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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by UgottaHaveHope on December 19, 2006, at 23:03:26
Thats what Im thinking about asking my pdoc to try for anxiety. Have you tried? What was your response?
Posted by UgottaHaveHope on December 19, 2006, at 23:06:16
In reply to Imipramine for anxiety? Anyone tried?, posted by UgottaHaveHope on December 19, 2006, at 23:03:26
nm
Posted by Phillipa on December 19, 2006, at 23:10:54
In reply to Imipramine for anxiety? Anyone tried?, posted by UgottaHaveHope on December 19, 2006, at 23:03:26
Is that pamelor? As that will knock you out. Love Phillipa
Posted by blueberry1 on December 20, 2006, at 4:17:49
In reply to Imipramine for anxiety? Anyone tried?, posted by UgottaHaveHope on December 19, 2006, at 23:03:26
I have never tried imipramine.
The side effect profile is harsher than other meds generally. Whether it works for anxiety or not I think depends on a person to person basis and could probably help or make things worse.
What else have you tried?
Posted by Quintal on December 20, 2006, at 10:03:37
In reply to Imipramine for anxiety? Anyone tried?, posted by UgottaHaveHope on December 19, 2006, at 23:03:26
Yes, I tried imipramine a few years ago to while I was withdrawing from benzos. I didn't like it at all. Lots of sweating and uncomfortable flushing. It did nothing for my anxiety. This could be due to the fact I was in benzo withdrawal of course.
I think clomipramine (Anafranil) would be worth looking at if you're considering a TCA.
Q
Posted by Tom Twilight on December 20, 2006, at 12:47:45
In reply to Re: Imipramine for anxiety? Anyone tried? » UgottaHaveHope, posted by Quintal on December 20, 2006, at 10:03:37
> I think clomipramine (Anafranil) would be worth looking at if you're considering a TCA.
>I can vouch for the fact that Clomipramine is good for Anxiety, if you can tollerate it!
Have no Experience with Imipramine
Posted by yxibow on December 20, 2006, at 19:13:17
In reply to Imipramine for anxiety? Anyone tried?, posted by UgottaHaveHope on December 19, 2006, at 23:03:26
> Thats what Im thinking about asking my pdoc to try for anxiety. Have you tried? What was your response?
Imipramine was the first TCA in the 50s (Tofranil); being the first it probably is less refined and has more side effects than later TCAs, but TCAs do carry certain burdens. Notably, anticholinergic activity, sedation, some cause sweating, and possible weight gain. Now this isn't to knock them -- even while SSRIs were already and still already available, Anafranil has been used for hard OCD cases. So clomipramine has some use in anxiety disorders still, as long as you can tolerate its side effects.
Getting used to sedation is probably one of them, I'm not sure, I haven't taken it before. I know doxepin is extremely sedating and is used for sleep but the sheer knockout quality for doxepin-naive people like myself turned me away from it. I do imagine that goes away, somewhat, over time but its probably the case that TCAs are taken more at night.Maybe someone can jump in here about that issue.
Posted by med_empowered on December 20, 2006, at 23:33:33
In reply to Re: Imipramine for anxiety? Anyone tried? » UgottaHaveHope, posted by yxibow on December 20, 2006, at 19:13:17
Tofranil sucks. I took the new-ish version, Tofranil-PM or whatever (its a once a day cap, which is a good call since the stuff is so sedating). Keep in mind that imipramine was derived from Thorazine and it was initially intended to be a neuroleptic. It is an antidepressant instead, but the intense sedation and cognitive impairment is kind of neuroleptic-ish. Plus, it just made me pissed off. Constantly.
Personally, I'd avoid TCAs if you can. They really aren't good drugs. If you have anxiety, try starting with the safest, most effective meds and then working out to less tolerable, less demonstrably effective meds. So...I'd say try starting with a benzo and possibly a first-tier Antidepressant.
Posted by Quintal on December 21, 2006, at 9:32:10
In reply to Re: Imipramine for anxiety? Anyone tried?, posted by med_empowered on December 20, 2006, at 23:33:33
>Personally, I'd avoid TCAs if you can. They really aren't good drugs. If you have anxiety, try starting with the safest, most effective meds and then working out to less tolerable, less demonstrably effective meds. So...I'd say try starting with a benzo and possibly a first-tier Antidepressant.
That's curious because imipramine was the 'gold standard' to which the efficiency of other antidepressants were compared, and still are to some extent. The TCAs are generally very effective, sometimes more so than the SSRIs - it's mainly the toxicity that makes the SSRIs the preferred first-line treatments. Side effects can be harsh, but personally I prefer the side effect profile of the TCAs over most SSRIs.Benzos also cause cognitive impairment though people are not usually aware of how badly they are affected.
Q
Posted by yxibow on December 21, 2006, at 13:31:50
In reply to Re: Imipramine for anxiety? Anyone tried? » med_empowered, posted by Quintal on December 21, 2006, at 9:32:10
> >Personally, I'd avoid TCAs if you can. They really aren't good drugs. If you have anxiety, try starting with the safest, most effective meds and then working out to less tolerable, less demonstrably effective meds. So...I'd say try starting with a benzo and possibly a first-tier Antidepressant.
>
>
> That's curious because imipramine was the 'gold standard' to which the efficiency of other antidepressants were compared, and still are to some extent. The TCAs are generally very effective, sometimes more so than the SSRIs - it's mainly the toxicity that makes the SSRIs the preferred first-line treatments. Side effects can be harsh, but personally I prefer the side effect profile of the TCAs over most SSRIs.
>
> Benzos also cause cognitive impairment though people are not usually aware of how badly they are affected.
