• N&PD Moderators: Skorpio | thegreenhand

Clomipramine | The "Gold Standard" when it comes to Depression and OCD?

Most psychiatrists would tell you that the "gold standard" antidepressant is imipramine.

Now I'm not a doctor (I just play one on TV), but that's a good one. I myself am fond of the MAOIs. No half measures, I say. If you don't have a risk of inducing mania then it ain't a good antidepressant. Bring back the Dexamyl capsules I say!

anfonelic acid. And yet, pretty much everyone who has used both will tell you that cocaine is much more euphoric.

I've heard some good things about AFA. And some bad things too, but more good than bad.

Also I would ascribe cocaine's euphoriant properties to more than exclusively DAT agonism, I think the NE and 5HT reuptake inhibition plays a big part too.

Actually, the rumor on the playground is that strictly dopaminergic compounds are less "fun"...seems to me that selectively activating nothing but the reward salience circuitry in the brain might be a bad thing. Imagine a drug that had nothing but moreish effects, that is, the only effect is it makes you want to do more. Nasty.
 
No half measures, I say. If you don't have a risk of inducing mania then it ain't a good antidepressant.
That. Is what I miss in AD research and part of what I like on dissociatives, they shift your mood towards mania and with the right dosages it's sustainable for amazingly long time as long as I continue to use the energy to feed the reward. Good example would be social contacts, doing things etc. Bad one to use straight dopaminergics, this works too for some time but begins to feel pale and yeah, real full on mania isnt exactly fun. Hypomania is what shines.

A skin rash was the only real reaction I got from AFA. Don't remember doses and time but was only a few times low doses so maybe if you don't get that reaction it can be fun..

Thought about the same, regarding a purely reinforcing compound and that selective activation of DA sounds much like that.. Indeed, might be true but guess its about moderation too. Too little DA certainly is dysphoric, some is actually euphoric and loads tend to induce mania or psychosis and feel emotionally flat.

Read somewhere in a paper that dopamine acts as a "safety net" for glutamate, limiting it's output. Afair it was about tardive dyskinesia but has interesting implications for other topics as DA agonism together with some NMDA antagonism is actually fun. As I never got to try a selective NMDAI like dizocilpine not sure here but e.g. tiletamine is described as being cold and clinical. Also pure DA agonists afaik have some heavy negative effects initially like being anxiogenic, which memantine (a balanced NMDAI and DA) certainly isn't.

But after all to me, it's nicotine which fits most under the description of something purely reinforcing - it has some minor positive effects, some nasty reactions when taking too much but with e-cigs w/o the MAOIs etc. I vaped and vaped some times just to hit overdose. With time and tolerance this doesnt happen anymore but still e-cigs are easy to quit for me because somehow I just smoke them to well, to smoke them. No other effects than a withdrawal and relief of that.
 
Actually, the rumor on the playground is that strictly dopaminergic compounds are less "fun"...seems to me that selectively activating nothing but the reward salience circuitry in the brain might be a bad thing. Imagine a drug that had nothing but moreish effects, that is, the only effect is it makes you want to do more. Nasty.

Introduce yourself to EMSAM
 
I made bad experiences with just 5mg of selegilin, increased tension and impulsivity leading to a police contact and legal percussions after some dumbass attacked me without reason. I'm not completely sure whether it wasn't coincidence but I certainly over-reacted much more than I should and would have in other situations ... enough not to continue. Still as the patch appears to be effective and offer different kinetics, hmm..
 
Is emsam/selegiline not a MAO-BI? So not 100% dopamine selective, just heavily biased as such?
 
I mean for the EMSAM patch they tell you to get on the diet on 6mg but it's only actually necessary when on 9mg/12mg--at which dose it's somewhat active on MAO-A. Ime there was no need for a diet, I'd just get a minor rush from soy sauce sometimes and the like. This was being on an oral MAOI too.
 
Yeah, it's said to loose the selectivity at afaik over 10mg orally. Thought though that they say with emsam that it's able to hit mao a without the need for diet, strangely?

