Misc How dangerous is Amitriptyline?

[Man67]

I've been on 100mg Amitriptyline for a decade. It doesn’t work as antidepressant at all. It's off the label sleeping aid and I take it together with 20mg Zolpidem and 6mg Bromazepam. Just then I can have 4-5 hours of sleep (if I am lucky). Wanted to tapper it down but my Neurologist (who originally prescribed this poison) is strongly against it. Why?

 

[pharaoh]

I don't have any knowledge pertaining to the chemistry of the question but the conduct of your psychiatrist sounds sketchy. Could you possibly request to see a different one who might have better insight into how to help you?

 

[burn out]

I don't think it's super dangerous although it's not good for your heart. I would say those other two drugs are more dangerous, especially to your brain.

 

[Man67]

Maybe this is the answer: "You should know that your mental health may change in unexpected ways when you take amitriptyline or other antidepressants even if you are an adult over age 24. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased."

 

[Man67]

I don't have any knowledge pertaining to the chemistry of the question but the conduct of your psychiatrist sounds sketchy. Could you possibly request to see a different one who might have better insight into how to help you?

My psychiatrist is excellent guy and I've been seeing him for more than 20 years.

 

[snmfmy]

My psychiatrist is excellent guy and I've been seeing him for more than 20 years.

You're on a not small dose that you've been on for 10 years. It has a reasonable analgesic effect especially for neuropathic pain, so reducing it may cause you to experience pain that you don't even know you have.

It will disrupt your dopamine norepinephrine and serotonin balance because you're going to be going from antagonism of 5HT and D1 receptors and reuptake inhibition of norepinephrine and serotonin because it inhibits net and sert. Not to mention the alpha adrenergic action it's been having on your body.

 

[Man67]

You're on a not small dose that you've been on for 10 years. It has a reasonable analgesic effect especially for neuropathic pain, so reducing it may cause you to experience pain that you don't even know you have.

It will disrupt your dopamine norepinephrine and serotonin balance because you're going to be going from antagonism of 5HT and D1 receptors and reuptake inhibition of norepinephrine and serotonin because it inhibits net and sert. Not to mention the alpha adrenergic action it's been having on your body.

Does that mean that l am stuck with Amitriptyline for life?

 

[snmfmy]

Does that mean that l am stuck with Amitriptyline for life?

I wouldn't say that I would say that if you want to get off amitriptyline that you would slowly taper off, after consulting with your psychiatrist that you don't need it for any mental health.

 

[Man67]

I wouldn't say that I would say that if you want to get off amitriptyline that you would slowly taper off, after consulting with your psychiatrist that you don't need it for any mental health.

I've got TRD (treatment resistant depression) and beside Amitriptyline I also take Zoloft in the morning but it just doesn't work. Tried all the major antidepressants from each category all in vain.

 

[snmfmy]

I've got TRD (treatment resistant depression) and beside Amitriptyline I also take Zoloft in the morning but it just doesn't work. Tried all the major antidepressants from each category all in vain.

Ketamine. Astounding success with people that have TRD

 

[Man67]

Ketamine. Astounding success with people that have TRD

I heard about that. Unfortunately it's not subsidised by Medicare in Australia. Monthly treatment (2 times per week) is between $5000-6000. I don't have that money and basically only rich people can afford it.

 

[snmfmy]

I heard about that. Unfortunately it's not subsidised by Medicare in Australia. Monthly treatment (2 times per week) is between $5000-6000. I don't have that money and basically only rich people can afford it.

I
The link that I posted mentioned $800 for a prescription.

 

[LucidSDreamr]

I’ve been up to 75 and stopped cold turkey tons of times. Main withdrawl symptom and only one really was nausea and headache.

I am not aware of other dangers of stopping it but I would seek a second opinion from your doctor or just taper yourself off

 

[Man67]

I
The link that I posted mentioned $800 for a prescription.

Sorry l don't see any link. Are we talking about the same thing? Spravato - nasal spray.

Why low-cost ketamine is still inaccessible to many with severe depression

www.unsw.edu.au

 

[LucidSDreamr]

Ketamine. Astounding success with people that have TRD

What do you do when the week long alleged benefit wears off? Keep taking 10,000$ infusions of ketamine every week the rest of your life? Or does the depression stay gone permanently.

I don’t understand the end game of this ketamine therapy.

It was originally intended for ppl that were about to kill tjemselves and had tried everything else to jolt them out of the suicide track hopefully.

Now it’s a normal mainstream thing. Even being given to hardcore drug addicts like Matthew Perry.

I haven’t researched the outcomes and I don’t have. Clinical depression so I don’t understand it but the whole thing seems fishy like another money grab by plying people with big problems with hard narcotics like we saw with opioids being prescribed to drug addict and depressed ppl that had no injury or physical disease.

I don’t understand what the end game of casual ketamine therapy is in the non suicidal non-institutionalized patient.

I support everyone’s should be right to use whatever drug they want for whatever reason but a lot of ppl don’t make decisions on their own health or research anything they just do whatever their doctor says and that doctor (in the US) is driven by profits not positive outcomes.

 

[snmfmy]

Sorry l don't see any link. Are we talking about the same thing? Spravato - nasal spray.

Why low-cost ketamine is still inaccessible to many with severe depression

www.unsw.edu.au

Sorry I thought I posted it.

Australian psychiatrists push for Medicare to subsidise ketamine for treatment-resistant depression

Application for subsidy follows results of a groundbreaking study into severe depression

www.google.com

They detail of generic subcutaneous injection version of ketamine that a study shows works just as well. Instead of $800 a dose, it's 1150 for an entire treatment regimen.

 

[Man67]

Sorry I thought I posted it.

Australian psychiatrists push for Medicare to subsidise ketamine for treatment-resistant depression

Application for subsidy follows results of a groundbreaking study into severe depression

www.google.com

They detail of generic subcutaneous injection version of ketamine that a study shows works just as well. Instead of $800 a dose, it's 1150 for an entire treatment regimen.

That's correct. But Medicare refused to subsidise it (3rd time) .

 

[snmfmy]

What do you do when the week long alleged benefit wears off? Keep taking 10,000$ infusions of ketamine every week the rest of your life? