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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by zarathustra on March 1, 2001, at 18:05:59
I HAVE BEEN ON VARIOUS SSRI's, MANERIX, EFFEXOR, AND WELLBUTRIN. NONE WORKED EXCEPT PAXIL, BUT I STOPPED DUE TO SEXUAL SIDE EFFECTS, AND WHEN I TRIED AGAIN, IT SIMPLY DIDNT WORK.
I WOULD LIKE TO TRY A TRICYCLIC, BUT DONT KNOW AN EXTREME AMOUNT ABOUT THEM: DO THEY HAVE SEXUAL SIDE EFFECTS? WHICH IS "STRONGEST"?
WHICH IS MOST ACTIVATING?
AND ARE THEY REALLY EQUAL IN EFFICACY TO THE SSRI's?
AND WHY HASNT MY M.D. SUGGESTED THEM?
ANDREW
Posted by SalArmy4me on March 1, 2001, at 20:21:53
In reply to SHOULD I TRY A TRI-CYCLIC? WHICH ONE?, posted by zarathustra on March 1, 2001, at 18:05:59
Why don't you try the tetracylcic Remeron. My doctor says it works when others have failed.
Here are the benefits of Remeron:
--It can be used for all types of depression, anxiety, OCD, and insomnia.
--It is convienient because it is taken only once at bedtime.
--It may improve libido and sexual performance (its the only medication that improves mine). Dr. Bob Hsieung's fellow doctors recommend it for sexual dysfunction.
--You can take Remeron with most antidepressants except MAOIs.
--It has none of the anticholinergic effects of SSRIs.
--It has gained recognition as a very useful medication from psychiatrists in only four years of FDA approval.http://www.dr-bob.org/tips/split/Mirtazapine-for-SSRI-ADRs.html
www.remeron.com
http://www.rxlist.com/cgi/generic/mirtaz.htmI started Remeron at 60 mg right away and had no side-effects. I had no weight gain or sedation during the day.
Posted by Dubya on March 1, 2001, at 21:08:58
In reply to Re: SHOULD I TRY A TRI-CYCLIC? WHICH ONE? » zarathustra, posted by SalArmy4me on March 1, 2001, at 20:21:53
SalArmy4Me seems to always have good advice, perhaps consider SalArmy4Me's advice. An alternative though would be to ask your pdoc about Remeron or another such alternative.
Good luck!
Posted by Margit on March 1, 2001, at 22:23:58
In reply to SHOULD I TRY A TRI-CYCLIC? WHICH ONE?, posted by zarathustra on March 1, 2001, at 18:05:59
All tricyclic ADs are great for depression. The are just as effetive than the SSRIs, if not better in some cases. Only problem their side effect profile differs from the SSRIs (more anti-cholinergic effects, increased pulse, bloodpressure, etc.) No problems in the sex dept. I am on Nortriptyline and have hardly experiences any side effects, except a little dry mouth, constipation and increased heart rate. For me compared to what the SSRIs put you through, this is nothing.
Elavil - probably one of the most sedating ones
Anafranil - also very sedating, but great for OCD as well
Doxepin - very sedating (used for anxiety an PD as well)
Imipramine - not quite as sedating (also used for anxiety and PD)
Desipramine and Nortriptyline are the more stimulating ones with the former being the most stimulating.
Both of these also have much lesser side effects than the others.
Hope this helps.
Posted by JohnL on March 2, 2001, at 3:09:53
In reply to SHOULD I TRY A TRI-CYCLIC? WHICH ONE?, posted by zarathustra on March 1, 2001, at 18:05:59
> I HAVE BEEN ON VARIOUS SSRI's, MANERIX, EFFEXOR, AND WELLBUTRIN. NONE WORKED EXCEPT PAXIL, BUT I STOPPED DUE TO SEXUAL SIDE EFFECTS, AND WHEN I TRIED AGAIN, IT SIMPLY DIDNT WORK.
>
> I WOULD LIKE TO TRY A TRICYCLIC, BUT DONT KNOW AN EXTREME AMOUNT ABOUT THEM: DO THEY HAVE SEXUAL SIDE EFFECTS? WHICH IS "STRONGEST"?
> WHICH IS MOST ACTIVATING?
> AND ARE THEY REALLY EQUAL IN EFFICACY TO THE SSRI's?
> AND WHY HASNT MY M.D. SUGGESTED THEM?
>
>
> ANDREWHere are some answers to your questions:
Do they have sexual side effects? Yes and no. Sometimes, sometimes not. It's different with each person. You won't know for sure until you try. Mileage varies.Which is the strongest? According to clinical comparison studies, Imipramine. Amitriptyline, Nortriptyline, and Desipramine are very close seconds.
Which is the most activating? Desipramine and Protriptyline.
Are they equal in efficacy to SSRIs? Some clinical studies show TCAs are more effective than SSRIs. Some studies show they have about the same efficacy. I think in general the evidence suggests TCAs are more effective.
Why hasn't your MD suggested them? Probably because of the side effects. They are difficult to tolerate for many people, in comparison to SSRIs. You can expect such things as dry mouth, constipation, frequent and difficult urination, which may or may not go away. Some of them, such as Imipramine, are quite sedating.
Of them all, your best bets are probably with Nortriptyline or Desipramine. They have the fewest side effects.
There was one clinical study a couple decades ago that was very interesting. What they did was try Ritalin on patients. If there was a positive response to Ritalin, then it predicted a good response to Desipramine. If there was a neutral or bad response to Ritalin, then it predicted a good response to Nortriptyline instead. Interesting. In my own experimentations I think there is validity to this test. You could try Ritalin just for about three days as a test and then use that to choose between Nortriptyline and Desipramine. As with all drugs, one may work while another doesn't.
Personally I think you would be much better off with a small dose of your favorite antidepressant so far (or sample a few to discover one you can live with), and then add an antipsychotic and/or stimulant to it. I sound like a broken record because I suggest this so often, but it really works well quite often.
John
This is the end of the thread.
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