>
> QAnafranil is more of a "gold standard" because of its SRI capabilities to SSRIs.
Amitryptaline has multipurpose use -- actually so does doxepin still, it is used in allergy cases as it blocks H1 and H2.
Posted by Quintal on December 21, 2006, at 14:39:05
In reply to Re: Imipramine for anxiety? Anyone tried? » Quintal, posted by yxibow on December 21, 2006, at 13:31:50
>Anafranil is more of a "gold standard" because of its SRI capabilities to SSRIs.
>Amitryptaline has multipurpose use -- actually so does doxepin still, it is used in allergy cases as it blocks H1 and H2.
I agree, but imipramine was the drug used as a benchmark in clinical trials against which the efficiency of other ADs were compared for many years, including clomipramine most likely.
http://bjp.rcpsych.org/cgi/content/full/180/1/8
Q
Posted by jimmygold70 on December 22, 2006, at 4:47:17
In reply to Imipramine for anxiety? Anyone tried?, posted by UgottaHaveHope on December 19, 2006, at 23:03:26
Imipramine is probably one of the most established therapies for anxiety. But do you actually tolerate it?!
> Thats what Im thinking about asking my pdoc to try for anxiety. Have you tried? What was your response?
Posted by naughtypuppy on December 22, 2006, at 9:47:05
In reply to Re: Imipramine for anxiety? Anyone tried? » med_empowered, posted by Quintal on December 21, 2006, at 9:32:10
> >Personally, I'd avoid TCAs if you can. They really aren't good drugs. If you have anxiety, try starting with the safest, most effective meds and then working out to less tolerable, less demonstrably effective meds. So...I'd say try starting with a benzo and possibly a first-tier Antidepressant.
>
>
> That's curious because imipramine was the 'gold standard' to which the efficiency of other antidepressants were compared, and still are to some extent. The TCAs are generally very effective, sometimes more so than the SSRIs - it's mainly the toxicity that makes the SSRIs the preferred first-line treatments. Side effects can be harsh, but personally I prefer the side effect profile of the TCAs over most SSRIs.I believe that Imipramine is usually used as a control because it is easy to measure it's blood serum levels. This adjusts for things like being a fast/slow metabolizer. I just started it a few days ago and strangly enough my anxiety level has been reduced for the last couple of days, but I think that is mainly because many TCA's cause Depakote to be metabolized more slowly, so it's similar to increasing the Depakote dosage.
>
> Benzos also cause cognitive impairment though people are not usually aware of how badly they are affected.
>
> Q
Posted by jimmygold70 on December 22, 2006, at 10:20:49
In reply to Re: Imipramine for anxiety? Anyone tried? » med_empowered, posted by Quintal on December 21, 2006, at 9:32:10
> >Personally, I'd avoid TCAs if you can. They really aren't good drugs. If you have anxiety, try starting with the safest, most effective meds and then working out to less tolerable, less demonstrably effective meds. So...I'd say try starting with a benzo and possibly a first-tier Antidepressant.
I agree that TCA are a third-tier. Start with a SSRI.
> That's curious because imipramine was the 'gold standard' to which the efficiency of other antidepressants were compared, and still are to some extent. The TCAs are generally very effective, sometimes more so than the SSRIs - it's mainly the toxicity that makes the SSRIs the preferred first-line treatments. Side effects can be harsh, but personally I prefer the side effect profile of the TCAs over most SSRIs.
Many people do, in fact.
> Benzos also cause cognitive impairment though people are not usually aware of how badly they are affected.
True. Though benzos are good on a as-needed basis or for augmentation or for sleep.
Jimmy
Posted by linkadge on December 22, 2006, at 20:34:40
In reply to Re: Imipramine for anxiety? Anyone tried? » Quintal, posted by jimmygold70 on December 22, 2006, at 10:20:49
I wouldn't say that the TCA's aren't good drugs. For some people they are highly effective drugs.
For me, SSRI's produce apathy at best.
Clomipramine was probably one of the only drugs that I would classify as an antidepressant.
Some theorize that the anticholinergic actions of the drugs are a necessary part of their overall efficacy in some depression. The combination of anticholinergic action + noradrenergic action is going to give an even more pronounced push allong that axis.
Linkadge
Posted by jimmygold70 on December 23, 2006, at 4:45:06
In reply to Re: Imipramine for anxiety? Anyone tried?, posted by linkadge on December 22, 2006, at 20:34:40
> I wouldn't say that the TCA's aren't good drugs. For some people they are highly effective drugs.
I strongly agree. I perosnally don;t like them and many will never tolerate them, but for some TCAs are a miracle.
> For me, SSRI's produce apathy at best.
>
> Clomipramine was probably one of the only drugs that I would classify as an antidepressant.
>
> Some theorize that the anticholinergic actions of the drugs are a necessary part of their overall efficacy in some depression. The combination of anticholinergic action + noradrenergic action is going to give an even more pronounced push allong that axis.I've heard that and it's not that convincing. But I also don't find the monoamines theory convincing either... (-:
> Linkadge
>
>
Posted by linkadge on December 23, 2006, at 10:14:40
In reply to Re: Imipramine for anxiety? Anyone tried? » linkadge, posted by jimmygold70 on December 23, 2006, at 4:45:06
Oftentimes patients being treated with neuroleptics would fake TD to experience the mindless euphoria of potent anticholinergics like cogentin.
Infact, I found cogentin to be as mood brightening as any TCA. Some researchers have shunned the use of cogentin as an active placebo in antidepressant trials because it often performs as well or better.
I found cogentin worked for panic attacks, as well as other thought frenzied states.
A few studies have even found anticholinergics active in forced swim tests.
Linkadge
This is the end of the thread.
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