Posted by Scott L. Schofield on January 27, 2000, at 9:54:02
In reply to Effexor itching-Now Desipramine, posted by Phil on January 25, 2000, at 11:29:04
> Also, probably the best AD I have ever been on was Amitriptyline but I don't want to go back because of side effects. May have to though. ANYONE HAVE ANY SUGGESTIONS?
Maybe you're a tricyclic person.There are quite a few to choose from besides amitriptyline (Elavil). I hated amitriptyline because of the heavy-duty sedation it caused me. I'm not sure how many people experience this to the same degree, but sedation is one of the more prominent effects that this drug is known for. In fact, doctors often make use of it to help treat insomnia. Other side-effects include those that are considered to be anticholinergic and/or norandrenergic: dry mouth, constipation, sweating, disturbances of vision, rapid pulse, and palpitations. Weight-gain is also common. However, it is the effects of tricyclics (and some other antidepressant drugs) on cardiac function that is important to screen for and follow-up on. Personally, I have not come across anyone for whom this has occurred.
Imipramine (Tofranil) is another tricyclic that is very similar to amitriptyline, but is considered to be less sedating. I have tried it several times and have found this to be true, although there was just a bit early on. Both amitriptyline and imipramine have "children" drugs named nortriptyline (Pamelor) and desipramine (Norpramin) respectively. They tend to have milder side-effects and are often just as effective as the parent drugs.
My guess is that a good place to start would be with nortriptyline. Since you have had such a good response to amitriptyline, using its active metabolite (child drug) will hopefully work as well. Nortriptyline has been the best studied of the tricyclics with respect to drug blood-levels and response patterns. My doctor likes this drug and usually targets 75 mg/day as being within the effective range. You *can* take too much nortriptyline and lose the antidepressant response, even though there may be no difference in side-effects.
There are more tricyclic antidepressants as well, but I think the ones mentioned above are the most frequently used. It might also be worth considering Ludiomil, Effexor, or reboxetine (not currently sold in the U.S.) based upon the possibility that you respond well to norepinephrine reuptake inhibitors.
- Scott
poster:Scott L. Schofield
thread:19661
URL: http://www.dr-bob.org/babble/20000112/msgs/19789.html