Posted by Phoenix1 on June 18, 2008, at 11:12:18
In reply to Re: Clomipramine vs. Nardil » Phoenix1, posted by SLS on June 18, 2008, at 4:46:22
Hi Scott,
Could you explain Clomipramine's dirtiness? I'm a little confused on it's primary mechanism even after browsing Pub Med. It seems to be a strong SRI with NE reuptake inhibition from it's major active metabolite. And it has a weak effect on dopamine too, right? And then the fun side effects caused by it's anticholingeric and antimuscarinic effects...
I've been on the med merry go round for almost 10 years. I have unipolar depression and GAD. I would guess that my depression would fall into the atypical class. Low mood with some reactivity to positive events, vegetative synptoms, sensitivity to criticism, etc. The GAD manifests itself in constant physical anxiety, extreme insomnia, rumination.
SSRI's make the anxiety worse. Meds that have a strong NE effect seem to make things much worse too (venlafaxine, bupropion. Dopaminergics have a neutral effect, but don't improve either my depressive or anxious symptoms.
Nardil, on the other hand was my first and only clear positive response to an AD. I felt normal, functional, and calm the whole time I was on it.
What, neurochemically speaking, would explain such a positive response to an MAOI, but negative responses to all other classes? Does this suggest some sort of trace amine deficiency that the other AD's don't touch? If that is the case, then I doubt any other class of drugs will help me. I know it's oversimplistic to choose a drug based on mechanisms, but I'm trying to figure out what the next rational choice is to avoid another round of unsuccessful trials...
Thanks for your help!
Phoenix
> Clomipramine (Anafranil) produces side effects that resemble both typical anticholinergic TCAs and typical SSRIs. How's that for fun? It is considered to be a "dirty" drug in this way. However, clomipramine might be the most potent antidepressant; second only to the MAOIs. It cannot be discounted that some of the drug's "dirtiness" contributes to its therapeutic effect.
>
> Do you really have much of a choice?
>
> The answer to that question is probably yes, but since you are here now, you might as well allow your doctor to take his shot. If things don't turn out well, you can always research the many drugs and drug combinations that you have not yet tried.
>
> Can you describe the nature and symptoms of your depression?
>
>
> - Scott
poster:Phoenix1
thread:835192
URL: http://www.dr-bob.org/babble/20080617/msgs/835238.html