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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by jay on January 19, 2003, at 16:08:22
Just curious...who on here get's benefits from older meds, especially the tricylic antidepressants? I have recently found imipramine very helpful, and have encountered less side effects, in particular sexual, then with the newer SRI/SNRI's. I was first put on a tricylic, and then was shifted quickly to an SRI. (Luvox.) I had far more problems, *especially* sexual and with 'temper' and suicidal thoughts, than I did on the tricyclic.Given the tricyclics are cheaper, and aren't under patent, they aren't marketed much. I am now *highly* skeptical of most of the reported rates of 'side effects' of the newer antidpressants, and wonder if a lot of people who could have done well on a tricyclic are being denied the chance to get better. Any people who have been on both newer and older antipressasnts agree? Just curious...
Thanx,
Jay
Posted by BrittPark on January 19, 2003, at 16:57:45
In reply to Older drugs vs. newer drugs..., posted by jay on January 19, 2003, at 16:08:22
I've found imipramine to be generally effective for the last 20 years and have found the side-effects, dry mouth and a tendency to become constipated, to be perfectly tolerable. My one trial of an SSRI (Paxil) didn't do much and made me jittery and slightly nauseated. All in all I prefer the TCAs to the SSRIs.
I think there is clinical evidence that third generation ADs are slightly better tolerated than TCAs, but the difference is small. I think doctors prescribe SSRIs in preference to TCAs not so much because SSRIs are more effective (they're not), or because they have more tolerable side effects, but because they are safer in overdose. There might also be a bit of "Marketing" at work ;)
Cheers,
Britt
Posted by Jumpy on January 19, 2003, at 17:24:31
In reply to Older drugs vs. newer drugs..., posted by jay on January 19, 2003, at 16:08:22
Dear J,
I have alway done better with older meds ... TCAs, MAOIs, lithium, benzos. I almost always fail new meds ... SSRIs, buspar, effexor, lamictal. New meds are big business and generate alot of revenue for the pharm companies. Some doc still think TCAs are more potent and give better responses to patients.
J
Posted by River1924 on January 19, 2003, at 17:49:10
In reply to Re: Older drugs vs. newer drugs... » jay, posted by Jumpy on January 19, 2003, at 17:24:31
Vivactil (a TCA) works for me in the winter when I tend to get sleepy but, in general, I would prefer other newer anti-depressants. Luckily, I can take most at very low or very high doseages with few side effects except weight gain and a degree of sexual ennui. I think it depends which side-effects you find most disabling to your non-depressed/non-anxious lifestyle. For me, and this is probably bizarre, the dry mouth and blurred vision of TCA's are far more annoying than the initial impotence caused by SSRIs' or Effexor.
Posted by Jumpy on January 19, 2003, at 18:58:07
In reply to Re: Older drugs vs. newer drugs..., posted by River1924 on January 19, 2003, at 17:49:10
Hey,
Yeah, I alway preferred dry mouth and some sedation caused by the TCAs rather than the impotence, diarrhea and insomnia from the SSRIs and effexor. I guess everyone is different.
J
Posted by zeugma on January 19, 2003, at 20:10:48
In reply to Older drugs vs. newer drugs..., posted by jay on January 19, 2003, at 16:08:22
I found I had to twist my doctor's arm to get him to prescribe me a TCA. This despite the fact that trials with two SSRI's (Prozac and Zoloft) had failed miserably and caused me to give up on medications for about eight years. I have found that unless I bring up alternatives myself (like TCA's), the reflex is to prescribe either an SSRI or Wellbutrin (I can't take Wellbutrin either). My former girlfriend takes an SSRI and her sex drive had disappeared soon after starting treatment with it. With a TCA, if I take it at the right time, I get a normal night's sleep, and the appetite increase and relief from serious gastrointestinal pain are invaluable side benefits.
Posted by highanxiety on January 19, 2003, at 20:34:39
In reply to Older drugs vs. newer drugs..., posted by jay on January 19, 2003, at 16:08:22
some of the reasons mentioned here are why im going to switch from remeron to a TCA. I do have problems with weight gain and sensory problems with remeron, but some of the others similarities with TCAs are helpful for things like IBS and insomnia - oh, and migraine!
Posted by zeugma on January 19, 2003, at 20:37:30
In reply to Re: Older drugs vs. newer drugs... » jay, posted by BrittPark on January 19, 2003, at 16:57:45
>
> I think doctors prescribe SSRIs in preference to TCAs not so much because SSRIs are more effective (they're not), or because they have more tolerable side effects, but because they are safer in overdose. There might also be a bit of "Marketing" at work ;)
>
> Cheers,
>
> BrittI suspect that this is the main reason too. It's understandable I guess, but also unfortunate and rather ironic, because what I have seen confirms my suspicions that TCA's are more effective in severe depression, especially long-term, than SSRI's.
