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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 bearfan on May 21, 2010, at 20:40:13
Are these compounds (Parent drug vs metabolite) essentially the same drugs in efficacy for anxiety/depression disorders? I inquired about Desimpramine for the notion in may have less side effects, and he said it didn't have the same track record for anxiety relief since it was primarily a NRE.
Posted by softheprairie on May 22, 2010, at 4:29:53
In reply to Imipramine vs Desimpramine, posted by bearfan on May 21, 2010, at 20:40:13
What that person told you sounds correct to me.
I take desipramine for my depression, and other meds for my anxiety. The serotonin in various other meds I tried previously didn't seem to do much if anything for me; it was the NE action I was after. You might like imipramine more than desipramine. I will give the caveat (not sure if I have said this to you before) that I think desipramine can actually worsen anxiety; I think it did for me.
Posted by linkadge on May 22, 2010, at 10:46:55
In reply to Re: Imipramine vs Desimpramine » bearfan, posted by softheprairie on May 22, 2010, at 4:29:53
It has been postulated that the primary amines are more effective for anxious depression and the secondary amines for anergic depression.
Linkadge
Posted by Roslynn on May 22, 2010, at 11:39:04
In reply to Re: Imipramine vs Desimpramine, posted by linkadge on May 22, 2010, at 10:46:55
Hi, sorry for my lack of knowledge but which is a primary and which is a secondary?
thank you
Roslynn> It has been postulated that the primary amines are more effective for anxious depression and the secondary amines for anergic depression.
>
> Linkadge
Posted by linkadge on May 22, 2010, at 14:49:24
In reply to Re: Imipramine vs Desimpramine » linkadge, posted by Roslynn on May 22, 2010, at 11:39:04
Sorry I am using the wrong termiology.
The tertiary amines (amitriptyline, imipramine etc) are metabolized into the secondary amines nortriptyline and desipramine respectively.
Amitriptyline and imipramine are more sedative and anxiolytic. Desipramine and nortriptyline have more effect on norepinephrine and are supposedly better for low energy states.
Linkadge
Posted by bearfan on May 22, 2010, at 18:20:43
In reply to Re: Imipramine vs Desimpramine, posted by linkadge on May 22, 2010, at 10:46:55
Would this explain why Venlafaxine is approved for all the anxiety disorder, while it's seconadry metabolite desvelafaxine (or Pristiq), isn't and has caused anxiety for many people?
Posted by Phillipa on May 22, 2010, at 18:22:47
In reply to Re: Imipramine vs Desimpramine, posted by bearfan on May 22, 2010, at 18:20:43
I didn't know that thought pristiq was just a longing acting effexor. Phillipa
Posted by ed_uk2010 on May 22, 2010, at 18:30:51
In reply to Re: Imipramine vs Desimpramine, posted by bearfan on May 22, 2010, at 18:20:43
> Would this explain why Venlafaxine is approved for all the anxiety disorder, while it's seconadry metabolite desvelafaxine (or Pristiq), isn't and has caused anxiety for many people?
No, both venlafaxine and desvenlafaxine can cause initial anxiety in some people. Both drugs can be effective for anxiety in the long term, however.
The reason that imipramine and amitriptyline may be more effective for anxiety than desipramine and nortriptyline is a) because they are more sedating and b) because they are more serotonergic.
Although imipramine is partly metabolised to desipramine in the body, imipramine itself also has substantial pharmacological activity, which is why it can be quite different to desipramine in clinical practice. This also applies to amitriptyline and nortriptyline. This does not apply to other psych medications however, it is only by chance that the metabolites of these two drugs are both more noradrenergic and less sedating than the parent compounds.
Posted by linkadge on May 22, 2010, at 19:50:59
In reply to Re: Imipramine vs Desimpramine, posted by bearfan on May 22, 2010, at 18:20:43
Not necessarily. It depends on the pharmacological activity of the metabolite.
In the case of the TCA's it just so happens that the metabolites show preferential effects on the norepinephrine system.
In the case of venlafaxine, desvenlafaxine is also a poten SNRI. The reasons for the differences (should they occur) between the two is unclear.
Posted by bearfan on May 23, 2010, at 0:07:48
In reply to Re: Imipramine vs Desimpramine » bearfan, posted by linkadge on May 22, 2010, at 19:50:59
So linkage what would consider the best mulltiple reuptake on the market right now ?
Posted by ed_uk2010 on May 23, 2010, at 3:30:28
In reply to Re: Imipramine vs Desimpramine » bearfan, posted by Phillipa on May 22, 2010, at 18:22:47
> I didn't know that thought pristiq was just a longing acting effexor. Phillipa
Pristiq was just a way for Wyeth to make more money. It's hardly an innovation.
I wouldn't say that any of the SNRIs on the market at the moment are 'the best', responses to ADs are too individual.
Posted by Roslynn on May 23, 2010, at 13:58:13
In reply to Re: Imipramine vs Desimpramine, posted by linkadge on May 22, 2010, at 14:49:24
Hi Linkadge,
How would protriptyline compare to those meds below?
Thank you,
Roslynn> Sorry I am using the wrong termiology.
>
> The tertiary amines (amitriptyline, imipramine etc) are metabolized into the secondary amines nortriptyline and desipramine respectively.
>
> Amitriptyline and imipramine are more sedative and anxiolytic. Desipramine and nortriptyline have more effect on norepinephrine and are supposedly better for low energy states.
>
> Linkadge
>
>
>
>
>
>
Posted by linkadge on May 23, 2010, at 20:34:44
In reply to Re: Imipramine vs Desimpramine » linkadge, posted by Roslynn on May 23, 2010, at 13:58:13
Protriptyline would be similar to desipramine in that it is a potent NRI. I don't have experiences with it. I think SLS does, although I don't think his are positive.
If protriptyline fails nortriptyline may be still an option.
Linkadge
Posted by ed_uk2010 on May 24, 2010, at 16:24:18
In reply to Re: Imipramine vs Desimpramine, posted by linkadge on May 23, 2010, at 20:34:44
>Protriptyline would be similar to desipramine in that it is a potent NRI. I don't have experiences with it.
Protriptyline doesn't seem to be a popular drug. I believe that it causes considerably more side effects than desipramine.
Posted by bearfan on May 24, 2010, at 16:55:21
In reply to Re: Imipramine vs Desimpramine » linkadge, posted by ed_uk2010 on May 24, 2010, at 16:24:18
Anyone use Desimpramine successfully for anxiety?
Posted by Roslynn on May 24, 2010, at 17:53:21
In reply to Re: Imipramine vs Desimpramine, posted by bearfan on May 24, 2010, at 16:55:21
I am on protriptyline, started a couple weeks ago and having a terrible time. The dry mouth is much worse than any I've had. I'm experiencing a lot of confusion, probably due to my total combination of meds. Also, you have to take this drug 3x per day but for me it's very sedative so this is hard.
Just my experience...
I may ask to be switched to a different TCA.
Posted by ed_uk2010 on May 24, 2010, at 17:56:36
In reply to Re: Imipramine vs Desimpramine, posted by Roslynn on May 24, 2010, at 17:53:21
>I may ask to be switched to a different TCA.
I think that sounds sensible. The various TCAs have different properties.
This is the end of the thread.
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