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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Lin on December 5, 2000, at 18:58:37
I am bipolar/ADD and currently take lithium, zyprexa, and dexadrine. For various reasons, I have been unable to take most ADs. The SSRIs caused mania, Serzone didn't touch my depression, and Effexor caused sexual dysfunction. Tonight, my MD suggested Anafranil. It is one of the only drugs that I know nothing at all about. CAn anyone here enlighten me? Thanks a lot! Lin
Posted by SLS on December 5, 2000, at 22:23:39
In reply to Need info on Anafranil, posted by Lin on December 5, 2000, at 18:58:37
> I am bipolar/ADD and currently take lithium, zyprexa, and dexadrine. For various reasons, I have been unable to take most ADs. The SSRIs caused mania, Serzone didn't touch my depression, and Effexor caused sexual dysfunction. Tonight, my MD suggested Anafranil. It is one of the only drugs that I know nothing at all about. CAn anyone here enlighten me? Thanks a lot! Lin
Hi Lin.Anafranil (clomipramine) is a tricyclic antidepressant and belongs to the family that includes Tofranil (imipramine), Elavil (amitriptyline), Pamelor (nortriptyline), Norpramin (desipramine), and Sinequan (doxepin). Any side effects you may have experienced with these drugs are potentials of Anafranil. In addition to the tricyclic-type side effects it produces some SSRI-like side effects, including sexual dysfunction. Anafranil is considered to be a very "dirty" drug in that it does so many things other than what it is "supposed" to do.
Aside from the MAOIs, Anafranil has shown itself as being perhaps the most effecacious antidepressant available. Because there is so much variability in the way any two individuals react to the same medication, I would not discourage you from trying it. I would only suggest that you discuss with your doctor the potential for Anafranil to produce mania. Seeing as how lithium and Zyprexa do not prevent the SSRIs from inducing mania, I would also suggest that you explore other mood stabilizers while keeping your existing ones. Depakote or Lamictal might help. Lamictal alone possesses antidepressant properties. If you have not yet tried it, you may want to give it a try prior to beginning Anafranil.
Again, Anafranil is a very powerful antidepressant and antiobsessional drug that often works when many others have not.
Good luck.
Sincerely,
Scott
Posted by buffalo1 on December 6, 2000, at 0:36:28
In reply to Re: Need info on Anafranil, posted by SLS on December 5, 2000, at 22:23:39
Great for depression & OCD... horrible sexual s/e (personal experience!)
Posted by JohnL on December 6, 2000, at 3:17:45
In reply to Need info on Anafranil, posted by Lin on December 5, 2000, at 18:58:37
> I am bipolar/ADD and currently take lithium, zyprexa, and dexadrine. For various reasons, I have been unable to take most ADs. The SSRIs caused mania, Serzone didn't touch my depression, and Effexor caused sexual dysfunction. Tonight, my MD suggested Anafranil. It is one of the only drugs that I know nothing at all about. CAn anyone here enlighten me? Thanks a lot! Lin
Hi Lin,
Anafranil is a serotonergic tricyclic antidepressant notorious for causing sexual dysfunction. I've tried four tricyclics--Nortriptyline, Desipramine, Anafranil, and Protriptyline. Of them all, Nortriptyline and Desipramine have the fewest side effects (mostly dry mouth and constipation). Nortriptyline might be better if insomnia is a problem, since it is slightly sedating. Desipramine might be better if daytime stimulation is desired. As for your depression, one should work if the other doesn't. Desipramine probably has the lowest chance of causing sexual dysfunction. No guarantees though. To further muddy the waters, the tricyclics are more apt to spark mania than other antidepressants. Again though, no guarantees. Just slightly increased odds, that's all.In general either Desipramine or Nortriptyline are easier to handle than Anafranil and are less likely to cause sexual dysfunction. In clinical trials Amitriptyline was discovered to be the only one significantly more effective than any of the others. But its side effect profile is harsher than the others and is not tolerable by many people. Desipramine or Nortriptyline I think are your best choices, not Anafranil. Of the two I think Desipramine would be least likely to cause sexual dysfunction. Some of the tricyclics (including Nortriptyline) have a therapeutic window. Desipramine is one that doesn't. Therefore you could take varying doses without worrying about whether you are inside a window or not.
I'm just thinking out loud. As I do so, I seem to have arrived at the conclusion that Desipramine is the best bet. Considering your sensitivity and sexual dysfunction with ADs, I cannot even imagine why the doc suggested Anafranil.
