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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by BrittPark on December 29, 2002, at 20:27:38
This is a curiousity post. I've taken imipramine (currently at 300mg/day) for about 20 years and besides dry mouth, which has made my dental bills big, I experience almost no side-effects, never have. At one point my psychiatrist added Paxil into my mix. It seemed to help for a while (I was experiencing a breakthrough depression at the time.) but made me nauseated and after 2-3 months extremely jittery. I discontinued the medication. So for me TCAs seem to have a much more benign side-effect profile than SSRIs.
I'd like to find out the conclusions of other people who have had experience with both TCAs and SSRIs.
My hidden motive is that I think that TCAs may have an unfair bad reputation for side-effects, and may be slightly more efficacious for people with melancholic depressions. There is a little research that supports the last claim.
So, please chime in.
Best wishes to all,
Britt
Posted by IsoM on December 31, 2002, at 0:46:16
In reply to SSRIs vs TCAs, posted by BrittPark on December 29, 2002, at 20:27:38
Britt, I used TCAs for many years till Luvox came out. I did try Prozac briefly, but after 6 weeks of constant nausea & no improvement, I went back to my TCAs. Luvox was the next SSRI to come out & I asked my doctor if I could try it.
The TCAs had worked for me but like you, I had a very dry mouth - sometimes so dry I couldn't even swallow. It was hard. My heart rate stayed at 110 & the constipation was very difficult to combat. For those 3 reasons, I wanted to try the SSRIs. Luvox worked for years but eventually started fading. It may have been my circumstances as life was becoming increasingly stressful.
Then I tried Zoloft (each time, I'd vomit as soon as I took it), Effexor (made me severely anorexic), then Paxil. I stayed on Paxil for a couple of years but am now currently taking Celexa, Provigil, & Dexedrine. In my case, Celexa has been the best but Provigil & Dexedrine have amazing AD properties too.
Posted by JohnL on December 31, 2002, at 6:45:33
In reply to SSRIs vs TCAs, posted by BrittPark on December 29, 2002, at 20:27:38
Hi,
I've tried all the SSRIs and many of the TCAs. My type of depression is in the melancholic anhedonic category, and TCAs were much more effective than SSRIs for this type. I liked Nortriptyline. I liked Desipramine better. I hated Vivactil and Clomipramine. The dry mouth thing was way too extreme for me, on any of them. I couldn't take it.
I felt good improvement from Nortriptyline in 2 weeks. I felt good improvement from Desipramine beginning the very first day. SSRIs on the other hand seemed to take forever, if they did anything at all.
I favor TCAs for effectiveness, but I can't take them due to the harsh side effects for me.
My current cocktail works very well. It is 20mg Prozac plus 5mg Zyprexa plus 300mg Adrafinil (not Anafranil).
My favorite of all time though is the European antipsychotic/antidepressant Amisulpride (also called Solian, Deniban, Amisulpridum). It works better than anything in the world for me, and it does so reliably in 2 days. But like the TCAs, Amisulpride has a side effect that I cannot deal with...impotence sets in at about day 5. So I keep Amisulpride on standby for any unforeseen turbulence. I use it temporarily only when needed. It is my lifeboat for emergencies and gets me out of any trouble extremely fast. If I was willing to put up with TCA side effects, Desipramine would do well for the same purpose. I've read that Desipramine does have some action at dopamine D2 receptors, as does Amisulpride, and perhaps that explains why I respond so well and so immediately to either one. My brain chemistry problem seems to be highly correlated with the dopamine/norepinephrine system, but not much with serotonin.
Back to the original topic, I favor TCAs for effectiveness, but I favor SSRIs for tolerability. With SSRIs, I think it is much more likely that combinations of drugs might be needed to get the same job done that just one TCA could do. Just my opinion though. Nothing scientific here. For people whos bodies accept TCAs without harsh side effects, awesome!
