Posted by Elizabeth on November 9, 2001, at 12:46:44
In reply to Re: T.C.A. Use...More Questions.. » Elizabeth, posted by jay on November 9, 2001, at 9:09:09
> I started this thread because I guess some of my prejudice favours TCAs. I have had some excellent responses to a few of them, and of course I know that means very little, but they seem to affect depression and anxiety in a *whole* different manner than many of the newer SRI/SNRIs, NRIs, etc.
I agree. Some people who don't respond to SSRIs (myself, for one) could do well on a TCA, if they can tolerate it. And while SSRIs are probably more effective than most TCAs for panic disorder, a lot of people with PD have a hard time tolerating SSRIs.
> Maybe it is because they are so "dirty" (which really is a subjective word...hitting more receptors is really in no way associated with dirt :-).
I don't think that anyone knows what's so special about TCAs, except that they all inhibit NE reuptake (as well as, to varying degrees, 5-HT).
> I often wonder how folks who are usually only given a trial of one of the newer popular drugs, say would react to a *complete* test of each of the TCAs?
I don't think it's necessary to try all the TCAs. But anyway, one thing that is pretty common if someone has only a partial response to a SSRI is to add a low dose of a TCA.
For safety and tolerability reasons, I think that for most patients, TCAs should be pretty far down the list of things to try (Effexor or Remeron will often work for people who respond to TCAs and should usually be tried first), but they shouldn't be ruled out altogether.
> Besides some different side effects, how much more effective is Paxil than clomipramine for anxiety and panic (with/without GAD)..or Serzone than clomipramine for anxious depression?
Paxil and clomipramine are probably equal for panic. Clomipramine is the most effective TCA for panic, I think, although not the most tolerable.
> For 'atypical' depression...what about Nortriptyline and Protriptyline...the later which is energizing and even linked to weight loss as a thermogenic effect (I have the citation if you want..)...Vs. Prozac and Welbutrin?
Protriptyline can cause weight loss, but it's probably the most dangerous of the TCAs -- it carries an increased risk of cardiovascular problems and seizures. And TCAs as a rule don't work very well for atypical depression. MAOIs should probably be tried before TCAs because MAOIs have a better chance of working and are about equally tolerable (subject to individual differences, of course).
> I know there are these "cautions" about tests and such with TCAs, often involving heart conditions, but so many doctors make them out to be like you need a major physical every week on a TCA.
No, but there are risks, and the rate of complications with TCAs and the need for expensive tests make it more cost-effective, as well as safer, to use newer ADs.