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Re: Desipramine (Norpramin) best TCA for ADHD?

Posted by SLS on August 13, 2022, at 7:50:31

In reply to Desipramine (Norpramin) best TCA for ADHD?, posted by undopaminergic on August 12, 2022, at 11:07:31

> Hi all,
> I read in a book on ADHD of a case of excellent results from treating a child with ADHD with desipramine (Norpramin). So I'm wondering if desipramine in general is better than other TCAs for ADHD, or if it's more likely just good luck?
> Incidentally, desipramine is very rarely mentioned here. Why might that be?
> -undopaminergic


Desipramine was the antidepressant of choice for treating ADHD / Adult ADD before atomoxetine (Strattera) was approved. Both drugs are potent NE reuptake inhibitors with very little effect on serotonin (5-HT). I saw atomoxetine turn someone's life around. He was treated for years as if he had Major Depressive Disorder. Then, one of his doctors became suspicious and gave him a drug known to be more effective for ADHD than depression - atomoxetine. The "depression" completely disappeared, and he reorganized and cleaned an apartment that had looked like a garbage dump.

Desipramine is a very potent and selective reuptake inhibitor of norepinephrine (NE). it is very effective for certain kinds of depression, but not for others. As with other tricyclics, it is more effective for endogenous / melancholic depression than it is for atypical depression.

Desipramine has flaws therapeutically that nortriptyline does not.

1. It feels very harsh at first, much like methylphenidate.

2. Cardiac side effects including heart palpitations and an accelerated heart rate that sometimes qualifies for tachycardia are common. For desipramine, some doctors have their patients tested with an ECG before prescribing desipramine, and then again after the patient has been taking it for a short while.

3. Desipramine produces multiple side effects that resemble the anti-cholinergic effects of other tricyclics. However, they are not at all anti-cholinergic. They are pro-noradrenergic. Dry mouth is especially common.

Personally, I prefer nortriptyline to desipramine. When combined with an MAOI, both drugs were equally effective for me, mostly with mental energy, cognitive clarity, thought speed, and other vegetative features. The presence of moderate to severe psychomotor retardation along with early morning awakenings and feeling worst in the morning begs treatment with tricyclics. For me, I found that nortriptyline produces therapeutic effects similar to desipramine, but with much better mood-brightening effects and the disappearance of anhedonia.

Both desipramine and nortriptyline are safe to use in combination with MAO inhibitors. This is the only treatment that ever brought me to a persistent remission. In addition to these, I also take lamotrigine and LOW DOSE (300 mg/day) of lithium now. Unlike the way I was in my 20s, TCA + MAOI is now insufficient to produce a robust response. On-off-on experiments with lamotrigine and lithium separately demonstrated how crucial both drugs are to my treatment.

- 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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