![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by femlite on January 10, 2004, at 16:37:28
I have had little success with ssris and had wellbutrin poop out and am unable to get to therapuetic dose on lamictal.
I have read some interesting info on tricyclics, but am curious as to why so few people take them. Are they passe and therefore underprescribed? OR considered ineffective?I am thinking about amitriptyline as an AD as I also have problems with chronic pain.
Are there people on this site who have experience with these types of meds?
Posted by Francesco on January 10, 2004, at 17:47:55
In reply to Who takes tricyclics?, posted by femlite on January 10, 2004, at 16:37:28
> I have read some interesting info on tricyclics, but am curious as to why so few people take them. Are they passe and therefore underprescribed? OR considered ineffective?I don't think they're considered ineffective, quite the opposite, but they're believed to have a worse side-effects profile compared to SSRIs.
However many people found them more tolerable and I'm one of them. I have had a long experience with clomipramine, which is considered the worst in term of side-effects but I did take it for years while I could not stand an SSRI for more than six months (prozac 6 months, celexa 2 months, paxil two months). What is most important is that secondary amines are considered best in term of side-effects. This is the reason why now I'm going to start desipramine.> I am thinking about amitriptyline as an AD as I also have problems with chronic pain.
I have took it for a while but it was so many years ago I can't remember nothing about it.
What follows is a table of the side-effects of TCAs whic was sent me by Psychobabble's fellow.
It comes out that amytriptiline is one of the worst offender but I have heard it's used at low doses for chronic pain ... another issue is the antidepressant dosage though. Good luck !PERRINE
(Listed from least to most tolerable in the general sense)
Amitriptyline (tertiary amine TC)
_Weight Gain: High
_Sedation: High
_Anticholinergic: High
_Hypotension: High
_Cardiotoxicity: HighClomipramine (tertiary amine TC)
_Weight Gain: Medium
_Sedation: Medium
_Anticholinergic: High
_Hypotension: Medium
_Cardiotoxicity: HighMaprotiline (secondary amine TC)
_Weight Gain: Medium
_Sedation: Medium
_Anticholinergic: Medium
_Hypotension: Medium
_Cardiotoxicity: MediumDoxepin (tertiary amine TC)
_Weight Gain: Medium
_Sedation: High
_Anticholinergic: Medium
_Hypotension: High
_Cardiotoxicity: MediumImipramine (tertiary amine TC)
_Weight Gain: Medium
_Sedation: Medium
_Anticholinergic: Medium
_Hypotension: Medium
_Cardiotoxicity: HighAmoxapine (secondary amine TC)
_Weight Gain: Medium
_Sedation: Low
_Anticholinergic: Low
_Hypotension: Medium
_Cardiotoxicity: MediumDesipramine (secondary amine TC)
_Weight Gain: Medium
_Sedation: Low
_Anticholinergic: Low
_Hypotension: Low
_Cardiotoxicity: MediumNortriptyline (secondary amine TC)
_Weight Gain: Medium
_Sedation: Low
_Anticholinergic: Low
_Hypotension: Low
_Cardiotoxicity: Medium-----------------------------------
GORMAN
Imipramine
_Anticholinergic: XX
_Sedation: X
_Insomnia: X
_Weight Gain: XX
_Dizziness: XXDesipramine
_Anticholinergic: X
_Sedation: -
_Insomnia: X
_Weight Gain: X
_Dizziness: XXAmitriptyline
_Anticholinergic: XXX
_Sedation: XX
_Insomnia: -
_Weight Gain: XX
_Dizziness: XXNortriptyline
_Anticholinergic: X
_Sedation: X
_Insomnia: X
_Weight Gain: X
_Dizziness: XDoxepin
_Anticholinergic: XX
_Sedation: XX
_Insomnia: -
_Weight Gain: XX
_Dizziness: XXTrimipramine
_Anticholinergic: XX
_Sedation: XX
_Insomnia: -
_Weight Gain: XX
_Dizziness: XXProtriptyline
_Anticholinergic: XXX
_Sedation: -
_Insomnia: XX
_Weight Gain: -
_Dizziness: XMaprotiline
_Anticholinergic: X
_Sedation: XX
_Insomnia: -
_Weight Gain: X
_Dizziness: X
------------------------------------------------------SMITH
http://www.umich.edu/~pharm660/addrugs.pdf
Amitriptyline
_Sedating: +++
_Anticholinergic: +++Doxepin
_Sedating: +++
_Anticholinergic: +++Imipramine
_Sedating: ++
_Anticholinergic: ++Desipramine
_Sedating: ++
_Anticholinergic: +Nortriptyline
_Sedating: +
_Anticholinergic: ++Protrityline
_Sedating: 0
_Anticholinergic: ++
--------------------------------------------
Posted by Elle2021 on January 11, 2004, at 2:11:38
In reply to Who takes tricyclics?, posted by femlite on January 10, 2004, at 16:37:28
> I have read some interesting info on tricyclics, but am curious as to why so few people take them. Are they passe and therefore underprescribed? OR considered ineffective?
I took Clomipramine for quite a while. It was effective for my depression, but not OCD.
