Posted by Elizabeth on November 3, 2001, at 11:19:48
In reply to ****Survey****: T.C.A. Drug Use, posted by jay on October 31, 2001, at 5:49:31
A while back I tried a couple of tricyclics (nortriptyline and amoxapine) but the side effects (mostly anticholinergic) were so bad that I gave up when I got to 75 mg. More recently I decided to try desipramine. This time I insisted that my doctor order a serum level as soon as I got up to a reasonable dose. That turned out to be a good idea, because my desipramine level was very high ( > 600 ng/mL) -- I seem to be deficient in an enzyme that catalyzes the metabolism of TCAs, which is probably why I had such a hard time tolerating the other ones I tried.
Desipramine doesn't seem to have any side effects, except that my early-morning insomnia has gotten worse rather than better. (I've tried taking it at various times of the day, all at once and in divided doses; it doesn't make a difference.) For me, it works better than the newer ADs (which, for the most part, didn't work at all), but that doesn't necessarily mean it will work better for other people.
There are some disorders for which tricyclics generally don't work very well compared with other antidepressants -- notably, atypical depression. They also don't help with borderline personality disorder, and there's even some evidence that they can make symptoms worse, so people with BPD should probably avoid them too. With the exception of clomipramine, they're not very effective with obsessive-compulsive disorder.