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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on May 2, 2010, at 21:30:30
In reply to Re: Questions about tricyclics??? » Phillipa, posted by floatingbridge on May 2, 2010, at 21:25:47
I adjusted to paxil l0mg took three months. But I couldn't with my responsibilities. Phillipa
Posted by Justherself54 on May 2, 2010, at 22:03:34
In reply to Re: Questions about tricyclics??? » Phillipa, posted by floatingbridge on May 2, 2010, at 21:25:47
I had unpleasant experiences with Amitriptyline, Nortriptyline and Desipramine, so you can imagine how reluctant I was to give Clomipramine a trial.
The side effects are very minimal, dry mouth and some difficulty staying asleep.
I've been on 100 mg. for a few days now. A little over weeks ago I wasn't able to leave my house and had to have a friend do my grocery shopping for me. I was very low. Last Wednesday I was able to take a trip to another city, shop, have dinner with friends and spent the rest of the evening socializing. A pretty significant change.
I'm still not even close to what I would call remission, but for the first time in a long time I have hope.
My pdoc and I were going over all the meds we had tried and retried and he mentioned clomipramine. I so did not want to try another TCA, but agreed rather than retry all the SSRI's. I can't handle the SNRI's and trials with MAOI's didn't pan out.
So for me, Clomipramine gets a tentative thumbs up!
Posted by floatingbridge on May 3, 2010, at 13:01:45
In reply to Re: Questions about tricyclics???, posted by Justherself54 on May 2, 2010, at 22:03:34
Justherself,
that's good to hear. Any analgesic effect?
:)
Posted by bulldog2 on May 3, 2010, at 17:07:51
In reply to Re: Questions about tricyclics???, posted by Justherself54 on May 2, 2010, at 22:03:34
> I had unpleasant experiences with Amitriptyline, Nortriptyline and Desipramine, so you can imagine how reluctant I was to give Clomipramine a trial.
>
> The side effects are very minimal, dry mouth and some difficulty staying asleep.
>
> I've been on 100 mg. for a few days now. A little over weeks ago I wasn't able to leave my house and had to have a friend do my grocery shopping for me. I was very low. Last Wednesday I was able to take a trip to another city, shop, have dinner with friends and spent the rest of the evening socializing. A pretty significant change.
>
> I'm still not even close to what I would call remission, but for the first time in a long time I have hope.
>
> My pdoc and I were going over all the meds we had tried and retried and he mentioned clomipramine. I so did not want to try another TCA, but agreed rather than retry all the SSRI's. I can't handle the SNRI's and trials with MAOI's didn't pan out.
>
> So for me, Clomipramine gets a tentative thumbs up!
>I'll second Justherself54. I'm on 75 mg of clomipramine and feel much better. Also not in remission but there is progress. Hardly know I'm on a drug and much easier to tolerate than Nortriptiline and amitriptyline.
Posted by SammyJar on May 4, 2010, at 21:08:29
In reply to Re: Questions about tricyclics???, posted by bulldog2 on May 3, 2010, at 17:07:51
Is it true that Tricyclics have little effect on social anxiety compared to SSRI's(which themselves seem to have a very limited effect on SAD in most people)?
Posted by Conundrum on May 4, 2010, at 23:22:51
In reply to Re: Questions about tricyclics???, posted by SammyJar on May 4, 2010, at 21:08:29
With the exception of clomipramine, maybe, you're probably right. I don't think the TCAs aren't strong enough serotonin boosters to help with social anxiety.
Posted by ed_uk2010 on May 5, 2010, at 13:22:48
In reply to Re: Questions about tricyclics???, posted by SammyJar on May 4, 2010, at 21:08:29
>Is it true that Tricyclics have little effect on social anxiety compared to SSRI's(which themselves seem to have a very limited effect on SAD in most people)?
Clomipramine can be effective for most forms of anxiety disorder eg. GAD, social phobia, panic disorder, OCD, mixed anxiety/depression and sometimes PTSD. Imipramine has a good track record in panic disorder.
