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

Posted by psychobot5000 on October 12, 2006, at 22:07:35

In reply to Re: Tricyclics - Q for SLS et. al. regarding ..., posted by michael on October 12, 2006, at 18:13:26

I would suggest nortriptyline, though many of those are good drugs. It is relatively good on side-effects, and though desipramine may narrowly beat it out on that score, I've seen metaanalyses that suggest nortriptyline may also a more powerful antidepressant.

It is, of course, very similar to amitriptyline, having noradrenaline and serotonin reuptake inhibiton, and hitting the various receptor sites, but has fewer side-effects. A disadvantage of amitriptyline is powerful sedation (from histamine blocking), which nortrip is much better about (my own experiences on those two bear this out). Nortrip is better on cardiac side-effects (less anticholinergic action) and has a more powerful noradrenaline reuptake-inhibiting effect. It also has much more serotonergic effects than desipramine.

But these are all good drugs, as far as I know. I would also consider clomipramine and doxepin. Still, you sound like you need a catecholaminergic effect, so that would suggest one of the more NA boosting drugs--nortrip and desip.

As for stimulants, as I understand these things, it's possible, but tricky. Your doctor may not approve it because of tricyclic cardiac effects. Still, if you monitor your heart, and there are no major effects on heart-rate or blood pressure from them, small doses of stimulants seem like they would be fine. I have seen them on a list of drugs contraindicated with TCAs, but, as is usually the case, some more experienced doctors are willing to use them with due care. You'd just have to see.

Hope you find something that helps!




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