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Re: Anafranil - chlomipramine

Posted by Gladys on April 2, 2001, at 16:56:58

In reply to Re: Anafranil - chlomipramine, posted by Scott L. Schofield on January 21, 2000, at 23:31:09

Hi Scott, you seemed to know a lot about the meds so I thought you might be able to give me some insight. I am on celexa now but the weight gain is only making me feel worse about myself and I am getting more depressed each day I cannot wear any of my clothes. I have anxiety, depression, and OCD. I was considering anafranil because I had heard it was good for OCDs. I am scared to try anything new because I had a terrible almost suicidal time on Paxil and the weight gain on celexa no matter how much I exercise and diet. I've been on it for about a year now so I would think if it was a side effect only it would have stopped, but I cannot lose the weight. Do you know of any meds that treat depression that is unlikely to cause weight gain? I am also on buspar for the anxiety and am considering going off celexa and going on St. John's Wort because there were no side effects and maybe I can lose this weight. I feel like crying when I look at myself now!
>
> If you are going to try a tricyclic for the first time, I'm not sure you would want to start with Anafranil (chlomipramine). By comparison to other tricyclics, it tends to have more side-effects. Of course, this might end up being the right antidepressant for you. Unfortunately, there is not yet any precise way to determine in advance which particular drugs you will respond to (damn-it). However, your doctor may have chosen Anafranil specifically because you had responded to Celexa, one of the SSRIs (selective serotonin reuptake inhibitor). Of all the tricyclics, Anafranil exerts the greatest degree of serotonin reuptake inhibition.
>
> Imipramine (Tofranil) was once considered to be the "gold standard" by which other antidepressants were gauged. It was the first of the tricyclic antidepressants to be developed. (MAO-inhibitors had been stumbled upon earlier). Side-effects include those known as anticholinergic. Anticholinergic side-effects include dry-mouth, constipation, rapid pulse, palpitations, sweating, disturbances of vision, and others. Not all of these side-effects will necessarily be experienced, nor may they necessarily be of significant magnitude. Your doctor should go over these with you.
>
> There are quite a few tricyclics. They vary from one another in terms of side-effects, and probably in some pharmacological aspects of their antidepressant effect. As with the SSRIs, finding one that works is often trial and error. However, sometimes a tricyclic is chosen based upon its side-effect profile. For instance, if one suffers from insomnia along with depression, amitriptyline (Elavil) may be used for its sedative effect. If anxiety is present, I believe that doxepin (Sinequan) is sometimes preferred. Protriptyline (Vivactil) is considered the most activating, but I found it to have the worst anticholinergic effects of any of the tricyclics I have tried. Both desipramine (Norpramin) and nortriptyline (Pamelor) are probably the most forgiving regarding anticholinergic side-effects. Of all of these, desipramine is thought to be the most selective reuptake inhibitor of norepinephrine.
>
> The most important side-effects of the tricyclics are cardiac in nature. Be sure to let your doctor know if you have, or have had, any heart trouble.
>
> Personally, I have not found either imipramine or desipramine to be sedating beyond the first week or so. Nortriptyline was more sedating, but the sedation seemed to abate over time. Amitriptyline was a killer.
>
> To get back to Anafranil, it is often touted as being a "dirty" drug because of its side-effects. It can even produce some of the same sexual problems as seen with the SSRIs. However, during the early to mid 1980's, it was considered to be the most effective tricyclic antidepressant in the world.
>
> Good luck.
>
>
> - Scott


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