Posted by Keith Talent on January 11, 2004, at 9:31:50
In reply to Re: Who takes tricyclics? » Elle2021, posted by tensor on January 11, 2004, at 3:50:46
My understanding is that blood levels have only been shown to be meaningful for nortriptyline. In any case, clinical features, not concentrations, should be what is treated. Personally, clomipramine is the bees knees for depression. I'm just stopping it because (a) most patients can't have an orgasm (this may be relieved with a stimulant) and (b) causes some memory impairment.
It caused absolutely no sedation and no weight gain for me. The limiting factor for dose might be the physician's nervousness about causing a heart rhythm disturbance, but generally up to about 300 mg per day is fine. For me, doxepin and amitriptyline were much weaker antidepressants.
Clomipramine has an active metabolite (desmethylclomipramine) which is about as potent at blocking noradrenaline reuptake as desipramine (about the strongest there is at this). So cl. is a true SNRI - the others are pretenders (venlafaxine is basically a very weak SSRI, I know nothing about duloxetine and milnacipran).
You will probably find it more acceptable to take an SSRI (sertraline and paroxetine are the strongest), with maybe some dextroamphetamine to boost your drive and relieve anorgasmia. It really depends if it's for the rest of your life, or just one episode.
Best of luck.
poster:Keith Talent
thread:299074
URL: http://www.dr-bob.org/babble/20040109/msgs/299341.html