Johnps...Just more food for thought. In the back of my mind I also thought about Tegretol. It is a mood stabilizer with anti-manic and anti-depressant potential that has a chemical structure very similar to the tricyclic antidepressants. The mild stimulant Adrafinil could be very helpful to you, with few (if any) side effects. It is used for alertness, mental cognition, vigilance, motivation, and antidepression. It goes real well with APs like Zyprexa, and also goes well with Adderall (personal experience). It is a different arena though, since you would have to mailorder it yourself instead of having the doctor prescribe it. Given the higher level of side effects of Anafranil or any other drugs, I really like Adrafinil (not to be confused with Anafranil) as a top choice. Just my experience in personal trials.
Posted by natg on December 6, 2000, at 10:05:59
In reply to Re: Need info on Anafranil, posted by SLS on December 5, 2000, at 22:23:39
> > I am bipolar/ADD and currently take lithium, zyprexa, and dexadrine. For various reasons, I have been unable to take most ADs. The SSRIs caused mania, Serzone didn't touch my depression, and Effexor caused sexual dysfunction. Tonight, my MD suggested Anafranil. It is one of the only drugs that I know nothing at all about. CAn anyone here enlighten me? Thanks a lot! Lin
>
Hello, Lin:
I tried Anafranil and the side- effects were very difficult to endure. I turned into a total zombie.
I was not too impressed with this med.
As Scott suggested, Lamictal is a good choice so is Depakote or Tegretol.
I personally prefer Lamictal or Neurontin-- they are both mood stabilizers and have AD properties.Just some thoughts.
All the best to you,
Nat
>
> Hi Lin.
>
> Anafranil (clomipramine) is a tricyclic antidepressant and belongs to the family that includes Tofranil (imipramine), Elavil (amitriptyline), Pamelor (nortriptyline), Norpramin (desipramine), and Sinequan (doxepin). Any side effects you may have experienced with these drugs are potentials of Anafranil. In addition to the tricyclic-type side effects it produces some SSRI-like side effects, including sexual dysfunction. Anafranil is considered to be a very "dirty" drug in that it does so many things other than what it is "supposed" to do.
>
> Aside from the MAOIs, Anafranil has shown itself as being perhaps the most effecacious antidepressant available. Because there is so much variability in the way any two individuals react to the same medication, I would not discourage you from trying it. I would only suggest that you discuss with your doctor the potential for Anafranil to produce mania. Seeing as how lithium and Zyprexa do not prevent the SSRIs from inducing mania, I would also suggest that you explore other mood stabilizers while keeping your existing ones. Depakote or Lamictal might help. Lamictal alone possesses antidepressant properties. If you have not yet tried it, you may want to give it a try prior to beginning Anafranil.
>
> Again, Anafranil is a very powerful antidepressant and antiobsessional drug that often works when many others have not.
>
> Good luck.
>
> Sincerely,
> Scott
Posted by PhoenixGirl on December 6, 2000, at 12:10:13
In reply to Re: Need info on Anafranil, posted by natg on December 6, 2000, at 10:05:59
I have to agree that Anafranil is a bad medication. I took it for over three years, and I yawned ALL THE TIME. I had zero interest in sex, and I had a hard time pee-ing. Can't believe I put up with that for 3 years.
Posted by Janice1 on December 10, 2000, at 21:20:43
In reply to Need info on Anafranil, posted by Lin on December 5, 2000, at 18:58:37
> I am bipolar/ADD and currently take lithium, zyprexa, and dexadrine. For various reasons, I have been unable to take most ADs. The SSRIs caused mania, Serzone didn't touch my depression, and Effexor caused sexual dysfunction. Tonight, my MD suggested Anafranil. It is one of the only drugs that I know nothing at all about. CAn anyone here enlighten me? Thanks a lot! Lin
hi Lin, I don't even know if you are still following this thread, or if you would appreciate being confused further. I'm both ADHD and manic depression (I respond wonderfully to both lithium and dexedrine). I also have alot of impulse control problems. Anyway, I tried Anafranil and had the most fantastic sex life of my life. My sex drive and ability to orgasm increased alot. But the Anafranil made me manic and my lack of impulse control got out of control...and this was on, I believe, a very small dose. If it weren't for my problems with impulse control I'd be back on this medication in a flash, but i was really out of control (combined with the mild mania)
I wouldn't knock it till you tried it. Just go slow and take the dose low. For me, the tricyclics are the best ADs out there. Janice
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