![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 36. Go back in thread:
Posted by ChrisK on October 31, 2001, at 13:16:43
In reply to ****Survey****: T.C.A. Drug Use, posted by jay on October 31, 2001, at 5:49:31
I've been taking 100 mg of Nortriptyline for years now. I never reacted to any of the SSRI's, Effexor, Remeron, etc. Since my father had done well with Elavil for most of his life I gave up on the SSRI's and went back to the TCA's. My doctor put me on the Nortrip due to concerns about liver damage (previous condition) and suicide ideations. It really helped with the baseline depression although it didn't due much for my anhedonia or ruminating thoughts.
The only noticable side effect I have is the dry mouth. I almost always need to have a water or mint with me.
I would recommend trying a TCA to anyone not getting any reaction to the "newer" meds.
>
> I am interested in getting an idea of who, and how many, have tried traditional tricyclic a.d's. Basically, what med, dose, how long, and what positive/negative effects did it have.? In particular, if you can relate your story to newer generation a.d's..SRI's/SNRI's...etc. Thanks. Jay :-)
Posted by Phil on November 1, 2001, at 18:33:10
In reply to Re: ****Survey****: T.C.A. Drug Use, posted by ChrisK on October 31, 2001, at 13:16:43
I was on Amitriptyline recently, for a short time. In combination w/ other drugs I was taking it didn't help.
About 20 years ago, I was on Amitrip. for 5 years or so. The start up side effects were pretty bad and I always was dealing with constipation, some fear of heights. I was taking an average of 250 mg daily and gained about 15 pounds of, mostly muscle. Had lots of energy and slept like a rock.
When I first reached a therapeutic dose, I saw a world I had never seen. It blew me away.
Also, SE wise, excessive sweating and it had it'ss share of sexual side effects.
Hope this helps some.
Posted by JohnL on November 2, 2001, at 2:04:46
In reply to ****Survey****: T.C.A. Drug Use, posted by jay on October 31, 2001, at 5:49:31
>
> I am interested in getting an idea of who, and how many, have tried traditional tricyclic a.d's. Basically, what med, dose, how long, and what positive/negative effects did it have.? In particular, if you can relate your story to newer generation a.d's..SRI's/SNRI's...etc. Thanks. Jay :-)Hi,
I have tried 4 different TCAs, though only about a week each.The first was Nortriptyline 50mg in combination with Zoloft 100mg. It was helpful, but sexual side effects from Zoloft were too much and I dumped the whole thing. Nortriptyline was good for sleep. Side effects not too bad.
Then came Protriptyline. I lasted one day on that one. It was nasty. Wicked dry mouth, wicked blurry eyes, wicked constipation, over energized, yikes.
Third was Clomipramine. I gave up on it pretty fast because it just didn't feel right. It felt like a very powerful SSRI, and that was not what I was looking for.
And most recently, now actually, I am trying Desipramine. It worked in 3 hours. No 6 week wait on that baby. I like Desipramine. It's mildly activating, yet calming and peaceful at the same time. I feel more motivated, active, energetic, and yet it is in a calm way. Currently I take 12.5mg in the morning. Because my primary AD is Prozac, Prozac happens to increase the blood levels of Desipramine anywhere from 2 to 5 times, so my small dose is actually a lot larger than it would appear. I've been sampling Desipramine now for almost a week. Side effects are dryish mouth, urinary hesitancy, urinary urgency, and I don't sleep as good. But these side effects are mild.
There was a clinical study a long time ago where they did a Ritalin Challenge test. They gave Ritalin to patients. If a patient responded well to Ritalin, then that predicted a good response to Desipramine. If the reaction to Ritalin was neutral or bad, then that predicted a better outcome with Nortriptyline instead. In my own n=1 study, this test proved accurate to me.
Anyway, hope something here is helpful.