@AlphaMethylPhenyl interesting, your reaction with soy sauce which must be one of the worst foods to take together with a maoi - did you measure blood pressure? With moclobemide, the reversible maoa-i (which was weird. Didnt feel any benefits from 600mg/d but cognitively limited not unlike pregabalin w/o the sedation or positive things) Id get heavy hypertension from experimental d-amph in just 1-2mg..

If a skin rash is all you get maybe I should try tranylcypromine..

So you combined emsam with an oral maoi too?
 
I originally was supplementing EMSAM with oral phenethylamine, which is just wrong and very dangerous. I stopped that after two weeks. I slowly added some foods like soy sauce. I was very careful about it until I didn't need to watch my diet. This is not recommended at all, though. I was being reckless.
 
Now I'm not a doctor (I just play one on TV), but that's a good one. I myself am fond of the MAOIs. No half measures, I say. If you don't have a risk of inducing mania then it ain't a good antidepressant. Bring back the Dexamyl capsules I say!

You are right. The non-selective, irreversible MAOIs are the only antidepressants ever created that are significantly more effective than placebo for the treatment of severe endogenous depression. SSRIs tend to make serious depression worse, as agonism of the 5-HTC2C receptors tends to decrease central dopaminergic tonus. There is a psychiatrist with over 30 years of experience in treating severe depression who stated that tranylcypromine and phenelzine are the only "true" antidepressants and that everything else is worthless for people that are tuly epressed. He is also a brilliant pharmacologist who discovered that methylene blue is a MAOI. He even elucidated the precise mechanism, which involves competitive inhibition of MAO-A at the serine residue of the protein.

Dr.Gillman believes that "true" antidepressants are essentially catecholaminergic, as the primary features of depression are anergia and anhedonia. "True" antidepressants raise norepinephrine and/or dopamine, especially dopamine, without which true remission is unlikely.

e heard some good things about AFA. And some bad things too, but more good than bad.

Amfonelic acid is a very potent DRI with low picomolar affinity for the protein. But it's slow rate of inhibition leads to a slower increase in extracellular dopamine which makes it less euphoric. Or so the pharmacological theory goes.

Also I would ascribe cocaine's euphoriant properties to more than exclusively DAT agonism, I think the NE and 5HT reuptake inhibition plays a big part too.

What makes cocaine so euphoric is not only affinity for the transporter, but also the manner that cocaine inhibits DAt. cocaine locks to DAT very tightly in the open forward configuration by inhibiting DAT's hydrogen bond. That is a tremendously effective way of stopping the protein from doing it's job. So even though most of cocaine enanthiomers have an affinity around 200 nmol for DAt, which is considered to be pretty weak, cocaine is still a brutally effective dopamine reuptake inhibitor.

And you are right that DRI by itself does not feel as good as when it is combined with SRI and NRI. I was taking amineptine, which is more-or-less pure and potent DRI, with IC50 in humans around 400 nmol, and it felt awesome. Your heart pounds, you are invaded by feelings of exhilaration and sexual thoughts, etc. But it also makes you agitated and restless, and even though it increases your positive feelings a lot, it does not decrease your negative feelings much. When I combined it with S-citalopram, a week latter I was feelings happier than I've ever felt in my life. Just this euphoric feelings with no worries whatsoever. There is no question that cocaine being a triple reuptake inhibitor makes it more rewarding than pure DRIs. The same goes for meth: it is more additive than amphetamine, in part, because it also releases serotonin. Meth is actually only 2 X as potent as amphetamine, but it is much more addictive.

[ctually, the rumor on the playground is that strictly dopaminergic compounds are less "fun"...seems to me that selectively activating nothing but the reward salience circuitry in the brain might be a bad thing. Imagine a drug that had nothing but moreish effects, that is, the only effect is it makes you want to do more. Nasty.

