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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Ruth on January 21, 2000, at 18:38:40
I've been on celexa for about a year. At first I had a positive response to it. But in the past few months the depression has been exacerbated. My pharmacologist has suggested taking me off celexa and starting anafronil. I've been on 20+ different meds and combos but never a tryclicate.
I wondered what people's experience with this has been and am particularly concerned about weight gain as a side effect.
Any info would be appreciated. Thanks
Posted by Scott L. Schofield on January 21, 2000, at 23:31:09
In reply to anafronil, posted by Ruth on January 21, 2000, at 18:38:40
> I've been on celexa for about a year. At first I had a positive response to it. But in the past few months the depression has been exacerbated. My pharmacologist has suggested taking me off celexa and starting anafronil. I've been on 20+ different meds and combos but never a tryclicate.
> I wondered what people's experience with this has been and am particularly concerned about weight gain as a side effect.
> Any info would be appreciated. Thanks
If you are going to try a tricyclic for the first time, I'm not sure you would want to start with Anafranil (chlomipramine). By comparison to other tricyclics, it tends to have more side-effects. Of course, this might end up being the right antidepressant for you. Unfortunately, there is not yet any precise way to determine in advance which particular drugs you will respond to (damn-it). However, your doctor may have chosen Anafranil specifically because you had responded to Celexa, one of the SSRIs (selective serotonin reuptake inhibitor). Of all the tricyclics, Anafranil exerts the greatest degree of serotonin reuptake inhibition.Imipramine (Tofranil) was once considered to be the "gold standard" by which other antidepressants were gauged. It was the first of the tricyclic antidepressants to be developed. (MAO-inhibitors had been stumbled upon earlier). Side-effects include those known as anticholinergic. Anticholinergic side-effects include dry-mouth, constipation, rapid pulse, palpitations, sweating, disturbances of vision, and others. Not all of these side-effects will necessarily be experienced, nor may they necessarily be of significant magnitude. Your doctor should go over these with you.
There are quite a few tricyclics. They vary from one another in terms of side-effects, and probably in some pharmacological aspects of their antidepressant effect. As with the SSRIs, finding one that works is often trial and error. However, sometimes a tricyclic is chosen based upon its side-effect profile. For instance, if one suffers from insomnia along with depression, amitriptyline (Elavil) may be used for its sedative effect. If anxiety is present, I believe that doxepin (Sinequan) is sometimes preferred. Protriptyline (Vivactil) is considered the most activating, but I found it to have the worst anticholinergic effects of any of the tricyclics I have tried. Both desipramine (Norpramin) and nortriptyline (Pamelor) are probably the most forgiving regarding anticholinergic side-effects. Of all of these, desipramine is thought to be the most selective reuptake inhibitor of norepinephrine.
The most important side-effects of the tricyclics are cardiac in nature. Be sure to let your doctor know if you have, or have had, any heart trouble.
Personally, I have not found either imipramine or desipramine to be sedating beyond the first week or so. Nortriptyline was more sedating, but the sedation seemed to abate over time. Amitriptyline was a killer.
To get back to Anafranil, it is often touted as being a "dirty" drug because of its side-effects. It can even produce some of the same sexual problems as seen with the SSRIs. However, during the early to mid 1980's, it was considered to be the most effective tricyclic antidepressant in the world.
Good luck.
- Scott
Posted by Cam on January 22, 2000, at 2:09:43
In reply to Re: Anafranil - chlomipramine, posted by Scott L. Schofield on January 21, 2000, at 23:31:09
> > I've been on celexa for about a year. At first I had a positive response to it. But in the past few months the depression has been exacerbated. My pharmacologist has suggested taking me off celexa and starting anafronil. I've been on 20+ different meds and combos but never a tryclicate.
> > I wondered what people's experience with this has been and am particularly concerned about weight gain as a side effect.
> > Any info would be appreciated. Thanks
>
>
> If you are going to try a tricyclic for the first time, I'm not sure you would want to start with Anafranil (chlomipramine). By comparison to other tricyclics, it tends to have more side-effects. Of course, this might end up being the right antidepressant for you. Unfortunately, there is not yet any precise way to determine in advance which particular drugs you will respond to (damn-it). However, your doctor may have chosen Anafranil specifically because you had responded to Celexa, one of the SSRIs (selective serotonin reuptake inhibitor). Of all the tricyclics, Anafranil exerts the greatest degree of serotonin reuptake inhibition.