John
Posted by Waterlily on November 2, 2001, at 7:46:56
In reply to ****Survey****: T.C.A. Drug Use, posted by jay on October 31, 2001, at 5:49:31
I started on imipramine about a year ago to help with generalized anxiety. That is in addition to the 300 mg. of Wellbutrin I take for depression. I was on 75 mg of imipramine, which is considered a low dose - about the minimum to produce therapeutic effect. My first blood test about 9 months ago showed the level to be in the high range of therapeutic. The second blood test about 3 months ago showed the level to be above therapeutic (too high). Since I was having no symptoms of overdose my pdoc suggested that I stay on the same dose, but have another blood test. I've decided to attempt stopping the imipramine, so I'm at 50 mg now for a week, then 25 for a week, and then none. The only side effect I have is dry mouth, which may have contributed to the two cavities I had at my last dentist appointment. I'm not sure how much good the imipramine was having...perhaps going off will tell me. I can't really compare it to other antidepressants because I'm taking it in addition to Wellbutrin and I've never taken any other medication for general anxiety.
Posted by caroline on November 3, 2001, at 4:28:30
In reply to ****Survey****: T.C.A. Drug Use, posted by jay on October 31, 2001, at 5:49:31
Hi,
I've been on 75mg of anafranil alongside 45mg of remeron for about 18 months now. I'd been on remeron solo for a couple of years before adding the TCA. The benefits of the anafranil for me have been major. Firstly it improved my ability to fall asleep/stay asleep by about 100%. Secondly it has effectively controlled my OCD, which is something the remeron alone never went near touching. On the negative side it has killed off my sex drive, more or less. 10 years ago I did anafranil solo for about 3 years. On balance I think the combination with the remeron is far more effective, but the anafranil solo probably was more effective for me than the remeron solo.
Hope this is of use
Caroline
Posted by Elizabeth on November 3, 2001, at 11:19:48
In reply to ****Survey****: T.C.A. Drug Use, posted by jay on October 31, 2001, at 5:49:31
A while back I tried a couple of tricyclics (nortriptyline and amoxapine) but the side effects (mostly anticholinergic) were so bad that I gave up when I got to 75 mg. More recently I decided to try desipramine. This time I insisted that my doctor order a serum level as soon as I got up to a reasonable dose. That turned out to be a good idea, because my desipramine level was very high ( > 600 ng/mL) -- I seem to be deficient in an enzyme that catalyzes the metabolism of TCAs, which is probably why I had such a hard time tolerating the other ones I tried.
Desipramine doesn't seem to have any side effects, except that my early-morning insomnia has gotten worse rather than better. (I've tried taking it at various times of the day, all at once and in divided doses; it doesn't make a difference.) For me, it works better than the newer ADs (which, for the most part, didn't work at all), but that doesn't necessarily mean it will work better for other people.
There are some disorders for which tricyclics generally don't work very well compared with other antidepressants -- notably, atypical depression. They also don't help with borderline personality disorder, and there's even some evidence that they can make symptoms worse, so people with BPD should probably avoid them too. With the exception of clomipramine, they're not very effective with obsessive-compulsive disorder.
-elizabeth
Posted by SLS on November 4, 2001, at 11:34:05
In reply to Re: ****Survey****: T.C.A. Drug Use, posted by Elizabeth on November 3, 2001, at 11:19:48
> Desipramine doesn't seem to have any side effects, except that my early-morning insomnia has gotten worse rather than better.I wonder if adding Neurontin might not help your insomnia. It might also make a nice add-on to Trileptal should it prove inadequate. Perhaps it would display some unexpected overall efficacy in treating your condition should you have any bipolarity (as might be suggested by your manic reactions to antidepressants).
- Scott
Posted by pedr on November 5, 2001, at 7:31:40
In reply to ****Survey****: T.C.A. Drug Use, posted by jay on October 31, 2001, at 5:49:31
Hi Jay,
I've been on 300mg Surmontil [a.k.a. trimipramine] for 5 months now. I've had severe depression for about 7 years now and surmontil's given me the best results of the drugs I've tried. I still feel dreadful [heavy heart, no energy, anxiety and so on] most days but I'm not as severely down as before. I also find that I want to sleep for very long periods [13+ hours] on the weekend.I've tried St John's Wort, lustral, sertraline and effexor xl. I had disasterous [shaking, jelly legs, constant terrifying visions, constant fear] reactions to all of those bar the effexor which I was on for 1.5 years. I gave up the effexor due the the stomach pains and constipation it gave me.
