Posted by Cam on January 22, 2000, at 2:09:43
In reply to Re: Anafranil - chlomipramine, posted by Scott L. Schofield on January 21, 2000, at 23:31:09
> > I've been on celexa for about a year. At first I had a positive response to it. But in the past few months the depression has been exacerbated. My pharmacologist has suggested taking me off celexa and starting anafronil. I've been on 20+ different meds and combos but never a tryclicate.
> > I wondered what people's experience with this has been and am particularly concerned about weight gain as a side effect.
> > Any info would be appreciated. Thanks
>
>
> If you are going to try a tricyclic for the first time, I'm not sure you would want to start with Anafranil (chlomipramine). By comparison to other tricyclics, it tends to have more side-effects. Of course, this might end up being the right antidepressant for you. Unfortunately, there is not yet any precise way to determine in advance which particular drugs you will respond to (damn-it). However, your doctor may have chosen Anafranil specifically because you had responded to Celexa, one of the SSRIs (selective serotonin reuptake inhibitor). Of all the tricyclics, Anafranil exerts the greatest degree of serotonin reuptake inhibition.
>
> Imipramine (Tofranil) was once considered to be the "gold standard" by which other antidepressants were gauged. It was the first of the tricyclic antidepressants to be developed. (MAO-inhibitors had been stumbled upon earlier). Side-effects include those known as anticholinergic. Anticholinergic side-effects include dry-mouth, constipation, rapid pulse, palpitations, sweating, disturbances of vision, and others. Not all of these side-effects will necessarily be experienced, nor may they necessarily be of significant magnitude. Your doctor should go over these with you.
>
> There are quite a few tricyclics. They vary from one another in terms of side-effects, and probably in some pharmacological aspects of their antidepressant effect. As with the SSRIs, finding one that works is often trial and error. However, sometimes a tricyclic is chosen based upon its side-effect profile. For instance, if one suffers from insomnia along with depression, amitriptyline (Elavil) may be used for its sedative effect. If anxiety is present, I believe that doxepin (Sinequan) is sometimes preferred. Protriptyline (Vivactil) is considered the most activating, but I found it to have the worst anticholinergic effects of any of the tricyclics I have tried. Both desipramine (Norpramin) and nortriptyline (Pamelor) are probably the most forgiving regarding anticholinergic side-effects. Of all of these, desipramine is thought to be the most selective reuptake inhibitor of norepinephrine.
>
> The most important side-effects of the tricyclics are cardiac in nature. Be sure to let your doctor know if you have, or have had, any heart trouble.
>
> Personally, I have not found either imipramine or desipramine to be sedating beyond the first week or so. Nortriptyline was more sedating, but the sedation seemed to abate over time. Amitriptyline was a killer.
>
> To get back to Anafranil, it is often touted as being a "dirty" drug because of its side-effects. It can even produce some of the same sexual problems as seen with the SSRIs. However, during the early to mid 1980's, it was considered to be the most effective tricyclic antidepressant in the world.
>
> Good luck.
>
>
> - Scott
Scott is correct in all he says. I have seen many good results with Anafranil (clomipramine). It used to be the "gold standard" in obsessive-compulsive disorders. As to the side effects profile, do have your heart checked, but new research has shown that after 6 months, the side effects incidence of the tricyclics are really no different than that of the Celexa-like SSRIs. It is getting to that 6 months and putting up with the Anafranil side effects that you may have to work at. Anafranil's side effects are worst in the first couple weeks and then they begin to taper, usually disappearing altogether within the 6 months. - Cam Walker
poster:Cam
thread:19364
URL: http://www.dr-bob.org/babble/20000112/msgs/19388.html