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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Walfredo on March 16, 2010, at 12:34:31
So, I'm considering giving a tricyclic a go. Partial response to aplenzin but definitely not completely satisfied/out of distress.
I'm a little worried about the side effects though because with the chronicity of my depression, I would probably be on the medication long term.
I know all this stuff is different for different people but I'm just curious what the consensus is on:
A) weight gain
B) sexual side effects - libido, anorgasmia, erectile dysfunction
Posted by Brainbeard on March 16, 2010, at 16:28:44
In reply to How bad is tricyclic weight gain + anorgasmia???, posted by Walfredo on March 16, 2010, at 12:34:31
> I know all this stuff is different for different people but I'm just curious what the consensus is on:
>
> A) weight gain
> B) sexual side effects - libido, anorgasmia, erectile dysfunctionClomipramine is worst for sexual side-effects since it's the strongest SRI; imipramine's already better, amitriptyline even less offensive, nortriptyline no problem at all, desipramine ditto.
The primary amine TCA's, clomipramine, amitriptyline, imipramine, are the worst offenders for weight gain, with amitriptyline probably leading the pack, at least at high doses, and clomipramine probably second. Nortriptyline also makes some people gain weight fast, but it can be less of a problem. Desipramine would be most weight neutral.
Posted by linkadge on March 16, 2010, at 16:34:29
In reply to How bad is tricyclic weight gain + anorgasmia???, posted by Walfredo on March 16, 2010, at 12:34:31
Totally depends on which TCA. I think clomipramine would be most likely to produce sexual dysfunction. Amitriptyline / doxapin would most likely produce weight gain but not necessarily sexual dysfunction.
Nortriptyline would be neutral with both regards.
Linkadge
Posted by Laney on March 16, 2010, at 16:57:30
In reply to Re: How bad is tricyclic weight gain + anorgasmia???, posted by linkadge on March 16, 2010, at 16:34:29
Can you order psych meds through the mail? I'd like to try nortrip but what if my doc doesn't agree?
Laney
Posted by bleauberry on March 16, 2010, at 17:09:02
In reply to How bad is tricyclic weight gain + anorgasmia???, posted by Walfredo on March 16, 2010, at 12:34:31
I didn't gain weight, but instead lost weight, on Nortriptyline. There were no sexual side effects at all for me.
Posted by Brainbeard on March 17, 2010, at 5:21:04
In reply to Re: How bad is tricyclic weight gain + anorgasmia???, posted by Laney on March 16, 2010, at 16:57:30
> Can you order psych meds through the mail? I'd like to try nortrip but what if my doc doesn't agree?
>
> LaneyYou can easily buy most TCA's over the web, except for desipramine which for some reason doesn't seem to be available without a prescription.
However, TCA's carry specific health risks which makes them less suitable for 'self-prescribed' use than perhaps some other drugs. Nortriptyline is the least toxic TCA. For the others, supervision of a medical professional is recommended.
I do take self-prescribed TCA's myself and hope my heart will survive it, otherwise my wife would kill me.
Posted by sukarno on March 18, 2010, at 22:08:14
In reply to Re: How bad is tricyclic weight gain + anorgasmia???, posted by Brainbeard on March 17, 2010, at 5:21:04
My heart bothered me a lot on imipramine, which is a tertiary amine in the TCA class. Nortriptyline is a secondary amine, IIRC, it is the active metabolite of amitriptyline and acts primarily as a noradrenaline (norepinephrine) reuptake inhibitor.
My heart only "skipped beats" when I would lie down before going to sleep at night. I would take 10mg (or 25mg.. I can't quite remember, but it was either of those dosages) at bedtime.
I had no sexual side effects and no weight gain. Then again, I was only 17 years old and that is near a man's prime as sex drive is supposed to steadily decline after age 18.
In the beginning it was quite sedating, but not as much as imipramine. I slept 12 hours the first night I tried it (nortriptyline) and had to get up slowly to avoid feeling faint. Over the next few days I adjusted completely to these side effects.
My psychiatrist said my blood pressure was elevated, although the blood level of nortriptyline was in the low end of the therapeutic range. She advised taking up exercise, which I gladly did. The exercise also eliminated the tachycardia (80 - 90bpm at rest), lowering my resting heart rate to the upper 50s or right around 60. Quite nice. :-)
I regret quitting that medication as 10 days later my panic attacks, anxiety, lack of motivation and constant worrying all returned, along with low self-esteem.
I also noticed that nortriptyline helped me to focus on my school work and my grades were 3.8 to 4.0 overall. Off nortriptyline my grades dropped to 2.0 or 2.3.
It's a fine medication and I would like to try it again. Perhaps I will try 10mg on the first night and then if I feel any cardiac effects such as "skipped beats" or palpitations, I will lower it to 5mg.
It is long acting and I didn't have any significant withdrawal symptoms going off it abruptly, except for some paroxysmal pressure in the head, which was probably due to cholinergic rebound.
I've read that it is good for ADD too.
Posted by desolationrower on March 26, 2010, at 0:06:28
In reply to nortriptyline, posted by sukarno on March 18, 2010, at 22:08:14
i have not had sexual side effects from nortryptaline. i have probably been a bit low in bodyfat, considering that i have not been able to go to the gym, and it has been too cold to run outside.
-d/r
Posted by conundrum on March 26, 2010, at 15:00:19
In reply to nortriptyline, posted by sukarno on March 18, 2010, at 22:08:14
I would like to try nortriptyline. I have responded to pristiq initially but it faded. Pristiq inhibits norepinpherine but only weakly. I'd like to try something stronger, but i'm worried about any cardiac problems. It seems like its not as bad as desipramine in that regard. Does it improve creating new memories at all? I have trouble getting things to go into my long term memory since stopping SSRIs.
Posted by sukarno on March 26, 2010, at 16:21:02
In reply to Re: nortriptyline » sukarno, posted by conundrum on March 26, 2010, at 15:00:19
Well, you can have an ECG/EKG prior to that for reassurance and start out with a very low dose... say, 10mg at bedtime.
With regards to creating new memories, I think that it could help since it is said to help ADD and anything that helps ADD generally improves focus/concentration. I know it helped me concentrate and improved my motivation to learn significantly. The more you can concentrate, the more likely that information is going to be passed on to long term memory.
Posted by conundrum on March 26, 2010, at 21:35:29
In reply to Re: nortriptyline, posted by sukarno on March 26, 2010, at 16:21:02
My memory of perceptual things has been shot since stopping prozac. This is also do to the fact that I don't seem to be as observant. I walk into my moms house and don't notice the kitchen is totally repainted or the floor is redone. I don't remember what houses or buildings in a neighborhood look like, they all seem the same. When i used to listen to music I could hear and remember all the instruments, now I mainly remember guitar, since I'm a guitarist, and vocals. Drum parts and complex rhythms don't really stick in my head. It kinda sucks what SSRIs do., :(
This is the end of the thread.
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