![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by jujube on October 31, 2004, at 15:20:03
Can anybody tell me if they have found TCAs more effective than SSRIs in treating depression with anxiety/panic? If so, which one would be considered most effect (with the least side effects)? Are the side effects for TCAs really bad? Do they go away after a few weeks?
Any information would be appreciated.
Thanks.
Tamara
Posted by jboud24 on October 31, 2004, at 17:39:54
In reply to Tricyclic ADs vs. SSRIs, posted by jujube on October 31, 2004, at 15:20:03
Clomipramine has been proven statistically superior for anxiety disorders over the other anti-depressants of the TCA class. That is, if you can handle the side-effects: anti-cholinergic, ie dry mouth, sedation, dizziness; anti-serotonin, ie sedations; alpha-adrenergic-blocking, ie orthostatic hypotension. You may not get any of these, or you may experience them all. As with any med, YMMV, but you won't know until you try.
Good luck,
Justin
Posted by jujube on October 31, 2004, at 18:01:20
In reply to Re: Tricyclic ADs vs. SSRIs » jujube, posted by jboud24 on October 31, 2004, at 17:39:54
Thanks. I will definitely be discussing TCAs with the pdoc next week. The dizziness is a concern because I already experience dizziness (maybe anxiety-related though). Plus, I do have slightly low blood pressure, so the postural hypotension is also a bit of a concern. Do you know if TCAs are considered superior for depression as well, particularly the adhedonic kind?
Tamara
> Clomipramine has been proven statistically superior for anxiety disorders over the other anti-depressants of the TCA class. That is, if you can handle the side-effects: anti-cholinergic, ie dry mouth, sedation, dizziness; anti-serotonin, ie sedations; alpha-adrenergic-blocking, ie orthostatic hypotension. You may not get any of these, or you may experience them all. As with any med, YMMV, but you won't know until you try.
>
> Good luck,
> Justin
Posted by jboud24 on October 31, 2004, at 18:59:51
In reply to Re: Tricyclic ADs vs. SSRIs » jboud24, posted by jujube on October 31, 2004, at 18:01:20
TCA's are probably better than SSRI's for anhedonic depression due to their effects on norepinephrine reuptake inhibition. Desipramine has the strogest and most selective profile in regards to the NRI effects. Clomipramine possesses them as well, but it is more of a dual reuptake inhibitor.
Perhaps combining a selective SSRI like Zoloft or Celexa with a selective NRI TCA like desipramine would be something to look into. You would probably risk less hypotension and dizziness with such a combination.
Good luck with your doc, my next appointment is Tuesday with a new pdoc. I'll be asking for a trial of Nardil and Klonopin. I'm tired of the monoamine reuptake inhibitors, they dont seem to be cutting the proverbial mustard for me.
Justin
Posted by jujube on October 31, 2004, at 19:14:22
In reply to Re: Tricyclic ADs vs. SSRIs, posted by jboud24 on October 31, 2004, at 18:59:51
Unfortunately, the pdoc I see doesn't seem to keen on combining ADs. I, myself, am not too keen on another 8 week trial, but if that's what I have to do, then so be it. I just hope I can have some relief before Christmas. I don't want to ruin Christmas too (haven't been very present for any celebrations, birthdays, Thanksgiving, etc., for the past number of months). By the way, I thought Nardil was a MOAI?
My appointment is on Tuesday as well. I am not the most open person when it comes to my emotions, even with the pdoc, so I don't think he is completely aware of how bad I am feeling. In my family, everybody else was allowed to be upset, sad, anxious, but I always got the "what have you got to worry about. Your problems are nothing compared to what I am going through.". Nobody wants me to be sad or sick or anything but available and supportive. So, I've learned to just deal with things myself, and keep a smile on my face. And, I am generally a happy person who can let things roll off there back. But not now or for the past number of months, and it is scaring the crap out of me. Oh well, I think the pdoc will run out of kleenex by the time my hour is up next week. Sorry to ramble.
Good luck to you with your new pdoc and at your appointment on Tuesday. I hope all goes well. Who knows, perhaps we will be comparing notes next week.
Take care and thanks.
Tamara
> TCA's are probably better than SSRI's for anhedonic depression due to their effects on norepinephrine reuptake inhibition. Desipramine has the strogest and most selective profile in regards to the NRI effects. Clomipramine possesses them as well, but it is more of a dual reuptake inhibitor.
>
> Perhaps combining a selective SSRI like Zoloft or Celexa with a selective NRI TCA like desipramine would be something to look into. You would probably risk less hypotension and dizziness with such a combination.
>
> Good luck with your doc, my next appointment is Tuesday with a new pdoc. I'll be asking for a trial of Nardil and Klonopin. I'm tired of the monoamine reuptake inhibitors, they dont seem to be cutting the proverbial mustard for me.
>
> Justin
Posted by cherylann on November 1, 2004, at 21:38:13
In reply to Re: Tricyclic ADs vs. SSRIs » jboud24, posted by jujube on October 31, 2004, at 18:01:20
I've tried my fair share of ADs and TCA's work best for me. I've got depression/severe panic and for whatever reason, I get awesome results from the TCA's. The SSRI's take the panic/anxiety away, but make me feel very cold and unloving.
Hope that helps,
best wishes,
cherylann
Posted by jujube on November 2, 2004, at 6:48:15
In reply to Re: Tricyclic ADs vs. SSRIs, posted by cherylann on November 1, 2004, at 21:38:13
Thanks so much. If you don't mind my asking, which TCAs have you tried? Which one did you find the best for anxiety/panic? What side effects did you have? Was the weight gain bad? And, how long did you have to put up with the side effects?
Tamara
> I've tried my fair share of ADs and TCA's work best for me. I've got depression/severe panic and for whatever reason, I get awesome results from the TCA's. The SSRI's take the panic/anxiety away, but make me feel very cold and unloving.
> Hope that helps,
> best wishes,
> cherylann
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.