Posted by zeugma on July 18, 2004, at 15:36:37
In reply to Re: Zeugma, ADD diagnosis » zeugma, posted by SLS on July 18, 2004, at 7:54:46
> Hi.
> Hi Scott.
> > That backs up what my pdoc told me, that desipramine and nortriptyline are virtually interchangeable in terms of clinical effect.
>
> This is pretty much true. There are two important differences, though. First, there are people who respond to one and not the other. Second, unlike desipramine, the dosages of nortriptyline that someone will respond to for depression will fall within a therapeutic window, outside of which, the quality of response is reduced. It is actually possible to take too much and lose the antidepressant effect. However, the blood levels of nortriptyline are well studied, and the therapeutic range has been established as being between 50-150 ng/mL. Simple blood tests will help with dosing. Most people end up taking 75mg. I don't know how true this is, but at one time, many clinicians felt that if a patient responded well to desipramine, they were less likely to respond to nortriptyline and vice versa. If you don't respond to one, don't rule out the other.I would describe myself as partially TCA (nortriptyline-) responsive. I have 'atypically typical' depression- that is, I have most of the symptoms of what is classically called 'melancholia,' including mood improvement in evening, poor appetite, insomnia- which are symptoms which have responded to nortriptyline. I also have extreme 'rejection sensitivity', which Mulder and Joyce, who have done extensive recent work on subtypes of depression and differential response, have tagged as pivotal to their construct of 'atypical' depression, and which they found does not respond to NOR (their representative TCA). In fact this symptom has not responded to anything, so maybe it doesn't matter :) I have no reason to think desipramine would be better than NOR in this respect, since rejection sensitivity seems to be responsive to strong SRI's (although seemingly not in my case).
>
> > Muscarinic receptors are associated with the memory deficits of Alzheimer's disease, and anti-muscarinic potency is why the TCA's are called (misleadingly) 'dumb drugs.'
>
> I take imipramine 300mg, and I feel pretty dumb. I know much of my problem is due to the depression itself, and some might even be due to Lamictal 300mg. How would you guess that much imipramine would affect me - or anyone else for that matter? Do you think the negative congnitive effects are exaggerated? I do enter REM early. It bugs the hell out of me to think that a drug is making me dumber than I am to begin with! Damn these illnesses.Well, my thought on this is that possibly a lot of the cognitive impairment you say you have is due to distorted self-perception generated by depression itself. Cognitive impairment does not come through in your posts. Do you find this idea plausible? I suspect that a kind of anosognia (blindness to one's self) is involved in severe depression, and this may be reflected in the findings of hippocampal abnormalities; the hippocampus is involved in spatial learning and probably self-perception as well.
But to answer your question. Yes, I think the cognitive liabilities of the TCA's are overstated. But so much of this is subject to interindividual variation': anti-muscarinic drugs aren't going to be 'dumb' for someone who is hyper-muscarinic. And everything is relative to the disorder one is considering: TCA's are considered a second-line treatment for ADHD, which is a cognitive disorder. So maybe they impair short-term memory, but improve other cognitive measures.
Do you think 300 mg imipramine is helping you? Or do you think that lowering the dose, or possibly substituting another TCA, would help? Did you respond to amitriptyline? That is the 'dumbest' TCA of all, but has a slightly different profile from imipramine. It seems, from what you've said in other posts, that you've built up a tolerance to the TCA's and MAOI's (excuse my use of euphemism). But there doesn't seem to be much else out there in terms of severe depression. Maybe Xyrem? I suggest that because it suppresses cataplexy, like the TCA's and MAOI's, but appears to work by an entirely different mechanism. The anti-cataplectic effects of AD's are presumed to stem from their REM-suppressing effects early in the sleep cycle, so maybe Xyrem gets the same job done in a novel way?
>
> >:-(
>
> Regarding sleep, I discovered a little trick a long time ago that helps me from suffering a worsening of depression when I need to catch up on sleep. Regardless of what time you go to bed, wake up at the same time every day, get out of bed, expose yourself to bright light, do anything that will bring yourself to a state of full wakefullness, and then go back to bed and sleep as long as you like. This resets the circadian clock and prevents a phase delay. It usually works for me.
>
> :-)
> Hmmm. Haven't tried that one. Might be a good idea. :-)
>
> - Scott-z
poster:zeugma
thread:364549
URL: http://www.dr-bob.org/babble/20040714/msgs/367415.html