I'm still looking for my wonder drug and am currently 3 weeks into trying 8mg reboxetine in conjunction with the surmontil. Still feeling bad.
Hope this helps in some way,
pedr.
Posted by jay on November 6, 2001, at 4:28:50
In reply to Re: ****Survey****: T.C.A. Drug Use, posted by Elizabeth on November 3, 2001, at 11:19:48
You seem to know a fair bit about meds Elizabeth, and your experience with TCA's, I was wondering if you have any info or comments about the possibility that taking too low of a dose of a TCA can cause REM rebound? As in, you get a bit of REM supression, but the dose is so low, later on in the night, it bounces back. (If anyone else cares to jump in with thoughts, please do!)
I am curious, because I seem to respond best to meds that deeply and quicly suppress REM. That is why I believe I respond to Effexor XR so well, is because a Medline search shows that it almost completely suppreses REM by the second or third night of use. Most other a.d's seem to have nasty effects on my REM sleep and dreaming, often making them vivid and "loud". Was it REM rebound...was I taking too low a dose that may have caused this? It took Zoloft a couple of weeks, at high doses to cut back the REM sleep. Any comments?
Thanks..
Jay
> A while back I tried a couple of tricyclics (nortriptyline and amoxapine) but the side effects (mostly anticholinergic) were so bad that I gave up when I got to 75 mg. More recently I decided to try desipramine. This time I insisted that my doctor order a serum level as soon as I got up to a reasonable dose. That turned out to be a good idea, because my desipramine level was very high ( > 600 ng/mL) -- I seem to be deficient in an enzyme that catalyzes the metabolism of TCAs, which is probably why I had such a hard time tolerating the other ones I tried.
>
> Desipramine doesn't seem to have any side effects, except that my early-morning insomnia has gotten worse rather than better. (I've tried taking it at various times of the day, all at once and in divided doses; it doesn't make a difference.) For me, it works better than the newer ADs (which, for the most part, didn't work at all), but that doesn't necessarily mean it will work better for other people.
>
> There are some disorders for which tricyclics generally don't work very well compared with other antidepressants -- notably, atypical depression. They also don't help with borderline personality disorder, and there's even some evidence that they can make symptoms worse, so people with BPD should probably avoid them too. With the exception of clomipramine, they're not very effective with obsessive-compulsive disorder.
>
> -elizabeth
Posted by Elizabeth on November 6, 2001, at 15:35:54
In reply to Re: ****Survey****: T.C.A. Drug Use » Elizabeth, posted by SLS on November 4, 2001, at 11:34:05
> I wonder if adding Neurontin might not help your insomnia.
I tried Neurontin for insomnia. It was like most sleep meds I've tried: I kept having to increase the dose. (It also gave me the munchies.) I was taking it t.i.d., not just for insomnia but as an anxiolytic also, and I do think it helped in that regard.
Say, have you ever tried Gabitril, or if not, do you have a feel for what it generally does for/to people?
> It might also make a nice add-on to Trileptal should it prove inadequate.
I'm waiting until I can see a neurologist to think about diddling the anticonvulsants.
> Perhaps it would display some unexpected overall efficacy in treating your condition should you have any bipolarity (as might be suggested by your manic reactions to antidepressants).
A lot of doctors have questioned whether I might be "a little bit" bipolar, but I think that's pretty much been ruled out. (It has been starting to seem like I'm "a little bit" epileptic these days, though!)
-elizabeth
Posted by Elizabeth on November 6, 2001, at 15:52:55
In reply to T.C.A. Drug Use REM rebound from low dose? » Elizabeth, posted by jay on November 6, 2001, at 4:28:50
> I was wondering if you have any info or comments about the possibility that taking too low of a dose of a TCA can cause REM rebound?
It's interesting that you should ask. REM rebound is a possible withdrawal symptom with TCAs (and MAOIs), but my experience on TCAs has been different. I generally tend to have vivid dreams and move a lot during REM sleep (i.e., REM sleep behavior disorder). Desipramine, amoxapine, and some of the atypical antipsychotics have exacerbated this, at both low/moderate and high doses.
