Posted by linkadge on June 3, 2008, at 17:26:57
In reply to Re: The best Tricyclic for anxiety)Link/johnj, posted by torachan on May 31, 2008, at 22:24:27
>Link, johnj suggested Nortryptyline. How does it >fare against Amitryptyline and Doxepin? Also, is >Cyproheptadine similar in chemistry and effects >to Zoplicone?
As a class of drugs, the TCA's have a diverse range of monoamine uptake site affinities. Nortryptaline and desipramine have the most effect on norepinephrine and the least on serotonin. Clomipramine has the most effect on serotonin and least on norepinephrine. One of the TCA's 'surmontil' or 'trimipramine' actually has no effect on monoamine uptake at all. Some of the TCA's are serotonin antagonists and others are not. Some respond to certain TCA's and not others. Interestingly, all of the TCA's produce the same long term adaptive changes regardless of monoamine uptake affinity. They all appear to increase the responsivness of d2/d3 receptors in certain limbic regions implicated in depression. So, the adaptive changes may be due to some yet unidentified mechanism of the TCA's. All of the TCA appear to have a final dopaminergic or opioid related activity.
Its hard to say which one may affect you most positively. Nortryptaline and desipramine can cause tachycardia in some patients. I would avoid desipramine unless depression is very anergic. Nortyrptaline has mixed stimulant/sedative effects. For some people it causes sedation and others it causes activation.
Doxapin, amitryptaline, surmontil and amoxapine are probably the best choice for mixed depressive/anxiety and insomnia issues. They can be helpful adjunctives for depression which is partially responsive to SSRI's or they can be used to relive certain side effects of SSRI's.
Some people use a combination of TCA's, i.e. doxapin in the evening + desipramine in the morning.
I did well on a combination of 10mg of doxapin + 10mg of celexa. Even though this is a low dose of a TCA it made some major impact on my depresion. Sleep improved, anxiety improved, and SSRI anhednoia improved quite significantly.
Cyproheptadine is an antihistamine with high affinity for the 5-ht2a/c receptors as an antagonist. It is not an anticonvulsant tranquilizer but it can act as a sedative.
Linkadge
poster:linkadge
thread:831465
URL: http://www.dr-bob.org/babble/20080528/msgs/832740.html