JohnL
> This is a curiousity post. I've taken imipramine (currently at 300mg/day) for about 20 years and besides dry mouth, which has made my dental bills big, I experience almost no side-effects, never have. At one point my psychiatrist added Paxil into my mix. It seemed to help for a while (I was experiencing a breakthrough depression at the time.) but made me nauseated and after 2-3 months extremely jittery. I discontinued the medication. So for me TCAs seem to have a much more benign side-effect profile than SSRIs.
>
> I'd like to find out the conclusions of other people who have had experience with both TCAs and SSRIs.
>
> My hidden motive is that I think that TCAs may have an unfair bad reputation for side-effects, and may be slightly more efficacious for people with melancholic depressions. There is a little research that supports the last claim.
>
> So, please chime in.
>
> Best wishes to all,
>
> Britt
>
>
Posted by Kari on December 31, 2002, at 11:56:39
In reply to SSRIs vs TCAs, posted by BrittPark on December 29, 2002, at 20:27:38
Hi Britt,
I have taken TCAs for many years before the SSRIs were available, particularly Clomipramine. They had no effect on me but I thought that was "as good as it gets". Clomipramine gave me bruxism but that was all it did:)
I also tried Amitriptyline. Both meds didn't make my condition worse but Dibenzepin and Maprotiline caused vomiting and overstimulation.
I guess SSRIs may be better for people who are already high on dopamine and noradrenaline.Kari.
Posted by EGR on January 1, 2003, at 2:01:24
In reply to Re: SSRIs vs TCAs, posted by JohnL on December 31, 2002, at 6:45:33
I took Elavil 16 years ago and loved it. I slept VERY well at night... had no sse's and felt GREAT. I did have some weight gain.... but not any more than I've had with Lexapro. Too bad this time around "they have much better drugs" to give me. My mom's taken Elavil, like forever.
Posted by oracle on January 1, 2003, at 2:58:23
In reply to Re: SSRIs vs TCAs, posted by Kari on December 31, 2002, at 11:56:39
I guess SSRIs may be better for people who are already high on dopamine and noradrenaline.
Kari.
AD and depression are not about levels
of dopamine and noradrenaline (or any NT)
being "high" or "low". If that was the case
depression would of been solved long ago.
The model for how mood and depression vd effects of AD's is very complex, levels of NT's are just the start.
Posted by Kari on January 1, 2003, at 12:21:08
In reply to Re: SSRIs vs TCAs, posted by oracle on January 1, 2003, at 2:58:23
You are right- it is probably much more complicated :)
Posted by oracle on January 1, 2003, at 14:07:12
In reply to Re: SSRIs vs TCAs » oracle, posted by Kari on January 1, 2003, at 12:21:08
> You are right- it is probably much more complicated :)
yea, i am picking nits. I do understand doc's
tell people this, to make it understandable.To me, mood is a set of upstraem and downstream
systems, all linked and related. Change one system and all adjust. AD's change (increase
NT's at first) at one specific point and then the whole
system readjusts. Sometimes we luck out and mood improves. The increase of NT's at one point is short lived, it is the readjustment that really
effects mood. Rather crude, as is our understanding of all of this at present.
Posted by not exactly on February 2, 2003, at 3:23:21
In reply to Re: SSRIs vs TCAs, posted by JohnL on December 31, 2002, at 6:45:33
John,
> My type of depression is in the melancholic anhedonic category
Mine too.
> TCAs were much more effective than SSRIs for this type.
I've found SSRIs to be useless or worse.
> I liked Desipramine better.
That's what I'm trying now.
> The dry mouth thing was way too extreme for me
I've noticed some anticholinergic side effects (drowsiness, constipation, clouded thinking - no dry mouth, tho), but so far they've been mild. Does anyone know if the TCA side effects diminish somewhat over time as your body gets used to the drug?
> I felt good improvement from Desipramine beginning the very first day.After only 2 days, I've noticed some AD effect starting to kick in.
> My current cocktail works very well. It is 20mg Prozac plus 5mg Zyprexa plus 300mg Adrafinil
Have you tried modafinil (Provigil)? I have, but not adrafinil. I'm wondering how similar they are.
> My favorite of all time though is the European antipsychotic/antidepressant Amisulpride
I've heard of this one and would like to try it. How did you obtain it? Mail order? Would you recommend your source?