I'm not sure if it's a rebound effect you're getting or what might be going on. The kind of rebound you describe can happen with short- or intermediate-acting barbiturates, but I don't think I've ever heard about it with antidepressants. You might think about taking a different TCA with more anticholinergic activity. Perhaps even adding a little bit of amitriptyline at bedtime (say, 25-50 mg) would help without making the side effects much worse.
It might be relevant to note that I experienced complete REM sleep suppression with MAOIs, but when I added amoxapine or atypical antipsychotics, the vivid dreams would come back. (I also tried adding nortriptyline to Marplan, but I don't recall any effect on my dreams, or rather, my lack of dreams.)
> I am curious, because I seem to respond best to meds that deeply and quicly suppress REM.
I suggest MAOIs, then! < g >
> That is why I believe I respond to Effexor XR so well, is because a Medline search shows that it almost completely suppreses REM by the second or third night of use.
That's interesting. I'd always assumed it had roughly the same effect on REM sleep as SSRIs -- decreasing the percentage of sleep that includes REMs, but increasing REM density during periods of REM sleep. A lot of people do seem to have vivid dreams on Effexor, as with SSRIs.
-elizabeth
Posted by SLS on November 6, 2001, at 20:10:26
In reply to Re: ****Survey****: T.C.A. Drug Use » SLS, posted by Elizabeth on November 6, 2001, at 15:35:54
Hi Elizabeth.
I really don't have much of an impression of Gabitril. I have seen a few people here try it. At least one person reported good things about it. I don't remember any details, but I guess doing a PB search would find the posts.
> A lot of doctors have questioned whether I might be "a little bit" bipolar, but I think that's pretty much been ruled out.
On what basis was it was ruled-out?
I asked you this question along another thread: What features of your depression, if any, deviate from the classic melancholic profile? I know you have suffered with insomnia for a long time, but is it limited to early morning awakenings (after 4:00am)?
> (It has been starting to seem like I'm "a little bit" epileptic these days, though!)
I'm sorry.
How's the rocket-fuel?
What do you think of trimipramine?
- Scott
Posted by sjb on November 7, 2001, at 9:49:41
In reply to ****Survey****: T.C.A. Drug Use, posted by jay on October 31, 2001, at 5:49:31
Jay,
I tried a TCA (desipramine) last week. Lasted 4 days at 50mg taken at bedtime. Dizziness upon standing, increase carbo cravings and binges and lots of sleep. Oh, yeah, depression worse including more suicidal thoughts. Except for the dizziness, the rest are problems I always struggle with and why I've taken meds and have seen a lot of PDocs. Giving up everything as of now. Probably a mistake but have lost patience. Good luck, I know everyone reacts differently.
Posted by sjb on November 7, 2001, at 9:55:56
In reply to Re: ****Survey****: T.C.A. Drug Use, posted by sjb on November 7, 2001, at 9:49:41
> Jay,
>
> I tried a TCA (desipramine) last week. Lasted 4 days at 50mg taken at bedtime. Dizziness upon standing, increase carbo cravings and binges and lots of sleep. Oh, yeah, depression worse including more suicidal thoughts. Except for the dizziness, the rest are problems I always struggle with and why I've taken meds and have seen a lot of PDocs. Giving up everything as of now. Probably a mistake but have lost patience. Good luck, I know everyone reacts differently.Oh, yeah, increased perspiration also -which is a problem when exericising 'cause I was more quickly dehydrated.
Posted by Elizabeth on November 7, 2001, at 11:48:22
In reply to Re: ****Survey****: T.C.A. Drug Use » Elizabeth, posted by SLS on November 6, 2001, at 20:10:26
> I really don't have much of an impression of Gabitril. I have seen a few people here try it. At least one person reported good things about it. I don't remember any details, but I guess doing a PB search would find the posts.
Okay. It's a GABA reuptake inhibitor, and I've been interested in trying it. (For some reason I have an aversion to taking benzos on a daily basis.)
> > A lot of doctors have questioned whether I might be "a little bit" bipolar, but I think that's pretty much been ruled out.
