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Re: Would strattera treat depression and ADD?? » zeugma

Posted by Chairman_MAO on June 6, 2004, at 15:15:27

In reply to Re: Would strattera treat depression and ADD?? » Chairman_MAO, posted by zeugma on June 4, 2004, at 17:08:51

The desipramine seems to have started working somwhat since approximately day two for attention (esp. "executive function"), motivation, and depression. It's amazing how much "coarser" of a mood lift desipramine seems to provide for me. Unfortunately, I tossed the 75mg of Effexor to the wind for lack of efficacy, fatigue, emotional numbing, and worsening of ADD & anhedonia, so now I am dealing with a mild SSRI withdrawal syndrome while as the desipramine kicks in. I now cannot tease apart the withdrawal syndrome's cognitive dysfunction from my default state, and probably will not be able to do so for at least two more weeks. For the record, I find that Trileptal and desipramine both help deal with the withdrawl syndrome somewhat; it's definitely much more bearable than SSRI withdrawl's been in the past.

The constellation of side effects is a pain, particularly the impotence and dry mouth, which I hope my doctor is amenable to treating with Flomax and a muscarinic agonist (Salagen, Evoxac respectively. That said, I hope in two weeks my doctor lets me raise the dose to 150mg (from 75). I see a lot of promise with the desipramine and am eager to experience a full therapeutic dose.

Regarding Strattera vs. TCAs, I think your doctor's line of reasoning is a heap of Eli Lilly-sponsored you-know-what. I have no sources to cite at this time, so I cannot be sure but I seem to recall reading abstracts indicating that both atomoxetine and nortriptyline (and so presumably desipramine, too) block DA reuptake in the prefrontal cortex. There are no DA reuptake transporters there, leaving the NE reuptake transporter on "double duty" for both DA and NE. My suspicions are obviously supported by the fact that desipramine, imipramine, and nortriptyline all have been shown efficacious in treating ADD.

Regarding the fatigue: I've tried both desipramine and Strattera, and can tell you that desipramine does not cause the fatigue Strattera does. In fact, it's mildly activating. Were it not for desipramine's antimuscarinic side effects, a choice between the two would be a no-brainer; desipramine all the way!


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poster:Chairman_MAO thread:353502
URL: http://www.dr-bob.org/babble/20040602/msgs/354315.html