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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by alchemy on August 3, 2009, at 14:31:37
I have tried about everything (the only MOAI was Emsam). Currently Lamictal, Xanax, Celexa, Wellbutrin, Synthroid.
There have been many times he seems like we are running out of options. I'm not sure whether to bring up tricylics. Do they usually cause weight gain? Can they be used with SSRIs?
Posted by viper1431 on August 3, 2009, at 14:35:45
In reply to Tricyclics- why do psychiatrists (mine) avoid?, posted by alchemy on August 3, 2009, at 14:31:37
One reason they tend to avoid them these days is that they are easier to overdose with where as SSRI's are generally safe if you overdose tricyclics arn't.
They can cause weight gain, they havn't for me though except for doxepin.
Posted by Justherself54 on August 3, 2009, at 15:08:17
In reply to Re: Tricyclics- why do psychiatrists (mine) avoid? » alchemy, posted by viper1431 on August 3, 2009, at 14:35:45
I think they have some harsher side effects too. At least for me they did.
Posted by SLS on August 3, 2009, at 16:25:50
In reply to Re: Tricyclics- why do psychiatrists (mine) avoid?, posted by Justherself54 on August 3, 2009, at 15:08:17
> I think they have some harsher side effects too. At least for me they did.
How long did you take a TCA for at any one time?
I think if one is "drug naive" and taking a tricyclic for the first time, the side effects are going to be more pronounced than those of the SSRIs. However, most of the side effects mitigate over time. Now that I am fully acclimated to nortriptyline, the only thing I notice is a slightly elevated heart rate. I would much rather take a tricyclic than a SSRI and suffer with the sexual side effects and apathy that seems to linger with continued use of these drugs.
Modern medicine still can't account for why two people will respond so differently to the same drug, both therapeutically and with regard to side effects.
- Scott
Posted by Phillipa on August 3, 2009, at 16:43:47
In reply to Re: Tricyclics- why do psychiatrists (mine) avoid?, posted by SLS on August 3, 2009, at 16:25:50
Yup mine won't use either overdose easy and side effects bad. For me sex is not a big deal so not an issue with me. Just know the three I tried increased anxiety horribly. Phillipa
Posted by bulldog2 on August 3, 2009, at 17:04:40
In reply to Tricyclics- why do psychiatrists (mine) avoid?, posted by alchemy on August 3, 2009, at 14:31:37
> I have tried about everything (the only MOAI was Emsam). Currently Lamictal, Xanax, Celexa, Wellbutrin, Synthroid.
> There have been many times he seems like we are running out of options. I'm not sure whether to bring up tricylics. Do they usually cause weight gain? Can they be used with SSRIs?My feelings were that tcas had rougher physical sides at startup and ssris had rougher mental sides. Maybe my doc started me to high at 50 mg of zoloft my first ssri but the feeling of agitation was to much for me to bear. Later another doc started me on nortriptyline and carefully titrated me up 10 mg at a time and that was more easily tolerated by me. Yes there more more sides with constipation and my thinking was quite blurred! However it did help quite a bit with sleep.
The sides of nortriptyline were easier for me than the agitation that was so severe I got addicted to benzos.This particular doc handed out a script for ssris with a a script for benzos.
Perhaps ssris have a greater margin for safety than tcas but for many create severe enough agitation that a benzo is required.Docs were often misinformed by pharm reps that the ssris were calming which often was quite misleading.
Posted by Justherself54 on August 3, 2009, at 20:37:30
In reply to Re: Tricyclics- why do psychiatrists (mine) avoid?, posted by SLS on August 3, 2009, at 16:25:50
I don't remember them all Scott. I've been on and off meds for 35 years..25 years of those misdiagnosed.
I wrote 2 short sentences, my thoughts only for why I think psychiatrists avoid prescribing TCA's. Why I avoid them? I don't like telling my horror stories regarding some meds, as I don't want to scare off some people who may benefit greatly by the same med that made me feel dreadful.
Drug naive? Sadly, no.
Posted by SLS on August 4, 2009, at 3:12:03
In reply to Re: Tricyclics- why do psychiatrists (mine) avoid? » SLS, posted by Justherself54 on August 3, 2009, at 20:37:30
> I don't remember them all Scott. I've been on and off meds for 35 years..25 years of those misdiagnosed.
I'm sorry that I didn't make myself better understood. My question was to inquire for how long you had taken any one tricyclic, not how many tricyclics you had taken. Since your second sentence referred to your own experience with these drugs, I was curious as to what that experience was.
- Scott
Posted by SLS on August 4, 2009, at 8:36:55
In reply to Re: Tricyclics- why do psychiatrists (mine) avoid? » SLS, posted by Justherself54 on August 3, 2009, at 20:37:30
> > I don't remember them all Scott. I've been on and off meds for 35 years..25 years of those misdiagnosed.
>
> I'm sorry that I didn't make myself better understood. My question was to inquire for how long you had taken any one tricyclic, not how many tricyclics you had taken. Since your second sentence referred to your own experience with these drugs, I was curious as to what that experience was.I apologize for the combative tone here. I guess something in your post triggered me.
- Scott
Posted by yxibow on August 8, 2009, at 18:25:26
In reply to Tricyclics- why do psychiatrists (mine) avoid?, posted by alchemy on August 3, 2009, at 14:31:37
> I have tried about everything (the only MOAI was Emsam). Currently Lamictal, Xanax, Celexa, Wellbutrin, Synthroid.
> There have been many times he seems like we are running out of options. I'm not sure whether to bring up tricylics. Do they usually cause weight gain? Can they be used with SSRIs?I would agree in cases where they have seen patterns of suicidal ideation, tricyclics -can- be as liable as barbiturates.
As for other options -- I don't know how long you've been on the mixture you have to appreciate its misgivings or benefits.
But tricyclics are another option, and they're old and well studied. Of course being older they do have more side effects than SSRIs.
I wouldn't combine Anafranil (clomipramine) with any significant dose of an SSRI -- it risks serotonin syndrome.
As for other TCAs, they may be less serotonergic but certainly have NE effects.
How much Lamictal ? It is an antidepressant in its own right or certainly an augmenter for suicidality and other traits of depression.
-- Jay
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