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Re: Best first Tricyclic to Try?

Posted by bleauberry on February 20, 2010, at 18:03:56

In reply to Best first Tricyclic to Try?, posted by bearfan on February 19, 2010, at 3:49:30

Well, this isn't the answer you were looking for, but it deserves mention.

When someone says they didn't reach "full remission" on SSRIs, that means the ssri worked, just not enough. In other words, serotonin was a player in the disease, but not the only player.

So instead of switching to an entirely different medication, it would make more sense to add another one that targets something else besides serotonin. You've got half the battle won with the ssri, but you'll give up that win and start from scratch with another med. For example, Nortriptyline added to any SSRI. Or Desipramine added.

Any combination of a TCA with a SSRI is likely to be faster and more thoroughly effective than either alone, no matter which TCA you choose.

If going TCA only, the one most likely to work thorough is Clomipramine, but it also has heavy side effects in the areas of constipation, dry mouth, blurry eyes, and tiredness.

The TCA with the tamest side effects is usually considered to be Nortriptyline. It happens to go very well with any of the SSRIs.

I did terrible on Zoloft, terrible on all SSRis actually, and terrible on Nortriptyline. But when Zoloft and Nortriptyline were combined, it was like a totally different drug and actually had some good to it. Other meds are more suited for me though.

I'm just saying, consider TCA+SSRI rather than either alone. You'll be able to have the potential of faster response, stronger response, and low side effects since the doses of each would be lower than if taken by themselves.

Another viable option would have been to add low dose Abilify to the SSRI, which is FDA approved for that, and seems to be quite popular these days, so I am surprised your doctor didn't mention it.

> I didn't have full remission with SSRIs and didn't like the SNRIs much. Doctor suggested maybe trying a tricyclic. Was wondering which ones I should try first. I've only vaguely familiar with the names Elavil, Pamelor, and a few other ones. What do these drugs 'feel like' and are they anything like SSRIs or have different side effect profiles? Anxiet and Depression are primary concerns


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