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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Hordak on January 12, 2019, at 21:30:21
Interesting article: http://www.psychiatrictimes.com/geriatric-psychiatry/not-obsolete-continuing-roles-tcas-and-maois
So are TCAs and MAOIs the real deal?
I know that TCAs and MAOIs have more side effects + dietary restrictions, but I really don't give a crap ;-))
Posted by Christ_empowered on January 13, 2019, at 14:12:25
In reply to Not Obsolete: Continuing Roles for TCAs and MAOIs, posted by Hordak on January 12, 2019, at 21:30:21
hi. the drug later known as Tofranil was considered a "breakthrough" in psychiatry. the molecule is a rip off of chlorpromazine. the idea was to generate a me-too drug, another tranq. and then...
I forget the exact numbers, but when they sprayed it on committed patients, something like 25% turned manic, gradually. then, they turned their gaze to the people hospitalized w/ depression, which...back then, was diagnosed differently, so the 'depressed inpatients' back then were generally -not doing well-, and the hospital environment often made things worse. so...
for a good % of people, there was definite mood elevation. the stuff is sedating, so at a time when psych drugs consisted mostly of uppers, downers, opioids, and Thorazine...this was a BFD.
the tca drugs, as a whole class, tend to be lethal in overdose. long term use sometimes brings with it risks of cardio problems (?), according a to former prescriber. there's supposedly more of a 'switch' into (hypo)mania than the ssri and i think also ssnri drugs...
and the drug-drug interactions can be a major problem, because even if the tca levels don't go toxic, something else can, and in older patients and/or patients with health problems...it can mean running into more weight gain, sedation, now and then seizures. and yet...
personally, i found Tofranil to be too rough to tolerate long term, -but- it did lift my mood without creating as much of that stimulated, yet quite apathetic feeling that many find with the newer drugs. i may be wrong, but i think akathisia is -less- of an issue with many tca drugs (obviously, this probably doesn't apply to amoxapine) than the ssri drugs.
most people ive known prescribed tca drugs for depression are given Elavil, which...seems an odd choice, to me. doxepin seems to remain somewhat popular as a night time sedative. my current prescriber told me that she does not use amoxapine often, but she's seen it in older people w/ delusions and such. I'm guessing its because the tranq action is sufficient in those cases without causing the same level of problems as most tranqs.
anafranil remains a valid option for the severe ocd people, in some cases. Hoffer, the orthomolecular psych I reference so often, used it frequently in his 'severely mentally ill' (usually 'schizophrenic') patients, because he said something like 'its hard to find a cheerful schizophrenic.'
amoxapine has been studied here and there as a low(er) cost alternative to risperidone, etc., in schizophrenia. I read a brief abstract of one such study that found it controlled positive symptoms just as well as Haloperidol, with less EPS, less prolactin elevation, and with the added bonus of elevating mood and reducing anxiety (which one would hope to find in a drug marketed for mood disorders, of course).
ok. the maois...i dunno. some people report amazing results. i find them frightening.
Posted by Hordak on January 13, 2019, at 17:47:34
In reply to Re: Not Obsolete: Continuing Roles for TCAs and MAOIs, posted by Christ_empowered on January 13, 2019, at 14:12:25
Although I rate Clomipramine ("Anafranil") higher in efficiency, because it offers potent 5Ht2-antagonism in addition to the other stuff..
Anafranil is the most potent SNRI on the market and in Europe it is used on-label for depression & panic. Very potent stuff.
https://www.socialanxietysupport.com/forum/f30/clomipramine-the-gold-standard-when-it-comes-to-depression-and-2148482/
>>> most people ive known prescribed tca drugs for depression are given Elavil, which...seems an odd choice, to me.
# WELL, it's a good sedative. Very strong antihistamine and 5HT2-antagonist.
Posted by SLS on January 13, 2019, at 22:32:41
In reply to Re: Not Obsolete: Continuing Roles for TCAs and MAOIs, posted by Hordak on January 13, 2019, at 17:47:34
Nortriptyline is an antagonist at 5-HT2a receptors. I find it to be the mildest of the TCAs with regard to side effects. I like it.
- Scott
Posted by bleauberry on January 14, 2019, at 8:06:53
In reply to Not Obsolete: Continuing Roles for TCAs and MAOIs, posted by Hordak on January 12, 2019, at 21:30:21
I've been deeply involved in the research and practice of psychiatry, from a conventional angle, from an alternative angle, from a patient's angle, a scientific angle and an anecdotal angle, all together, for about a quarter of a century. There is so much mystery. But I have concluded with everything I have seen that our medical community has it backwards.
What we view as alternative medicines - Rhodiola Rosea, Lemon Balm, Curcumin, Passion flower, the adaptogens, St Johns Wort, etc etc - these should be first line treatments.
Second line treatments should be Parnate, Nardil, Ritalin, Adderall, Modafinil.
Third line T.C.A.s.
Last in line SSRIs combined with any of the above except Parnate/Nardil, but never SSRI mono therapy.
Antidepressants in general - in my opinion - should all be obsolete because I believe they miss the target almost completely. Some of them have some strong anti-histamine, which is good, for stealth infections, for reducing systemic inflammation, and some of them tweak genetics in a favorable way totally separate from their psychiatric role. But I think they generally miss the target.
