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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by G-man885858 on March 15, 2009, at 20:41:50
Hello!
I want to try Vivactil. I have tried ALL the SSRI drugs for 4.5 miserable years, and had a nasty withdrawal syndrome.
Are tricyclics better than SSRI's? Do they have the same withdrawal syndrome as SSRI's?
Please help.
Thank you!!!
Posted by Phillipa on March 16, 2009, at 0:02:46
In reply to I want to try Vivactil, posted by G-man885858 on March 15, 2009, at 20:41:50
Is vivactal still available for some reason I thought it no longer was? Phillipa
Posted by sam K on March 16, 2009, at 7:55:32
In reply to I want to try Vivactil, posted by G-man885858 on March 15, 2009, at 20:41:50
i dont know if their better. Some things/readings say they are. They probably have some withdrawl, effexor did a bit for me.
vivactal is most likely to cause the increased heart rate. Im pretty sure. I really hope it works for you. It should be stimulating! yay for stimulation
Posted by jms600 on March 17, 2009, at 16:41:52
In reply to I want to try Vivactil, posted by G-man885858 on March 15, 2009, at 20:41:50
I have read in numerous texts that tricyclics are more effective than SSRIs (however, whether they actually are is another matter - I guess it varies from patient to patient).
They don't have the same severe withdrawal syndrome as SSRIs although they still need to be tapered. I have just stopped taking Amitripyline after taking it for eight months. I was on the max dose (200mg) and tapered the drug over a period of three weeks. I had absolutely no problems coming off the drug at all.
You have to remember that tricyclics do have the anticholigenic side effects, which can be a little uncomfortable - but there again the SSRIs have some fairly uncomfortable side effects too.
There are many tricyclics to choose from - I believe Lofepramine has one of the best side effect profiles.
It's certainly worth giving them consideration. As long as you taper the dose when withdrawing from the drug, you shouldn't have too much trouble.
Posted by bleauberry on March 17, 2009, at 19:06:13
In reply to I want to try Vivactil, posted by G-man885858 on March 15, 2009, at 20:41:50
I am curious why you singled out Vivactil of all the TCAs? That one is rarely prescribed.
Not that there is anything wrong with it. It just isn't used much. Maybe because of its side effects. I tried it once and couldn't even get past 2 days the side effects were so harsh. That is one powerful drug. If you want something really strong on Norepinephrine, well, Vivactil is.
The most common ones are Nortriptyline and Desipramine. Are they better than SSRIs? Well, I guess that depends on who you ask and what study you look at. Generally they are considered better, though it is hard to prove, but the drawback is side effects are usually more. Some people however find the TCA side effects tolerable compared to SSRIs they couldn't tolerate. Mileage varies. Generally speaking though, the TCAs are going to give you some dry mouth and constipation that maybe the SSRIs didn't.
I've only tried very low doses of Nortriptyline, Desipramine, and Vivactil, so I can't really comment with authenticity how they feel. In my short trials though, Nortriptyline felt like a regular antidepressant with a touch of NE boost in it. Desipramine felt similar to Ritalin, and I definitely sensed some special potential in Desipramine. Vivactil was more like a strong diet pill. I could not however tolerate the side effects of any of them, probably because I think I was allergic. It did feel more like an allergic reaction than side effects.
Posted by G-man885858 on March 17, 2009, at 21:27:03
In reply to Re: I want to try Vivactil, posted by bleauberry on March 17, 2009, at 19:06:13
Hey Bleuberry!
I chose Vivactil because it is a Dopamine-increasing med. I have a very positive reaction to caffeine, which also raises Dopamine. Caffeine gives me motivation, improves concentration, and reduces my anger. I am looking for an antidepressant that is similar to caffeine..
I know that Wellbutrin increases dopamine, but Im a little scared of it because its new, and I think newer antidepressants dont have the track record and efficacy of Tricyclics.
Posted by Phillipa on March 17, 2009, at 21:28:48
In reply to Re: I want to try Vivactil, posted by bleauberry on March 17, 2009, at 19:06:13
Now I know why I couldn't tolerate TCA's before SSRI's came out they made me feel like I was in outerspace. So overstimulated. Phillipa
Posted by zzzz7 on March 18, 2009, at 5:37:47
In reply to Re: I want to try Vivactil » bleauberry, posted by G-man885858 on March 17, 2009, at 21:27:03
V really doesn't touch DA. Try amantadine or Requip or Wellbutrin (or Ritalin).
If you want something for NE, desipramine is nearly as potent at NE blockade as V is, but has a better side effect profile.
Posted by bleauberry on March 18, 2009, at 17:50:58
In reply to Re: I want to try Vivactil » bleauberry, posted by G-man885858 on March 17, 2009, at 21:27:03
> Hey Bleuberry!
>
> I chose Vivactil because it is a Dopamine-increasing med. I have a very positive reaction to caffeine, which also raises Dopamine. Caffeine gives me motivation, improves concentration, and reduces my anger. I am looking for an antidepressant that is similar to caffeine..
>
> I know that Wellbutrin increases dopamine, but Im a little scared of it because its new, and I think newer antidepressants dont have the track record and efficacy of Tricyclics.
>Yeah, Wellbutrin is a strange one. It's not new though. Been around a couple decades or more. Pharmacologists claim its dopamine effects are minor, not strong enough to account for its therapeutic effect. It has other unknown mechanisms.
Here is a much milder drug than Vivactil that works on DA and NE...Milnacipran. Actually it is similar to Vivactil except in its side effects which are far less. As Stahl wrote in his pharmacology book, Milnacipran increases dopamine in the frontal cortex by blocking NE reuptake sites...dopamine transporters are lacking in the frontal cortex, and DA is usually taken up by NE neurons. So when the NE neurons are blocked, DA is allowed to build up. Most importantly, in the frontal cortex where mood is critical.
Have you ever tried Ritalin? Milnacipran feels kinda sorta like a long lasting milder Ritalin. My experience anyway. It does kinda have that coffee feel to it in terms of mood, but without the physical stimulation or jitters.
Desipramine would accomplish what you are looking for with milder side effects than Vivactil. Do some pubmed studies on Desipramine and you'll see it has interactions with dopamine.
But then again, trying to predict in advance what drug will do what is a losing game. The drugs are extremely more complicated than that. The only true test is to try them and see what happens. You seem sold on Vivactil. Cool enough. Try it and see what happens. On the back burner, just in case it doesn't work out, have Milnacipran, Desipramine, or Prozac+Zyprexa+Ritalin ready to go. Or just straight Parnate.
Hopefully Vivactil will work out for you and you can tolerate it, if the doc goes along with it. If not, there are other good options. So the doors are wide open for you.
Posted by G-man885858 on March 19, 2009, at 22:45:34
In reply to Re: I want to try Vivactil » G-man885858, posted by bleauberry on March 18, 2009, at 17:50:58
Isn't it true though that SSRIs have caused a LOT more suicides and school shootings than any other class of antidepressants? Doesn't this say anything?
Posted by desolationrower on March 20, 2009, at 23:30:32
In reply to Re: I want to try Vivactil, posted by G-man885858 on March 19, 2009, at 22:45:34
> Isn't it true though that SSRIs have caused a LOT more suicides and school shootings than any other class of antidepressants? Doesn't this say anything?
>
>ssris have been the most popular antidepressants at a time when it because noticed that depressed people, especially depressed enough to be taking antidepressants, do stupid sh*t.
-d/r
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