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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by bulldog2 on December 4, 2008, at 11:27:38
It appears as if the tcas are more effective for major depression than the ssris. Your list seemed to affirm this from your subjective experiences.
Here are some of my theories.
1. They affect more neurotranmitters. Generally effect ne and se.
2. Their effect on se is not nearly as profound as the ssris.
3. It seems as if the marked elevation of se by the ssris eventually diminishes dopamine which probably has a negative effect on the mood and hormonal system.
4. Perhaps the tcas do not have as much negative impact on dopamine as the ssris. I believe dimished dopamine produces the apathy that many describe on ssris.
5. I remember my physician years ago was very skeptical about the new wonder ssris. Felt the huge elevation in serotonin could lead to problems.Do you have any theories Scott?
Posted by desolationrower on December 4, 2008, at 14:25:49
In reply to To Scott - Why TCAS Are More Effective Than SSRIs?, posted by bulldog2 on December 4, 2008, at 11:27:38
> It appears as if the tcas are more effective for major depression than the ssris. Your list seemed to affirm this from your subjective experiences.
interesting topic.
> Here are some of my theories.
> 1. They affect more neurotranmitters. Generally effect ne and se.Also, are 5ht2 antagonists, especially amytrytiline which i'd say is the best one at least for efficacy. And antihistamine improves sleep, which might be marginally helpful for melacholia which features insomnia and early wakening.
> 2. Their effect on se is not nearly as profound as the ssris.
> 3. It seems as if the marked elevation of se by the ssris eventually diminishes dopamine which probably has a negative effect on the mood and hormonal system.Right, especially since nris can improve DA function offsetting this somewhat.
> 4. Perhaps the tcas do not have as much negative impact on dopamine as the ssris. I believe dimished dopamine produces the apathy that many describe on ssris.
> 5. I remember my physician years ago was very skeptical about the new wonder ssris. Felt the huge elevation in serotonin could lead to problems.
>
> Do you have any theories Scott?
>
>Also, the bad side effects probably increase comittment to drug therapy, this might improve outcomes.
There is also the question of distribution of the molecule to various regions of the brain, and there is little research indicating where this happens for antidepressants. Preferential reuptake in some regions might be better than in others.
My guess is that milnacipran + low dose risperidone would be about as effective as a good tca.
Generally i'd think desipramine is probably a little better for depression than an sri, but an sri might be somewhat preferable for most anxiety disorders. A lot of the antidepressant effect could be because of reduced anxiety.
-d/r
Posted by SLS on December 4, 2008, at 17:40:20
In reply to Re: To Scott - Why TCAS Are More Effective Than SSRIs?, posted by desolationrower on December 4, 2008, at 14:25:49
I am in agreement with the both of you. I do think that the 5-HT2 blockade is important when assessing the efficacy of the TCAs. However, the anticholinergic properties of these drugs might also contribute to their therapeutic effect. ACh and DA systems need to be in balance.
To paraphrase Desolationrower: location, location, location. I can hardly believe how most psychopharmacologists fail to take into consideration the loci of accumulation of various drugs and the circuits they affect when developing theories as to how antidepressants and other psychotropics work.
- Scott
Posted by Phillipa on December 5, 2008, at 0:03:15
In reply to Re: To Scott - Why TCAS Are More Effective Than SSRIs?, posted by SLS on December 4, 2008, at 17:40:20
Tried them before the SSRI"s existed and panic so bad walked the streets crying all night was 24. Guess my chemistry works in reverse. Phillipa lumiomil was one finally like a twilight sleep and working nursing and wasn't safe on them with patient care and needed to support three kids. Also Pamelor plastered me to the bed couldn't move and another referred at time as upper downer. Forgot the name.
Posted by bulldog2 on December 5, 2008, at 15:03:04
In reply to Re: To Scott - Why TCAS Are More Effective Than SSRIs?, posted by Phillipa on December 5, 2008, at 0:03:15
> Tried them before the SSRI"s existed and panic so bad walked the streets crying all night was 24. Guess my chemistry works in reverse. Phillipa lumiomil was one finally like a twilight sleep and working nursing and wasn't safe on them with patient care and needed to support three kids. Also Pamelor plastered me to the bed couldn't move and another referred at time as upper downer. Forgot the name.
You're posts are positive. If someone read your posts no one would ever take an ad again.
Posted by bulldog2 on December 5, 2008, at 15:12:16
In reply to Re: To Scott - Why TCAS Are More Effective Than SSRIs?, posted by bulldog2 on December 5, 2008, at 15:03:04
> > Tried them before the SSRI"s existed and panic so bad walked the streets crying all night was 24. Guess my chemistry works in reverse. Phillipa lumiomil was one finally like a twilight sleep and working nursing and wasn't safe on them with patient care and needed to support three kids. Also Pamelor plastered me to the bed couldn't move and another referred at time as upper downer. Forgot the name.
