Posted by Sad Panda on May 10, 2004, at 23:23:43
In reply to Re: best first TCA to try, posted by SLS on May 10, 2004, at 16:42:36
> > Any suggestions, bear in mind, I am in university.
>
> Hi Linkadge.
>
> I think the first two drugs to consider are desipramine and nortriptyline. They have the mildest side effects. Imipramine was at one time the gold standard by which all other antidepressants were compared, and will get more people well than the other two. Some will argue that amitriptyline is statistically better than imipramine, but it can be unacceptably soporific and sedating. Nortriptyline has a therapeutic window within which it exerts an antidepressant effect. This is associated with blood levels between 50-150 ng/ml. The drug can actually lose efficacy at higher dosages.
>
> I'll be curious to see what others recommend.
>
>
> - Scott
>I agree with Scott, desipramine, nortriptyline & imipramine would be the ones which have the best side effects profile. Desipramine & nortriptyline would also be the ones that you could add to a functioning SSRI, clomipramine would be the one with the best efficacy, amitriptyline has the worst anti-muscarinic side effects & doxepin should only be used at low doses as a sedative(Like Remeron). Dothepin should be avoided totally as it is twice as toxic as any other TCA.
Here's a table I made with data from http://www.psychotropical.com/
________________5-HT__NE___H1___5-HT2A__A1___M1
CLOMIPRAMINE__0.28__38____15____23_____50___25
IMIPRAMINE_____1.4___37____37____150____32___60
AMITRIPTYLINE__4.3___35____1_____18_____24___13
DOTHIEPIN______8.6___46____3.6__________450___38
NORTRIPTYLINE__18____4.3___6.3___41_____55___50
DESIPRAMINE__________0.83__60____350___100__210
DOXEPIN________68____29.5__0.2___27_____23___52
Cheers,
Panda.
poster:Sad Panda
thread:345436
URL: http://www.dr-bob.org/babble/20040510/msgs/345602.html