Psycho-Babble Medication Thread 1116976

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Is anyone now taking or has taken a TCA? Results?

Posted by Mtom on September 17, 2021, at 10:47:34

I initially posed this question under another thread and topic about which antidepressants are less activating (which Ive found a problem with many). That thread evolved to a discussion about Tricyclics (TCAs) but as only one member responded, I thought I would repost as a new thread.

Is anyone currently taking a Tricyclic or has taken one in past? What were your specific experiences regarding efficacy and adverse effects? If youve tried more than one TCA, I would be interested in what differences you found between them, again both efficacy and adverse effects. Thanks!

 

Re: Is anyone now taking or has taken a TCA? Results?

Posted by undopaminergic on September 17, 2021, at 11:51:44

In reply to Is anyone now taking or has taken a TCA? Results?, posted by Mtom on September 17, 2021, at 10:47:34

> I initially posed this question under another thread and topic about which antidepressants are less activating (which Ive found a problem with many). That thread evolved to a discussion about Tricyclics (TCAs) but as only one member responded, I thought I would repost as a new thread.
>
> Is anyone currently taking a Tricyclic or has taken one in past? What were your specific experiences regarding efficacy and adverse effects? If youve tried more than one TCA, I would be interested in what differences you found between them, again both efficacy and adverse effects. Thanks!
>

I'm currently taking trimipramine (Surmontil), and have been on it for soon to be 2 years. It is the best antidepressant I've tried, but it is my only TCA so far. I've tried several SSRIs, reboxetine, duloxetine, and more.

I'm interested in trying clomipramine next (as far as ADs are concerned).

-undopaminergic

 

Re: Is anyone now taking or has taken a TCA? Results?

Posted by linkadge on September 19, 2021, at 15:57:35

In reply to Is anyone now taking or has taken a TCA? Results?, posted by Mtom on September 17, 2021, at 10:47:34

As mentioned before, I have taken doxapin, clomipramine, trimipramine, amitriptyline and nortriptyline.

Linkadge

 

Re: Is anyone now taking or has taken a TCA? Results? linkadge

Posted by Mtom on September 20, 2021, at 10:53:15

In reply to Re: Is anyone now taking or has taken a TCA? Results?, posted by linkadge on September 19, 2021, at 15:57:35

> As mentioned before, I have taken doxapin, clomipramine, trimipramine, amitriptyline and nortriptyline.
> Linkadge

Linkadge, I'm curious if you switched these up due to efficacy or adverse reaction differences between them? Did some offer a better balance of these than others?

 

Re: Is anyone now taking or has taken a TCA? Results?

Posted by linkadge on September 20, 2021, at 14:51:54

In reply to Re: Is anyone now taking or has taken a TCA? Results? linkadge, posted by Mtom on September 20, 2021, at 10:53:15

Amitriptyline (for me) was more effective than nortriptyline. Clomipramine was more effective than both of those. I stopped for side effects not lack of efficacy. Unfortunately, the meds I am taking right now are not as effective. I would like to return to nortriptyline as it seemed to offer a good balance of side effects and efficacy.

Linkadge

 

Re: Is anyone now taking or has taken a TCA? Results? linkadge

Posted by SLS on September 20, 2021, at 20:22:52

In reply to Re: Is anyone now taking or has taken a TCA? Results?, posted by linkadge on September 20, 2021, at 14:51:54

Hi, Linkadge


> Amitriptyline (for me) was more effective than nortriptyline. Clomipramine was more effective than both of those. I stopped for side effects not lack of efficacy. Unfortunately, the meds I am taking right now are not as effective. I would like to return to nortriptyline as it seemed to offer a good balance of side effects and efficacy.


I can't stress enough how critical it is stay within *your* individual dosage window for nortriptyline. Using blood tests to determine an effective dosage isn't always reliable. The recommended range of blood concentrations is 50-150 ng/mL. That's a pretty wide spread. At 150 mg/day of nortriptyline, my concentration was 153 ng/mL. My doctor moved it down to 100 mg/day. I discovered that I did not maintain a consistent antidepressant response until the dosage was dropped to 75 mg/day. 50 mg/day proved to be too low, as I began to relapse at that dosage. I might get a blood test for informational purposes.

- Scott


 

Re: Is anyone now taking or has taken a TCA? Results? SLS

Posted by Mtom on September 21, 2021, at 12:46:42

In reply to Re: Is anyone now taking or has taken a TCA? Results? linkadge, posted by SLS on September 20, 2021, at 20:22:52

> I can't stress enough how critical it is stay within *your* individual dosage window for nortriptyline. Using blood tests to determine an effective dosage isn't always reliable. The recommended range of blood concentrations is 50-150 ng/mL. That's a pretty wide spread. At 150 mg/day of nortriptyline, my concentration was 153 ng/mL. My doctor moved it down to 100 mg/day. I discovered that I did not maintain a consistent antidepressant response until the dosage was dropped to 75 mg/day. 50 mg/day proved to be too low, as I began to relapse at that dosage. I might get a blood test for informational purposes.
> - Scott

That's interesting. I'm sure a read a paper recently that discussed how both too low a dose of TCA AND too high a dose were ineffective for depression. That would make things tricky with a lot of experimentation and time. I'm going to try to find it again...