>
> You're posts are positive. If someone read your posts no one would ever take an ad again.
>It seems like all your posts are a series of horror stories. You certainly have exgagerrated effects to ads not typical of most people. 10 mg of pamelor would generally not plaster most people to their bed. I read an excerpt in a Burns book that neurotic depressives respond the poorest to ads. The mind is a powerful tool and can influence how we respond to drugs. There is always the possibility that your neurotic fear of drugs is influencing your response to drugs. Really 10 mg of pamelor which is some activating would not plaster most people to their beds!
Posted by bleauberry on December 5, 2008, at 15:28:58
In reply to Re: To Scott - Why TCAS Are More Effective Than SSRIs?, posted by desolationrower on December 4, 2008, at 14:25:49
>
> My guess is that milnacipran + low dose risperidone would be about as effective as a good tca.This comment caught my attention. There is a case report where 5 treatment resistant hospitalized patients who were getting little benefit from Milnacipran had .5mg to 1mg Risperidone added. Three of the 5 were in remission within 4 days and were discharged from the hospital. The other two had partial responses. Pretty darn good odds for a group of treatment resistant patients.
Another case report was of a woman with both treatment resistant depression and delusions. Her remission cocktail ended up being Milnacipran plus Zyprexa.
Posted by Phillipa on December 5, 2008, at 19:46:37
In reply to Re: To Scott - Why TCAS Are More Effective Than SSRIs?, posted by bulldog2 on December 5, 2008, at 15:03:04
That is my personal experiece. Isn't that what babble is about personal experiences. We're just all different. Phillipa
Posted by Phillipa on December 5, 2008, at 19:51:16
In reply to Re: To Scott - Why TCAS Are More Effective Than SSRIs?, posted by bulldog2 on December 5, 2008, at 15:12:16
Bulldog most is a generalization in my opinion. This my personal experience and at the time was very young before nursing so no experiences with meds. Can't help if not like others. As I said in last post we all have different body chemistries. Neurotic is very negative to me. Please don't refer to my personal expiences in those terms. Phillipa
Posted by Phillipa on December 5, 2008, at 19:59:14
In reply to Re: To Scott - Why TCAS Are More Effective Than SSRIs?, posted by bulldog2 on December 5, 2008, at 15:12:16
All way before perimenopause or before thyroid problems. Ludiomil age 38 last one tried. Sorry my reponses don't please you. Ask my body to cooperatate. Now that would be appreciated. Thanks Phillipa
Posted by Deputy Dinah on December 5, 2008, at 21:32:39
In reply to Re: To Scott - Why TCAS Are More Effective Than SSRIs?, posted by bulldog2 on December 5, 2008, at 15:12:16
> It seems like all your posts are a series of horror stories.
Please don't post anything that could lead others to feel accused or put down.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Dr. Bob is always free to override deputy decisions. His email is on the bottom of each page. Please feel free to email him if you believe this decision was made in error.
Dinah, acting as deputy to Dr. Bob
Posted by bulldog2 on December 6, 2008, at 7:26:43
In reply to Re: To Scott - Why TCAS Are More Effective Than SSRIs? » bulldog2, posted by Phillipa on December 5, 2008, at 19:46:37
> That is my personal experiece. Isn't that what babble is about personal experiences. We're just all different. Phillipa
Yes but you have told that particular experience about being plastered many times. Posting the same experience over and over may give some the wrong impression about the drug.
Posted by bulldog2 on December 6, 2008, at 7:29:22
In reply to Re: To Scott - Why TCAS Are More Effective Than SSRIs? » bulldog2, posted by Phillipa on December 5, 2008, at 19:51:16
> Bulldog most is a generalization in my opinion. This my personal experience and at the time was very young before nursing so no experiences with meds. Can't help if not like others. As I said in last post we all have different body chemistries. Neurotic is very negative to me. Please don't refer to my personal expiences in those terms. Phillipa
Neurotic is a psychological term used by psychiatrists.
Posted by bulldog2 on December 6, 2008, at 8:00:12
In reply to Please be civil » bulldog2, posted by Deputy Dinah on December 5, 2008, at 21:32:39
> > It seems like all your posts are a series of horror stories.
>
> Please don't post anything that could lead others to feel accused or put down.