>
> Imipramine (Tofranil) was once considered to be the "gold standard" by which other antidepressants were gauged. It was the first of the tricyclic antidepressants to be developed. (MAO-inhibitors had been stumbled upon earlier). Side-effects include those known as anticholinergic. Anticholinergic side-effects include dry-mouth, constipation, rapid pulse, palpitations, sweating, disturbances of vision, and others. Not all of these side-effects will necessarily be experienced, nor may they necessarily be of significant magnitude. Your doctor should go over these with you.
>
> There are quite a few tricyclics. They vary from one another in terms of side-effects, and probably in some pharmacological aspects of their antidepressant effect. As with the SSRIs, finding one that works is often trial and error. However, sometimes a tricyclic is chosen based upon its side-effect profile. For instance, if one suffers from insomnia along with depression, amitriptyline (Elavil) may be used for its sedative effect. If anxiety is present, I believe that doxepin (Sinequan) is sometimes preferred. Protriptyline (Vivactil) is considered the most activating, but I found it to have the worst anticholinergic effects of any of the tricyclics I have tried. Both desipramine (Norpramin) and nortriptyline (Pamelor) are probably the most forgiving regarding anticholinergic side-effects. Of all of these, desipramine is thought to be the most selective reuptake inhibitor of norepinephrine.
>
> The most important side-effects of the tricyclics are cardiac in nature. Be sure to let your doctor know if you have, or have had, any heart trouble.
>
> Personally, I have not found either imipramine or desipramine to be sedating beyond the first week or so. Nortriptyline was more sedating, but the sedation seemed to abate over time. Amitriptyline was a killer.
>
> To get back to Anafranil, it is often touted as being a "dirty" drug because of its side-effects. It can even produce some of the same sexual problems as seen with the SSRIs. However, during the early to mid 1980's, it was considered to be the most effective tricyclic antidepressant in the world.
>
> Good luck.
>
>
> - Scott
Scott is correct in all he says. I have seen many good results with Anafranil (clomipramine). It used to be the "gold standard" in obsessive-compulsive disorders. As to the side effects profile, do have your heart checked, but new research has shown that after 6 months, the side effects incidence of the tricyclics are really no different than that of the Celexa-like SSRIs. It is getting to that 6 months and putting up with the Anafranil side effects that you may have to work at. Anafranil's side effects are worst in the first couple weeks and then they begin to taper, usually disappearing altogether within the 6 months. - Cam Walker
Posted by Janice on January 22, 2000, at 22:25:28
In reply to Re: Anafranil - chlomipramine, posted by Cam on January 22, 2000, at 2:09:43
hi Ruth,
Just to confuse you further, I was on Anafranil for a short period of time. Anafranil made my OCD much worse, and very quickly. It was so bad that upon feeling the affects of Anafranil, I had pulled out all my eyelashes and some of my hair within 24 hours. I later found out that I have ADHD.
The good news is that Anafranil 'undepressed' my body very quickly. My appetite did increase dramatically - to the point where I was binge eating. Even better, Anafranil gave me a great sex drive and sex life.
In the end, my impulse control problems caused me to quit Anafranil - hair pulling, binge eating (and yes, weight gain).
My sex life was incredible.
I did better on desipramine. Less side effects, no worsening of impulse control, small increase of appetite, but I could control my eating. And still, a fantastic sex life. Good luck Ruth, Janice
Posted by Michael on April 10, 2000, at 10:51:27
In reply to Re: Anafranil - chlomipramine, posted by Janice on January 22, 2000, at 22:25:28
On Anafranil , it takes me a long time to ejaculate. I think I'm getting tired of pounding my girlfriend for hours on end. She's not complaining however. Why is this?
Posted by Cam W. on April 10, 2000, at 18:46:32
In reply to Re: Anafranil - chlomipramine, posted by Michael on April 10, 2000, at 10:51:27
> On Anafranil , it takes me a long time to ejaculate. I think I'm getting tired of pounding my girlfriend for hours on end. She's not complaining however. Why is this?
Michael - There are a number of theories on this but I believe it has to do with the stimulation of serotonin-2A receptors. Since Anafranil is the TCA closest to the SSRIs in action (blocks serotonin reuptake much more than norepinephrine reuptake) it has similar sexual side effects to the SSRIs. Some find this a curse; others a blessing. Actually the SSRIs are being used to treat premature ejaculation. Hope this helps - CAm W.
