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Re: Tricyclics - ... Darwin

Posted by michael on October 25, 2006, at 23:50:19

In reply to Re: Tricyclics - Q for SLS et. al. regarding ... michael, posted by Darwin on October 12, 2006, at 13:41:58

> I am also dysthymic with most of the symptoms you describe. I have tried imipramine, desipramine, nortriptyline, doxepin, and amitriptyline.
> To my surprise, desipramine was the worst in both effectiveness and side-effects (impotence, urinary retention, rapid heart beat, orthostatic hypotension, poor sleep quality).
> Nortriptyline was the best as far as side-effects are concerned but the best overall was amitriptyline. I am currently on amitriptyline and it helps considerably in treating my dysthymia.
> Here's my guess on why amitriptyline is helpful in treating my dysthymia but desipramine is not (for me). I think, in many cases, dystyhmia is largely a problem of poor sleep quality. Sleep is not fully restorative thus the chronic low mood and tiredness and amitriptyline is better at restoring sleep quality than desipramine.
> Also, amitriptyline hits most of the antidepressant mechanisms:
> * norepinephrine reuptake inhibition
> * serotonin reuptake inhibition
> * alpha-2 receptor antagonism
> * 5ht2a recepton antagonism
> * cholinergic receptor antagonism
> On the other hand, desipramine is primarily a norepinephrine reuptake inhibitor and not much else.
> Having said all this I must admit that we are all unique biochemically and I'm sure that there are dysthymics who do better on desipramine than amitriptyline. As they say, YMMV.
> Darwin


Thanks very much for sharing your experience.

From the above, I take it that you like amitriptyline better than imipramine - at least in your experience? It looks like those are probably the two that I'll be choosing from...

Given the fatigue issues, you dont' find that amitriptyline's sedative side effects are a problem? Or are they similar to imipramine's, and therefore irrelevant in choosing between the two?

Btw, do you take the amitriptyline at night - to "take advantage" of the sedative effect? [as opposed to taking it in the morning & being sleepy during the day?] My pdoc mentioned that idea, which makes sense - but I'm just skeptical that PM dosing will take care of the sedative side effects...

In any case, I'd be interested in your opinion, should you have a chance to read & reply to this before I meet w/my pdoc tomorrow evening [10-26].

Thanks again for your previous feedback.





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