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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by tensor on March 20, 2012, at 2:56:30
How bad are the anticholinergic side effects compared to other TCAs?
Thanks.
Posted by Beckett on March 20, 2012, at 18:39:13
In reply to Doxepin, posted by tensor on March 20, 2012, at 2:56:30
I've only tried doxepin so far. For what it's worth, it gave me a heck of a time, but I am not sure how it stacks up to amitriptyline. Until someone experienced weighs in, Wiki has a nice comparison chart under TCA's. I don't find doxepin to have a particularly fun reputation though.
Posted by tensor on March 21, 2012, at 12:27:47
In reply to Re: Doxepin, posted by Beckett on March 20, 2012, at 18:39:13
> I've only tried doxepin so far. For what it's worth, it gave me a heck of a time, but I am not sure how it stacks up to amitriptyline. Until someone experienced weighs in, Wiki has a nice comparison chart under TCA's. I don't find doxepin to have a particularly fun reputation though.
What do you mean with 'heck of a time', did it work good for depression? Yeah, I've seen the table at wiki but I prefer first hand experiences :)
Posted by Beckett on March 21, 2012, at 13:04:16
In reply to Re: Doxepin » Beckett, posted by tensor on March 21, 2012, at 12:27:47
Sorry Tensor :) I guess 'heck of a time' is a bit obscure. No, not for depression. I was prescribed it for sleep and pain and did not make it past two days. I was unable to function. Thank goodness my husband was home to care for our child, that was the extremity of my reaction to doxepin. I have since read doxepin is particularly harsh...?
I am looking at TCA's again myself in place of Emsam. I have been thinking of Surmontil. I saw your thread on Amitriptyline. What other TCA's have you considered?
Posted by tensor on March 21, 2012, at 13:17:07
In reply to Re: Doxepin » tensor, posted by Beckett on March 21, 2012, at 13:04:16
> Sorry Tensor :) I guess 'heck of a time' is a bit obscure. No, not for depression. I was prescribed it for sleep and pain and did not make it past two days. I was unable to function. Thank goodness my husband was home to care for our child, that was the extremity of my reaction to doxepin. I have since read doxepin is particularly harsh...?
>
> I am looking at TCA's again myself in place of Emsam. I have been thinking of Surmontil. I saw your thread on Amitriptyline. What other TCA's have you considered?NP :)
Surmontil can be a good choice, didn't work for me but I know it works well for some, not so much bothersome side effects either. Don't think I had sexual difficulties on it, so worth a try. I'm thinking of trying nortrip again, had a good run on it years ago. Certainly more benign in terms of side effects than clomipramine for example.
It makes me wonder though.. take venlafaxine for example which is supposed to be a clean TCA, it has never done a thing for me while nortrip has. Maybe the TCAs aren't so 'dirty' after all, I mean the mechanisms that produces side effects could contribute to their efficacy.
Posted by Beckett on March 21, 2012, at 13:46:32
In reply to Re: Doxepin » Beckett, posted by tensor on March 21, 2012, at 13:17:07
Well, speaking of venlafexine, I felt that way about effexor and pristiq. Whatever made efffexor dirtier than pristiq seemed to make it more effective for me. The same may not hold true for amytriptyline and nortriptyline unless one gets into specific target uses. Interesting point. Good luck with your selection process.
Posted by SLS on March 21, 2012, at 13:52:17
In reply to Re: Doxepin » Beckett, posted by tensor on March 21, 2012, at 13:17:07
> It makes me wonder though.. take venlafaxine for example which is supposed to be a clean TCA,
Venlafaxine does not block serotonin 5-HT2a receptors the way nortriptyline does.
Since trimipramine is a TCA stripped of reuptake inhibition, this is a clue that TCA might exert some of their therapeutic effects through other mechanisms.
I try not to be "too smart" when making treatment decisions. It is not so important what I know as what I don't know. Different is different. Why someone responds to Paxil and not to Zoloft is not well understood. Are they exactly the same drug with exactly the same pharmacology? Obviously not, even if the differences between the actions of these drugs are not yet understood.
- Scott
Posted by tensor on March 21, 2012, at 14:18:49
In reply to Re: Doxepin, posted by SLS on March 21, 2012, at 13:52:17
> Venlafaxine does not block serotonin 5-HT2a receptors the way nortriptyline does.
>
> Since trimipramine is a TCA stripped of reuptake inhibition, this is a clue that TCA might exert some of their therapeutic effects through other mechanisms.
>
> I try not to be "too smart" when making treatment decisions. It is not so important what I know as what I don't know. Different is different. Why someone responds to Paxil and not to Zoloft is not well understood. Are they exactly the same drug with exactly the same pharmacology? Obviously not, even if the differences between the actions of these drugs are not yet understood.
>
>
> - ScottYes. And no. One can not be 'too smart' when making decisions about treatments. I agree it's no point in getting too hardcore about receptor affinities. However, it does feel better (for me) if you have some neuroscientific basis when choosing (whatever is left) your next poison. I believe there are some pharmachological differencies between paroxetine and sertraline but I guess that's not your point.
One can not simply add mechanisms from several meds to substitute another, that's something I have learned the hard way.
/t
This is the end of the thread.
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