Psycho-Babble Medication Thread 1120319

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Desipramine (Norpramin) best TCA for ADHD?

Posted by undopaminergic on August 12, 2022, at 11:07:31

Hi all,

I read in a book on ADHD of a case of excellent results from treating a child with ADHD with desipramine (Norpramin). So I'm wondering if desipramine in general is better than other TCAs for ADHD, or if it's more likely just good luck?

Incidentally, desipramine is very rarely mentioned here. Why might that be?

-undopaminergic

 

Re: Desipramine (Norpramin) best TCA for ADHD?

Posted by linkadge on August 12, 2022, at 11:30:13

In reply to Desipramine (Norpramin) best TCA for ADHD?, posted by undopaminergic on August 12, 2022, at 11:07:31

Desipramine is probably the best studied TCA for ADHD. That being said, it's got a crappy cardiovascular side effect profile, not to mention being one of the genotoxic TCAs. I wouldn't use it. Why not just use atomoxetine?

Linkadge

 

Re: Desipramine (Norpramin) best TCA for ADHD?

Posted by undopaminergic on August 12, 2022, at 12:13:46

In reply to Re: Desipramine (Norpramin) best TCA for ADHD?, posted by linkadge on August 12, 2022, at 11:30:13

> Desipramine is probably the best studied TCA for ADHD. That being said, it's got a crappy cardiovascular side effect profile, not to mention being one of the genotoxic TCAs. I wouldn't use it. Why not just use atomoxetine?
>
> Linkadge

Well, if we're speaking of myself specifically, in my opinion atomoxetine (and reboxetine) have all the side effects of methylphenidate and none of the desirable effects.

To be fair, during my trial of atomoxetine, I set a new record in a DOS computer game I used to play, so maybe it does have some beneficial effect that you just don't notice subjectively.

I tried reboxetine too, and as I've mentioned before, it permanently worsened my depersonalisation/derealisation, in particular numbing my emotions. It was welcome at the time, but in retrospect, I wonder if I hadn't been better off never trying it.

I've also tried ephedrine, and I found it better than atomoxetine and reboxetine, in that it helped slightly with my apathy. However, more generally speaking, it has all the side effects of (dextro-,meth-)amphetamine with little of the benefits.

So why desipramine? That is the question. Is it any better than eg. atomoxetine or nortriptyline?

-undopaminergic

 

Re: Desipramine (Norpramin) best TCA for ADHD?

Posted by linkadge on August 12, 2022, at 13:18:38

In reply to Re: Desipramine (Norpramin) best TCA for ADHD?, posted by undopaminergic on August 12, 2022, at 12:13:46

I have never taken desipramine myself, so I can't compare. I have taken nortriptyline which was decent. Desipramine is supposedly less sedating and a bit cleaner than nortriptyline. The advantage over atomoxetine is that it is effective for depression where atomoxetine hasn't really proven itself in that regard. However, there are quite a few reports of kids just randomly dying of heart attacks and stuff on desipramine, so I think it has fallen into disuse.

Linkadge

 

Re: Desipramine (Norpramin) best TCA for ADHD?

Posted by PeterMartin on August 12, 2022, at 23:07:03

In reply to Desipramine (Norpramin) best TCA for ADHD?, posted by undopaminergic on August 12, 2022, at 11:07:31

For some reason I thought the newly approved/released ADHD drug "Qelbree" (Viloxazine) was a tricyclic.

Checking again I'm wrong, but I figured I'd mention it anyway as it's not a typical ADHD medicine being an SNRI. It's a drug that was originally markeded for depression, discontinued, and now repurposed as an ADHD medication.

https://en.wikipedia.org/wiki/Viloxazine

As for desipramine, I tried to add it to my Marplan/Lamictal cocktail a few months back but couldn't tolerate it. Even a super low dose (10-25mg) caused tachycardia and extreme sweating/overheating.

I do think it helped w/ mood/drive though but I was only on it for a couple of weeks.

 

Re: Desipramine (Norpramin) best TCA for ADHD?

Posted by SLS on August 13, 2022, at 7:50:31

In reply to Desipramine (Norpramin) best TCA for ADHD?, posted by undopaminergic on August 12, 2022, at 11:07:31

> Hi all,
>
> I read in a book on ADHD of a case of excellent results from treating a child with ADHD with desipramine (Norpramin). So I'm wondering if desipramine in general is better than other TCAs for ADHD, or if it's more likely just good luck?
>
> Incidentally, desipramine is very rarely mentioned here. Why might that be?
>
> -undopaminergic
>

Hi.

Desipramine was the antidepressant of choice for treating ADHD / Adult ADD before atomoxetine (Strattera) was approved. Both drugs are potent NE reuptake inhibitors with very little effect on serotonin (5-HT). I saw atomoxetine turn someone's life around. He was treated for years as if he had Major Depressive Disorder. Then, one of his doctors became suspicious and gave him a drug known to be more effective for ADHD than depression - atomoxetine. The "depression" completely disappeared, and he reorganized and cleaned an apartment that had looked like a garbage dump.

Desipramine is a very potent and selective reuptake inhibitor of norepinephrine (NE). it is very effective for certain kinds of depression, but not for others. As with other tricyclics, it is more effective for endogenous / melancholic depression than it is for atypical depression.

Desipramine has flaws therapeutically that nortriptyline does not.

1. It feels very harsh at first, much like methylphenidate.

2. Cardiac side effects including heart palpitations and an accelerated heart rate that sometimes qualifies for tachycardia are common. For desipramine, some doctors have their patients tested with an ECG before prescribing desipramine, and then again after the patient has been taking it for a short while.

3. Desipramine produces multiple side effects that resemble the anti-cholinergic effects of other tricyclics. However, they are not at all anti-cholinergic. They are pro-noradrenergic. Dry mouth is especially common.

Personally, I prefer nortriptyline to desipramine. When combined with an MAOI, both drugs were equally effective for me, mostly with mental energy, cognitive clarity, thought speed, and other vegetative features. The presence of moderate to severe psychomotor retardation along with early morning awakenings and feeling worst in the morning begs treatment with tricyclics. For me, I found that nortriptyline produces therapeutic effects similar to desipramine, but with much better mood-brightening effects and the disappearance of anhedonia.

Both desipramine and nortriptyline are safe to use in combination with MAO inhibitors. This is the only treatment that ever brought me to a persistent remission. In addition to these, I also take lamotrigine and LOW DOSE (300 mg/day) of lithium now. Unlike the way I was in my 20s, TCA + MAOI is now insufficient to produce a robust response. On-off-on experiments with lamotrigine and lithium separately demonstrated how crucial both drugs are to my treatment.


- Scott

 

Re: Desipramine (Norpramin) best TCA for ADHD? » undopaminergic

Posted by TriedEveryMedication on August 13, 2022, at 14:48:48

In reply to Desipramine (Norpramin) best TCA for ADHD?, posted by undopaminergic on August 12, 2022, at 11:07:31

In college, I had outstanding results from desipramine for ADD. I went from failing out to an A/B student. In math and science classes. I got an A in general chemistry Berkeley while on the stuff, a notoriously difficult class. The dose was low, either 10mg or 25mg, I forget.

For me it was almost a wonder drug. Almost.

Downside is it makes me super depressed and anxious. Also extremely irritable. To the point where I can't stand being on it.

Tried it a couple years back again and it gave me terrible insomnia, no matter when I took it.

Something else to look at is Qelbree. Similar MOA


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