Posted by SLS on September 21, 2001, at 1:15:31
In reply to Experiences w/ switching from SSRI to tricyclic?, posted by lisamb on September 20, 2001, at 4:46:41
> I did a search but couldn't find anything that exactly answered my questions here. I'm currently on 75mg of zoloft, 30 mg of ritalin and 15mg of ambien per day. My therapist said some months ago after my ADD diagnosis that she didn't think zoloft was right for me - but I seemed to stabilise and so we left things as-is. I've been in a downward slump over the past few weeks, though, and now we're revisiting the issue. She wants me to switch across to Ethipramine (local generic name for Imipramine) - she believes it's more suited to the ADD/depression dx and will help more effectively with the mood swings..??
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> I could really use some input on the process of switching across from an SSRI to a tricyclic-- how easy is it.. Zoloft was the first AD I was put on and so I don't have any experiences with any others. I'm anxious about coping with the tapering off period, and dealing with new side effects.. I'm on the thin side already, but I'm obsessing about the possibility of putting on weight with the Ethipramine. I DON'T want this to happen. My therapist knows it's a "thing" for me and deliberately left it out when she was listing the potential side effects for me.
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> Sorry not very clear... hoping for any input/advice/experience.
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> Thanks so much
> LisaHi Lisa.
If you are ADD, and need to address the behavioral (as opposed to the attentional) aspects of your illness, a tricyclic is often effective; imipramine being the one most often chosen. If your doctor thinks that desipramine would work as well, it is not as liable to produce weight-gain. However, I'm not convinced that it is as good as imipramine for ADD.
If you are trying to address depression, it might make sense to first try increasing the Zoloft if you had previously been happy with it.
If you have not responded well to the other SSRIs, it might make sense to simply add a tricylic to your Zoloft. You can always try to discontinue the Zoloft once you feel the depression has been controlled. However, an SSRI and a tricyclic can sometimes work when neither alone produces an adequate response. The one tricyclic you would probably want to stay away from is clomipramine (Anafranil). Clomipramine, like Zoloft, is a serotonin reuptake inhibitor. Some people react to such combinations with something called the serotonin syndrome. I'll defer to someone else to itemize the symptoms if necessary.
Just to throw out a few more ideas...
If depression is the only feature of your illnesses needing treatment, it probably makes sense to first increase the Zoloft.
If your doctor feels strongly that a tricyclic by itself will treat everything, then switch.
If your depression has previously failed to respond to other SSRIs, and you are still receiving some benefit from Zoloft, you might be better off continuing it and not risk becoming completely non-responsive to it in the future. You can try increasing the dosage of Zoloft first and then add your tricylic once you determine if the increased dosage of Zoloft is of any benefit. I doubt you would need more than two weeks to see if it helps.
If you haven't already tried Effexor, you should keep it in mind as it has shown efficacy in both depression and ADD (behavioral symptoms).
Good luck.
- Scott
poster:SLS
thread:79138
URL: http://www.dr-bob.org/babble/20010917/msgs/79204.html