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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by bearfan on February 21, 2010, at 4:12:04
Which one on the market is most similar to Effexor and Cymbalta? I have been trying nortriptyline, and do not seem to be getting any Serotonin/ relaxed effect. Just seems like an NRI.
Posted by Brainbeard on February 21, 2010, at 8:42:55
In reply to Tricyclic most like SNRIs?, posted by bearfan on February 21, 2010, at 4:12:04
> Which one on the market is most similar to Effexor and Cymbalta? I have been trying nortriptyline, and do not seem to be getting any Serotonin/ relaxed effect. Just seems like an NRI.
I would say imipramine (aka Tofranil). Imipramine might be the most underrated and underprescribed antidepressant of our time. Effexor (venlafaxine) and Cymbalta (duloxetine) are actually inferior NRI's compared to the TCA's, so there's a big difference there. And Effexor surely is a much weaker SRI than imipramine and especially clomipramine (aka Anafranil), which is a very strong SRI as well as a strong NRI. Imipramine is a medium strong SRI and a strong NRI.
Ken Gillman, the TCA guru for some of us, wrote an interesting article comparing the properties of the old TCA's with new drugs like Effexor and Cymbalta: http://www3.interscience.wiley.com/cgi-bin/fulltext/121665024/HTMLSTART?CRETRY=1&SRETRY=0
Posted by Phillipa on February 21, 2010, at 10:48:51
In reply to Re: Tricyclic most ..... - How About Imipramine?, posted by Brainbeard on February 21, 2010, at 8:42:55
Not going off topic but reading Listening To Prozac and the doc writes of when the TCA's were discovered. It's very interesting and would also answer your question on the TCA's. Phillipa
Posted by Bob on February 21, 2010, at 12:45:07
In reply to Re: Tricyclic most ..... - How About Imipramine? » Brainbeard, posted by Phillipa on February 21, 2010, at 10:48:51
> Not going off topic but reading Listening To Prozac and the doc writes of when the TCA's were discovered. It's very interesting and would also answer your question on the TCA's. Phillipa
So what does he say about them? How does it answer the question?
Posted by Phillipa on February 21, 2010, at 19:45:10
In reply to Re: Tricyclic most ..... - How About Imipramine? » Phillipa, posted by Bob on February 21, 2010, at 12:45:07
Bob it's rather complicated you have to read it and form your own conclusions. He so far seems rather in awe that any med is changing a patients personality as he refers to it. I so far think he feels that psychology is more the answer than mes. Phillipa
Posted by gman22 on February 22, 2010, at 18:28:47
In reply to Tricyclic most like SNRIs?, posted by bearfan on February 21, 2010, at 4:12:04
I totally agree with brainbeard. Imipramine no doubt saved my life at one point. Side effects were moderate but one millionth as bad as severe anxiety and depression. It' a very safe and effective drug when used properly.
Posted by bleauberry on February 22, 2010, at 19:57:23
In reply to Tricyclic most like SNRIs?, posted by bearfan on February 21, 2010, at 4:12:04
Clomipramine is the one.
Other than that, best bet is to combine Nort with an SSRI. Usually zoloft or prozac sometimes lexapro. That way you can custom tailor your balance of serotonin and NE. Single meds have fixed ratios that you can't change and may not be right for you.
All that said, effexor and cymbalta are barely SNRIs. It is almost ingenuous to call them SNRIs. They are predominantly serotonin. Marketing gimmickery probably.
Posted by conundrum on February 22, 2010, at 22:23:18
In reply to Re: Tricyclic most like SNRIs?, posted by bleauberry on February 22, 2010, at 19:57:23
Taken from the following study:
http://cat.inist.fr/?aModele=afficheN&cpsidt=2585906
"Duloxetine (5.0 mg/kg, s.c.) and fluoxetine (10.0 mg/kg, s.c.) increased dialysate levels of DA (65 and 60% vs. basal values, respectively), NAD (400 and 90%, respectively), and 5-HT (130 and 110%, respectively) in the frontal cortex (FCX)."
If I'm interpreting this correctly Duloxetine increases norepinephrine more than serotonin or dopamine in the PFC. Perhaps this isn't true through out the brain but it probably has clinical significance.
Posted by Brainbeard on February 23, 2010, at 8:59:10
In reply to Re: Tricyclic most like SNRIs?, posted by bleauberry on February 22, 2010, at 19:57:23
> Clomipramine is the one.
Clomipramine does seem to be the one for OCD or severe endogenous depression, and in low doses for panic disorder, but for other types of depression and/or anxiety, it has the disadvantage of offering all the typical side-effects of the tertiary amine TCA's PLUS one of the typical side-effects of the SSRI's, namely severe sexual dysfunction. This may not happen to everyone, but clomipramine is about as strong an SRI as Zoloft (sertraline), so you can expect the sexual dysfunction to be about as bad. This has often been overlooked in applauding clomipramine.
The sexual dysfunction is likely to be less on imipramine, although it is dose dependent. Of the tertiary amine TCA's, amitriptyline is probably the most friendly to sex life.
Anyway, when strong SRI, which comes at a price, isn't necessary, imipramine makes for a great SNRI+.
Nortriptyline isn't the noradrenergic TCA of choice for everyone, since desipramine, a much stronger NRI, has the benefit of being suitable to treat AD(H)D related disorders and in practice also seems to be able to treat certain types of pain more effectively than nortriptyline (my own experience as well as those of others).
Posted by Dr. Bob on February 26, 2010, at 8:41:42
In reply to Re: Tricyclic most like SNRIs? » bleauberry, posted by conundrum on February 22, 2010, at 22:23:18
> "Duloxetine (5.0 mg/kg, s.c.) and fluoxetine (10.0 mg/kg, s.c.) increased dialysate levels of DA (65 and 60% vs. basal values, respectively), NAD (400 and 90%, respectively), and 5-HT (130 and 110%, respectively) in the frontal cortex (FCX)."
Sorry to interrupt, but I'd like to redirect follow-ups regarding dialysate levels, etc., to Psycho-Babble Neurotransmitters. Here's a link:
http://www.dr-bob.org/babble/neuro/20100223/msgs/937959.html
That'll be considered a new thread, so if you'd like to be notified by email of follow-ups to it, you'll need to request that there.
It's fine to keep discussing more basic medication-related issues here.
Thanks,
Bob
This is the end of the thread.
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