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Re: To Scott - Why TCAS Are More Effective Than SSRIs?

Posted by desolationrower on December 4, 2008, at 14:25:49

In reply to To Scott - Why TCAS Are More Effective Than SSRIs?, posted by bulldog2 on December 4, 2008, at 11:27:38

> It appears as if the tcas are more effective for major depression than the ssris. Your list seemed to affirm this from your subjective experiences.

interesting topic.

> Here are some of my theories.
> 1. They affect more neurotranmitters. Generally effect ne and se.

Also, are 5ht2 antagonists, especially amytrytiline which i'd say is the best one at least for efficacy. And antihistamine improves sleep, which might be marginally helpful for melacholia which features insomnia and early wakening.

> 2. Their effect on se is not nearly as profound as the ssris.
> 3. It seems as if the marked elevation of se by the ssris eventually diminishes dopamine which probably has a negative effect on the mood and hormonal system.

Right, especially since nris can improve DA function offsetting this somewhat.

> 4. Perhaps the tcas do not have as much negative impact on dopamine as the ssris. I believe dimished dopamine produces the apathy that many describe on ssris.
> 5. I remember my physician years ago was very skeptical about the new wonder ssris. Felt the huge elevation in serotonin could lead to problems.
> Do you have any theories Scott?

Also, the bad side effects probably increase comittment to drug therapy, this might improve outcomes.

There is also the question of distribution of the molecule to various regions of the brain, and there is little research indicating where this happens for antidepressants. Preferential reuptake in some regions might be better than in others.

My guess is that milnacipran + low dose risperidone would be about as effective as a good tca.

Generally i'd think desipramine is probably a little better for depression than an sri, but an sri might be somewhat preferable for most anxiety disorders. A lot of the antidepressant effect could be because of reduced anxiety.





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