Posted by bleauberry on June 15, 2009, at 18:15:53
In reply to What are TCa's like?, posted by newo38 on June 15, 2009, at 2:22:19
Link said it pretty well.
If we look at metastudies, numbers, statistics, TCAs don't perform any better than the SSRIs you have been on. But if we look at the real world outside of academia and clinical settings, TCAs do anecdotally have more power on depression. Patient experience rapidly over-rules clinical experience.
Why the difference? Clinical studies for the most part have rather rigid exclusion rules to cherrypick a defined patient sample that is NOT representative of the people who walk into doctor's offices everyday. Therefore, any results of clinical analysis are flawed in a realworld setting.
TCAs are called dirty drugs because they are not selective. Celexa for example is considered a clean drug because it is selective for serotonin and nothing else. That is viewed as a benefit. I personally, as well as Dr Gillman at psychotropical.com, view that as a handicap...the dirtier ones work better. We don't want selective. We want drugs that hit multiple targets.
TCAs have different side effects. Common to most of them are dry mouth, constipation, and early sleepiness/fatigue. Those diminish or disappear with time.
Some are more activating, some are more sedating. Amitriptyline for example is often given in low doses for sleep and is probably one of the world's best sleep meds that can be taken longterm. It is also very good for aches and pains, a benefit of its dirtyness. Desipramine is more activating. Somewhere inbetween would be Nortriptyline. The two with the least side effects are Nortriptyline and Desipramine. Of all the TCAs, I would guess Nortriptyline is the most commonly used of them all for depression, though one of the others could work better if it didn't work well.
Clomipramine is still, after almost 50 years, considered the antidepressant for all others to be compared to. The problem with it is that few people can get up to therapeutic doses with its side effects.
The hardest part with any of them is getting through the first couple of months with the side effects...dry mouth, blurry vision, constipation, maybe some brain fog.
Sexual side effects can happen with any of them, but are I believe much less frequent than with the serotonin selective meds.
Here is an idea to seriously consider. What is better than an SSRI, and better than a TCA? Both combined. Some of the best results, and a side effect burden not any greater than either alone, comes from combinations such as Nortriptyline+Zoloft, Nortriptyline+Celexa, Nortriptyline+Prozac, or Desipramine with any of them, or Amitriptyline in modest doses for both sleep and depression along with the SSRI. With this strategy you can likely take only half the dose of Celexa or whatever that you are accustomed to taking.
I mentioned psychotropical.com. You should go there and check it out. Lots of good reading on different types of antidepressants and the experience of a doctor who has treated over 1000 patients with them.
poster:bleauberry
thread:901060
URL: http://www.dr-bob.org/babble/20090611/msgs/901174.html