Posted by torachan on May 27, 2008, at 22:14:18
In reply to Re: The best Tricyclic for anxiety...., posted by linkadge on May 27, 2008, at 20:48:11
> Well one theory suggests that serotonergic medications can actually increase certain forms of anxiety via stimulation of certain serotonin receptors.
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> Stimulation of the central 5-ht2a/c 5-ht3 receptors can cause anxiety.
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> Peripherially, stimulation of 5-ht3 receptors in the stomach can cause nausia.
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> Atypical antipsychotics are sometimes used to mitigate these side effects. Zyprexa/seroquel blocks 5-ht2a/c and 5-ht3, Risperidal blocsk 5-ht2c etc. Remeron also blocks 5-ht2a/c and 5-ht3 receptors and is somtimes used to reduce the side effecs of SSRI's.
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> Imirpamine is a TCA but is somewhat like effexor in that it doesn't block any serotonin receptors. By blocking the reuptake of serotonin it increases serotonin signalling at every serotonin receptor in the body. Other TCA's like doxapin, trimipramine, amitryptaline clomipramine etc, block certain serotonin receptors which can sometimes result in a more comprehensive antianxiety effect.
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> 5-ht2a blockade can improve sleep. 5-ht2c blockade can reduce psychomotor agitation. 5-ht3 blockade can reduce nausia (peripherially) and anxiety centraly.
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> So I guess the bottom line is that if imipramine made anxiety worse another TCA may act differently.
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> Linakdge
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>Link, so if I understand you correctly, blocking of the 5HT2a/c receptors and 5HT3 receptor in a general way helps with anxiety because it reduces serotonin signalling at these sites. And you say amitryptiline and doxepin are the TCA's which have these effects most prominently. You are also indicating that Seroquel and Remeron both have these effects as well. Am I correct so far? Hope so.
So, with my incredible deductive skills--sarcasm--, since I tried Remeron unsuccessfully for a lengthy trial for my "anxiety" whether its GAD related, existentially related, whatever, and am currently trying Seroquel, in a way, without feeling better so to speak, these TCA's you mention as efficacious for anxiety would be 'duds' for me, since their action closely mimics that of Rem/Seroquel?
Just to give you perspective, my condition arose in the from of panic attacks in 1994 and have been on clonazepam ever since, with the odd SSRI experiment here and there, and a long mildly successful experience with Effexor. Once I was put on clonazepam, the PA's ended abruptly; they're certainly good for that.
By the way, what's your fee? ;)
poster:torachan
thread:831465
URL: http://www.dr-bob.org/babble/20080519/msgs/831527.html