Best Tricyclic

[BearFan]

Anyone know what tends to be the best tricyclic that is still widely used? The ones I tend to hear the most about are Pamelor and Elavil. I remember a pdoc saying they tend to have less or no sexual side effects compared to the SSRIs. Looking specifically the most efficacious Tricyclic in regards to anxiety/depression without weight gain and sexual issues. Or just one that is useful from people on this board.

[Ehsan]

Palemor is a popular Norepinephrine Reuptake Inhibitor thus is activating, antidepressant and has little side effects.
however Palemor hasn't much use in anxiety treatment coz they increase extracellular NE. serotonergic TCAs are more effective in anxiety and depression but are sedating and have more side effects(dry mouth, sexual dysfuction,..)
Anfranil(clomipramine) is indicated for OCD and has many off-label uses but its side effects are Slightly higher than other TCAs and SSRI.

[UltraShy]

No TCA is widely used in 2010. They were almost entirely killed off by SSRIs over the last 20+ years.

The only common use for TCAs today is as sleep aids. I've tried Elavil & Doxepin for that: problem -- they don't sedate me at all, even at max recommended dose. They do produce one hell of a dry mouth though.

I tried imipramine for 28 days as an anxiety treatment. That ended after 4 weeks, because even this trooper who will consume damn near any pill presented as a potential "cure" could no longer stand the side effects. It produces EXTREME dry mouth (you don't know what dry is till you take this pill from hell). But that's the nicer of the side effect. Just imagine walking into your bathroom to pee. Then imagine standing there for 15 minutes and being unable to get out even a drop such that you give up to try again later. It's enough to make atheists start praying, praying to simply pee! You have no idea how important urination is till you can't.

[BearFan]

There were a few tricyclics still in the top 10 depression medications prescribed in recent years. If one must be used, which ones are still clinically useful?

[UltraShy]

Originally Posted by BearFan

There were a few tricyclics still in the top 10 depression medications prescribed in recent years. If one must be used, which ones are still clinically useful?

While TCAs are antidepressants, I'm sure any on that top 10 list are actually being used as sleep aids in almost all cases. Despite all the med discussions I've seen here over the years, I can't think of anyone here who is using a TCA to treat anxiety.

I'm guessing you're looking into TCAs as you're not too happy with the sexual side effects of SSRIs?

[Ehsan]

in my experience, majority of TCAs are not hypnotic.
Palemor is activating instead.
anfranil is slightly sedating but not hypnotic at all and is useful for anxiety as a potent SRI and 5-HT2 antagonist.
doxepin and amitriptyline may be hypnotic due to strong H1 antagonism.

[Heuer]

Originally Posted by BearFan

Anyone know what tends to be the best tricyclic that is still widely used? The ones I tend to hear the most about are Pamelor and Elavil. I remember a pdoc saying they tend to have less or no sexual side effects compared to the SSRIs. Looking specifically the most efficacious Tricyclic in regards to anxiety/depression without weight gain and sexual issues. Or just one that is useful from people on this board.

Hi,

I've been on Elavil for 37 years.
This drug is a very good sleep aid.

Now I'm on Remeron and Lyrica for sleep.
Wellbutrin sweeps my tiredness away.

Best regards,
Heuer

[euphoria]

Amineptine. lol.

[meyaj]

Pamelor helped my sleep quality and daytime energy a lot. It's been the best antidepressant I've tried so far (it + wellbutrin were the only ones that were positive AT ALL), but my own personal response to it was still pretty incomplete, my depression and SA being classified as severe, so I had to move on. I'm on an MAOI now but not really at a proper therapeutic dose yet, so I have to reserve judgment on it. BUT, I have to be honest, I actually miss Pamelor, lol. It might not have done everything I needed it to, but it was a positive experience with very little in the way of side effects (dry mouth).

It IS rather activating most of the time, but immediately after taking a dose, it will be somewhat sedating, which is why it's taken pretty much always taken before bed. It's not that icky antihistamine kind of sedation though which feels so horrible that it's counterproductive for me, but pretty subtle. I didn't really feel knocked out or anything, but it seemed to put my mind and body at ease, making it easier to fall asleep. I was able to cut my sleep meds in half while on it with no problem. Since I got off it, I had to double up again. And as I mentioned before, it really seemed to improve my overall sleep quality and I've never woken up so refreshed. Lately I've been waking up feeling hungover every morning, which really sucks

[jim_morrison]

Originally Posted by meyaj

Pamelor helped my sleep quality and daytime energy a lot. It's been the best antidepressant I've tried so far (it + wellbutrin were the only ones that were positive AT ALL), but my own personal response to it was still pretty incomplete, my depression and SA being classified as severe, so I had to move on. I'm on an MAOI now but not really at a proper therapeutic dose yet, so I have to reserve judgment on it. BUT, I have to be honest, I actually miss Pamelor, lol. It might not have done everything I needed it to, but it was a positive experience with very little in the way of side effects (dry mouth).

