Posted by zeugma on June 6, 2004, at 19:47:57
In reply to Re: Would strattera treat depression and ADD?? » zeugma, posted by Chairman_MAO on June 6, 2004, at 15:15:27
<Regarding Strattera vs. TCAs, I think your doctor's line of reasoning is a heap of Eli Lilly-sponsored you-know-what. I have no sources to cite at this time, so I cannot be sure but I seem to recall reading abstracts indicating that both atomoxetine and nortriptyline (and so presumably desipramine, too) block DA reuptake in the prefrontal cortex. There are no DA reuptake transporters there, leaving the NE reuptake transporter on "double duty" for both DA and NE. My suspicions are obviously supported by the fact that desipramine, imipramine, and nortriptyline all have been shown efficacious in treating ADD.
Regarding the fatigue: I've tried both desipramine and Strattera, and can tell you that desipramine does not cause the fatigue Strattera does. In fact, it's mildly activating. Were it not for desipramine's antimuscarinic side effects, a choice between the two would be a no-brainer; desipramine all the way!>
All NE reuptake inhibitors block DA reuptake too, with a higher affinity for taking up DA than NE itself. And as you point out, DA transporters are sparse in the prefrontal cortex, so NRI's finction as DRI's there as the NE transporter is the major source of DA reuptake in that region.
My pdoc did not deny this, but claimed that Strattera 'gravitated' to the PFC more than the TCA's. I think what this debate will hinge on ultimately will be head-to-head comparisons of atomoxetine vs. desipramine, which I doubt will happen, as desipramine has been off patent for many years and Lilly will benefit from the adverse publicity desipramine received in the last decade when four children died of unknown causes during DMI treatment. I had always assumed that it was DMI's proven effectiveness in treating ADD, coupled with the bad name TCA's earned through these unfortunate incidents, that inspired Lilly to pick up development on their drug as a 'safer' 'non-stimulant' alternative to Ritalin et al.I am sticking with nortriptyline for now, as it helps me sleep without giving me too much of a hangover (insomnia's one of my chronic complaints). I am going to get another plasma level done and I'll see if I can up the dose of NOR to 100 mg. I want to lower the Strattera as I raise the NOR, and eventually get a stimulant to replace the Strattera. That should doubly help the fatigue: not only will I be ridding myself of Strat, I'll be adding something that should actually help with this odious symptom (I spent most of the weekend in bed, typically).
poster:zeugma
thread:353502
URL: http://www.dr-bob.org/babble/20040602/msgs/354368.html