Tricyclic Antidepressants: Are They Really Better Than SNRIs?
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- Опубликовано: 8 май 2024
- You asked for it and here it is, the deep dive on TCAs. I'm starting with the time stamps because this is a long one, there are lots of good pearls about TCA use, and I'm looking forward to the Q/A.
Time Stamps
Introduction: 00:00 to 00:35
History of TCAs: 00:36 to 03:25
Tertiary Vs Secondary Amines: 03:26 to 08:45
Important risks with TCAs: 08:46 to 10:30
Indications for use: 10:31 to 11:17
MOA, dose range, plasma levels: 11:18 to 13:53
Drug interactions: 13:54 to 16:16
SNRIs Vs TCAs: 16:17 to 18:50
When to use TCAs: 18:51 to 21:28
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I was on amitriptyline for ten years and it worked well for my anxiety. My doctor took me off to put me on ssri and later an snri, and my anxiety has completely took over my life. SSRI and SNRI almost killed me!
I see you going in on the steady content. Love it! Do you have any vids on SARIs? Thanks sir.
I have never been able to tolerate SSRIs or SNRIs. I have horrible reactions. The only antidepressant I've ever done well on is Pamelor (Nortriptyline). I took it for severe depression and anxiety after my uncle passed away suddenly in 2004 and it honestly saved me. I took it again back in 2012 for nerve pain. I was recently diagnosed (age 41) with ADHD and my life now makes sense. Anway, the doctor told me I can restart Pamelor as it is used off label for ADHD. Wish me luck and thanks for making this video!
Hi Alisha, I have the same situation. Did you have insomnia and did this medication help with that as well? Hope you can help.
I've been prescribed Nortriptyline for my severe Depression which went to 225mg, it has been the best mood elevator "antidepressant" yet!
I know what you mean. In 2021 I developed panic disorder at 35 years old. Totally out of the blue. Woke up in the middle of the night with a panic attack (my first one ever), it lasted almost 5 weeks. Benzos would stop them, but they would come back even stronger than before.
SSRIs like lexapro and sertraline made me worse. Mirtazapine stopped working after a few weeks. Amitriptyline is the only thing that saved me. I’m sure I would have ended my life if it wasn’t for one psychiatrist who gave it a shot.
I took them for a year, tappered off them a few weeks ago. Now medication free.
If my problem ever returns, I know exactly what to take, no more drug-roulette.
Amitriptyline saved my life. It’s a shame most doctors don’t even know about this, or are hesitant to even prescribe it.
Good luck to you. Life can still be beautiful
@hoyconjessi5141 I am so sorry that I didn't see this sooner! 😢 I tend to have issues sleeping anyway. Like I'm wired at night. For some people, the Pamelor can help as it typically does make people sleepy. But for me, until my body adjusts in the beginning, I get very vivid dreams, which wake me up co constantly. That tends to settle down after a while, though.
@mikesnyder7961 Thank you for your kind words, and I'm sorry to hear that you suffered so badly with panic attacks. I still get ones in the middle of the night, and omg! You sit straight up out of sleep, and your heartbeat is in your ears!
I am so glad Amitriptyline worked for you though 🙂 That one made me too sleepy, but I know it can be a life saver for others!
I just gave Prozac another try and had an allergic reaction yet again. So back to the Pamelor I go!
Hello, amitriptiline+perphenazine 25mg+2mg respectively, twice a day along with 10mg of escitalopramhas worked wonders for my persistent chronic anxious depression. What is your take on this combo? Is it valid for chronic use ( 3 months in). Thanks
AS a PMHNP, you have greatly contributed to my career and learning. please continue to do what you do. very comprehensive and informative!😊
hi, what are your thoughts on adding low dose amitriptyline to ssri?
İ tried imipramine, duloxetine and venlafaxine even at low doses imipramine more effective but it has more and strong side effects than others for that i couldn't continue
You know your stuff
Neat
By blocking alpha and histamine receptors, it seems that TCAs would be better for anxiety.
100 Mgs of Nortryptalline a day makes me run rock solid and allows me to forget about the two women I lost to Crystal methamphetamine out there freezing in the strts all Winter long.
Is combining tricyclic & SSRI a common practice now?
Is there a generalized circumstance that you would go for a TCA rather than augment an snri w/ an atypical/lithium/lamictal/prami for TRD, or just depends on each patient and what they're comfortable with?
Depends largely on the patient but I think in most cases the TCA would be reserved for cases where augmentation has failed. Although I'm not fully convinced the TCAs are that much better for treatment resistant depression. On an individual level there are going to be subsets of the population that just respond better to a TCA, but it's trial and error to get there
How does TCA cause mania? is there an advantage to adding lithium to someone in a TCA if they are developing manic symptoms?
