Posted by SLS on March 3, 2002, at 12:43:06
In reply to Re: Amoxapine » SLS, posted by TSA West on March 2, 2002, at 16:38:06
Hi TSA.
I tried amoxapine when it first came out in 1982. I don't recall any of the details regarding dosage or length of trial. Sorry. It didn't help at all. In fact, it made my depression worse, particularly with regard to psychomotor-retardation, reduced libido, and a feeling of mental slowing or numbness. I attribute the DA antagonist properties of amoxapine for this.
Your question involving EPS (ExtraPyramidal Symptoms = parkinsonian involuntary movements and akathisia) is a good one. It can be debated as to whether amoxapine should ever been approved as an antidepressant. While working as a research assistant for Baron Shopsin, I investigated the FDA approval process and the ethics practiced by its administrators. In the original trial of 10 subjects, I believe three developed unequivocal EPS. I'd have to go back and find my old notebooks to detail what symptoms developed. Regardless, a 30% incidence of EPS in a trial should have received more focus. It seems that Lederle had a friend in the FDA, for these results were swept under the rug and the approval process allowed to continue.
Amoxapine is derived from the antipsychotic loxapine (Loxitane). Many people would argue that any incidence of EPS is unacceptable in an antidepressant, even if the risk were substantially lower than that of the typical neuroleptic antipsychotics. There were already quite a few effective tricyclics available without the liability of producing EPS and tardive-dyskinesia. However, some people do very well on amoxapine whom had not found success with any of the others. If I were one of those people, I would have quite a different view as to what is unacceptable. I would find it unacceptable to remove amoxapine from the market and applaud everyone who were responsible for it getting there in the first place.
Clomipramine (Anafranil) had at one time been considered the most effective antidepressant available. Although its side effects are generally greater than the other tricyclics, I think its use should be considered in light of your partial response to the others. Clomipramine combines the reuptake inhibitions of both norepinephrine with serotonin. In addition to the anticholinergic side effects common to tricyclics, it can also produce sexual side effects that are similar to those of the SSRIs.
I guess the knee-jerk reaction to your query is, "have you tried an MAOI yet?"
Good luck. It might make sense to first try augmenting amoxapine with things like lithium or Wellbutrin.
- Scott
poster:SLS
thread:95939
URL: http://www.dr-bob.org/babble/20020301/msgs/96182.html