Also, we have to consider the fact that TCA's were discovered by 'accident' whereas SSRI's were deliberately engineered. This may seem to favor the SSRI's, but inasmuch as we still don't know what depression IS, there's no guarantee that the deliberately designed drug is going to work better than the accidental product. I think really it's the reverse- given our ignorance of how depression works, it's inevitable that a drug designed to hit ONLY this 'target' is going to be dicey at best.
Also selectivity would seem to have another downside as well- more knowledgeable posters please correct me on this. If a drug is basically only inhibiting 5-HT reuptake, that results in a tremendously higher level of reuptake inhibition than any of the older drugs. If a TCA is equally selective for 5-HT and NE, then you would basically need to double the dosage of the TCA to get an equivalent level of 5-HT effect to an SSRI because half of its binding is going to NE. Actually, it's even less than that (again correct me if I'm wrong) because these are very 'dirty' drugs. So a lot of it is going to histamine, ACH inhibition, etc. Resulting in an even more dispersed level of action that might for all we know be more effective in alleviating depression.
Posted by oracle on January 19, 2003, at 20:52:21
In reply to Re: Older drugs vs. newer drugs... » jay, posted by BrittPark on January 19, 2003, at 16:57:45
> I think there is clinical evidence that third generation ADs are slightly better tolerated than TCAs, but the difference is small. I think doctors prescribe SSRIs in preference to TCAs not so much because SSRIs are more effective (they're not), or because they have more tolerable side effects, but because they are safer in overdose.
That is the major advantage. TCA's seem better for
stronger depressions. SSRI's tend to be less sedating and don't have anticolonergic effects.
Posted by Jackster on January 19, 2003, at 23:48:48
In reply to Re: Older drugs vs. newer drugs... » BrittPark, posted by zeugma on January 19, 2003, at 20:37:30
>
> I suspect that this is the main reason too. It's understandable I guess, but also unfortunate and rather ironic, because what I have seen confirms my suspicions that TCA's are more effective in severe depression, especially long-term, than SSRI's.This is just a layperson's observation (and could be scientifically completely wrong) - but the tricyclics also seem to last a lot longer than SSRI's before pooping out. (Just from comments posted on this board). Could be because they're not as selective?
After experiencing the full side effects of an SSRI I have to admit to thinking - how could the tricylics be any worse??? I'd take a dry mouth over insomnia any day...
Jackie
Posted by Ritch on January 20, 2003, at 10:00:24
In reply to Older drugs vs. newer drugs..., posted by jay on January 19, 2003, at 16:08:22
Jay, the TCA's are can be dangerous in overdose and do cause cardiac conduction problems in quite a few people (at higher doses). The number one thing I don't like about TCA's is the orthostatic hypotension. I even got that with Remeron and it was the number #2 side effect (besides duhhness) that I didn't like about the Remeron. Nortriptyline was the easiest in that regard, and nort. is probably the only TCA I would ever retry.
Posted by skills on January 20, 2003, at 10:28:19
In reply to Re: Older drugs vs. newer drugs..., posted by River1924 on January 19, 2003, at 17:49:10
the tca's seem to help every one that i have spoken to far better than any of the new ssri's and snri's. I spoke to an english proffessor who told me that tca's are the 'best weve got'. The side effects may be slightly worse but lofepramine has far less than all the others and is just as effective. The proffessor said the seretonin,norepinephrine and dopamine combo kick which the trycyclics give has given new life to many of his patients. it certainly helped mei noticed and inprovement in 4 days. Something that had not happened in 23 years. 10 years on i feel as right as rain...peace
Posted by jay on January 20, 2003, at 11:02:52
In reply to Older drugs vs. newer drugs..., posted by jay on January 19, 2003, at 16:08:22
There have been some interesting and diverse replies, and I didn't mean to tip the bias in favour of older, TCA drugs. It seems there are a wide number of people who get results, from both classes. I'd *really* like to know the specific modes of action of all the drugs out there, because even within the different classes, only certain drugs seem to work for certain people.
Like for example...I've heard that Paxil is supposed to be more like an SNRI, and that Prozac also works on some Dopamine inhibition. I wish we could get an *exact* chemical mode of action from all antidepressants.
Jay
Posted by coral on January 20, 2003, at 12:20:46
In reply to Older drugs vs. newer drugs..., posted by jay on January 19, 2003, at 16:08:22
Tofranil (even at max dosages) was worthless for me, and Elavil caused a sense of rage. Zoloft worked like a charm.
Xanax wraps me up in cotton batting but Librium does the trick.
Go figure.
