tofranil-pm.com/ (egg and sweet bird)
and anafranil (clomipramine) available. Not sure about its therapeutic advantages.
of course if someone know of cardiac arrhythmias naturally or after bad events it must be very carefully used if used. Toxicity at high dosages (torsade, widened QRS complexes and marked S-T shifts). But thats only my paper knowledge
warm regards
sdb
Posted by Quilter on November 23, 2007, at 0:49:22
In reply to Re: TCA's, the best one for you ?, posted by sdb on November 22, 2007, at 12:55:00
I did well on a combination of Surmontil (trimiprimine) and Cytomel for several years.
Quilter
Posted by brooke484 on November 23, 2007, at 10:19:47
In reply to Re: TCA's, the best one for you ?/ Nortriptylline, posted by stargazer2 on November 21, 2007, at 22:46:18
Stargazer,
When did you really notice that Nardil was helping you? I know you've been on it awhile. I was hoping to stick with it but could never go above 45 mgs without feeling 10 times worse than I already did. Just curious.
I'm on week 9 of Marplan (5th week on 30 mgs) but it isn't doing anything yet.
Thanks,
Brooke
Posted by stargazer2 on November 23, 2007, at 15:33:51
In reply to Re: TCA's, the best one for you ? - stargazer2, posted by brooke484 on November 23, 2007, at 10:19:47
Hi Brooke...
I started Nardil in May of this year. I had an immediate response after about 5 days at 30 mg but I was also on Abilify 2.5. This initial response was only for a week or so. Nardil was increased to 45 in June, ankles became swollen and resolved in 3-4 weeks. I was still on Abilify at 10 mg and then mid June, Wellbutrin 150 SR was added. On July 6, Abilify was d/c'ed per my request. The Wellbutrin was increased to 300 but was the Budeprion brand and I was very unsure of this brand. The end of July I was very depressed again.
In July I pondered the addition of a few other meds to give me energy and focus, such as Strattera, Adderall or a TCA (Nortriptylline of Desipramine). I initially tried generic adderall since I had some lying around. I tried 5 mg initially, but had extremes lows in my BP, recorded at 75/45, next day normal BP, but a pulse of 44. And then I did a dumb thing by increasing my amphetamine to 10 mg, which preceipitated a hypertensive reaction, so all
amphetamines were stopped. They are contra indicated anyway but did something at 5 mg to increase my energy.In mid August I added Nortriptylline 75mg at bedtime to the Nardil to see if this would decrease the depression. I also began Synthroid 50 mcg after seeing an endocrinologist to evaluate my TRD.
Mid September, had some improvement in my depression and felt good enough to start looking for a job (hadn't been able to do this since previous July). But by Mid October the depression
flared up again. I increased the Nardil to 60 mg along with taking Synthyroid 50 mcg and Nortriptylline 75 mg.This increase in Nardil was the key to boost my mood where it has been since then, so it hasn't really been that long so there's no telling what can happen next. I do feel much better though and again have been job seeking and although my self-esteem is shaky, I believe once I get a job I will feel much better.
I also started deplin about 4 days ago and can't really tell much about it but feel like it will keep the Nardil working if it starts to poop out.
That's the story of my Nardil history so hope you can find something that may help you. Perhaps another med with the Marplan might help or go a little bit higher, another user has success at 40 mg.
I'll keep in touch or if you want to babble me ever, you're welcome to...Stargazer
Posted by banga on November 25, 2007, at 7:29:32
In reply to Re: TCA's, the best one for you ?, posted by Quilter on November 23, 2007, at 0:49:22
I did fairly well on clomipramine for a while, then it pooped out.
I switched to desipramine--which has worked well, at least in combination with Abilify 5mg and Lamictal 200mg. The latter sometimes seems to not add much, but when I have tried to discontiinue it I feel a difference.
In any case, desipramine was best for me, though for some it may be too activating. I really need things to combat sluggishness when depressed.
I tried nortryptiline, I honestly dont remember what I disliked about its effects; I do remember it also caused immediate weight gain.
Posted by kaleidoscope on November 25, 2007, at 13:14:43
In reply to Re: TCA's, the best one for you ?, posted by sdb on November 22, 2007, at 12:55:00
Hi SDB
In the UK, amitriptyline is very widely prescribed to treat chronic neuropathic pain. It's also sometimes used to treat chronic insomnia and recurrent migraine. It's not much used to treat depression anymore.
