Posted by zeugma on May 9, 2004, at 4:09:33
In reply to Re: ok, here's what my pdoc said, posted by harryp on May 9, 2004, at 1:46:56
> Have you tried desipramine? My literature indicates it's the least sedating TCA, and has a very powerful norepinephrine effect.
I brought this up to my dr. it was actually the first thing out of my mouth when I sat down there- 'what about replacing Pamelor and Strattera with Norpramin?' He claimed that nortriptyline and desipramine were, from his point of view, virtually interchangeable, except that he claimed he saw less side effects on nortriptyline, because a lower dose was required to obtain an effect. This was how we got talking about the brainstem vs. frontal lobe sites of action, because he thought the secondary amine TCA's worked mainly in the brainstem while strattera worked in the frontal lobes- hence its greater efficacy in ADD. We argued about this for a while, because i have seen no evidence that indicates that Strattera is more effective than desipramine for ADD. He claimed to be doubtful about this, and that he didn't know why desipramine was so effective for ADD if it worked more in the lower brain, and that he wasn't sure that the two drugs had the same effect on ADD despite the studies. My ignorance on this caused me to insert a question mark on this point in an earlier post. Several thoughts:
Strattera does have a distinctly different effect on ADD than nortriptyline. Over the last year I've attributed it mainly to Strattera's lack of a sedating effect, leading to greater mental clarity. I suppose it could also be attributed to a slight difference in where the drug's action falls, or for all I know it could be a pure placebo effect.
Two years ago before strattera came out, he had mentioned the drug to me as a promising one to try if nortriptyline didn't reverse all my symptoms. He said "the two drugs go very well together." It's apparent from what he said the other day that he was referring to this localization effect, and I don't know if this is something the Lilly people are pushing, or if there is evidence out there that I haven't seen. I am a natural skeptic, but he doesn't seem like the type of pdoc to fall for the latest marketing hype. He's kept me on a TCA for two years, despite protests from me at tmes, and no one's marketed nortriptyline since the Stone age.
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> You could probably replace the TCA, SSRI, and the Strattera with Parnate and get a much better SE profile. It is a remarkable drug for vegetative depression and anxiety. The diet requires care, and you should make arrangements with a local doctor and ER to have your chart and phentolamine availiable in the event you have a hypertensive rxn. (Not something to be paranoid over--just requires prompt treatment).And I bet parnate would be great for ADD because of its dopaminergic and noradrenergic effects. It's something I've definitely considered. <See my comments too below.>
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poster:zeugma
thread:343353
URL: http://www.dr-bob.org/babble/20040505/msgs/345000.html