Psychiatrists are terribly afraid..." /> Psychiatrists are terribly afraid..." />

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Re: Lofepramine and tricyclics

Posted by Elizabeth on October 31, 1999, at 12:41:11

In reply to Re: Lofepramine and tricyclics, posted by Refractory on October 31, 1999, at 10:46:08

> I have read and been told that the tricyclics are actually oftentimes superior to the SSRIs for severe depression or refractory. particular for the "melancholic" subtype (which often isn't helped by SSRIs).

> Psychiatrists are terribly afraid of being sued for any reason, as are all doctors these days. Part of their reluctance nowadays to prescribe TCAs probably has to do with their fear a patient may use the TCA prescription to overdose and thus commit suicide. Thus they try to stay with the newer, "cleaner" antidepressants like the SSRIs whenever possible. As none of these can be used for overdose.

Well, they can, but the most that's liable to happen is a great deal of vomiting. I think fear that patients will use a medication as a means to attempt suicide is a legitimate concern. Lofepramine is supposed to be much less cardiotoxic than other TCAs, which makes it an attractive choice. (Does anyone happen to know what company markets it in the UK?)

Another risk of tricyclics is that they seem to cause mania (in particular, dysphoric or mixed mania) or rapid cycling than SSRIs and possibly MAOIs. (Hypomania seems to be very common with MAOIs, though.)

> I am sure there are many, many people out there with more severe depression, who would probably be better off on a TCA or even an MAOI but their doctor wont voluntarily put them on one because of the docs fear of overdose and potential lawsuits. Such is the state of modern day medicine.

My impression is that tricyclics are better for the melancholic end of the spectrum, SSRIs for the atypical end, and MAOIs are more versatile. This is, of course, an extremely broad generalization.




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