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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by bulldog2 on April 12, 2010, at 11:07:57
I guess the new thinking is tca's for moderate to severe depressdion. The thinking is severely depressed people are more likely to put up with the sides.
SSRI's for mild to moderate depression. They don't seem to work well with severe depression. My opinion or from what I've read that all that elevated serotonin is toxic to the brain and causes your dopamine to go down which is not good for the limbic area of the brain.
I saw a study that seemed to show that low dose tca's were more effective than ssris for mild to moderate depression. I guess using tca's this way would be novel and the side effects would be tolerable. So this puts another option on the table.
Posted by SLS on April 12, 2010, at 11:19:43
In reply to Low Dose TCA's For Mild to Mod Depression?, posted by bulldog2 on April 12, 2010, at 11:07:57
> I saw a study that seemed to show that low dose tca's were more effective than ssris for mild to moderate depression. I guess using tca's this way would be novel and the side effects would be tolerable. So this puts another option on the table.
Do you recall the details of the study?
Prescribing practices have always been to use lower dosages of TCAs for outpatients and higher dosages for inpatients.
- Scott
Posted by Phillipa on April 12, 2010, at 12:48:52
In reply to Re: Low Dose TCA's For Mild to Mod Depression?, posted by SLS on April 12, 2010, at 11:19:43
Scott is that due to the potential for overdose? Or just bad side effects? Thanks Phillipa
Posted by SLS on April 12, 2010, at 15:01:40
In reply to Re: Low Dose TCA's For Mild to Mod Depression? » SLS, posted by Phillipa on April 12, 2010, at 12:48:52
> Scott is that due to the potential for overdose? Or just bad side effects? Thanks Phillipa
I suppose it is an attempt to establish the lowest effective dosage. I guess there has been a notion that more severe depressions require higher dosages to produce a therapeutic effect. I don't know to what extent this notion has been validated through scientific investigation.
- Scott
Posted by bulldog2 on April 12, 2010, at 17:10:04
In reply to Re: Low Dose TCA's For Mild to Mod Depression?, posted by SLS on April 12, 2010, at 15:01:40
> > Scott is that due to the potential for overdose? Or just bad side effects? Thanks Phillipa
>
> I suppose it is an attempt to establish the lowest effective dosage. I guess there has been a notion that more severe depressions require higher dosages to produce a therapeutic effect. I don't know to what extent this notion has been validated through scientific investigation.
>
>
> - ScottScott haven't been able to find the study. I do recall they were using low doses such as 50 mg of amitriptyline and finding relief for mild to moderate depression.
In looking around there seem to be some studies that some people with severe depression will respond to low dose tcas.
I think the current attitude to not medicate mild depression may be misguided. I agree that talk therapy and other methods should be tried first. But they talk of chronic mild depression is something called dysthymia which also robs one of enjoyment in life. Also now you have all these studies popping up that antidepressants don't work on mild depression.So now I've seen this study that low dose tcas may be more effective than ssris for mild depression. So maybe the problem is one of dosage. Possibly more severe depressions call for higher doses of tca's and the patients seem to tolerate the sides better. However a person with mild depression may only need 25 - 50 mg of a drug such as amitriptyline and tolerate the sides. I had a doc who was a pharmacologist around the time of the advent of ssris. He was very concerned about all the serotonin being unleashed in the brain. He talked of an old lady who was a patient of his who would do well on mini doses of amitriptyline for her mild depressions. The pedulum tends to swing from one side to another on this depression issue. Now everyone is becoming scared of them. I think there are issues of serotonin poisoning with the ssris. So with someone with mild depression maybe low dose tca's should be the way to go if they work.
Posted by Phillipa on April 12, 2010, at 21:08:30
In reply to Re: Low Dose TCA's For Mild to Mod Depression?, posted by bulldog2 on April 12, 2010, at 17:10:04
Seems like Scotts explanation makes sense to me. Interesting. Thanks Phillipa
This is the end of the thread.
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