I feel that way because my journey has taught me that the vast majority of psychiatric symptoms out there in the world are caused by a combination of unsuspected unseen systemic inflammation, brain inflammation, stealth microbial infection, and the toxic build-up as a result of those. They all send cytokines into orbit, which is very bad for health in general but especially the brain's mood center.
Anti-cytokines is the best therapy for psychiatric symptoms I am aware of. Most antidepressants don't do anything about that.
I am in the camp that believes psychiatric medicines are very valuable and essential for acute treatments of symptoms, but not as valuable for medium or longterm treatments - simply because they never get to the actual cause of the problems, they only mask the problems.
Infection, inflammation and toxicity. That's where our symptoms come from. IMO Whatever class of antidepressants, they really aren't al that different in terms of scientific benefit, not all that impressive in clinical trials either, but good for short term management of a wide variety of issues.
If someone just wants antidepressants, then I think the medical community has it backwards. Start with MAOIs and go to SSRIS as the last resort. They shy away from MAOIs because of diet safety - and in the meantime however many people would have had a crisis from that, I propose is way lower than the number of people who committed suicide from failed meds or who lost 10 or 20 years out of their life, or maybe their whole life, from messing around with all sorts of SSRI combinations. Maximum benefit = MAOIs or stimulants. Least benefit = SSRIs. Inbetween are the TCAs.
Alternatives are better than all of them because they can actually address the causes, not just the symptoms.
Posted by Hordak on January 14, 2019, at 15:37:05
In reply to Re: Not Obsolete: Continuing Roles for TCAs and MAOIs » Hordak, posted by SLS on January 13, 2019, at 22:32:41
Yeah, it's a pretty good one...
> Nortriptyline is an antagonist at 5-HT2a receptors. I find it to be the mildest of the TCAs with regard to side effects. I like it.
>
>
> - Scott
Posted by Hordak on January 14, 2019, at 15:42:28
In reply to Re: Not Obsolete: Continuing Roles for TCAs and MAOIs, posted by bleauberry on January 14, 2019, at 8:06:53
Anti-cytokines? Are there natural Anti-cytokines which I can buy @iherb?
> Anti-cytokines is the best therapy for psychiatric symptoms I am aware of. Most antidepressants don't do anything about that.
Posted by Hordak on January 14, 2019, at 15:44:32
In reply to Re: Not Obsolete: Continuing Roles for TCAs and MAOIs, posted by bleauberry on January 14, 2019, at 8:06:53
How so?
> and some of them tweak genetics in a favorable way totally separate from their psychiatric role. But I think they generally miss the target.
>
Posted by SLS on January 15, 2019, at 8:14:00
In reply to Re: Not Obsolete: Continuing Roles for TCAs and MAOIs, posted by Hordak on January 14, 2019, at 15:42:28
> Anti-cytokines? Are there natural Anti-cytokines which I can buy @iherb?
>
> > Anti-cytokines is the best therapy for psychiatric symptoms I am aware of. Most antidepressants don't do anything about that.
>
>Acetyl-L-Carnitine.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2365445/
- Scott
Posted by bleauberry on January 23, 2019, at 8:03:00
In reply to Re: Not Obsolete: Continuing Roles for TCAs and MAOIs » bleauberry, posted by Hordak on January 14, 2019, at 15:44:32
Scientific studies. I don't have the links. At pubmed is where I saw them. One of them was on Zyprexa. They showed that it turns on or turns up about 2 dozen different genes - the weight gain genes obviously turned up. And turns off or down about 2 dozen different genes. Some return to baseline after the drug is removed and some don't. Our meds do a lot more than the things we commonly talk about. There is a lot we don't know. The more we learn, the less we know..
> How so?
>
>
> > and some of them tweak genetics in a favorable way totally separate from their psychiatric role. But I think they generally miss the target.
> >
>
Posted by SLS on January 24, 2019, at 8:39:34
In reply to Re: Not Obsolete: Continuing Roles for TCAs and MAOIs » Hordak, posted by bleauberry on January 23, 2019, at 8:03:00
> Our meds do a lot more than the things we commonly talk about. There is a lot we don't know. The more we learn, the less we know..
Absolutely.
- Scott
Posted by ed nieg on January 26, 2019, at 4:06:32
In reply to Re: Not Obsolete: Continuing Roles for TCAs and MAOIs » Hordak, posted by bleauberry on January 23, 2019, at 8:03:00
> Scientific studies. I don't have the links. At pubmed is where I saw them. One of them was on Zyprexa. They showed that it turns on or turns up about 2 dozen different genes - the weight gain genes obviously turned up. And turns off or down about 2 dozen different genes. Some return to baseline after the drug is removed and some don't. Our meds do a lot more than the things we commonly talk about. There is a lot we don't know. The more we learn, the less we know..
>
> > How so?
> >
> >
> > > and some of them tweak genetics in a favorable way totally separate from their psychiatric role. But I think they generally miss the target.
> > >
> >
>
This is probably why I largely lost the ability to feel pleasure after discontinuing olanzapine and still haven't recovered; turned off a few key dopamine genes I presume.
This is the end of the thread.
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