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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by DINGBAT on January 11, 2002, at 3:50:54
Any opinions re: which TCA's are most reliable (ito of inducing remission of depression without too much side-effect). Also, anybody know which (if any) TCA has the most dopaminergic action? Or is it better to take something like imipramine and augment it with a dopaminergic agent? If so, any advice on reliable dopaminergics?
Posted by CalvaryHill on January 11, 2002, at 4:08:11
In reply to WHICH TRICYCLIC TO TRY?, posted by DINGBAT on January 11, 2002, at 3:50:54
There is more evidence that serotonin and norepinephrine are linked to depression/wellness than dopamine. Simple dopamine agonists (like pramipexole and pergolide) have fewer studies showing that they are effective in depression, and clinicians rarely prescribe dopamine agonists as first-line or second-line choices.
There are no known tricyclic agents that have effects on dopamine. The tertiary amine tricyclics are serotonergic and noradrenergic, an the secondary amine tricyclics are mostly noradrenergic.
The SNRI venlafaxine is dopaminergic at the highest doses which most people cannot tolerate. Sertraline has 10 times more effect on serotonin than on dopamine. And buproprion's effect on dopamine is miniscule compared to its effect on norepinephrine.
Your best bet is to try a secondary amine tricyclic with good reputation and benign side-effect profile such as desipramine and nortriptyline. They are available as generics and can be titrated to a therapeutic dose with moderate speed.
Good question,
CalvaryHill
Posted by ChrisK on January 12, 2002, at 4:38:46
In reply to WHICH TRICYCLIC TO TRY?, posted by DINGBAT on January 11, 2002, at 3:50:54
Fo r the last few years I have been taking Nortriptyline without any problems. In the past I had success with Imiprimine. Amitriptyline was OK but a little sedating. My current Nortrip seems to have a pretty benign side effect side to it. The worst I have is some dry mouth problems.
I also take Mirapex to augment the Nortrip. I've been on that for about one year now and it has really helped with the anhedonia aspect of my depression. I wouldn't consider it a first line of defense against depression though. I'd look to get the depression to a 'livable' point and then augment based on the symptoms that still are around.
For me that meant using Zyprexa to ease some of the ruminating thoughts and then Mirapex to ease the anhedonia/apathy.
I found that for me the TCA's were much more efective than any of the SSRI's, Effexor, Wellbutrin, Remeron, etc.
Hope you find something that works soon.
Chris
Posted by CalvaryHill on January 12, 2002, at 15:53:57
In reply to Re: WHICH TRICYCLIC TO TRY?, posted by ChrisK on January 12, 2002, at 4:38:46
God forbid, but if the Mirapex should "poop"-out, consider another dopamine agonist like Bromocriptine (Parlodel), which I found was tolerable and helped with the nagging anhedonia, or ReQuip (ropinirole).
Here's hoping for your continued success on Mirapex...
Nurses make the world go round: CalvaryHill
Posted by manowar on January 13, 2002, at 1:26:44
In reply to WHICH TRICYCLIC TO TRY?, posted by DINGBAT on January 11, 2002, at 3:50:54
TCAs in my opinion, should only be used for last resort. They can cause all sorts of problems--VERY dirty drugs. Desepermine is probibly the cleanest and most activating. My pdoc was going to put me on another test of desepermine. Thank-God I talked him into giving me a trial of Provigil. I haven't felt this good in years!
Posted by DINGBAT on January 13, 2002, at 5:42:33
In reply to Re: WHICH TRICYCLIC TO TRY?, posted by ChrisK on January 12, 2002, at 4:38:46
> Fo r the last few years I have been taking Nortriptyline without any problems. In the past I had success with Imiprimine. Amitriptyline was OK but a little sedating. My current Nortrip seems to have a pretty benign side effect side to it. The worst I have is some dry mouth problems.
>
> I also take Mirapex to augment the Nortrip. I've been on that for about one year now and it has really helped with the anhedonia aspect of my depression. I wouldn't consider it a first line of defense against depression though. I'd look to get the depression to a 'livable' point and then augment based on the symptoms that still are around.