You have just described methylphenidate and amineptine. Yeah, the only thing you get from these two ugly beasts is a desire to do more. And yes, I am addicted to this shit and I haven't found a solution to it. The only thing that goes through my mind when I quit is just how much more fun I would be having if I were under the influence.
 
Is emsam/selegiline not a MAO-BI? So not 100% dopamine selective, just heavily biased as such?

No. Emsam is a selegiline patch that allows a much higher amount of deprenyl to be delivered to the brain than you get from the typical oral dosage of 10 mg. That allows it to inhibit both MAO-A and MAO-B in the brain without inhibiting MAO-A in the gut, so you don't have to restrict tyramine ingestion. Basically, the 6 mg patch inhibits brain MAO-A to a degree comparable to an oral 60 mg dose, but without inhibiting gut MAO-A.

They are also working on a patch version of rasagiline, but rasagiline is a particularly nasty and potent MAOI at high doses which creates some serious issues.
 
Clomipramine is a stronger reuptake inhibitor of serotonin, but that is not the same as saying that it is a better antidepressant than imipramine. The latter has a lot of functions besides inhibiting serotonin and norepinephrine reuptake, like stimulating monoamine receptors and effects on the opioidergic systems.

Also, affinity is not the same as potency. Affinity is just a general indicator of potency, but half inhibitory maximum is a much better indicator of potency. The reason why IC50 is generally not used much is because it requires you to know the experimental conditions, like substrate concentration. So it is difficult to compare drugs using this measure. Affinity is much more universal, which is why it is used. But affinity is a poor measure of potency. For instance cocaine is nothing special when it comes to affinity to the dopamine transporter compared to, say, anfonelic acid. And yet, pretty much everyone who has used both will tell you that cocaine is much more euphoric. That is because cocaine inhibits DAT in the open forward conformation by inhibiting DATs hydrogen bond, which is a particulary effective way of stopping DAT from doing it's job. As another example, moclobemide, the RIMA used to treat depression, has an insignificant affinity for MAO of 200 Um. That is so weak that it is considered insignificant. And yet, moclobemide is effective at inhibiting MAO-A. We know that it is because moclobemide when combined with SSRIs induce severe serotonin syndrome. If it were not effective, then it wouldn't induce ST when combined with therapeutic doses of SSRIs.

There are many, many factors that determine how potent a drug is besides just affinity, such as: resistance to hydrolysis by hydrochloric acid in the stomach, absorption through the G.I tract, degree of first by-pass metabolism in the liver, whether it induces or inhibits liver enzymes and what type, level of protein plasma binding in blood, and binding profile to the receptor or enzyme that it targets. In general, orally active potent drugs tend to be small molecules of a non-polar chemical configuration, with low degree of first by-pass metabolism, relatively low protein plasma binding and low nanomolar affinity for the target. Examples would be tghe SSRI escitalopram and the MAOI, rasagiline. Being lipophilic is also important as most cells have lipid layers, and crossing them is important for a molecule to reach it's target site.
What is Doctor Gillman's take on Clomipramine, Amitriptyline and Imipramine? ;=)
 
A good one for depression and sever anger issues, is escitalopram, I use to be very angry all the time, truly felt like my anger came from deep within my soul. I would get so pissed off over the smallest most unimportant shit, all the time.
Escitalopram is used to treat anxiety in adults, also used to treat major depressive disorder in adults.
Now I couldn't give a shit, lol
 
Opposite was true for me, I have severe PTSD with anxiety and impulse control / anger issues about certain things (when people do stupid things to me which feel just wrong for example..) and the citaloprams exacrebated this. DXM is the only S/NRI which actually calms me down without sedating.
 
What is Doctor Gillman's take on Clomipramine, Amitriptyline and Imipramine? ;=)

His take is that clomipramine is a genuine NSRI, and that amitriptyline is an SRI, but not a true SNRI. He hasn't spoken much on imipramine. My impression is that he considers imipramine to be a genuine NSRI just like clomipramine, albeit a weaker one. The advantage of imipramine is that there is some evidence that it increases the synthesis and release of endogenous opiates, which makes it very powerful for treatment resistant depression. Of course, all tricyclics have some affinity for Mu opioid receptors, which is what, in part, makes them more effective than SSRIs(the other reason they are more effective is muscarinic receptor antagonism).
 
