Posted by JohnL on March 2, 2001, at 3:09:53
In reply to SHOULD I TRY A TRI-CYCLIC? WHICH ONE?, posted by zarathustra on March 1, 2001, at 18:05:59
> I HAVE BEEN ON VARIOUS SSRI's, MANERIX, EFFEXOR, AND WELLBUTRIN. NONE WORKED EXCEPT PAXIL, BUT I STOPPED DUE TO SEXUAL SIDE EFFECTS, AND WHEN I TRIED AGAIN, IT SIMPLY DIDNT WORK.
>
> I WOULD LIKE TO TRY A TRICYCLIC, BUT DONT KNOW AN EXTREME AMOUNT ABOUT THEM: DO THEY HAVE SEXUAL SIDE EFFECTS? WHICH IS "STRONGEST"?
> WHICH IS MOST ACTIVATING?
> AND ARE THEY REALLY EQUAL IN EFFICACY TO THE SSRI's?
> AND WHY HASNT MY M.D. SUGGESTED THEM?
>
>
> ANDREWHere are some answers to your questions:
Do they have sexual side effects? Yes and no. Sometimes, sometimes not. It's different with each person. You won't know for sure until you try. Mileage varies.Which is the strongest? According to clinical comparison studies, Imipramine. Amitriptyline, Nortriptyline, and Desipramine are very close seconds.
Which is the most activating? Desipramine and Protriptyline.
Are they equal in efficacy to SSRIs? Some clinical studies show TCAs are more effective than SSRIs. Some studies show they have about the same efficacy. I think in general the evidence suggests TCAs are more effective.
Why hasn't your MD suggested them? Probably because of the side effects. They are difficult to tolerate for many people, in comparison to SSRIs. You can expect such things as dry mouth, constipation, frequent and difficult urination, which may or may not go away. Some of them, such as Imipramine, are quite sedating.
Of them all, your best bets are probably with Nortriptyline or Desipramine. They have the fewest side effects.
There was one clinical study a couple decades ago that was very interesting. What they did was try Ritalin on patients. If there was a positive response to Ritalin, then it predicted a good response to Desipramine. If there was a neutral or bad response to Ritalin, then it predicted a good response to Nortriptyline instead. Interesting. In my own experimentations I think there is validity to this test. You could try Ritalin just for about three days as a test and then use that to choose between Nortriptyline and Desipramine. As with all drugs, one may work while another doesn't.
Personally I think you would be much better off with a small dose of your favorite antidepressant so far (or sample a few to discover one you can live with), and then add an antipsychotic and/or stimulant to it. I sound like a broken record because I suggest this so often, but it really works well quite often.
John
poster:JohnL
thread:55254
URL: http://www.dr-bob.org/babble/20010221/msgs/55301.html