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Re: TCAs

Posted by bleauberry on July 23, 2012, at 17:08:08

In reply to TCAs, posted by jerseygal111 on July 23, 2012, at 16:50:12

Statistically speaking, TCA's and SSRIs share approximately the same efficacy rate, though clinically the general impression is TCAs are better. Not sure where your doc got his opinion from but I don't think it is correct. He sounds like a real good doc though, considering maois.

Comparing TCAs and SSRIs is like comparing apples and oranges. They're different. TCA's used to be king of hill, but when ssri's came along they took over, a combination of a supposedly better side effect profile and marketing by the pharm companies for newer meds. The better side effect profile actually isn't accurate, because some people find the side effects of tca's better than ssri's. Each has different kinds of side effects, so again it is not easy to compare. For example we can reliably predict a likelihood of sexual side effects on ssris, and we can reliably predict a likelihood of dry mouth on tca's.

You would probably love reading the stuff by Dr Gillman at psychotropical.com. I agree with him on most issues. Long story short, the best success comes not from tca or ssri, but a combination of both. That is because that is the only way to get a true SNRI. You have not tried an SNRI. Effexor might be called one for marketing purposes, but its ratio of serotonin to norepinephrine is 30:1. Cymbalta is 9 to 1. They are both almost completely SSRI. Savella is 2 to 3, and Clomipramine is about 1 to 1.

I like the maoi idea. I can understand wanting to try something else first. In that case, prozac+nortriptyline, zoloft+nortriptyline, maybe desipramine instead of nortriptyline, savella.

If your doc could give you maybe 2 pills of ritalin, 2 pills of adderall, and 2 pills of vicodin, that would allow you the opportunity to zero in on what chemistry you need to work with, take some of the guess work out of it. For example, according to a study, response to ritalin predicts a more likely response to nortriptyline, where a response to adderall points to desipramine. Either way, they work fast so it doesn't require a long trial. Couple days will tell you a lot. I know it sounds weird, but in just one week these kinds of experiments can give you enough clues and hints to avoid months or years of guessing.

Maybe you don't respond to either, and that is helpful too. Vicodin is to see if there is an opioid connection. People feel one of 3 ways of vicadin....tired crappy....euphoric.....normal. Me, it can make me feel just plain normal, not high, not drugged, not anything, just plain normal. So I know my opioid system is involved in my symptoms. That is helpful when choosing future meds, herbs, or supplements.

> Are TCAs less potent than SSRIs and SNRIs? I've been through all the SSRIs and am trying the last SNRI which is cymbalta. If cymbalta doesn't work, I'll have to move on to another class of antidepressants. My doctor said that TCAs are not as potent as SSRIs and SNRIs so he didn't think they were worth trying. He wants me to go to an MAOI. I'm reluctant to start an MAOI because of all the dietary restrictions. If there's a chance that a TCA could work, I'd rather try that first.


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poster:bleauberry thread:1022001
URL: http://www.dr-bob.org/babble/20120718/msgs/1022002.html