Posted by floatingbridge on May 5, 2010, at 13:30:08
In reply to Re: Questions about tricyclics???, posted by ed_uk2010 on May 5, 2010, at 13:22:48
Analgesic properties?
Posted by ed_uk2010 on May 5, 2010, at 15:01:57
In reply to Re: Questions about tricyclics??? » ed_uk2010, posted by floatingbridge on May 5, 2010, at 13:30:08
>Analgesic properties?
Amitriptyline is used most frequently for neuropathic pain. Alternatives include nortriptyline, desipramine, imipramine and clomipramine.
Posted by bulldog2 on May 5, 2010, at 18:03:27
In reply to Questions about tricyclics???, posted by Roslynn on May 2, 2010, at 16:38:49
> Hi, I was wondering about the tricyclics...
>
> Which ones are most often prescribed, does anyone know? Is there one that is more reliable than the others?
> Which is considered the strongest, is that imipramine, nortriptyline or protriptyline?
>
> Thanks for any help!
> RoslynnI believe imipramine and clomipramine (anafranil) are considered the strongest. I'm on 75 mg of clomipramine and doing well. The sides were minimal and for me much easier than an ssri.The depression lifted in about a week and things have been getting better since than. Pick clomipramine if you want that extra boost of serotonin. But there's also plenty norepinephrine. Very nice blend.
I feel like I'm sitting in a meadow with the sun shining in my face and all these colorful flowers flooding my senses. I used to obsess about others people's opinion and now I just done't care. I have confidence in my choices. Just go slowly. Spend at least a week at each dose increase.
If I listened to all the negative people who tell stories of horrible sides I would still be a depressed person filled with anxiety and wondering what people are saying about me.
Stop listening to the voices of fear. Take the dive. You can always get out of the water if you don't like it. Remember you are unique and your experience will be unique. All of a sudden I realized I was wasting precious time reading everyone's feedback and getting more confused and unable to make a decision. So what if it doesn't work. Stop and try another.
If you read stories about advil you would never take another one. I read that about 15,000 people a year die from sides. (ulcers,kideny failure etc). Probably a lot more than tcas and maois.
Look at the upside. Depression really damages our body. The tcas are stronger and better than ssris. There's one psychiatrist that rates parnate no. 1 and clomipramine no 2.The best way to educate yourself is to read from men who have worked with thousands of patients. You need feedback from many patients to know what works. One person's experience is just not that helpful
Read this man's link who have treated thousands and find out what the gold standards are.http://www.psychotropical.com/dual_action_ads.shtml
Posted by Justherself54 on May 5, 2010, at 19:11:21
In reply to Re: Questions about tricyclics??? » Justherself54, posted by floatingbridge on May 3, 2010, at 13:01:45
Hi FB. Sorry I didn't answer sooner. Yes, it certainly does have analgesic effect. I have fibromyalgia and coccyxdenia. The pain from the cocyxdenia was really awful. I started at 50 mg. and after the first dose I woke up without the tailbone pain. I was really shocked.
I'm now taking 100 mg. and the tailbone pain has not returned, although I feel at times I'm having some breakthrough pain. My pdoc said it would be interesting to see if the pain returned at higher doses. I sure hope it doesn't.
I'm still not anywhere near remission. I have to have my blood levels tested after I've been at 100 mg. for two weeks, so probably no increase until those results are back.
The dry mouth side effect is very unpleasant. My mouth feels like the bottom of a birdcage..even my teeth feel furry. My appetite has increased unfortunately soon after I started at 100 mg. Hopefully, I'll be able to get a grip on that. The thought of gaining more weight is very depressing in itself, however, I'll take the weight gain vs. the pain.
It's too early to tell if it's going to be effective against the depression, but here's hoping.