A good one for depression and sever anger issues, is escitalopram, I use to be very angry all the time, truly felt like my anger came from deep within my soul. I would get so pissed off over the smallest most unimportant shit, all the time.
Escitalopram is used to treat anxiety in adults, also used to treat major depressive disorder in adults.
Now I couldn't give a shit, lol

S-citalopram is, honestly, the best anxiolytic I have ever taken. It is as good or better than clonazepam, but without the brutal hangovers. But as an antidepressant it is not very effective, unless your "depression" is mostly severe anxiety and angsty feelings. (S)citalopram is not very good to lift melancholia.

Of course, all SSRIs have this problem: somewhat effective as anxiolytics, but not very effective at lifting truly depressed mood. The only SSRI that has ever shown any effectiveness at treating severe melancholic depression is paroxetine. And I suspect that has more to do with it's anti-muscarinic effect than it's SSRI ability. Of course, paroxetine is a very powerful SRI, much more potent than the other SSRIs and almost as potent as clomipramine. The extreme potency at inhibiting serotonin reuptake coupled with it's muscarinic receptor antagonism probably explains it's superior effectiveness for serious depression. I actually took paroxetine as a teenager for severe social anxiety, and while it made my shyness go away, it make me feel sleepy and grogged out all day long. And after about a couple weeks, I felt like I had no emotion at all. No anger, or joy, or sadness, or anxiety. I became a robot basically. It is a nasty drug, and probably the only SSRI that should be reserved for serious depression and prescribed only as a second or third-like treatment for depression.
 
I've been reading the following articles:
https://psychotropical.info/clomipramine-potent-snri-anti-depressant/
https://psychotropical.info/tca-intro/
https://psychotropical.info/snri-intro/

Seems to be a pretty potent drug: SNRI, antagonist of the alpha1-adrenergic receptor, the histamine H1 receptor, the serotonin 5-HT2A, 5-HT2C receptors, the dopamine D1, D2, and D3 receptors, and the muscarinic acetylcholine receptors. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system; so that speaks for itself.

The reviews on drugs.com and other sites also are quite positive.

The following ranking is interesting: http://slatestarcodex.com/2015/04/30/prescriptions-paradoxes-and-perversities/

These numbers are based on aggregated patient ratings. Top 4 drugs:
# Nardil 1.25
# Parnate 1.23
# Chlomipramine 1.22
# Emsam/selegeline 1.07

=> Clomipramine roughly on pair with MAOI, followed by Nefazodone (R.I.P) and Imipramine. Imipramine is also a potent SNRI, but lacks the strong 5HT-antagonism compared to Clomipramine. I suppose that's the pharmacological difference which makes Clomipramine superior... ?

Clomipramine exhibits some antagonism of dopamine D1, D2 and D3 receptors... can one expect some clinical & therapeutic benefits from this?

Clomipramine acts as a functional (potent!) inhibitor of acid sphingomyelinase (FIASMA): http://en.wikipedia.org/wiki/FIASMA
Some interesting graphs regarding antidepressant FIASMAs: http://d-nb.info/1011278227/34

Who here has been on Clomipramine and what were your experiences with it?

I believe SSRI/SNRI's are considered the gold standard for depression (by doctors).
 
Personally, I think Amphetamine Sulphate is the miracle drug for depression AND for weightloss/obesity....but you know, psychosis/heart attack. There were a lot of very slim, very happy, psychotic, housewives in the 50's-70's
Or opioids.
 
is as good or better than clonazepam, but without the brutal hangovers
Yeah no hangover, but. After about 4 to 5 days without them, I get some crazy electrical shock feelings in my brain. It's actually pretty horrible, feels like a hundred barbeque ignitors going off randomly all over my brain...
 
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