> Amisulpride has a side effect that I cannot deal with...impotence sets in at about day 5.
I wonder if Viagra (acute) or pramipexole (chronic) would fix that side effect.
> My brain chemistry problem seems to be highly correlated with the dopamine/norepinephrine system, but not much with serotonin.
Have you tried augmenting an AD with a dopamine-booster? I have had some luck with adding Ritalin. For example, it changed Wellbutrin from "acceptable" to "robust". If I'm not completely thrilled with desipramine (after giving it enough time to "do its thing", of course), I might try adding Ritalin again. Has anyone else tried TCA + Ritalin?
> For people whos bodies accept TCAs without harsh side effects, awesome!
I've got my fingers crossed...
- Bob
Posted by BrittPark on February 2, 2003, at 10:40:11
In reply to Re: SSRIs vs TCAs » JohnL, posted by not exactly on February 2, 2003, at 3:23:21
> Does anyone know if the TCA side effects diminish somewhat over time as your body gets used to the drug?
In my experience they do. The only S/E, for me, that remains noticeable is the sedation from imipramine. I take care of that by taking it all just before bed. I don't wake up groggy.Cheers,
Britt
Posted by not exactly on February 2, 2003, at 12:17:11
In reply to Re: SSRIs vs TCAs » not exactly, posted by BrittPark on February 2, 2003, at 10:40:11
Thanks. That's encouraging. The side effects already seem less noticable today, and I'm glad it's not just wishful thinking.
- Bob
Posted by zeugma on February 2, 2003, at 22:01:03
In reply to Re: SSRIs vs TCAs » JohnL, posted by not exactly on February 2, 2003, at 3:23:21
> John,
>
> > My type of depression is in the melancholic anhedonic category
>
> Mine too.
>
> > TCAs were much more effective than SSRIs for this type.
>
> I've found SSRIs to be useless or worse.
>
> > I liked Desipramine better.
>
> That's what I'm trying now.
>
> > The dry mouth thing was way too extreme for me
>
> I've noticed some anticholinergic side effects (drowsiness, constipation, clouded thinking - no dry mouth, tho), but so far they've been mild. Does anyone know if the TCA side effects diminish somewhat over time as your body gets used to the drug?
>
> > I felt good improvement from Desipramine beginning the very first day.
>
> After only 2 days, I've noticed some AD effect starting to kick in.
>
> > My current cocktail works very well. It is 20mg Prozac plus 5mg Zyprexa plus 300mg Adrafinil
>
> Have you tried modafinil (Provigil)? I have, but not adrafinil. I'm wondering how similar they are.
>
> > My favorite of all time though is the European antipsychotic/antidepressant Amisulpride
>
> I've heard of this one and would like to try it. How did you obtain it? Mail order? Would you recommend your source?
>
> > Amisulpride has a side effect that I cannot deal with...impotence sets in at about day 5.
>
> I wonder if Viagra (acute) or pramipexole (chronic) would fix that side effect.
>
> > My brain chemistry problem seems to be highly correlated with the dopamine/norepinephrine system, but not much with serotonin.
>
> Have you tried augmenting an AD with a dopamine-booster? I have had some luck with adding Ritalin. For example, it changed Wellbutrin from "acceptable" to "robust". If I'm not completely thrilled with desipramine (after giving it enough time to "do its thing", of course), I might try adding Ritalin again. Has anyone else tried TCA + Ritalin?
>
> > For people whos bodies accept TCAs without harsh side effects, awesome!
>
> I've got my fingers crossed...
>
> - Bob
>I haven't tried TCA plus Ritalin, but TCA plus Buspar seems to be a good combination. My problem was the blood pressure s/e- every time I increased my dosage of nortriptyline I'd get dizzy and felt like I was going to keel over (it was summer too, and that didn't help). I'm only on 40 mg- it helps with 'basic' stuff like sleep and appetite and probably concentration too.
But adding Buspar which is dopaminamergic (among other things) has been really helpful.
Buspar also has some pro-sexual effect which I'm quite happy about.
This is the end of the thread.
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