Posted by torachan on June 1, 2008, at 14:25:30
In reply to Re: The best Tricyclic for anxiety...., posted by SLS on June 1, 2008, at 5:28:04
> > The TCA can be more tollerable than the SSRI's for some. Amitrpytaline is still considered a gold standard against which AD efficacy is measured.
> >
> > The TCA's also have a record of actually getting people *well*.
>
> At this point, it seems that Effexor is closest to the TCAs with respect to percentage of responders and quality of response.
>
> Imipramine was considered to be the gold standard and was used as the standard comparator drug in clinical trials. However, amitriptyline is indeed somewhat better with regard to percentage of responders, and clomipramine better yet.
>
> Regarding anxiety, some people experience an improvement with desipramine, especially once they begin to see the depression abate. Perhaps Linkadge knows of a receptor to which it binds other than NE alpha-1. Or perhaps there are NE pathways that are inhibitory upon the anxiogenic serotonergic tracts.
>
> It is hard to say whether the anxiety is constantly in the background like GAD or a psychosocial consequence of being to asked to perform while in the depressed state.
>
>
> - ScottScott, I still don't understand how SSRI/NRI's can be effective for anxiety as some are indicated for anxiety use when, as you say, serotonergic tracts can be anxiogenic. As I understand these particular drugs, the increase the action of serotonin by blocking reuptake. Why is there this inconsistency between claims made that increased serotonin activity aggravates anxiety and the claim that serotonin activating drugs improve anxiety?
And do the trycyclics work in any significantly different way in this respect to the SSRI/NRI's?
Honestly, in my opinion as I mentioned somewhere else on this board, the medical community has yet to develop drugs effective for anxiety that rival the benzodiazepines, even though long term benzo treatment carries some disadvantages like tolerance and reduced sleep quality. I believe drugs are being primarily developed with depression/bipolar in mind, while largely ignoring Anxiety. Even these SSRI's have relatively low efficacy with depression which they're meant to treat primarily, so how can they be considered effective against anxiety?
Also, do you know of any promising new drugs on the horizon which focuses on anxiety. I looked at Valdoxan, which should help with sleep, but it's still focused on depression.
poster:torachan
thread:831465
URL: http://www.dr-bob.org/babble/20080528/msgs/832375.html