Posted by Bob on May 5, 2010, at 21:07:28
In reply to Re: Questions about tricyclics???, posted by Justherself54 on May 5, 2010, at 19:11:21
> Hi FB. Sorry I didn't answer sooner. Yes, it certainly does have analgesic effect. I have fibromyalgia and coccyxdenia. The pain from the cocyxdenia was really awful. I started at 50 mg. and after the first dose I woke up without the tailbone pain. I was really shocked.
>
> I'm now taking 100 mg. and the tailbone pain has not returned, although I feel at times I'm having some breakthrough pain. My pdoc said it would be interesting to see if the pain returned at higher doses. I sure hope it doesn't.
>
> I'm still not anywhere near remission. I have to have my blood levels tested after I've been at 100 mg. for two weeks, so probably no increase until those results are back.
>
> The dry mouth side effect is very unpleasant. My mouth feels like the bottom of a birdcage..even my teeth feel furry. My appetite has increased unfortunately soon after I started at 100 mg. Hopefully, I'll be able to get a grip on that. The thought of gaining more weight is very depressing in itself, however, I'll take the weight gain vs. the pain.
>
> It's too early to tell if it's going to be effective against the depression, but here's hoping.
Have you been diagnosed with your coccydynia? Do you have any idea what causes or caused it?I have had episodes of excruciating tailbone type pain on certain drugs - the most memorable one being Abilify. It would often occur after a bowel movement.
Posted by floatingbridge on May 5, 2010, at 21:31:00
In reply to Re: Questions about tricyclics???, posted by Justherself54 on May 5, 2010, at 19:11:21
Justherself,
Here's hoping, too, both for pain relief and depression. Would you consider an add-on for depression, and if so, what's in the running?
I am glad you're starting to feel better.
Posted by floatingbridge on May 5, 2010, at 21:32:09
In reply to Questions about tricyclics???, posted by Roslynn on May 2, 2010, at 16:38:49
Roslynn, how's it going?
Posted by bulldog2 on May 6, 2010, at 9:04:06
In reply to Re: Questions about tricyclics??? » Justherself54, posted by Bob on May 5, 2010, at 21:07:28
> > Hi FB. Sorry I didn't answer sooner. Yes, it certainly does have analgesic effect. I have fibromyalgia and coccyxdenia. The pain from the cocyxdenia was really awful. I started at 50 mg. and after the first dose I woke up without the tailbone pain. I was really shocked.
> >
> > I'm now taking 100 mg. and the tailbone pain has not returned, although I feel at times I'm having some breakthrough pain. My pdoc said it would be interesting to see if the pain returned at higher doses. I sure hope it doesn't.
> >
> > I'm still not anywhere near remission. I have to have my blood levels tested after I've been at 100 mg. for two weeks, so probably no increase until those results are back.
> >
> > The dry mouth side effect is very unpleasant. My mouth feels like the bottom of a birdcage..even my teeth feel furry. My appetite has increased unfortunately soon after I started at 100 mg. Hopefully, I'll be able to get a grip on that. The thought of gaining more weight is very depressing in itself, however, I'll take the weight gain vs. the pain.
> >
> > It's too early to tell if it's going to be effective against the depression, but here's hoping.
>
>
> Have you been diagnosed with your coccydynia? Do you have any idea what causes or caused it?
>
> I have had episodes of excruciating tailbone type pain on certain drugs - the most memorable one being Abilify. It would often occur after a bowel movement.
>
>Bob
Very unlikely that any med caused your tailbone pain. Howevever constipation and straining can. You mention after bowel movements so I think you may have your answer there. Many of these meds do cause constipation. So you may need to address that issue.
Posted by bulldog2 on May 6, 2010, at 9:14:37
In reply to Re: Questions about tricyclics???, posted by Justherself54 on May 5, 2010, at 19:11:21
> Hi FB. Sorry I didn't answer sooner. Yes, it certainly does have analgesic effect. I have fibromyalgia and coccyxdenia. The pain from the cocyxdenia was really awful. I started at 50 mg. and after the first dose I woke up without the tailbone pain. I was really shocked.
