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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 linkadge on May 10, 2004, at 14:25:36
Any suggestions, bear in mind, I am in university.
Linkadge
Posted by SLS on May 10, 2004, at 16:42:36
In reply to best first TCA to try, posted by linkadge on May 10, 2004, at 14:25:36
> Any suggestions, bear in mind, I am in university.
Hi Linkadge.
I think the first two drugs to consider are desipramine and nortriptyline. They have the mildest side effects. Imipramine was at one time the gold standard by which all other antidepressants were compared, and will get more people well than the other two. Some will argue that amitriptyline is statistically better than imipramine, but it can be unacceptably soporific and sedating. Nortriptyline has a therapeutic window within which it exerts an antidepressant effect. This is associated with blood levels between 50-150 ng/ml. The drug can actually lose efficacy at higher dosages.
I'll be curious to see what others recommend.
- Scott
Posted by finelinebob on May 10, 2004, at 16:53:34
In reply to best first TCA to try, posted by linkadge on May 10, 2004, at 14:25:36
Nortriptyline.
Worked for me after disasterous trials with SSRIs. Tried desipramine -- didn't quite do it for me.
If I recall correctly, nortriptyline and imipramine have better side effect profiles than the other TCAs ... I'm certain about nortrip being one of those, not so certain about imipramine. I also believe imipramine has a better response for anxiety issues. Please, folks, chime in if you know any better!
Back to what I know for certain. Side effects to watch out for with nortriptyline are dry mouth, constipation, elevated heart rate and dizziness, and drowsiness. If you go on it, make sure you wear your sunblock.
For me, it was a really good match. No dizzies/racing heart, no constipation. Mild initial dry mouth. It knocked me out initially ... drowsiness went away pretty quick. While the dosage was still low, I made sure I took it an hour or two before bed. Right now I'm at 100mg/d, have been as high as 150mg/d -- I split my dosage. No side effects to speak of now that I've gotten used to it.
Let me know if you have any other questions!
flb
Posted by finelinebob on May 10, 2004, at 16:59:37
In reply to Re: best first TCA to try, posted by SLS on May 10, 2004, at 16:42:36
Posted by finelinebob on May 10, 2004, at 17:03:17
In reply to Re: best first TCA to try, posted by SLS on May 10, 2004, at 16:42:36
> ... Nortriptyline has a therapeutic window within which it exerts an antidepressant effect. This is associated with blood levels between 50-150 ng/ml....
Linkadge,
my pdoc says this is one of the best things about nortriptyline -- there actually is a blood test, a number you can get that will tell you if it should be working or not! If you're in that range and it ain't doing it for you, time for something else or to augment (if it sorta does it for you).
Posted by zeugma on May 10, 2004, at 20:16:30
In reply to Re: best first TCA to try, posted by finelinebob on May 10, 2004, at 17:03:17
nortriptyline is a good TCA, relatively low side effects, it increases the will to live, it is one of the things I am currently counting on to help get me through a hard time....
Posted by Sad Panda on May 10, 2004, at 23:23:43
In reply to Re: best first TCA to try, posted by SLS on May 10, 2004, at 16:42:36
> > Any suggestions, bear in mind, I am in university.
>
> Hi Linkadge.
>
> I think the first two drugs to consider are desipramine and nortriptyline. They have the mildest side effects. Imipramine was at one time the gold standard by which all other antidepressants were compared, and will get more people well than the other two. Some will argue that amitriptyline is statistically better than imipramine, but it can be unacceptably soporific and sedating. Nortriptyline has a therapeutic window within which it exerts an antidepressant effect. This is associated with blood levels between 50-150 ng/ml. The drug can actually lose efficacy at higher dosages.
>
> I'll be curious to see what others recommend.
>
>
> - Scott
>I agree with Scott, desipramine, nortriptyline & imipramine would be the ones which have the best side effects profile. Desipramine & nortriptyline would also be the ones that you could add to a functioning SSRI, clomipramine would be the one with the best efficacy, amitriptyline has the worst anti-muscarinic side effects & doxepin should only be used at low doses as a sedative(Like Remeron). Dothepin should be avoided totally as it is twice as toxic as any other TCA.
Here's a table I made with data from http://www.psychotropical.com/
________________5-HT__NE___H1___5-HT2A__A1___M1
CLOMIPRAMINE__0.28__38____15____23_____50___25
IMIPRAMINE_____1.4___37____37____150____32___60
AMITRIPTYLINE__4.3___35____1_____18_____24___13
DOTHIEPIN______8.6___46____3.6__________450___38
NORTRIPTYLINE__18____4.3___6.3___41_____55___50
DESIPRAMINE__________0.83__60____350___100__210
DOXEPIN________68____29.5__0.2___27_____23___52
Cheers,
Panda.
Posted by KimberlyDi on May 13, 2004, at 16:57:40
In reply to best first TCA to try, posted by linkadge on May 10, 2004, at 14:25:36
I recommend Imipramine. It works for me. I take it at night, and it is wonderful for my lifelong problem with insomnia. (I combine it with trazadone). Man, if you can get regular sleep, that eliminates alot of anxiety right there. It has never given me any problems. It doesn't clash with my mood stabilizer "Tegretol" during the day.
Oh, and it is cheap if you don't have insurance.
KDi in TX
> Any suggestions, bear in mind, I am in university.
>
>
> Linkadge
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