>
> On what basis was it was ruled-out?Nonresponse to various pharmacotherapies for bipolar disorder. Lack of spontaneous (non-med-induced) hypomania or mania. Except for the one associated with serotonin syndrome, the med-induced episodes have not been clear-cut hypomania or mania. When Nardil pooped out, I suffered what was then thought to be dysphoric hypomania or mania. It resolved after I'd been off the Nardil for a while, but it didn't improve with various mood stabilizers (Depakote, Lamictal, Neurontin, lithium). Really it was more a case of extreme mood reactivity than of hypomania. It's now thought that the irritability/moodiness was something like a withdrawal symptom (lots of people have very bad reactions when MAOIs poop out).
> I asked you this question along another thread: What features of your depression, if any, deviate from the classic melancholic profile? I know you have suffered with insomnia for a long time, but is it limited to early morning awakenings (after 4:00am)?
Well, my sleep has been disturbed all my life, not just during major depressions. I'm told that even when I was a baby I had trouble maintaining a consistent circadian rhythm -- it was like I didn't care what the sun did. I also slept irregularly -- a few hours here, a few hours there -- and this has happened at other times in my life too. When I was a kid I would sometimes have trouble getting to sleep due to anxious rumination ("can't shut down my thoughts," is how I tried to describe it). The early-morning insomnia is something that started when I was first seriously depressed. I also sometimes have middle insomnia (waking after 2-4 hours, say). The frequent irregularity of my sleep makes it hard to characterize the insomnia completely. It is also hard to characterize the diurnal variation in mood, although I definitely think it's there.
Some other "deviant" features:
* early onset
* presence of dysthymia or residual symptoms between episodes
* attention-deficit, panic, and social phobia symptoms
* anergia
* chronic musculoskeletal pain; the ADs that work best for me (Nardil, while it was working, and buprenorphine) also eliminate the pain (not sure if this means anything or not)It's possible that some of the symptoms (such as the chronicity and some of the anxiety problems) are secondary to the depression and may be accounted for by early onset. However, it's clear that there's something else going on in addition to depression. One suggestion has been that since both my parents have depression (mother atypical, father "typical" dysthymia), I might have two different but overlapping syndromes.
> > (It has been starting to seem like I'm "a little bit" epileptic these days, though!)
>
> I'm sorry.Hey, you didn't cause it. (did you??? :-) )
> How's the rocket-fuel?
Not on rocket fuel yet.
> What do you think of trimipramine?
I think it could be very good, especially if you have sleep continuity problems. I like the idea of a sedating tricyclic, but I've never tried it myself.
-elizabeth
Posted by Elizabeth on November 7, 2001, at 11:53:59
In reply to Re: ****Survey****: T.C.A. Drug Use, posted by sjb on November 7, 2001, at 9:49:41
> I tried a TCA (desipramine) last week. Lasted 4 days at 50mg taken at bedtime. Dizziness upon standing, increase carbo cravings and binges and lots of sleep. Oh, yeah, depression worse including more suicidal thoughts. Except for the dizziness, the rest are problems I always struggle with and why I've taken meds and have seen a lot of PDocs.
It sounds like you might have what's known as "atypical depression." Here's a link (thanks to Scott for posting it): http://www.lorenbennett.org/atypical.htm
If this is what you have, TCAs are probably not for you. Have you tried any other treatments? There are things that can help (notably, MAOIs), so don't give up! I think the doctor who prescribed desipramine for you made a mistake in not noticing the type of depression you're having, that's all.
-elizabeth
Posted by Lorraine on November 8, 2001, at 10:51:08
In reply to Re: ****Survey****: T.C.A. Drug Use » SLS, posted by Elizabeth on November 7, 2001, at 11:48:22
> * chronic musculoskeletal pain; the ADs that work best for me (Nardil, while it was working, and buprenorphine) also eliminate the pain (not sure if this means anything or not)
elizabeth: You've ruled out FMS? By the way, one of the posts here said that you could take Bupe under the tongue by squirting the contents of the syringe there. Have you ever tried this?