It can trigger mania in people who already have a predisposition to bipolar disorder, in which case lithium/sodium valproate is something you’d want to treat it with anyway. But most people don’t really need to worry about that.
Starting Nortripyline today
How’s it going??
I thought Cymbalta was inferior to imipramine and amitriptyline. In regards to mood elevation.
Yes, but less for Anxiety
Is it normal to feel your depression worse first two three weeks of ssri/TCA treatment? Why it happens?
Have you been back to the arcade since last October?
I went to a psychiatrist for the first time and she gave me tcas without trying sriis... Is it okay?
Good doctor
can i take PPIs with TCA ?
It's always good to plug the medication into an interaction checker such as the one found here to check as it will depend on which medication we are talking about
reference.medscape.com/drug-interactionchecker
May I know your medical degree sir if you don't mind
just google my name you will find it
Tianeptine ????
The superior antidepressant to all the rest. Not available because it would simply put the others out of business! So unfortunate the cure is not politically correct here in America. Other countries do not have the same political agenda . Tianeptine actually doesn’t have the side affects . You can stop and start it without bodily ailments, not so the American drugs that have side affects headaches, weight gain etc. The U S lost the Patent on stabalon, it’s about money not health , or wellness
Tricyclic antidepressants are way better than snris
Many people feel that way, the pooled data doesn't really show that but then again there is no money to made in running head to head trials of SNRIs and TCAs but in general I think older meds are more effective, newer ones are safer
There’s no doubt about that. So long as there’s not a huge risk of serotonin syndrome, side-effects are the patient’s trade-off to make, whether it’s with amitriptyline, lofepramine, maprotiline or clomipramine. All doctors and pharmacists should really be doing at that point is advising, not forcing patients to take weaker meds just because of less likelihood of certain side-effects. In certain counties you’re paying directly for their services so in any case if you’re a knowledgeable patient and there aren’t any significant contra-indications or huge risks that you need to be aware of, you need to let it be known that you ain’t playing with them and you’re not really asking, you’re good-as telling them that unless there’s a good reason not to, you absolutely will be having nortriptyline, fluvoxamine, moclobemide or phenelzine and not citalopram, desvenlafaxine or more sertraline garbage if that’s the way you want it. That’s your prerogative when you’re sensible and knowledgeable enough to guide yourself through your own treatment and take greater initiative for it than doctors who may or may not know that much about so many of the drugs they prescribe. They just need to agree that you know what you’re doing (if truly you do) and authorise the prescription. Caution and the right amount of hesitancy are obviously important when there’s interactions with other medications that might cause extreme side-effects (such as serotonin syndrome) and that bit’s completely understood (or at least it should be) but beyond stuff like that it’s more the patient’s call. If they don’t tolerate it will they can always come off it and try something else. I’m not saying be rude but I am saying advocate for yourself and make it clear that you’re not really trying to be disrespected or have your knowledge-base dismissed by someone who doesn’t know you if you’re that kind of patient. And so you liaise with the doctor as a patient-client to the end that you’re most comfortably satisfied with, not the one that has the least side-effects but doesn’t work more than halfway if you’re not trying to play that game but do want a potent solution. Alcohol and CNS depression isn’t really a problem either with tertiary-amine tricyclics so long as you stick to your limits and start your waking day with a bit more caffeine. There’s never any need to go teetotal for a minute outside antibiotics and diazepam. It’s just a case of being a bit more careful than you would be otherwise but it’s not to now abstain from or avoid alcohol altogether.
When you’re doing all this through primary care and you’re a smart, savvy patient who’s done your homework anyway, chances are you will know more about the pharmacology of these drugs than the doctors anyway. GPs are not seasoned psychiatrists. They’re just a general, non-stigmatising reference-point who often know very little of the specifics. That’s not even in their job description. Nor are they there to block your progress just because you might get one or two extra side-effects. It’s your body. Only you will know whether it’s worth it or not.
77-LH-28-1 (a little something for brain-power) + bethanechol would make burnt toast out of every anticholinergic effect but we don’t seem to sort of wanna teach people how to take and prescribe these drugs optimally anymore so people suffer with urinary hesitancy and constipation for nothing. But even at that it’s often worth it and always the person’s call to make for their body, not the doctor’s.
If that individual doctor doesn’t play ball and wants to push sertraline on you like there’s no tomorrow, then you find someone who respects you and knows you’ll get on better with another medicine. Just like if one particular Starbucks doesn’t do pumpkin-spiced lattes but that’s the one you really want, you find somewhere that does do them. Either way, if they ain’t balling, you walkin.
They are all bad.
No, they have all bad side effects