Posted by Davida Lee on July 17, 2000, at 20:48:27
In reply to anafronil, posted by Ruth on January 21, 2000, at 18:38:40
I'm on Anafronil. I was on 100mg, but I had many, if not ALL of the symtoms. I was extremely fed up with medicines and wanted badly to go off of it. But, my pharmacologist suggested just lessening the dossage. At first, when I went down to 50mg, I had a few awful nights where the depression was terrible. But afterwards, the symptoms went mostly away and the depression seemed better.
This medicine, compared to SSRIs (especially zoloft, luvox) have seemed different in a few ways. On the zoloft especially, it seemed more of a fake "high" than normality. On the Anafronil, I live a normal, happy life.
Posted by Gladys on April 2, 2001, at 16:56:58
In reply to Re: Anafranil - chlomipramine, posted by Scott L. Schofield on January 21, 2000, at 23:31:09
Hi Scott, you seemed to know a lot about the meds so I thought you might be able to give me some insight. I am on celexa now but the weight gain is only making me feel worse about myself and I am getting more depressed each day I cannot wear any of my clothes. I have anxiety, depression, and OCD. I was considering anafranil because I had heard it was good for OCDs. I am scared to try anything new because I had a terrible almost suicidal time on Paxil and the weight gain on celexa no matter how much I exercise and diet. I've been on it for about a year now so I would think if it was a side effect only it would have stopped, but I cannot lose the weight. Do you know of any meds that treat depression that is unlikely to cause weight gain? I am also on buspar for the anxiety and am considering going off celexa and going on St. John's Wort because there were no side effects and maybe I can lose this weight. I feel like crying when I look at myself now!
>
> If you are going to try a tricyclic for the first time, I'm not sure you would want to start with Anafranil (chlomipramine). By comparison to other tricyclics, it tends to have more side-effects. Of course, this might end up being the right antidepressant for you. Unfortunately, there is not yet any precise way to determine in advance which particular drugs you will respond to (damn-it). However, your doctor may have chosen Anafranil specifically because you had responded to Celexa, one of the SSRIs (selective serotonin reuptake inhibitor). Of all the tricyclics, Anafranil exerts the greatest degree of serotonin reuptake inhibition.
>
> Imipramine (Tofranil) was once considered to be the "gold standard" by which other antidepressants were gauged. It was the first of the tricyclic antidepressants to be developed. (MAO-inhibitors had been stumbled upon earlier). Side-effects include those known as anticholinergic. Anticholinergic side-effects include dry-mouth, constipation, rapid pulse, palpitations, sweating, disturbances of vision, and others. Not all of these side-effects will necessarily be experienced, nor may they necessarily be of significant magnitude. Your doctor should go over these with you.
>
> There are quite a few tricyclics. They vary from one another in terms of side-effects, and probably in some pharmacological aspects of their antidepressant effect. As with the SSRIs, finding one that works is often trial and error. However, sometimes a tricyclic is chosen based upon its side-effect profile. For instance, if one suffers from insomnia along with depression, amitriptyline (Elavil) may be used for its sedative effect. If anxiety is present, I believe that doxepin (Sinequan) is sometimes preferred. Protriptyline (Vivactil) is considered the most activating, but I found it to have the worst anticholinergic effects of any of the tricyclics I have tried. Both desipramine (Norpramin) and nortriptyline (Pamelor) are probably the most forgiving regarding anticholinergic side-effects. Of all of these, desipramine is thought to be the most selective reuptake inhibitor of norepinephrine.
>
> The most important side-effects of the tricyclics are cardiac in nature. Be sure to let your doctor know if you have, or have had, any heart trouble.
>
> Personally, I have not found either imipramine or desipramine to be sedating beyond the first week or so. Nortriptyline was more sedating, but the sedation seemed to abate over time. Amitriptyline was a killer.
>
> To get back to Anafranil, it is often touted as being a "dirty" drug because of its side-effects. It can even produce some of the same sexual problems as seen with the SSRIs. However, during the early to mid 1980's, it was considered to be the most effective tricyclic antidepressant in the world.
>
> Good luck.
>
>
> - Scott
This is the end of the thread.
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