Posted by brooke484 on November 25, 2007, at 14:20:18
In reply to Brooke/Nardil history, May - Nov by stargazer2, posted by stargazer2 on November 23, 2007, at 15:33:51
Thanks, stargazer. Today I went up to 35 mgs and in a week I'll go to 40. My doctor wanted me to go straight to 40 mgs, but when I did that I had major lightheadedness for about a week until I went back to 30. This time I'm taking it slow (I should know better). And he wanted me to add Lamictal but I'm not until I'm stable on Marplan. I don't want to increase two drugs at the same time and have to guess which one is causing which side effects. I'll probably stop at 40 mgs and then add Lamictal.
I've only been on Marplan 10 weeks so it's still early. I remember when I took Lexapro I was ready to give up and then after about 12 weeks it finally kicked in and I was a new person. I'll never forget walking outside that morning and the "fog" that I had had for so many years was gone.
Thanks for sharing your story. I'm glad you're feeling well enough to look for a job. That's what I should do too, but I can't right now. Too tired and too out of it. Like you I also have thyroid issues.
Take care,
Brooke
Posted by tecknohed on November 25, 2007, at 16:59:59
In reply to Re: Brooke/Nardil history, May - Nov by stargazer2, posted by brooke484 on November 25, 2007, at 14:20:18
brooke, I really hope you can get up to 40mg soon (or beyond). 40mg is really still the low end of the theraputic range, hence why I went to 40mg ASAP.
If I was you I'd hold off the lamotrigine for as long as you can. I tried it with Nardil twice & it made everything worse.
But I'm not you so you do what you feel is right. After all some people have resolved Nardil poopout with lamotrigine.
You'll get there m8!
teck
Posted by Phillipa on November 25, 2007, at 18:01:59
In reply to Re: Brooke/Nardil history, May - Nov by stargazer2, posted by brooke484 on November 25, 2007, at 14:20:18
May I interject that it seemed when I worked that the majority of patients with depression had thyroid problems? Phillipa me too.
Posted by stargazer2 on November 25, 2007, at 18:41:31
In reply to Re: Brooke/Nardil history, May - Nov by stargazer2 » brooke484, posted by Phillipa on November 25, 2007, at 18:01:59
Phillia, seems reasonable except I don't really consider myself having thyroid problems except I was put on a very low dose (50 mcg) of Synthroid for a normal TSH but many endocrinologists feel that someone with a long (mine > 20 years) history of depression may felt better when their TSH is closer to 1. Mine was 2.3 and 3.4, and the lab results consider that "normal" but I know you are aware of why they keep it closer to 1. My latest test was 1.4.
but thyroid is a very common condition especially in women, not sure why.
Stargazer
Posted by stargazer2 on November 25, 2007, at 18:46:35
In reply to 40mg+! » brooke484, posted by tecknohed on November 25, 2007, at 16:59:59
Lamictal caused me to have a lack of balance walking and I had several falls before the link was made. So I will not try Lamictal again, although i was taking it with something other than Nardil, so perhaps it may not cause the same efects in you. But if you do try it, just beware that I had the balance problems which went on far longer than it should have. Sometimes the most obvious side effects are not associated with the med, in retrospect, it now seems really very obvious.
Stargazer
Posted by sdb on November 25, 2007, at 19:23:38
In reply to Re: TCA's, the best one for you ? » sdb, posted by kaleidoscope on November 25, 2007, at 13:14:43
> Hi SDB
>
> In the UK, amitriptyline is very widely prescribed to treat chronic neuropathic pain. It's also sometimes used to treat chronic insomnia and recurrent migraine. It's not much used to treat depression anymore.
>
>Hi K!
Thanks for your information. Didn't know.
But amitriptyline is not no more used because of lack of efficacy treating symptoms of depression?
warm regards
sdb
Posted by sdb on November 25, 2007, at 19:34:05
In reply to Re: TCA's, the best one for you ? }} K, posted by sdb on November 25, 2007, at 19:23:38
www.torsades.org
www.qtdrugs.orgecg + serum-potassium control
if LQTS is known <no> such drugs.
short list of drug interactions possible:
antiarrhythmics
antidepressants, antihistamines
antimycotics
antibioticsmany genetic problems:
lqts1 kcnq 11p15.5 kvlqt1 (Iks-alpha) ca. 45 %
.......-lqts8
Posted by brooke484 on November 26, 2007, at 10:52:04
In reply to 40mg+! » brooke484, posted by tecknohed on November 25, 2007, at 16:59:59
I'm trying, I'm trying. I take forever to get to where I'm supposed to be. My body just can't take too much at one time.
So far so good with 35 mgs though. No dizziness today. I'll try 40 again next week.
I'm not giving up!
brooke
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