>
> For me that meant using Zyprexa to ease some of the ruminating thoughts and then Mirapex to ease the anhedonia/apathy.
>
> I found that for me the TCA's were much more efective than any of the SSRI's, Effexor, Wellbutrin, Remeron, etc.
>
> Hope you find something that works soon.
> ChrisWhat is Mirapex (i.e. what's the generic name) and what does it do pharmacologically? I think I am in a position where I need to decide on a 1st line antidepressant like my current SNRI - that is, stay on Effexor 300mg XR and AUGMENT for anhedonia/apathy. Cost wise, I wouldn't mind trying a TCA (imipramine/nortriptyline) and still AUGMENT for anhedonai/apathy. What drugs are good for augmenting against residual symptoms of ahedonia/apathy?
Posted by DINGBAT on January 13, 2002, at 5:49:15
In reply to RE: Which TCA?- None if you can help it! » DINGBAT, posted by manowar on January 13, 2002, at 1:26:44
> TCAs in my opinion, should only be used for last resort. They can cause all sorts of problems--VERY dirty drugs. Desepermine is probibly the cleanest and most activating. My pdoc was going to put me on another test of desepermine. Thank-God I talked him into giving me a trial of Provigil. I haven't felt this good in years!
Excuse my ignorance, but what is Provigil (generic name)? What does it do pharmacologically? Dosage? Cost? Any info will be appreciated ...
Posted by bob on January 13, 2002, at 14:20:45
In reply to RE: Which TCA?- None if you can help it! » DINGBAT, posted by manowar on January 13, 2002, at 1:26:44
Is that all you're on is provigil, or is it augmenting something else?
What tricyclics did you take? I gather that desipramine was one of them.
Posted by ChrisK on January 13, 2002, at 14:40:46
In reply to Re: WHICH TRICYCLIC TO TRY?, posted by DINGBAT on January 13, 2002, at 5:42:33
> What is Mirapex (i.e. what's the generic name) and what does it do pharmacologically? I think I am in a position where I need to decide on a 1st line antidepressant like my current SNRI - that is, stay on Effexor 300mg XR and AUGMENT for anhedonia/apathy. Cost wise, I wouldn't mind trying a TCA (imipramine/nortriptyline) and still AUGMENT for anhedonai/apathy. What drugs are good for augmenting against residual symptoms of ahedonia/apathy?
Mirapex is a Dopamine agonist primarily used in the treatment of Parkinson's Disease but found to have good AD qualities. Try these two pages for some info:
http://www.parkinson.org/mxdepress.htm
http://www.psycom.net/depression.central.resistant.html (look part way down the page). Pramixipole)
Posted by manowar on January 13, 2002, at 18:25:49
In reply to Re: RE: Which TCA?- None if you can help it! » manowar, posted by DINGBAT on January 13, 2002, at 5:49:15
> > TCAs in my opinion, should only be used for last resort. They can cause all sorts of problems--VERY dirty drugs. Desepermine is probibly the cleanest and most activating. My pdoc was going to put me on another test of desepermine. Thank-God I talked him into giving me a trial of Provigil. I haven't felt this good in years!
>
> Excuse my ignorance, but what is Provigil (generic name)? What does it do pharmacologically? Dosage? Cost? Any info will be appreciated ...There is at least one thread currently on Provigil which generic name is Modafinil. Also look for Adrafinil. If you do a search, you find lots of info here.
Good Luck
Tim
Posted by manowar on January 13, 2002, at 18:38:25
In reply to Re: RE: Which TCA?- None if you can help it! » manowar, posted by bob on January 13, 2002, at 14:20:45
> Is that all you're on is provigil, or is it augmenting something else?
>
> What tricyclics did you take? I gather that desipramine was one of them.Yeah, desipramine with Klonipin seemed to work well for a while, but it pooped out. I can't remember taking what other TCAs I tried in the past, because it's been so long, but the side effects were horrible.
My current regimen is:
Wellbutrin (300 mg a day)+ Provigil (200 mg a day).
In the evening I take 1.5 mg of Klonipin.
This is the end of the thread.
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