Posted by klein on April 24, 2014, at 4:40:57
In reply to Re: Cymbalta vs Pristiq, posted by LouisianaSportsman on April 23, 2014, at 21:01:03
Hey LP, thanks for answering!
If you can believe it, where I live most TCAs have been gradually withdrawn from the market due to poor sales :( I've tried the available ones - all 3 of them! Amitriptyline (ok), imipramine (iffy) and clomipramine (ugh!). Not combined with sertraline though.
I talked to my doc earlier and we've tentatively settled on Pristiq (given that Effexor was pretty good) and either Remeron or Tolvon/Lerivon/ mianserin.
Although I tried it indirectly as a metabolite, I wish I could try nortiptyline, it sounds very good on paper..
-thanks, I appreciate your reply.
> I doubt desvenlafaxine is significant enough to be different from venlafaxine as it is just a synthetic form of its major active metabolite. If you failed venlafaxine, it is likely you'll fail desvenlafaxine as well. I wouldn't trial Pristiq.
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> If you failed on milnacipran, it hints that you'll fail duloxetine and recently approved SNRI that is is an active enantiomer of milnacipran, levomilnacipran (Fetzima). It is similar to the Pristiq situation.
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> I do not think SNRIs are the right option for you. An MAOI would probably be the right option, but you could consider a TCA.
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> I would look into desipramine. There are other medications within the TCA class, and other classes which could boost NE as well, desipramine (Norpramin): I would compare it more to Savella. Within the TCA class, you can also strongly consider nortriptyline (Pamelor): I would compare it more to Effexor.
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> If you preferred venlafaxine, consider nortriptyline; if you preferred milnacipran, consider desipramine-- it hits NE harder than nortriptyline. The strongest NE boost would come from protriptyline, but many patients complain about side effects; however, it is a valid consideration you and your doctor could discuss.
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> The best thing, honestly, would be a MAOI. The EMSAM patch is very safe but selegiline (Deprenyl) comes in a pill form as well.
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> Phenelzine (Nardil) and tranylcypromine (Parnate) would likely be the best options for you in termrs of MAOIs.
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> Good luck with your treatment!
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>
poster:klein
thread:1064701
URL: http://www.dr-bob.org/babble/20140419/msgs/1064725.html