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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 schleprock on August 20, 2012, at 11:49:50
OK, I sort of need the definitive answer beacause I might just try this. Thinking about moving from Nortriptyline to Clomipramine, because the latter I discovered is rumoured to be one of the best ADs for depression, and my Nortriptyline (150 mg) isn't as effective as it used to be (and switching between the same class doesn't scare me as much.) 2 Questions:
1. Is it somehow a forgone conclusion that switching from a pooped-out TCA to a different TCA will make little difference. Or are the mechanisms of these specific TCAs just different enough to justify a trial of one over the other. (I guess similar more common strategies of SSRI being swapped around for one another.)
2. Being on Nortriptyline for 20 years, should I expect anything severe in terms of withdrawel (I'd actually be switching from Pamelor, which I've been on a few months, to a generic Clomipramine, so I know that some symptoms will be involved.) Since both are TCAs, are their compositions similar enough that my body won't miss what's specefic to Nortriptyline too badly. And would tapering even be necessary?
Also, can anyone confirm that 150mg of Nortriptyline is equivalent to 300mg of Clomipramine, as those seem to be their maximum dosages.
On a side note, I mentioned augmenting my current Nortriptyline dose with Effexor and he said that it wouldn't make sense, because "it would be like just adding another pill of Nortriptyline." I'm not too sure what to make of that.
Posted by phidippus on August 20, 2012, at 14:24:16
In reply to Nortriptyline x Clomipramine, posted by schleprock on August 20, 2012, at 11:49:50
Clomipramine is considered the 'gold' standard for treating depression.
1. It is not a forgone conclusion switching from one pooped-out TCA to another will make little difference. Each TCA has a different and specific mechanism of action. For instance, Clomipramine antagonizes dopamine, whereas Nortryptaline does not.
2. I wouldn't expect withdrawal symptoms especially if you cross-taper between each medication.
Effexor and Nortryptaline are both SNRIs and have similar modes of action.
Eric
Posted by schleprock on August 20, 2012, at 16:48:16
In reply to Re: Nortriptyline x Clomipramine » schleprock, posted by phidippus on August 20, 2012, at 14:24:16
> Clomipramine is considered the 'gold' standard for treating depression.
>
> 1. It is not a forgone conclusion switching from one pooped-out TCA to another will make little difference. Each TCA has a different and specific mechanism of action. For instance, Clomipramine antagonizes dopamine, whereas Nortryptaline does not.
>
> 2. I wouldn't expect withdrawal symptoms especially if you cross-taper between each medication.
>
> Effexor and Nortryptaline are both SNRIs and have similar modes of action.
>
> Eric
>Thanks. Due to this and a response on another forum, I might actually be looking forward to this. Do you know offhand if Clomipramine requires the same plasma-level testing (for the "therapeutic window") that Nortriptyline does?
Posted by SLS on August 20, 2012, at 17:10:06
In reply to Re: Nortriptyline x Clomipramine » schleprock, posted by phidippus on August 20, 2012, at 14:24:16
> Clomipramine antagonizes dopamine,
Where can I find more information on this?
Is this a direct effect at the DA synapse, or an effect secondary to serotonin reuptake inhibition?
- Scott
Posted by phidippus on August 20, 2012, at 19:19:59
In reply to Re: Nortriptyline x Clomipramine » phidippus, posted by SLS on August 20, 2012, at 17:10:06
http://www.biologicalpsychiatryjournal.com/article/0006-3223%2891%2990107-W/abstract
its an effect secondary to serotonin reuptake inhibition
Eric
Posted by phidippus on August 20, 2012, at 19:21:16
In reply to Re: Nortriptyline x Clomipramine » phidippus, posted by schleprock on August 20, 2012, at 16:48:16
No plasma-level testing necessary.
Eric
Posted by jono_in_adelaide on August 20, 2012, at 19:25:20
In reply to Re: Nortriptyline x Clomipramine » phidippus, posted by SLS on August 20, 2012, at 17:10:06
You have nothing to lose by trying clomipramine, and everything to gain.
Start off at say 75mg per day and increase to 150mg over a few days - then take it from there.
Posted by Resistant on August 20, 2012, at 22:08:02
In reply to Re: Nortriptyline x Clomipramine » schleprock, posted by phidippus on August 20, 2012, at 14:24:16
> Effexor and Nortryptaline are both SNRIs and have similar modes of action.
>
> Eric
>Isn't Nortryptaline a NRI ? I had a quick look and it says it actually a serotonin antagonist. I was taking it with Parnate recently.
Posted by Phillipa on August 21, 2012, at 10:03:43
In reply to Nortriptyline x Clomipramine, posted by schleprock on August 20, 2012, at 11:49:50
I wanted to congratulate you for the nortriptyline working for 20 years this gives me hope that my luvox is still doing something as can't stop it seems body needs it. I'm assuming you can't raise the dose? Phillipa
Posted by phidippus on August 21, 2012, at 16:28:39
In reply to Re: Nortriptyline x Clomipramine, posted by Resistant on August 20, 2012, at 22:08:02
Nortriptyline inhibits the reuptake of norepinephrine (noradrenaline) and, to a lesser extent, serotonin with negligible effects on dopamine reuptake. Nortriptyline also has antagonistic effects at a variety of receptors:
Strong: H1
Moderate: 5-HT2, α1-adrenergic, mACh
Weak: 5-HT1[1]Eric
This is the end of the thread.
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