 

Re: Is anyone now taking or has taken a TCA? Results? Mtom

Posted by SLS on September 23, 2021, at 9:58:15

In reply to Re: Is anyone now taking or has taken a TCA? Results? SLS, posted by Mtom on September 21, 2021, at 12:46:42

Hi, Rose.


> > I can't stress enough how critical it is stay within *your* individual dosage window for nortriptyline. Using blood tests to determine an effective dosage isn't always reliable. The recommended range of blood concentrations is 50-150 ng/mL. That's a pretty wide spread. At 150 mg/day of nortriptyline, my concentration was 153 ng/mL. My doctor moved it down to 100 mg/day. I discovered that I did not maintain a consistent antidepressant response until the dosage was dropped to 75 mg/day. 50 mg/day proved to be too low, as I began to relapse at that dosage. I might get a blood test for informational purposes.
> > - Scott
>
> That's interesting. I'm sure a read a paper recently that discussed how both too low a dose of TCA AND too high a dose were ineffective for depression. That would make things tricky with a lot of experimentation and time. I'm going to try to find it again...


The only TCA for which a hard dosage window has been demonstrated is nortriptyline.

My first robust response to an antidepressant, albeit for less than two weeks, was imipramine at a dosage of 150 mg/day. Upon the failure to retain an antidepressant response at that dosage, I was gradually titrated up to 300 mg/day. Later, I would try 75 mg/day without success.

In 1987, I responded to treatment robustly for a period of six months before mania emerged and the drugs were discontinued. I was being treated with a combination of Parnate 60 mg/day + desipramine 125 mg/day. Parnate monotherapy produced a brief, mild improvement for less than a week. I don't recall with certainty the dosage used, but I think it was 50 mg/day.

The second treatment I responded to for a period of months without relapse has been is my current drug regime. I am still responding well to it.

Nardil - 75 mg/day
nortriptyline - 75 mg/day
lamotrigine - 300 mg/day
lithium - 300 mg/day

Not bad for only four drugs.


- Scott

 

Re: Is anyone now taking or has taken a TCA? Results? SLS

Posted by undopaminergic on September 23, 2021, at 12:00:54

In reply to Re: Is anyone now taking or has taken a TCA? Results? Mtom, posted by SLS on September 23, 2021, at 9:58:15

>
> My first robust response to an antidepressant, albeit for less than two weeks, was imipramine at a dosage of 150 mg/day. Upon the failure to retain an antidepressant response at that dosage, I was gradually titrated up to 300 mg/day. Later, I would try 75 mg/day without success.
>

I've said it before, but I enjoy your anecdotes. I now think this is in part because they remind me of my own psychopharmacological adventures, such as the powerful stimulant effect of sulpiride, and the anti-anhedonic effects of pramipexole. My first dose of selegiline was also a time of some brief joy. My most useful regimen ever, however (rhyme not intended), was the combination of buprenorphine and methylphenidate ("speedball jr."?).

> In 1987, I responded to treatment robustly for a period of six months before mania emerged and the drugs were discontinued. I was being treated with a combination of Parnate 60 mg/day + desipramine 125 mg/day. Parnate monotherapy produced a brief, mild improvement for less than a week. I don't recall with certainty the dosage used, but I think it was 50 mg/day.
>

I wish I had access to your doctors!

>
> Not bad for only four drugs.
>

My current psychiatrist seems to have a preoccupation with using as few drugs as possible. Of course no-one would want to use more drugs for no reason, but with this preoccuption there's a risk treatment may fail just due to misguided idealism.

Anyway, there's finally some news. We are terminating the lurasidone. I don't know yet if I get to try asenapine or clomipramine.

-undopaminergic

 

Re: Is anyone now taking or has taken a TCA? Results?

Posted by Lamdage22 on October 25, 2021, at 4:15:33

In reply to Re: Is anyone now taking or has taken a TCA? Results? SLS, posted by undopaminergic on September 23, 2021, at 12:00:54

Whatever floats your boat. Pretty sure I am done with experimenting with pharmaceuticals. It is usually no fun for me. I have gone through some crazy eperiences with this stuff. Maybe it just isn't meant for me. I just wait for specific stuff like Aloradine. Considering to give that a whirl. Really new stuff with better tolerability, maybe. New stuff of the old kind, no!


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