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Re: ****Survey****: T.C.A. Drug Use

Posted by Adam on November 8, 2001, at 17:25:03

In reply to ****Survey****: T.C.A. Drug Use, posted by jay on October 31, 2001, at 5:49:31

I have tried two TCA's: desipramine and clomipramine.

I found both nearly intolerable. On both I had (so bad I couldn't tell the difference between them): Somnolence, dry mouth, complete sexual dysfunction (on an SSRI I could at least get it up), orthostatic hypotension, mental cloudiness, and last, but certainly not least, constipation. I just couldn't take these drugs at a "therapeutic dose". I should mention that no one who prescribed these (I had two p-docs try DES on me) even mentioned getting blood work done, and all seemed incredulous upon hearing my complaints. I can only guess that if I had gotten the bloods (the DES blood test is de rigeur, I found out, long after I had switched docs, and meds) I might have discovered a smaller dose was sufficient (due probably to a metabolic polymorphism) and I perhaps would have experienced less discomfort as a result. If you try a TCA, insist on getting a blood level reading. You might save yourself a bad experience, and hence also get an adequate trial.

The first generation tricyclics (or I should say, all those in the "tertiary amine" sub-class) are thought to be particularly noxious as far as side-effects go, and I guess, for those who find relief with those TCAs, they learn to live with it. I'm not sure I could (but again, see above). Relatively newer drugs like desipramine (secondary amine TCA, nothing more than demethylated imipramine) are thought to be more tolerable (and more specific for the NE reuptake pump, relative to other targets), though I'm not sure all who have taken them would agree. Clomipramine, a halogenated version of imipramine, thought to be one of the best drugs for OCD and a darn good antidepressant, is unfortunately also one of the worst antidepressants of any class for side-effects, so it is said. Yet many take it, and do well.

TCAs are widely regarded, despite their relatively poor side-effect profile, as being highly effective for depression (especially the "melancholic" variety), but they're also potentially dangerous (some can be cardiotoxic, all can be lethal in overdose, etc.), so I think if you're thinking of giving one a go, make sure you've got yourself a good doctor. Don't be put off if he/she prescribes you only a few doses at a time at first; precautions make both of you safer. Again, get the blood work done, if you can, so you know what your real "dose" is.
>
> I am interested in getting an idea of who, and how many, have tried traditional tricyclic a.d's. Basically, what med, dose, how long, and what positive/negative effects did it have.? In particular, if you can relate your story to newer generation a.d's..SRI's/SNRI's...etc. Thanks. Jay :-)


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poster:Adam thread:82743
URL: http://www.dr-bob.org/babble/20011104/msgs/83576.html