>
> If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
>
> http://www.dr-bob.org/babble/faq.html#civil
>
> Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
>
> Dr. Bob is always free to override deputy decisions. His email is on the bottom of each page. Please feel free to email him if you believe this decision was made in error.
>
> Dinah, acting as deputy to Dr. BobI cannot locate Dr. Bob's email. You said it is at the bottom of each page. I wish to protest your decision as I feel my statement was accurate. In the real world the truth is not always nice and I do not feel my statement was uncivil.
Posted by Deputy Racer on December 6, 2008, at 10:53:31
In reply to Re: Please be civil, posted by bulldog2 on December 6, 2008, at 8:00:12
> I wish to protest your decision as I feel my statement was accurate. In the real world the truth is not always nice and I do not feel my statement was uncivil.
You've been asked to abide by the civility guidelines here at PsychoBabble, and you have continued the behaviors that led to those warnings. As a result, I am blocking you from posting for one week. You may not always agree with the site policies, but they still apply to you. In the real world the truth may not always be nice, but here at Babble opinions must always be stated respectfully according to the guidelines here. As Dr Bob has said, expressing yourself may be therapeutic, but this may not necessarily be the place to do so.
If you have any questions regarding the posting policies on this site, please read the FAQ, located at http://www.dr-bob.org/babble/faq.html#civil Follow ups to this action should be directed to the Administration board and should themselves be civil.
Dr Bob has ultimate authority over all administrative issues on this site, and may choose at any time to revise or reverse any action taken by a deputy.
Deputy Racer
Posted by dapper on December 6, 2008, at 16:16:35
In reply to Blocked for 1 week » bulldog2, posted by Deputy Racer on December 6, 2008, at 10:53:31
Wow bulldog, you got cornered here...Blocking him for that comment is unwarranted.
Posted by psychobot5000 on December 7, 2008, at 14:37:56
In reply to Re: Blocked for 1 week, posted by dapper on December 6, 2008, at 16:16:35
> Wow bulldog, you got cornered here...Blocking him for that comment is unwarranted.
I would respectfully disagree. I found the collection of comments, especially the first, to be at least a little insensitive and unnecessary. If I had been the poster it was responding to, I believe I would have felt under attack, after reporting my personal experiences.
Best,
Psychbot
Posted by okydoky on December 8, 2008, at 14:18:31
In reply to Re: Blocked for 1 week » dapper, posted by psychobot5000 on December 7, 2008, at 14:37:56
I have not been on the site for a while. I decided to participate mostly when I have a medication need.
I thought I would take a look today and this was the first thread I read.
My experience with this site is that it is far from a real world experience. It is much more akin to a mental health experience. Nothing wrong with that if that is what one is looking for. Artificial boundaries and "protections" for ones' mental health that the "real world" would never afford and "real people" would not tolerate for a variety of reasons. Free speech comes to mind off the top of my head.
Let's not complain. It would be like going to a christian fundamentalist church when your belief system was secular and complaining about the sermon in my humble opinion.
Maybe not the best analogy but I am not the most intelligent person.
oky
Posted by CaptainAmerica1967 on December 12, 2008, at 6:58:35
In reply to To Scott - Why TCAS Are More Effective Than SSRIs?, posted by bulldog2 on December 4, 2008, at 11:27:38
All sounds good plus MAOI's and TCA have a much more profound effect in suppressing REM sleep more than the SSRI' and the various other antidepressants in other categories like Wellbutrin.
Parnate almost completely eliminate REM as well as Total Sleep Deprivation Therapy. One really needs minimal REM sleep to survive.
The new Deep Brain Stimulation (DBS) Device may suppress REM sleep as well and decreased overactivity in areas of the brain (Broadmann's Area 25 or BA25). www.BroadenStudy.com ..."A series of PET scans and neuroimaging experiments have demonstrated that this area of the brain is overactive during periods of profound negative mood (sadness). Helen Mayberg, M.D., professor of Psychiatry/Neurology at Emory University is one of the pioneers on DBS.
Triple reuptake inhibitors with inherit the depression medication market in the future, ie, less ssri will be used, although the MAOI's and TCA's will always have a strong placement and I personally believe the MAOI's (type A) are superior to all other treatment even ECT in my personal experience and are very under utilized and the hypertensive crisis and serotonin syndrome is way way over rated, but being caution is good although it prevents many FP's and even psychiatrists from RXing them for the fear that patients won't follow a diet (which is very easily done). The newer reversable MAOI's aren't very effective in my opinion and new ones (Tyrima) are being studied but are the drug companies way of trying to make money...and probably try to influence more physicians into RX safer useless MAOI's. www.neurotransmitter.net/newdrugs.html
This is the end of the thread.
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