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Re: Which antidepressants are 'less' activating?

Posted by SLS on August 9, 2021, at 13:30:46

In reply to Re: Which antidepressants are 'less' activating? SLS, posted by linkadge on August 6, 2021, at 14:16:29

> >When Prozac and Zoloft had just come out, my >archaic way of thinking was that the TCAs would >show better than the SSRIs.
> I am still under the impression that TCAs are slightly more effective than the SSRIs but with a different side effect profile (perhaps more significant side effects for some patients). Some studies show superiority of TCAs in patients with higher inflammatory markers. If you could only chose between, say, amitriptyline and escitalopram, and there was no ability to drop out because of side effects, I would think that amitriptyline would do a better job at dropping depression symptoms. I think this is especially true in patients with a broader range of symptoms (i.e. insomnia, anxiety, anhedonia, energy etc). The amitriptyline group would have more side effects, however.
> Apathy, for example, is a somewhat common effect of SSRIs but less so with TCAs.
> Linkadge

Nice, post.

I think psychomotor retardation is a hallmark symptom that leaves TCAs to be a better choice than SSRIs. I am thinking that Prozac (fluoxetine) might be a better choice of SSRI after one failed trial of another SSRI. I would gravitate towards Lexapro or Zoloft as the first choice, but that is more of a subjective impression than a statistical appraisal.

1. Which drug - of any class - would be your first pick for the average case of Major Depressive Disorder (atypical)?

2. What would be your first choice of a pro-serotoninergic drug for treating "atypical" depression presenting WITHOUT psychomotor retardation?

3. Which drug - of any class - would be your first choice for treating "endogenous" or "melancholic" depression presenting WITH psychomotor retardation?

4. How would you characterize Prozac *clinically*, and what place would it have in your treatment algorithm?

5. Why am I annoying you with so many questions?

Your opinions carry great with me. Of course, you don't have to answer all of my questions, but if you feel strongly about any of them, your input would be greatly appreciated.


- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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