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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Bob on September 21, 2009, at 17:17:17
I know I'm probably beating a dead horse here as this has undoubtedly been asked before, but I'm still wondering whether it is accepted in medical psychiatry that there has to be a serotonergic drug in the mix to properly treat depression.
In this case I am wondering about Nortriptyline monotherapy, but I guess I could also include Desipramine, Wellbutrin and the like. It seems that very few on this board are treating their conditions with a complete absence of serotonergic drugs - either SSRIs, MAOI's or something else with action at serotonin receptors.
I recently saw a study about people suffering from major depression who underwent ECT and they put them on Nortriptyline and Lithium in an effort to avoid relapse. I thought it was interesting that they didn't use either SSRI's or SNRI's. I realize that Lithium can have serotonergic effects but I don't think many use it for that purpose.
Bob
Posted by linkadge on September 21, 2009, at 19:45:01
In reply to Need for Serotonergic component in treatment?, posted by Bob on September 21, 2009, at 17:17:17
I certainly wouldn't say there is a need - but I don't know. Agents like seroquel have some marked antidepresant properties but no marked serotonin enhancing effect. There is wellbutrin too. Depends on the depression I guess.
Nortriptyline had *some* ad effect for me, but amitriptyline has been better.
Linkadge
Posted by Bob on September 21, 2009, at 21:37:03
In reply to Re: Need for Serotonergic component in treatment?, posted by linkadge on September 21, 2009, at 19:45:01
> I certainly wouldn't say there is a need - but I don't know. Agents like seroquel have some marked antidepresant properties but no marked serotonin enhancing effect. There is wellbutrin too. Depends on the depression I guess.
>
> Nortriptyline had *some* ad effect for me, but amitriptyline has been better.
>
> Linkadge
>
>You're on amitriptyline now? Do you have any theories as to why it might be better than Nortriptyline for you?
Isn't amitriptyline a 'dirtier' med? I thought it had heavy anticholinergic effects including weight gain and sedation.
Posted by Bob on September 21, 2009, at 22:07:28
In reply to Re: Need for Serotonergic component in treatment?, posted by linkadge on September 21, 2009, at 19:45:01
>
> Nortriptyline had *some* ad effect for me, but amitriptyline has been better.
>
> Linkadge
>
>Are you using amitriptyline as monotherapy?
Posted by Netch on September 22, 2009, at 5:41:56
In reply to Need for Serotonergic component in treatment?, posted by Bob on September 21, 2009, at 17:17:17
Agomelatine is an AD with 5HT2C antagonist properties.
Posted by linkadge on September 22, 2009, at 8:50:01
In reply to Re: Need for Serotonergic component in treatment? » linkadge, posted by Bob on September 21, 2009, at 21:37:03
>Isn't amitriptyline a 'dirtier' med? I thought >it had heavy anticholinergic effects including >weight gain and sedation.
I like my meds dirty :)
Anticholinergics have always had antidepressant effects for me. I used the scopolamine patch when depression got bad for me. It was too costly to use on a regular basis ($4 a patch).
Amitriptyline is just a more effective medication for me. Not sure why.
Linkadge
Posted by linkadge on September 22, 2009, at 8:51:51
In reply to Re: Need for Serotonergic component in treatment? » linkadge, posted by Bob on September 21, 2009, at 22:07:28
I also do use a lowish dose of methylphenidate (20mg). For symptoms of ADHD.
I'm not sure if I ever had childhood ADHD. I personally think the longer term SSRI use screwed up the development of my dopaminergic circutry in adolesence.
Linkadge
Posted by Phillipa on September 22, 2009, at 10:36:55
In reply to Re: Need for Serotonergic component in treatment?, posted by linkadge on September 22, 2009, at 8:51:51
I just read that men do better on TCA's than women and women on SSRI's any truth in this hence seems the men on babble on TCA's? Phillipa
Posted by Bob on September 22, 2009, at 16:42:30
In reply to Re: Need for Serotonergic component in treatment?, posted by Phillipa on September 22, 2009, at 10:36:55
> I just read that men do better on TCA's than women and women on SSRI's any truth in this hence seems the men on babble on TCA's? Phillipa
Just curious... where did you see this?
This is the end of the thread.
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