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Re: Tricyclics - Q for SLS et. al. regarding ... michael

Posted by Darwin on October 12, 2006, at 13:41:58

In reply to Tricyclics - Q for SLS et. al. regarding ..., posted by michael on October 11, 2006, at 14:45:09

I am also dysthymic with most of the symptoms you describe. I have tried imipramine, desipramine, nortriptyline, doxepin, and amitriptyline.

To my surprise, desipramine was the worst in both effectiveness and side-effects (impotence, urinary retention, rapid heart beat, orthostatic hypotension, poor sleep quality).

Nortriptyline was the best as far as side-effects are concerned but the best overall was amitriptyline. I am currently on amitriptyline and it helps considerably in treating my dysthymia.

Here's my guess on why amitriptyline is helpful in treating my dysthymia but desipramine is not (for me). I think, in many cases, dystyhmia is largely a problem of poor sleep quality. Sleep is not fully restorative thus the chronic low mood and tiredness and amitriptyline is better at restoring sleep quality than desipramine.

Also, amitriptyline hits most of the antidepressant mechanisms:

* norepinephrine reuptake inhibition
* serotonin reuptake inhibition
* alpha-2 receptor antagonism
* 5ht2a recepton antagonism
* cholinergic receptor antagonism

On the other hand, desipramine is primarily a norepinephrine reuptake inhibitor and not much else.

Having said all this I must admit that we are all unique biochemically and I'm sure that there are dysthymics who do better on desipramine than amitriptyline. As they say, YMMV.

Darwin


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