Lorraine
Posted by Elizabeth on November 8, 2001, at 17:13:29
In reply to Re: ****Survey****: T.C.A. Drug Use » Elizabeth, posted by Lorraine on November 8, 2001, at 10:51:08
> > * chronic musculoskeletal pain; the ADs that work best for me (Nardil, while it was working, and buprenorphine) also eliminate the pain (not sure if this means anything or not)
>
> elizabeth: You've ruled out FMS?It's not widespread enough to be FMS. It's been diagnosed as myofascial pain syndrome. (IMO, both of these are euphemisms for "it's all in your head." < g >)
> By the way, one of the posts here said that you could take Bupe under the tongue by squirting the contents of the syringe there. Have you ever tried this?
No. I asked Dr. Bodkin about it, but he said that it wasn't a very reliable way of taking the solution (I think that Subutex/Temgesic works better). Also, I'd definitely need a much higher dose. I don't want to go to the trouble of trying to figure out how much to take when it's not a reliable method and the SL tablets are (hopefully) going to be available soon.
-e
Posted by Adam on November 8, 2001, at 17:25:03
In reply to ****Survey****: T.C.A. Drug Use, posted by jay on October 31, 2001, at 5:49:31
I have tried two TCA's: desipramine and clomipramine.
I found both nearly intolerable. On both I had (so bad I couldn't tell the difference between them): Somnolence, dry mouth, complete sexual dysfunction (on an SSRI I could at least get it up), orthostatic hypotension, mental cloudiness, and last, but certainly not least, constipation. I just couldn't take these drugs at a "therapeutic dose". I should mention that no one who prescribed these (I had two p-docs try DES on me) even mentioned getting blood work done, and all seemed incredulous upon hearing my complaints. I can only guess that if I had gotten the bloods (the DES blood test is de rigeur, I found out, long after I had switched docs, and meds) I might have discovered a smaller dose was sufficient (due probably to a metabolic polymorphism) and I perhaps would have experienced less discomfort as a result. If you try a TCA, insist on getting a blood level reading. You might save yourself a bad experience, and hence also get an adequate trial.
The first generation tricyclics (or I should say, all those in the "tertiary amine" sub-class) are thought to be particularly noxious as far as side-effects go, and I guess, for those who find relief with those TCAs, they learn to live with it. I'm not sure I could (but again, see above). Relatively newer drugs like desipramine (secondary amine TCA, nothing more than demethylated imipramine) are thought to be more tolerable (and more specific for the NE reuptake pump, relative to other targets), though I'm not sure all who have taken them would agree. Clomipramine, a halogenated version of imipramine, thought to be one of the best drugs for OCD and a darn good antidepressant, is unfortunately also one of the worst antidepressants of any class for side-effects, so it is said. Yet many take it, and do well.
TCAs are widely regarded, despite their relatively poor side-effect profile, as being highly effective for depression (especially the "melancholic" variety), but they're also potentially dangerous (some can be cardiotoxic, all can be lethal in overdose, etc.), so I think if you're thinking of giving one a go, make sure you've got yourself a good doctor. Don't be put off if he/she prescribes you only a few doses at a time at first; precautions make both of you safer. Again, get the blood work done, if you can, so you know what your real "dose" is.
>
> I am interested in getting an idea of who, and how many, have tried traditional tricyclic a.d's. Basically, what med, dose, how long, and what positive/negative effects did it have.? In particular, if you can relate your story to newer generation a.d's..SRI's/SNRI's...etc. Thanks. Jay :-)
Posted by Adam on November 8, 2001, at 17:37:12
In reply to Re: ****Survey****: T.C.A. Drug Use » SLS, posted by Elizabeth on November 7, 2001, at 11:48:22
In reading down this thread, I find I can't help but ask, since sleep issues keep coming up: Have you tried strenuous exercise? It's working wonders for me. It always used to exercise a lot, esp. my teen years and in college. I used to be pretty into sports, especially running. After a good workout (running or swimming were the best), I fell asleep hard at bedtime, and always woke up feeling refreshed. I think one of the worst things I did during my twenties, when injuries kept me from running, was to not shift to some other strenuous activity that I could do on a regular basis.