Posted by zeugma on January 20, 2003, at 16:57:18
In reply to Re: Older drugs vs. newer drugs..., posted by coral on January 20, 2003, at 12:20:46
> Tofranil (even at max dosages) was worthless for me, and Elavil caused a sense of rage. Zoloft worked like a charm.
>
> Xanax wraps me up in cotton batting but Librium does the trick.
>
> Go figure.I had increased irritability when I started nortriptyline too. Things I didn't like but had been prepared to tolerate because I felt so 'out of it' (really bad foggy feelings) suddenly caused me to act, which in the long run was a good thing(I'm glad I left a bad work situation), but was definitely unsettling at first. I assume this is due to increased NE levels. I'm really thankful I made the changes, I consider them the first signs the med was helping me, about a week into it; but I suppose if I had existing problems with irritability they could have been worsened intolerably.
What I'm curious about is 1) how TCA's and other older compare to SSRI's in terms of 'poop-out'(I'd guess they're less liable to this, for a number of reasons, but what research has been done on this topic?) and 2) whether they treat what are really different syndromes or illnesses. For example, I have severe ADD, and TCA's are considered a second-line treatment for this condition, but not SSRI's. Or we can think about the classic distinction between 'endogeneous' or 'melancholic' depression and atypical depression. I have read many studies for example that assert that melacholics are helped more by TCA's
and atypicals by MAOI's. One criticism I have is that this promising line of research seems to have been abandoned, as SSRI's have replaced both classes of drugs in all but the most refractory cases. I'll just state my personal opinion on SSRI's just to throw it out there. They seem to be really good at relieving acute symptoms of depression in a lot of people, but don't seem to help the 'core' problems; they seem to camouflage depression more than truly relieve it. I should add that I'm talking about people with chronic depression. I know some people who took Prozac for relatively brief periods who didn't have a history of more-or-less lifelong depression, and did just fine on it.
Posted by zeugma on January 20, 2003, at 17:15:59
In reply to Re: Older drugs vs. newer drugs..., posted by zeugma on January 20, 2003, at 16:57:18
I'm also curious about how Wellbutrin fits into the antidepressant picture. It seems to be one of the few antidepressants that increase REM sleep (along with trimipramine), and has been called a 'stimulating' antidepressant. It's also used a lot for ADD conditions. I would like to hear any ideas from people about how Wellbutrin is different from other antidepressants?
Posted by coral on January 20, 2003, at 19:00:06
In reply to Re: Older drugs vs. newer drugs..., posted by zeugma on January 20, 2003, at 16:57:18
Not a lifetime of depression, by any means, but I was in the depths of hell for three years and a half years..... before going on Zoloft and started the climb out. Other than two minor episodes, I've been depression free for 7 yrs.
Posted by lonesomeloser on January 20, 2003, at 20:32:53
In reply to Older drugs vs. newer drugs..., posted by jay on January 19, 2003, at 16:08:22
I have found that the MAOI's are an underused AD that can be very helpful, with few side-effects in many cases. I hope the Nardil patch comes out soon, however :)
I had horrible S/E from the old tricyclic AD's like Imipramine and Elavil.
My.02
> Just curious...who on here get's benefits from older meds, especially the tricylic antidepressants? I have recently found imipramine very helpful, and have encountered less side effects, in particular sexual, then with the newer SRI/SNRI's. I was first put on a tricylic, and then was shifted quickly to an SRI. (Luvox.) I had far more problems, *especially* sexual and with 'temper' and suicidal thoughts, than I did on the tricyclic.
>
> Given the tricyclics are cheaper, and aren't under patent, they aren't marketed much. I am now *highly* skeptical of most of the reported rates of 'side effects' of the newer antidpressants, and wonder if a lot of people who could have done well on a tricyclic are being denied the chance to get better. Any people who have been on both newer and older antipressasnts agree? Just curious...
>
> Thanx,
> Jay
Posted by lonesomeloser on January 20, 2003, at 20:53:25
In reply to Re: Wellbutrin question, posted by zeugma on January 20, 2003, at 17:15:59
> I'm also curious about how Wellbutrin fits into the antidepressant picture. It seems to be one of the few antidepressants that increase REM sleep (along with trimipramine), and has been called a 'stimulating' antidepressant. It's also used a lot for ADD conditions. I would like to hear any ideas from people about how Wellbutrin is different from other antidepressants?
Wellbutrin doesnt target Serotonin all that much by the liturature on its actions. It targets Epineperine and Dopamine, which, I suppose is why some people become so hypersexual on it.
I found it to be very stimulating, but too much so, with insomnia and irritability a constant companion/ side-effect.