It IS rather activating most of the time, but immediately after taking a dose, it will be somewhat sedating, which is why it's taken pretty much always taken before bed. It's not that icky antihistamine kind of sedation though which feels so horrible that it's counterproductive for me, but pretty subtle. I didn't really feel knocked out or anything, but it seemed to put my mind and body at ease, making it easier to fall asleep. I was able to cut my sleep meds in half while on it with no problem. Since I got off it, I had to double up again. And as I mentioned before, it really seemed to improve my overall sleep quality and I've never woken up so refreshed. Lately I've been waking up feeling hungover every morning, which really sucks

Are you considering adding pamelor back to parnate soon? I know you've discussed this option before. Since pamelor works well for you it might actually be a decent combo for you.

[meyaj]

Originally Posted by jim_morrison

Are you considering adding pamelor back to parnate soon? I know you've discussed this option before. Since pamelor works well for you it might actually be a decent combo for you.

I'd like to but I kind of hinted at it to my psychiatrist and I really don't think there's a chance in hell she'd go for it. Because I'm taking Dexedrine and Parnate at the same time she's already taking it extra slow, but I'll wait until I'm at a decent dose of the latter for a few weeks before I really push the idea. No use getting ahead of myself

[phob33]

I have been on low dose anafranil for 20 years. It saved my life. The way I was living for probably 5 years was aweful! If I would see someone I knew in a store, I would blush and shake and couldn't even look them in the eye. Just sitting around a table having coffee at work was pure hell! I would blush any time someone would look at me. I didn't want to live like that, that's for sure. After 2 weeks on anafranil I found myself actually laughing for the first time in about 5 years. I wouldn't "Obsess" about how people looked at me. I got my life back!! So please don't say nobody uses Tricylic... they have a place. And for me, there are literally ZERO side effects. I remember when I first started taking them I had dry mouth but that's about it.

[Ehsan]

Originally Posted by phob33

I have been on low dose anafranil for 20 years. It saved my life. The way I was living for probably 5 years was aweful! If I would see someone I knew in a store, I would blush and shake and couldn't even look them in the eye. Just sitting around a table having coffee at work was pure hell! I would blush any time someone would look at me. I didn't want to live like that, that's for sure. After 2 weeks on anafranil I found myself actually laughing for the first time in about 5 years. I wouldn't "Obsess" about how people looked at me. I got my life back!! So please don't say nobody uses Tricylic... they have a place. And for me, there are literally ZERO side effects. I remember when I first started taking them I had dry mouth but that's about it.

it worked great for me too.
i thought i'm the only one who has found Anfranil great for SAD.

[phob33]

My doctor waaayy back then said the results he had with anafranil were amazing. Years later when I had to switch docs, he thought I was crazy using anafranil (it was so "yesterday"). The pharmaceutical companies deal the cards and if they say SSRIs are best, physician's don't blink an eye.... yes, I think it would be quite difficult for a person to get anafranil unless you go to a few doctors and one has an open mind.

[Ehsan]

Originally Posted by phob33

My doctor waaayy back then said the results he had with anafranil were amazing. Years later when I had to switch docs, he thought I was crazy using anafranil (it was so "yesterday"). The pharmaceutical companies deal the cards and if they say SSRIs are best, physician's don't blink an eye.... yes, I think it would be quite difficult for a person to get anafranil unless you go to a few doctors and one has an open mind.

i'm not sure but i think it dose not work only as a SNRI. i read somewhere that it works on oxytocin and CRF too.
further evidences and experiences needed.
there are few researches considering effectiveness of TCAs in SAD.

[quat]

I'm taking endep at a very low dose, really just as a sleep aid at night. It brings me down and when it wears off during the day i'm on an upper. Then I take Parnate during the day.

[BearFan]

I took it at night for the first days, it does kind of feel like an NRI which is not what I want. Does it get more calming later, because I had a bit of that 'crawling out of my skin feeling' (though not as bad as pristiq) I tend to do the best on heavier serotonin drugs with a bit of the NE kick (ie Prozac, Effexor, Cymbalta). Which Tricyclic is more like those with the least side effects?

[meyaj]

Originally Posted by BearFan

Which Tricyclic is more like those with the least side effects?

Clomipramine...