Psycho-Babble Medication Thread 937358

Shown: posts 1 to 8 of 8. This is the beginning of the thread.

 

Best first Tricyclic to Try?

Posted by bearfan on February 19, 2010, at 3:49:30

I didn't have full remission with SSRIs and didn't like the SNRIs much. Doctor suggested maybe trying a tricyclic. Was wondering which ones I should try first. I've only vaguely familiar with the names Elavil, Pamelor, and a few other ones. What do these drugs 'feel like' and are they anything like SSRIs or have different side effect profiles? Anxiet and Depression are primary concerns

 

Re: Best first ... - Overview Of Properties

Posted by Brainbeard on February 19, 2010, at 6:13:44

In reply to Best first Tricyclic to Try?, posted by bearfan on February 19, 2010, at 3:49:30

I wrote a post that might be helpful to you in this thread (it's the last post in the thread, currently): http://www.dr-bob.org/cgi-bin/pb/mget.pl?post=/babble/20090620/msgs/902389.html#902389

Quoting myself ('->' means: 'metabolizes into [active metabolite]'):

'imipramine (relatively strong, mildly sedative SNRI) -> desipramine (strong NRI). Since desipramine potentially has a half-life of more than hundred hours, and imipramine a half-life of less than 24 hours, the desipramine tends to dominate on higher dosages.

amitriptyline (dirty, sedative, anxiolytic NSRI -> nortriptyline (sedative, anxiolytic NRI)

clomipramine (strong, sedative, anxiolytic SRI and SNRI) -> desmethylclomipramine (NRI). Also with clomipramine, the metabolite has a longer half-life, so on higher dosages the NRI-action is boosted significantly more than the SRI-action. In fact, clomipramine is such a strong SRI that even 10mg is enough to reach the amount of serotonin reuptake inhibition that a typical therapeutic dose of an SSRI delivers (http://archpsyc.ama-assn.org/cgi/content/full/60/4/386).'

It depends a bit on the type of anxiety you have which TCA might work best. If you got OCD of any kind, clomipramine is the drug of choice. If it's more general anxiety, amitriptyline or imipramine might work best. The TCA's are, in my not so humble opinion, superior to the newer antidepressants, but it can be hard to tolerate their side-effects. I like clomipramine a lot, but it makes my eyes extremely, even painfully sensitive to sunlight, which is a real bummer. It also gave me worse sexual side-effects than even Paxil gave me.

Anyway, hope this helps.

Make your day, go TCA!!!

 

Re: Best first Tricyclic to Try? » bearfan

Posted by Maxime on February 19, 2010, at 8:11:31

In reply to Best first Tricyclic to Try?, posted by bearfan on February 19, 2010, at 3:49:30

Since anxiety is a concern, you should probably try "amitriptyline" first. Take it at night as it's very sedating.

Good luck with your quest.

 

Re: Best first Tricyclic to Try? » Maxime

Posted by Phillipa on February 19, 2010, at 10:50:39

In reply to Re: Best first Tricyclic to Try? » bearfan, posted by Maxime on February 19, 2010, at 8:11:31

Pamelor l0mg with benzos taken at night left me plastered in bed couldn't move. I only took it once. Didn't feel bad then and other stuff was working. Good luck. Phillipa

 

Re: Best first Tricyclic to Try?

Posted by Phillipa on February 19, 2010, at 10:51:53

In reply to Re: Best first Tricyclic to Try? » Maxime, posted by Phillipa on February 19, 2010, at 10:50:39

Sorry above to Bearfan. Phillipa

 

Re: Best first Tricyclic to Try?

Posted by bearfan on February 19, 2010, at 19:05:32

In reply to Best first Tricyclic to Try?, posted by bearfan on February 19, 2010, at 3:49:30

SNRIs gave me a slightly higher remission of symptoms, but the side effects were more. Primary concerns, anxiety, depression, some OCD and a touch of ADD. Would love for their to be a drug that could control those without making me sexless and gain weight. Prozac and Cymbalta were the most effective.

 

Re: Best first Tricyclic to Try?

Posted by gman22 on February 20, 2010, at 15:32:44

In reply to Best first Tricyclic to Try?, posted by bearfan on February 19, 2010, at 3:49:30

I had great success with imipramine at 150 mg. I only took it for 9 months and was in remission for about 10 years. Now on nortriptyline (with zoloft), and seems to be going fine. Side effects were worse on imipramine, but not too bad.

 

Re: Best first Tricyclic to Try?

Posted by bleauberry on February 20, 2010, at 18:03:56

In reply to Best first Tricyclic to Try?, posted by bearfan on February 19, 2010, at 3:49:30

Well, this isn't the answer you were looking for, but it deserves mention.

When someone says they didn't reach "full remission" on SSRIs, that means the ssri worked, just not enough. In other words, serotonin was a player in the disease, but not the only player.

So instead of switching to an entirely different medication, it would make more sense to add another one that targets something else besides serotonin. You've got half the battle won with the ssri, but you'll give up that win and start from scratch with another med. For example, Nortriptyline added to any SSRI. Or Desipramine added.

Any combination of a TCA with a SSRI is likely to be faster and more thoroughly effective than either alone, no matter which TCA you choose.

If going TCA only, the one most likely to work thorough is Clomipramine, but it also has heavy side effects in the areas of constipation, dry mouth, blurry eyes, and tiredness.

The TCA with the tamest side effects is usually considered to be Nortriptyline. It happens to go very well with any of the SSRIs.

I did terrible on Zoloft, terrible on all SSRis actually, and terrible on Nortriptyline. But when Zoloft and Nortriptyline were combined, it was like a totally different drug and actually had some good to it. Other meds are more suited for me though.

I'm just saying, consider TCA+SSRI rather than either alone. You'll be able to have the potential of faster response, stronger response, and low side effects since the doses of each would be lower than if taken by themselves.

Another viable option would have been to add low dose Abilify to the SSRI, which is FDA approved for that, and seems to be quite popular these days, so I am surprised your doctor didn't mention it.

> I didn't have full remission with SSRIs and didn't like the SNRIs much. Doctor suggested maybe trying a tricyclic. Was wondering which ones I should try first. I've only vaguely familiar with the names Elavil, Pamelor, and a few other ones. What do these drugs 'feel like' and are they anything like SSRIs or have different side effect profiles? Anxiet and Depression are primary concerns


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