Posted by SLS on March 18, 2014, at 1:34:36
In reply to TCAs calming vs. sedating/ nortrip vs. Saphris SLS, posted by tom2228 on March 17, 2014, at 19:24:38
Hi.
I prefer nortriptyline to desipramine. I find that nortriptyline is less apt to cause "anticholinergic" side effects. Desipramine increases sympathetic tone more potently than nortriptyline due to its being a more potent NRI. This causes desipramine to produce side effects that appear much like anticholinergic effects. These include dry mouth, constipation, blurred vision, tachycardia, delayed micturition, urinary retention, nasal stuffiness, etc. For me, NOR is milder than DMI. However, NOR made me very sleepy for the first two days. I began treatment at 25 mg/day. I probably should have started at 10 mg/day. Thereafter, I found NOR to be free of somnolence and sedation. It is actually a pretty clean drug. Some people will respond to NOR and not to DMI. The reverse is also true.
DMI and NOR are good choices to add to Marplan. They are safe, and even have a protective effect against a tyramine pressor reaction. Hypotension with dizziness can be a problem, as the TCA will block NE alpha-1a receptors peripherally. This usually is limited to orthostatic challenge, though. Although trimipramine should be safe to add to MAOI, I have never heard of it being done. Clomipramine is prohibited, and I would avoid imipramine as well. Both of these drugs are too serotonergic and can produce serotonin syndrome. I would also add that Wellbutrin is safe to take with MAOI.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1062693
URL: http://www.dr-bob.org/babble/20140307/msgs/1062715.html