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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by tensor on April 6, 2010, at 13:35:41
Which one would you choose for TRD with anxiety? Did well on nortrip once but pooped-out after a year, made me tired, too much NE? If not too much work, some pros and cons (if you have own experiences) for the two would be great!
Thanks,
Mattias
Posted by ed_uk2010 on April 6, 2010, at 13:48:29
In reply to Quick poll: Amitriptyline or Doxepin, posted by tensor on April 6, 2010, at 13:35:41
> Which one would you choose for TRD with anxiety? Did well on nortrip once but pooped-out after a year, made me tired, too much NE? If not too much work, some pros and cons (if you have own experiences) for the two would be great!
>
> Thanks,
> MattiasI wouldn't recommend doxepin for severe depression. It's mainly an antihistamine - a very strong one indeed! Very low doses are useful for chronic insomnia. It's also used to relieve itching eg. in urticaria or uncontrolled eczema. Doxepin is a very weak 5-HT/NE re-uptake inhibitor. It's not as well established for depression as other TCAs.
Amitriptyline is certainly an effective antidepressant but it's very sedating. Why not consider a less sedating tricyclic such as imipramine? Also, clomipramine causes some sedation but not as much as amitriptyline.
Posted by tensor on April 6, 2010, at 13:55:51
In reply to Re: Quick poll: Amitriptyline or Doxepin, posted by ed_uk2010 on April 6, 2010, at 13:48:29
> I wouldn't recommend doxepin for severe depression. It's mainly an antihistamine - a very strong one indeed! Very low doses are useful for chronic insomnia. It's also used to relieve itching eg. in urticaria or uncontrolled eczema. Doxepin is a very weak 5-HT/NE re-uptake inhibitor. It's not as well established for depression as other TCAs.
>
> Amitriptyline is certainly an effective antidepressant but it's very sedating. Why not consider a less sedating tricyclic such as imipramine? Also, clomipramine causes some sedation but not as much as amitriptyline.
>
>Thanks for your input. I have no experience from imipramine but I have used clomipramine, I just can't remember how effective it was. Clomipramine vs. amitriptyline, hmm.. not easy. :)
Btw, how come clomipramine does not have FDA approval for the treatment of depression?
/Mattias
Posted by tensor on April 6, 2010, at 14:05:43
In reply to Re: Quick poll: Amitriptyline or Doxepin, posted by ed_uk2010 on April 6, 2010, at 13:48:29
>Why not consider a less sedating tricyclic such as imipramine?
I sort of overlooked this one, it wasn't listed as available ADs here but that's because the list is incomplete. It sure seems like a good candidate for me. Some interesting reading here:
http://www.dr-bob.org/babble/20040724/msgs/371048.htmlThanks Ed!
Posted by ed_uk2010 on April 6, 2010, at 14:31:07
In reply to Re: Quick poll: Amitriptyline or Doxepin » ed_uk2010, posted by tensor on April 6, 2010, at 13:55:51
>Btw, how come clomipramine does not have FDA approval for the treatment of depression?
When clomipramine (Anafranil) was launched in the US, there were already several tricyclics on the market, all of which were approved for depression. Geigy (now Novartis) must have decided to promote Anafranil for OCD, rather than depression, in order to establish a unique place for their new product in psychiatry. I don't think that Geigy ever applied to the FDA for Anafranil to be approved for depression.
In many countries, such as the UK, Anafranil has always been approved for depression AND for OCD. Anafranil is certainly an effective treatment for severe depression. It's also useful for panic disorder and other types of anxiety and phobias. Anafranil is the only TCA which is effective for OCD.
The situation with clonazepam is rather similar. When clonazepam was launched, there were already several benzos on the market for anxiety and insomnia. As a result, Roche decided to promote clonazepam as a anti-epileptic. It's also effective for anxiety, of course.
Posted by Phillipa on April 6, 2010, at 17:26:21
In reply to Clomipramine (Anafranil), posted by ed_uk2010 on April 6, 2010, at 14:31:07
Ed wasn't that same with servior and Luvox? Love PJxx
Posted by linkadge on April 6, 2010, at 18:10:27
In reply to Re: Clomipramine (Anafranil) » ed_uk2010, posted by Phillipa on April 6, 2010, at 17:26:21
I just wrote a very long post and then it got accedentally closed!!! (I though there was supposed to be a pop up for that).
Anyhow, I found that doxapin hit a deeper brain region for me. It seemed to be much better for anhedonia and sleep for that matter. I remember feeling that I was looking upon the world from from a rich perspective which I had not felt before. This was (mind you) after the sedation wears off. It can be very sedating.
Posted by ed_uk2010 on April 7, 2010, at 13:57:07
In reply to Re: Clomipramine (Anafranil) » ed_uk2010, posted by Phillipa on April 6, 2010, at 17:26:21
> Ed wasn't that same with Servier and Luvox?
Similar, yes. Fluvoxamine has always been approved for depression in most countries, just not the US.
This is the end of the thread.
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