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Re: SSRIs vs TCAs

Posted by JohnL on December 31, 2002, at 6:45:33

In reply to SSRIs vs TCAs, posted by BrittPark on December 29, 2002, at 20:27:38


I've tried all the SSRIs and many of the TCAs. My type of depression is in the melancholic anhedonic category, and TCAs were much more effective than SSRIs for this type. I liked Nortriptyline. I liked Desipramine better. I hated Vivactil and Clomipramine. The dry mouth thing was way too extreme for me, on any of them. I couldn't take it.

I felt good improvement from Nortriptyline in 2 weeks. I felt good improvement from Desipramine beginning the very first day. SSRIs on the other hand seemed to take forever, if they did anything at all.

I favor TCAs for effectiveness, but I can't take them due to the harsh side effects for me.

My current cocktail works very well. It is 20mg Prozac plus 5mg Zyprexa plus 300mg Adrafinil (not Anafranil).

My favorite of all time though is the European antipsychotic/antidepressant Amisulpride (also called Solian, Deniban, Amisulpridum). It works better than anything in the world for me, and it does so reliably in 2 days. But like the TCAs, Amisulpride has a side effect that I cannot deal with...impotence sets in at about day 5. So I keep Amisulpride on standby for any unforeseen turbulence. I use it temporarily only when needed. It is my lifeboat for emergencies and gets me out of any trouble extremely fast. If I was willing to put up with TCA side effects, Desipramine would do well for the same purpose. I've read that Desipramine does have some action at dopamine D2 receptors, as does Amisulpride, and perhaps that explains why I respond so well and so immediately to either one. My brain chemistry problem seems to be highly correlated with the dopamine/norepinephrine system, but not much with serotonin.

Back to the original topic, I favor TCAs for effectiveness, but I favor SSRIs for tolerability. With SSRIs, I think it is much more likely that combinations of drugs might be needed to get the same job done that just one TCA could do. Just my opinion though. Nothing scientific here. For people whos bodies accept TCAs without harsh side effects, awesome!


> This is a curiousity post. I've taken imipramine (currently at 300mg/day) for about 20 years and besides dry mouth, which has made my dental bills big, I experience almost no side-effects, never have. At one point my psychiatrist added Paxil into my mix. It seemed to help for a while (I was experiencing a breakthrough depression at the time.) but made me nauseated and after 2-3 months extremely jittery. I discontinued the medication. So for me TCAs seem to have a much more benign side-effect profile than SSRIs.
> I'd like to find out the conclusions of other people who have had experience with both TCAs and SSRIs.
> My hidden motive is that I think that TCAs may have an unfair bad reputation for side-effects, and may be slightly more efficacious for people with melancholic depressions. There is a little research that supports the last claim.
> So, please chime in.
> Best wishes to all,
> Britt




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