>
> I'm now taking 100 mg. and the tailbone pain has not returned, although I feel at times I'm having some breakthrough pain. My pdoc said it would be interesting to see if the pain returned at higher doses. I sure hope it doesn't.
>
> I'm still not anywhere near remission. I have to have my blood levels tested after I've been at 100 mg. for two weeks, so probably no increase until those results are back.
>
> The dry mouth side effect is very unpleasant. My mouth feels like the bottom of a birdcage..even my teeth feel furry. My appetite has increased unfortunately soon after I started at 100 mg. Hopefully, I'll be able to get a grip on that. The thought of gaining more weight is very depressing in itself, however, I'll take the weight gain vs. the pain.
>
> It's too early to tell if it's going to be effective against the depression, but here's hoping.Hi
Look into low dose metformin for the appetite increase. Soom use it for antidepressant weight issues. People seem to lose weight on this med.
Posted by Roslynn on May 6, 2010, at 17:20:50
In reply to Questions about tricyclics???, posted by Roslynn on May 2, 2010, at 16:38:49
Thank you all for your informative and helpful posts, especially bulldog2!
Based on this feedback I will mention a couple tricyclics to my doc and see what he says.
He is of the opinion that I'm bipolar and need fewer ADs, not more, but I'm feeling like I'm missing an AD piece. Back in the fall I was taking nortriptyline. I didn't feel great, but I wasn't falling to the great depths as I am now.Thanks all,
Roslynn
Posted by linkadge on May 8, 2010, at 15:43:05
In reply to Re: Questions about tricyclics??? » SammyJar, posted by Conundrum on May 4, 2010, at 23:22:51
Who says social anxiety is a result of serotonin deficit?
Linkadge
Posted by SLS on May 8, 2010, at 17:38:39
In reply to Re: Questions about tricyclics???, posted by linkadge on May 8, 2010, at 15:43:05
> Who says social anxiety is a result of serotonin deficit?
I'm trying to figure out why 5-HT1a receptor knock-out mice demonstrate increased anxiety. My mind is mush. Also, people with SA have reduced numbers of 5-HT1a receptors, particularly in the amygdala as determined by PET scans. Are these receptors normally inhibitory or excitatory? I would guess that they would be inhibitory if they are heteroreceptors.
It is interesting that 5-HT1a receptor partial agonists are proposed as efficacious in treating anxiety disorders.
- Scott
Posted by SLS on May 8, 2010, at 20:08:45
In reply to Re: Questions about tricyclics???, posted by SLS on May 8, 2010, at 17:38:39
> > Who says social anxiety is a result of serotonin deficit?
>
> I'm trying to figure out why 5-HT1a receptor knock-out mice demonstrate increased anxiety. My mind is mush. Also, people with SA have reduced numbers of 5-HT1a receptors, particularly in the amygdala as determined by PET scans. Are these receptors normally inhibitory or excitatory? I would guess that they would be inhibitory if they are heteroreceptors.Ok. This explains it:
- Scott
Posted by linkadge on May 8, 2010, at 20:39:19
In reply to Re: Questions about tricyclics???, posted by SLS on May 8, 2010, at 20:08:45
First off the whole 5-ht1a autoreceptor level depression link is a bunch of bunk IMHO. I have read dozens of studies on whether serotonin 1a autoreceptor are overactive or underactive in depression. Nothing seems conclusive. Perhaps the antidepressant effect of SSRI's is dependant upon the activity of 5-ht1a autreceptors, but not drugs like NRI's or other atypical antidepressants (?). Running acutally increase the responsivity of 5-h1a autoreceptors, yet is a clinically effective antidepressant strategy.
>I'm trying to figure out why 5-HT1a receptor >knock-out mice demonstrate increased anxiety. My >mind is mush. Also, people with SA have reduced >numbers of 5-HT1a receptors, particularly in the >amygdala as determined by PET scans.