My girlfriend at the time loved it, however ;)
Posted by Jumpy on January 20, 2003, at 21:41:37
In reply to Re: Older drugs vs. newer drugs... » jay, posted by Ritch on January 20, 2003, at 10:00:24
> Jay, the TCA's are can be dangerous in overdose and do cause cardiac conduction problems in quite a few people (at higher doses). The number one thing I don't like about TCA's is the orthostatic hypotension. I even got that with Remeron and it was the number #2 side effect (besides duhhness) that I didn't like about the Remeron. Nortriptyline was the easiest in that regard, and nort. is probably the only TCA I would ever retry.
I though imipramine's side effects were similar to nortriptyline's. In the test tube, imipramine might have more affinately for receptors causing certain side effects. But in vivo, people have a good amount of the imipramine converted to desipramine, which for many has less side effects than nortri.
J
Posted by highanxiety on January 20, 2003, at 21:46:03
In reply to Re: Older drugs vs. newer drugs... » Ritch, posted by Jumpy on January 20, 2003, at 21:41:37
apologies if this has been addressed but which is the best TCA for OCD type thinking and behaviors? thanks
Posted by Darwin on January 20, 2003, at 21:57:58
In reply to now that we are on this subject..a question, posted by highanxiety on January 20, 2003, at 21:46:03
> apologies if this has been addressed but which is the best TCA for OCD type thinking and behaviors? thanks
Clomipramine (Anafranil) is best by far.
Darwin
Posted by Ritch on January 21, 2003, at 0:05:29
In reply to Re: Older drugs vs. newer drugs... » Ritch, posted by Jumpy on January 20, 2003, at 21:41:37
> > Jay, the TCA's are can be dangerous in overdose and do cause cardiac conduction problems in quite a few people (at higher doses). The number one thing I don't like about TCA's is the orthostatic hypotension. I even got that with Remeron and it was the number #2 side effect (besides duhhness) that I didn't like about the Remeron. Nortriptyline was the easiest in that regard, and nort. is probably the only TCA I would ever retry.
>
> I though imipramine's side effects were similar to nortriptyline's. In the test tube, imipramine might have more affinately for receptors causing certain side effects. But in vivo, people have a good amount of the imipramine converted to desipramine, which for many has less side effects than nortri.
>
> J
>I had an *excellent* anti-ADD response with taking low-dose desipramine, but had *much* more blurred vision, tachycardia, and dizziness, that nortiptyline didn't cause, but I needed to take something else with the NT to get the anti-ADD response as robust as with desip. (in my case low-dose Zoloft).
Posted by zeugma on January 21, 2003, at 11:28:52
In reply to Re: Older drugs vs. newer drugs... » Jumpy, posted by Ritch on January 21, 2003, at 0:05:29
> > > Jay, the TCA's are can be dangerous in overdose and do cause cardiac conduction problems in quite a few people (at higher doses). The number one thing I don't like about TCA's is the orthostatic hypotension. I even got that with Remeron and it was the number #2 side effect (besides duhhness) that I didn't like about the Remeron. Nortriptyline was the easiest in that regard, and nort. is probably the only TCA I would ever retry.
> >
> > I though imipramine's side effects were similar to nortriptyline's. In the test tube, imipramine might have more affinately for receptors causing certain side effects. But in vivo, people have a good amount of the imipramine converted to desipramine, which for many has less side effects than nortri.
> >
> > J
> >
>
> I had an *excellent* anti-ADD response with taking low-dose desipramine, but had *much* more blurred vision, tachycardia, and dizziness, that nortiptyline didn't cause, but I needed to take something else with the NT to get the anti-ADD response as robust as with desip. (in my case low-dose Zoloft).
>
>
The side effects to nortriptyline that I had besides increased irritability (some of which actually was healthy) were lowered blood pressure and dizziness. My doctor was extremely cautious and wouldn't let me increase the dosage until these effects diminished, and even then would only let me go up by 5 mg increments. This was really frustrating, because although the NT was definitely helping the depression and ADD (actually ADD more than depression) I felt it was a partial response and my mood sucked.I started asking him about meds to treat anxiety and social phobia, because I have those problems too and the NT didn't help them that much. He pointed to my improvement of digestive symptoms as evidence that my anxiety was going down; I agreed, but still felt like I needed either a higher dosage of NT (I take only 40 mg) or something else. Finally he let me try Buspar although he seemed doubtful it would help. I tried it, and yes the improvement was immediate. It's helped with ADD, social phobia, depression, and virtually everything else I suffer from.
Posted by skills on January 21, 2003, at 12:58:26
In reply to Re: Older drugs vs. newer drugs..., posted by zeugma on January 21, 2003, at 11:28:52
why does no one talk about lofepramine. it is a newer tca and has less reported side effects as the older one whilst being just as effective. It is also good for insomnia. peace
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