Trust me, I know how hard it is to get into that kind of a groove. But I've bitten the bullet, and it's working really, really well. Plus, I'm realizing a lot of the fringe benefits ( e.g., I feel more alert, g.f. seems to think my butt is cuter :), etc.) of working out.
I'm sure this has occured to you, and all, but I thought I would put in a plug all the same.
Posted by Elizabeth on November 8, 2001, at 20:52:44
In reply to Re: ****Survey****: T.C.A. Drug Use » Elizabeth, posted by Adam on November 8, 2001, at 17:37:12
> In reading down this thread, I find I can't help but ask, since sleep issues keep coming up: Have you tried strenuous exercise?
My sleep problems date back to childhood, when I was very active (I was a climber, ran around a lot, etc). I don't think they're due to lack of exercise, since they don't seem to be affected by changes in level of activity, except that exercising too close to bedtime makes it hard to get to sleep.
Congratulations about your cute butt, BTW :-)
-elizabeth
Posted by jay on November 9, 2001, at 9:09:09
In reply to Re: ****Survey****: T.C.A. Drug Use » Lorraine, posted by Elizabeth on November 8, 2001, at 17:13:29
I started this thread because I guess some of my prejudice favours TCAs. I have had some excellent responses to a few of them, and of course I know that means very little, but they seem to affect depression and anxiety in a *whole* different manner than many of the newer SRI/SNRIs, NRIs, etc. Maybe it is because they are so "dirty" (which really is a subjective word...hitting more receptors is really in no way associated with dirt :-).I often wonder how folks who are usually only given a trial of one of the newer popular drugs, say would react to a *complete* test of each of the TCAs? Besides some different side effects, how much more effective is Paxil than clomipramine for anxiety and panic (with/without GAD)..or Serzone than clomipramine for anxious depression? (Most depression involves anxiety often.) For 'atypical' depression...what about Nortriptyline and Protriptyline...the later which is energizing and even linked to weight loss as a thermogenic effect (I have the citation if you want..)...Vs. Prozac and Welbutrin? I was on Remeron for a short period of time, and honestly it felt much like doxepin, with a tad more of a 'punch'.
I know there are these "cautions" about tests and such with TCAs, often involving heart conditions, but so many doctors make them out to be like you need a major physical every week on a TCA. I know it is not the total motivating factor, but one that must play some kind of role is the $$$ factor. I generally dislike corporations, but I think out of all the useful ones in society, drug companies are the 'best' also in ethical terms.(Some will strongly disagree of course.) Anyhow...that's a whole different debate.
So...more questions...and I have few answers as always..heh.
Jay
Posted by Elizabeth on November 9, 2001, at 12:46:44
In reply to Re: T.C.A. Use...More Questions.. » Elizabeth, posted by jay on November 9, 2001, at 9:09:09
> I started this thread because I guess some of my prejudice favours TCAs. I have had some excellent responses to a few of them, and of course I know that means very little, but they seem to affect depression and anxiety in a *whole* different manner than many of the newer SRI/SNRIs, NRIs, etc.
I agree. Some people who don't respond to SSRIs (myself, for one) could do well on a TCA, if they can tolerate it. And while SSRIs are probably more effective than most TCAs for panic disorder, a lot of people with PD have a hard time tolerating SSRIs.
> Maybe it is because they are so "dirty" (which really is a subjective word...hitting more receptors is really in no way associated with dirt :-).
I don't think that anyone knows what's so special about TCAs, except that they all inhibit NE reuptake (as well as, to varying degrees, 5-HT).
> I often wonder how folks who are usually only given a trial of one of the newer popular drugs, say would react to a *complete* test of each of the TCAs?
I don't think it's necessary to try all the TCAs. But anyway, one thing that is pretty common if someone has only a partial response to a SSRI is to add a low dose of a TCA.
For safety and tolerability reasons, I think that for most patients, TCAs should be pretty far down the list of things to try (Effexor or Remeron will often work for people who respond to TCAs and should usually be tried first), but they shouldn't be ruled out altogether.
> Besides some different side effects, how much more effective is Paxil than clomipramine for anxiety and panic (with/without GAD)..or Serzone than clomipramine for anxious depression?