It totally depends on whether this is pre or post synaptic.
>Are these receptors normally inhibitory or >excitatory? I would guess that they would be >inhibitory if they are heteroreceptors.
Post synaptic 5-ht1a receptors are typically inhibitory but other receptors (ie 5-ht2) are excitory. Activating presynaptic receptors would reduce overall serotonergic neurotransmission (in certain brain regions) and hence decrease post synaptic activity at all serotonin receptor subtypes. Serotonin (in hippocapal regions) is typically anxiolytic, but this is more controlled by 5-ht1b autoreceptors. In the DRN it is anxiogenic.
>It is interesting that 5-HT1a receptor partial >agonists are proposed as efficacious in treating >anxiety disorders - and perhaps depression.Serotonergic firing in the DRN can be highly anxiogenic. On the other hand increased firing of the DRN may be associated with antidepressant effect. Drugs like buspar and nicotine decrease (or regulate?) DRN firing wherase drugs like pindolol increase it. The former is associated with reducing anxiety and the latter with reducing depression.
Anyhow, I *highly doubt* that serotonin is the only neurotransmitter implicated in social anxiety. After all, drugs like Nardil and Clonazepam are the gold standard for SAD. Nardil is not selective to serotonin and both agents have strong gabaergic effect. Gabapentin also shows anti-SAD effects and is not a reuptake inhibitor. I would think that this implicates GABA more than serotonin in SAD.
Dopamine, somostatin, oxytocin, CCK, gaba, substance p, 5-ht2, enkaphalin, PEA, etc etc. have also been implicated in SAD at one point or another.
The problem is that SAD is a post SSRI disorder. Just because the TCA's were not typically used in SAD does not mean they are not effective.
Some studies suggest that inhibiting noradrenergic reuptake increases impaired social functioning (in depression) more than serotonin reuptake inhibition. I would think that the TCAs are probably highly efficatious in SAD.
Linkadge
Posted by SLS on May 8, 2010, at 21:10:03
In reply to Re: Questions about tricyclics???, posted by linkadge on May 8, 2010, at 20:39:19
> First off the whole 5-ht1a autoreceptor level depression link is a bunch of bunk IMHO. I have read dozens of studies on whether serotonin 1a autoreceptor are overactive or underactive in depression. Nothing seems conclusive.
That's because it was previously impossible to separate out the actions of autoreceptors versus heteroreceptors. The article explains that.
- Scott
Posted by SLS on May 8, 2010, at 21:43:51
In reply to Re: Questions about tricyclics???, posted by linkadge on May 8, 2010, at 20:39:19
> I would think that the TCAs are probably highly efficatious in SAD.
Yes. Even desipramine can be anxiolytic (as well as anxiogenic).
I guess at some point, you come to know that everything is effective for everything, yet nothing is effective for anything.
- Scott
Posted by Bob on May 8, 2010, at 21:55:16
In reply to Re: Questions about tricyclics???, posted by SLS on May 8, 2010, at 21:43:51
> > I would think that the TCAs are probably highly efficatious in SAD.
>
> Yes. Even desipramine can be anxiolytic (as well as anxiogenic).
>
> I guess at some point, you come to know that everything is effective for everything, yet nothing is effective for anything.
>
>
> - Scott
It seems like the more they "discover" about the putative mechanisms behind these things the more out of focus it all becomes.
Posted by bearfan on May 12, 2010, at 3:00:59
In reply to Questions about tricyclics???, posted by Roslynn on May 2, 2010, at 16:38:49
There are basically 3 major Tricyclics Elavil (and Pamelor its metabolite), Impramine (and Norpramin its its metabolite), and Clomipramine. The metabolites may have slightly less side effects, but will be more noradrenalic than sertoinergic. Clomipramine should be the strongest sertonin effect, followed by Elavil and Impramine. Ask your Doctor which one he thinks is right for you.
This is the end of the thread.
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