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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 lizzyg on March 11, 2002, at 11:55:04
Having been (happily) free of depression for nearly seven years until a couple of months ago, I haven't done any research on antidepressants for a while. What I've noticed from this and other sites is that tricyclics now seem to be relegated to a third-line treatment behind SSRIs and the newer ADs.
My first attack of major depression/anxiety 19 years ago was treated successfully with amitriptyline and a benzo (I guess there weren't as many options then). Subsequent attacks also responded well to Lofepramine (a third generation tricyclic available here in the UK but not in the US, which has fewer side effects) and a short course of benzos. I found the Lofepramine neither stimulating nor sedating; it just made me feel like myself - surely the goal of all ADs.
I have tried SSRIs a couple of times and found them difficult to tolerate. In fact, this time round, my depression is not a severe as previously and I have found the side effects from all the prescribed meds I've tried unacceptable, so am testing out SAM-e. If that doesn't work it's back to the drawing board.
Just wondered, are there any positive stories about tricyclics out there, especially newer variants like Lofepramine or Tianeptine?
Thanks for your help.
Lizzy
Posted by Chloe on March 11, 2002, at 20:15:22
In reply to Are tricyclics now more or less discredited?, posted by lizzyg on March 11, 2002, at 11:55:04
> Having been (happily) free of depression for nearly seven years until a couple of months ago, I haven't done any research on antidepressants for a while. What I've noticed from this and other sites is that tricyclics now seem to be relegated to a third-line treatment behind SSRIs and the newer ADs.
>
> My first attack of major depression/anxiety 19 years ago was treated successfully with amitriptyline and a benzo (I guess there weren't as many options then). Subsequent attacks also responded well to Lofepramine (a third generation tricyclic available here in the UK but not in the US, which has fewer side effects) and a short course of benzos. I found the Lofepramine neither stimulating nor sedating; it just made me feel like myself - surely the goal of all ADs.
>
> I have tried SSRIs a couple of times and found them difficult to tolerate. In fact, this time round, my depression is not a severe as previously and I have found the side effects from all the prescribed meds I've tried unacceptable, so am testing out SAM-e. If that doesn't work it's back to the drawing board.
>
> Just wondered, are there any positive stories about tricyclics out there, especially newer variants like Lofepramine or Tianeptine?
>Hi Lizzy
I too, was put on TCA's years ago before the advent of Prozac and did not *like* the side effects. I too, don't tolerate SSRI"s well, but the tiniest bit, say one tenth of the initial dose works well for me(1.3 mgs Celexa). So when I added a small amount of TCA, amitriptyline(20 mgs) to the SSRI, I really had a lift in mood and no major side effect complaints from the SSRI or the TCA.
So my humble opinion is that the older generation TCA's (though I am not familiar with the UK brands) are still extremely useful for some people who can't tolerate the newer AD's. And sometimes a lower dose of TCA can acheive remission of depression if it is combined with a small amount of newer antidepressant, lessening the chance of uncomfortable adverse effects.I don't think I answered your question, but this is what I was able to express about the topic! Ignore it if it's not useful!
Chloe
Posted by Lizzy G on March 12, 2002, at 9:03:05
In reply to Re: Are tricyclics now more or less discredited? » lizzyg, posted by Chloe on March 11, 2002, at 20:15:22
Chloe - thanks for your history. It seems that in the US, combining medicines is much more prevalent than over here. I've had some good suggestions of mixes that might work - just need to find the right doctor to implement them!
Lizzy
Posted by noa on March 12, 2002, at 15:23:32
In reply to Re: Are tricyclics now more or less discredited? » Chloe, posted by Lizzy G on March 12, 2002, at 9:03:05
I don't think they are discredited, but they tend to not be first choice for most people because there are newer meds with better side effect profiles.
Posted by fachad on March 13, 2002, at 10:08:27
In reply to Are tricyclics now more or less discredited?, posted by lizzyg on March 11, 2002, at 11:55:04
Tricyclics are not discredited.
In fact, I'm fairly sure that no new antidepressant has ever really been proven to be more effective than the oldest tricyclic, Tofranil (imipramine).
It's just that the newer ones have less obnoxious side effects (at first anyway).
> Having been (happily) free of depression for nearly seven years until a couple of months ago, I haven't done any research on antidepressants for a while. What I've noticed from this and other sites is that tricyclics now seem to be relegated to a third-line treatment behind SSRIs and the newer ADs.
>
> My first attack of major depression/anxiety 19 years ago was treated successfully with amitriptyline and a benzo (I guess there weren't as many options then). Subsequent attacks also responded well to Lofepramine (a third generation tricyclic available here in the UK but not in the US, which has fewer side effects) and a short course of benzos. I found the Lofepramine neither stimulating nor sedating; it just made me feel like myself - surely the goal of all ADs.
>
> I have tried SSRIs a couple of times and found them difficult to tolerate. In fact, this time round, my depression is not a severe as previously and I have found the side effects from all the prescribed meds I've tried unacceptable, so am testing out SAM-e. If that doesn't work it's back to the drawing board.
>
> Just wondered, are there any positive stories about tricyclics out there, especially newer variants like Lofepramine or Tianeptine?
>
> Thanks for your help.
>
> Lizzy
Posted by lizzyg on March 13, 2002, at 11:47:57
In reply to Re: Are tricyclics now more or less discredited? » lizzyg, posted by fachad on March 13, 2002, at 10:08:27
It's interesting that you say that, fachad. As a newcomer to these boards, it struck me right away that there are hundreds of posts about SSRIs and newer ADs and next to nothing about TCAs. And most of the posts concern unwelcome or downright intolerable side effects from the first two categories, so they're not exactly benign.
I agree that scientific studies don't seem to show superiority of effectiveness of other classes over TCAs, and those involving SSRIs seem to prove the reverse. Maybe TCAs are being unfairly overlooked. Especially newer ones such as Lofepramine (European) which have few cholinergic and cardiac side effects and are much less toxic in overdose than their predecessors.
Lizzy
> Tricyclics are not discredited.
>
> In fact, I'm fairly sure that no new antidepressant has ever really been proven to be more effective than the oldest tricyclic, Tofranil (imipramine).
>
> It's just that the newer ones have less obnoxious side effects (at first anyway).
>
>
>
> > Having been (happily) free of depression for nearly seven years until a couple of months ago, I haven't done any research on antidepressants for a while. What I've noticed from this and other sites is that tricyclics now seem to be relegated to a third-line treatment behind SSRIs and the newer ADs.
> >
> > My first attack of major depression/anxiety 19 years ago was treated successfully with amitriptyline and a benzo (I guess there weren't as many options then). Subsequent attacks also responded well to Lofepramine (a third generation tricyclic available here in the UK but not in the US, which has fewer side effects) and a short course of benzos. I found the Lofepramine neither stimulating nor sedating; it just made me feel like myself - surely the goal of all ADs.
> >
> > I have tried SSRIs a couple of times and found them difficult to tolerate. In fact, this time round, my depression is not a severe as previously and I have found the side effects from all the prescribed meds I've tried unacceptable, so am testing out SAM-e. If that doesn't work it's back to the drawing board.
> >
> > Just wondered, are there any positive stories about tricyclics out there, especially newer variants like Lofepramine or Tianeptine?
> >
> > Thanks for your help.
> >
> > Lizzy
This is the end of the thread.
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