Paxil and clomipramine are probably equal for panic. Clomipramine is the most effective TCA for panic, I think, although not the most tolerable.
> For 'atypical' depression...what about Nortriptyline and Protriptyline...the later which is energizing and even linked to weight loss as a thermogenic effect (I have the citation if you want..)...Vs. Prozac and Welbutrin?
Protriptyline can cause weight loss, but it's probably the most dangerous of the TCAs -- it carries an increased risk of cardiovascular problems and seizures. And TCAs as a rule don't work very well for atypical depression. MAOIs should probably be tried before TCAs because MAOIs have a better chance of working and are about equally tolerable (subject to individual differences, of course).
> I know there are these "cautions" about tests and such with TCAs, often involving heart conditions, but so many doctors make them out to be like you need a major physical every week on a TCA.
No, but there are risks, and the rate of complications with TCAs and the need for expensive tests make it more cost-effective, as well as safer, to use newer ADs.
-elizabeth
Posted by sjb on November 9, 2001, at 14:22:28
In reply to Re: ****Survey****: T.C.A. Drug Use » sjb, posted by Elizabeth on November 7, 2001, at 11:53:59
Elizabeth,
Yes, we were both aware that I was bascially typical atyipical. I tried Parnate and it basically did nothing except make driving scarier 'cause my reaction time seemed drastically reduced. Also caused big time insomnia at the beginning and lots of lethargy late in the day. I'm giving up on meds and PDocs. Most aren't as up on things as folks are on this board and not worth my insurance's money.
Thanks for your help nonetheless.
Posted by sjb on November 9, 2001, at 14:25:01
In reply to Re: ****Survey****: T.C.A. Drug Use, posted by Adam on November 8, 2001, at 17:25:03
> I have tried two TCA's: desipramine and clomipramine.
>
> I found both nearly intolerable. On both I had (so bad I couldn't tell the difference between them): Somnolence, dry mouth, complete sexual dysfunction (on an SSRI I could at least get it up), orthostatic hypotension, mental cloudiness, and last, but certainly not least, constipation. I just couldn't take these drugs at a "therapeutic dose". I should mention that no one who prescribed these (I had two p-docs try DES on me) even mentioned getting blood work done, and all seemed incredulous upon hearing my complaints. I can only guess that if I had gotten the bloods (the DES blood test is de rigeur, I found out, long after I had switched docs, and meds) I might have discovered a smaller dose was sufficient (due probably to a metabolic polymorphism) and I perhaps would have experienced less discomfort as a result. If you try a TCA, insist on getting a blood level reading. You might save yourself a bad experience, and hence also get an adequate trial.
>
> The first generation tricyclics (or I should say, all those in the "tertiary amine" sub-class) are thought to be particularly noxious as far as side-effects go, and I guess, for those who find relief with those TCAs, they learn to live with it. I'm not sure I could (but again, see above). Relatively newer drugs like desipramine (secondary amine TCA, nothing more than demethylated imipramine) are thought to be more tolerable (and more specific for the NE reuptake pump, relative to other targets), though I'm not sure all who have taken them would agree. Clomipramine, a halogenated version of imipramine, thought to be one of the best drugs for OCD and a darn good antidepressant, is unfortunately also one of the worst antidepressants of any class for side-effects, so it is said. Yet many take it, and do well.
>
> TCAs are widely regarded, despite their relatively poor side-effect profile, as being highly effective for depression (especially the "melancholic" variety), but they're also potentially dangerous (some can be cardiotoxic, all can be lethal in overdose, etc.), so I think if you're thinking of giving one a go, make sure you've got yourself a good doctor. Don't be put off if he/she prescribes you only a few doses at a time at first; precautions make both of you safer. Again, get the blood work done, if you can, so you know what your real "dose" is.
> >
> > I am interested in getting an idea of who, and how many, have tried traditional tricyclic a.d's. Basically, what med, dose, how long, and what positive/negative effects did it have.? In particular, if you can relate your story to newer generation a.d's..SRI's/SNRI's...etc. Thanks. Jay :-)I, too, had constipation on desipramine. Also, very dizzy upon standing.
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