Posted by zeugma on March 8, 2005, at 19:56:17
In reply to Re: TCA plus bethanechol? » KaraS, posted by Sarah T. on March 8, 2005, at 19:35:32
Although maprotiline was reputed to have fewer anticholingergic effects, it turned out to be much worse for me than any other TCA as far as constipation, urinary retention and dry mouth. All of the other TCA's had bad anticholinergic effects, but their adverse effects seemed to diminish with time. That did not happen with Ludiomil, perhaps because of what Steven Stahl refers to as the "pseudo-anticholinergic effect" produced by highly noradrenergic medications. The idea behind his theory is that the parasympathetic nervous system attempts to counteract the sympathetic stimulation caused by all that excess norepinephrine>>
Is that Stahl's idea? it would seem to me that possibly the reason the 'pseudo-anti-cholinergic' side effects are more intractable than the non-pseudo ones is because the parasympathetic nervous system does NOT compensate for muscarinic blockade by releasing excess acetylcholine, which would mitigate the constipation dry mouth etc. I did experience constipation on Strattera that was far worse than anything I got from nortriptyline.
anyway, this is an idea that I've had floating around for a while, that cholinergic blockade causes cholinergic release to compensate, analogous to the way haloperidol causes increased DA efflux to compensate for dopamine receptor blockade.
-z
poster:zeugma
thread:468334
URL: http://www.dr-bob.org/babble/20050308/msgs/468441.html