Posted by Elizabeth on January 23, 2002, at 14:11:50
In reply to Re: Are tricylics safer than ssris? » Mr. Scott, posted by spike4848 on January 20, 2002, at 16:13:29
> As far as long term side effects, we have use tricyclic for years with no known long term adverse effects. And there studies to show TCA are safe on the heart.
Depends what you mean. They can cause cardiac arrhythmias (this is well known), especially in overdose. For a person who's seriously suicidal, this can be an important issue. There are also plenty of people who don't metabolize TCAs normally. For these people, taking a normal therapeutic dose of a TCA will result in abnormally high serum levels. This can have serious consequences. (I had a seizure on desipramine, and my serum level turned out to be high, probably due to inadequate metabolism. Lowering of the seizure threshold is another serious side effect of the TCAs, BTW.)
> With SSRIs .... who knows? We do know that similar drugs that raise serotonin levels may cause primary pulmonary hypertension and cardiac valve defects.
You mean fenfluramine, I guess. I wouldn't call that a "similar drug" to the SSRIs. Fenfluramine enhances serotonin release rather than blocking reuptake. It has been pretty well established, that SSRIs don't cause the problems that fenfluramine can cause. (These problems occur rapidly enough that we would know by now if SSRIs caused them. Fenfluramine had been around since the '70s, but it wasn't until dexfenfluramine (Redux) was approved in the mid-1990s (1995 or 1997, I think) that the serious side effects were discovered. Prozac has been around since late 1987, much longer than Redux had been available before it got pulled from the market.)
Also, of course, Anafranil (the TCA that borderliner21 was considering) blocks serotonin reuptake to a clinically significant degree at prescribed doses, just as the SSRIs do. (Most of the tertiary-amine TCAs are mixed serotonin-norepinephrine reuptake inhibitors, while the secondary-amine TCAs mainly affect norepinephrine.)
> Unfornuately .... companies pushing SSRI downplay the fact that many people on ssri's are suffer from nausea, impotency, insomnia!
I think Remeron is a good addition for people who benefit from SSRIs but suffer from these side effects, FWIW.
> So my vote is for tertiary TCA!
I prefer the secondary-amine TCAs, myself (such as the ones you tried) -- they have milder side effects, in general.
-elizabeth
poster:Elizabeth
thread:90799
URL: http://www.dr-bob.org/babble/20020116/msgs/91272.html