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Re: I need some advice regarding my medication regimen

Posted by linkadge on July 29, 2019, at 19:09:45

In reply to Re: I need some advice regarding my medication regimen, posted by Christ_empowered on July 28, 2019, at 12:20:29

I would disagree that the TCAs are 'toxic'.

It really depends on the TCA. Clomipramine is a very tolerable medication. Many docs don't even know that anafranil is a TCA. It is like a combination of a balanced SNRI (SSRI + NRI metabolite) and mirtazapine. It is still considered the 'gold standard' for OCD and is probably one of the most effective antidepressants. The anticholinergic side effects vary from TCA to TCA. Nortriptyline, for example, is less anticholingeric than amitriptyline.

Yes, the TCAs can induce mania. I haven't seen any conclusive evidence that TCAs are more likely to cause mania than SSRIs. However, if they do, it might be a sign of their superior antidepressant effects.

They are not selective and they hit a lot of targets. However, this may make them more effective in certain cases. Many of them can be taken at night, which can reduce daytime side effects and they tend to be much less disruptive on sleep than SSRIs.

Imipramine and amitriptyline are still a very effective antidepressants. They are (IMHO) much stronger for depression than any SSRI and the side effects are different (less sexual dysfunction, for example).

The SSRIs are safer in overdose, but this is a very poor rationale for selecting an antidepressant. Supposedly only a very (very) small portion of completed suicides are actually from antidepressant overdoses.





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