Posted by spike4848 on January 23, 2002, at 16:56:26
In reply to Re: Are tricylics safer than ssris? » spike4848, posted by Elizabeth on January 23, 2002, at 14:11:50
>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
Yes, I believe in normal doses though, the only cardiac contraindication to a TCA is Left Bundle Branch or 2 degree heart block. In overdose, I understand SSRIs can cause serontonin syndrome ... also potential lethal.
>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.)
I am sorry you had to go through that horrible experience. I have heard of slow metabolizers and the risk of elevated serum TCAs .... more often elevated TCAs levels with combination with SSRIs. I think a blood level is always wise during a course of TCA therapy.
>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.)
I didn't mean to infer that SSRIs will have the same effects as fenfluramine/phentermine, just that we simply haven't had them as long as the TCAs, and really don't know the long term side effect profile. I wasn't aware that there were studies ongoing concerning the long term safety of SSRIs .... can you give me those citations. Thanks.
>I think Remeron is a good addition for people >who benefit from SSRIs but suffer from these >side effects, FWIW.I think I would prefer just to take one medication ... I need to take ambien with nardil currently for sleep. It is very inconvenant .... if I am invited to stay over a friends apartment and I don't have ambien .... no sleep. An also the extra cost as well. If one has a good response to an SSRI .... remeron at low dose is a great option for side effects.
> > 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.Oops ... I mean't secondary TCA .... sorry.
Thanks for the information Elizabeth!
Spike
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