Elle
Posted by tensor on January 11, 2004, at 3:50:46
In reply to Re: Who takes tricyclics? » femlite, posted by Elle2021 on January 11, 2004, at 2:11:38
How much clomipramine did you take? A pdoc told me about a girl who suffered from OCD, while closely monitoring blood levels they pushed the dosage up to 275mg(!) and the blood levels where still within the limits. It took a few months at that dose for her to get cured, but it worked.
/tensor
Posted by Keith Talent on January 11, 2004, at 9:31:50
In reply to Re: Who takes tricyclics? » Elle2021, posted by tensor on January 11, 2004, at 3:50:46
My understanding is that blood levels have only been shown to be meaningful for nortriptyline. In any case, clinical features, not concentrations, should be what is treated. Personally, clomipramine is the bees knees for depression. I'm just stopping it because (a) most patients can't have an orgasm (this may be relieved with a stimulant) and (b) causes some memory impairment.
It caused absolutely no sedation and no weight gain for me. The limiting factor for dose might be the physician's nervousness about causing a heart rhythm disturbance, but generally up to about 300 mg per day is fine. For me, doxepin and amitriptyline were much weaker antidepressants.
Clomipramine has an active metabolite (desmethylclomipramine) which is about as potent at blocking noradrenaline reuptake as desipramine (about the strongest there is at this). So cl. is a true SNRI - the others are pretenders (venlafaxine is basically a very weak SSRI, I know nothing about duloxetine and milnacipran).
You will probably find it more acceptable to take an SSRI (sertraline and paroxetine are the strongest), with maybe some dextroamphetamine to boost your drive and relieve anorgasmia. It really depends if it's for the rest of your life, or just one episode.
Best of luck.
Posted by sailor on January 12, 2004, at 7:40:28
In reply to Who takes tricyclics?, posted by femlite on January 10, 2004, at 16:37:28
Amitriptyline (Sp?) ,for a while, I think starting in the late 60's was considerede the "gold standard" (my psychiatrist's phrase back then) and was widely prescribed and dramatically helpful to lots of people. I took it for about ten years. It is especially effective at helping with insomnia, a condition often associated with depression. In fact, some depression diagnoses could in fact be a primary sleep disorder--chronic fatigue from poor sleeping can mimic depression.
It was very effective for me, with a few side effects that I could tolerate back then. The most pronounced was an intense craving for sweets/carbohydrates that can obviously lead to weight gain. There was also some sexual dysfunction, I think occasional difficulty with erection and/or anorgasmia, but most of the time I was able to overcome those tendencies. I don't remember for sure (this was almost 20 years ago), but I think I was taking 150mg/day. I do remember other people I knew then who were responding very positively. Some ER docs still prescribe it for short-term resolutuion of insomnia. It's also potentially fatal at overdose, which is one drug feature the companies have tried to "select out" of newer drugs for liability reasons. It's now often referred to as one of the "dirty tricyclics" meaning it's side effects are allegedly not always worth the benefits.
However, I don't trust the politics (motives) of drug corporations nor the prescribing guidelines of some docs (pre-occupation with liability), so I would do some research of your own on the drug and make your own decision. It has been a life-saver for some. It's also very cheap in generic. The original brand name was Elavil. I hope this is helpful. Regards, Sailor
Posted by Elle2021 on January 12, 2004, at 10:42:09
In reply to Re: Who takes tricyclics? » Elle2021, posted by tensor on January 11, 2004, at 3:50:46
I was taking 100 mg. a day. The stuff just didn't seem to be doing anything. My pdoc told me I needed to be up to at least 100 mg. before I could expect anything, but he said I might have to take more than that! 275 mg is a lot!! I'm glad it worked for her. Right now I'm taking Chlorpromazine. It seems to be doing an okay job even though it's in a super low dose. It's the first one I've taken that didn't give me nauseating side effects! :)
Elle
Posted by Ilene on January 12, 2004, at 21:32:10
In reply to Who takes tricyclics?, posted by femlite on January 10, 2004, at 16:37:28
> I have had little success with ssris and had wellbutrin poop out and am unable to get to therapuetic dose on lamictal.
> I have read some interesting info on tricyclics, but am curious as to why so few people take them. Are they passe and therefore underprescribed? OR considered ineffective?
>
> I am thinking about amitriptyline as an AD as I also have problems with chronic pain.
>
> Are there people on this site who have experience with these types of meds?
I'm taking desipramine right now. It was the first AD I ever took, about 15 or 16 years ago. It worked very well for a year or so. I stopped when I was pregnant, and when I started it again it had no effect. I'm taking it now because I'm almost out of alternatives.Tricyclics are not prescribed as often these days because the SSRIs are much safer and about as effective. You can kill yourself with enough of them, something that is hard to do with SSRIs. The SEs are unpleasant and can be dangerous, too--you can pass out when you stand up, for example. My biggest problem now is blurred vision, which makes it hard to drive at night.
Ilene
Posted by femlite on January 15, 2004, at 10:30:25
In reply to Re: Who takes tricyclics?, posted by Keith Talent on January 11, 2004, at 9:31:50
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.