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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 francineus on March 10, 2008, at 20:54:46
Hi
I tried nortryptline a few months back and it did nothing for my depression. Does anyone have an opinion about whether all TCA's work alike and whether giving tofranil a try may be worth it?
Trying everything...still in a funk and feeling like nothing will work. Any thoughts on lithium?
Posted by bleauberry on March 10, 2008, at 21:26:41
In reply to TCA's are they similar? Tried nortryp.nada, posted by francineus on March 10, 2008, at 20:54:46
There is a thing called the Methylphenidate challenge test. A patient is given 20mg Ritalin. If they respond positively to that, it fairly reliably predicts a response to Desipramine. If the Ritalin test is not positive it fairly reliably predicts a response to Nortriptyline.
Does this test really work? Well in a small clinical study it had significance. In the real world, I don't know. But the real point here is...yes, the TCAs are different. In that small trial most of the patients who did not respond to Nortriptyline did respond to Desipramine, and vica versa.
Considering the issues of side effects, Nortriptyline and Desipramine have fewer side effects than most of the others. So if Nortriptyline didn't work, then maybe Desipramine would be considered next.
Old proven add-ons such as Lithium should not be ruled out. I generally shy away from antipsychotics, but they do have good antidepressant potential when added to antidepressants of all kinds. The most anecdotal reliable one I know of is Zyprexa. Second to that would be Risperdal. Others work also, but it seems more hit and miss.
When logic fails you, when things that seem to make sense don't work, then maybe it makes sense to try things that are illogical and don't make sense. For example, a minority of people find Neurontin stimulating and powerfully antidepressant, where with most people it is sedating and not much of an antidepressant. Same with Depakote. I know a guy who got a little bit of response to Lexapro, a little bit more with Risperdal added to it, and then a perfect robust response with Depakote added to that. So sometimes you just gotta try different stuff whether it makes sense or not.
Posted by Phillipa on March 10, 2008, at 21:48:46
In reply to Re: TCA's are they similar? Tried nortryp.nada, posted by bleauberry on March 10, 2008, at 21:26:41
Don't they all cause a lot of weight gain? Love Phillipa
Posted by mav27 on March 11, 2008, at 0:28:40
In reply to TCA's are they similar? Tried nortryp.nada, posted by francineus on March 10, 2008, at 20:54:46
I've been on both, tofranil (imipramine) worked wonders, nortriptyline did nothing except make me irritable.
Posted by Jedi on March 12, 2008, at 2:12:10
In reply to TCA's are they similar? Tried nortryp.nada, posted by francineus on March 10, 2008, at 20:54:46
Did you have the blood tests to make sure you were in the therapeautic window. I think I am a rapid metababolizer of TCAs. I've taken desipramine, nortriptyline, and nortriptyline with Nardil. I have never came close to the therapeautic window on any of them. Off the charts low no matter how high the dosage.
Lithium is probably the most widely used augmentor there is. It is always worth a shot.
Good Luck,
Jedi
> Hi
> I tried nortryptline a few months back and it did nothing for my depression. Does anyone have an opinion about whether all TCA's work alike and whether giving tofranil a try may be worth it?
> Trying everything...still in a funk and feeling like nothing will work. Any thoughts on lithium?
>
>
>
Posted by francineus on March 12, 2008, at 20:18:57
In reply to Re: TCA's are they similar? Tried nortryp.nada » francineus, posted by Jedi on March 12, 2008, at 2:12:10
Thank you for all of the great info. May try imipramine and discuss lithium. The Ritalin and deseryl connection is an interesting one. I do feel better on ritalin...although totally speeded up.
Great to have all of the support!
Posted by francineus on March 12, 2008, at 20:22:04
In reply to Re: TCA's are they similar? Tried nortryp.nada, posted by bleauberry on March 10, 2008, at 21:26:41
oops. desipramine isn't same as desyrl I guess. It's norpramin. Will ask doc about this./
Posted by Dopamine123 on March 14, 2008, at 16:57:20
In reply to Re: TCA's are they similar? Tried nortryp.nada, posted by francineus on March 12, 2008, at 20:18:57
All the TCA's are fairly different drugs, so if you fail one of them you definitely might want to try the others. The SSRI's for the most part, all have the same mechanism of action. TCA's on the other hand hit many different types of receptors. If you don't do well on one, another might hit a different neurotransmitter/receptor system and give you a better response. Also, remember to try adjusting the dosage of the drug. These drugs have very different effects at different dosages so if you fail at a one dose level, you might want to try a different dose before moving on.
This is the end of the thread.
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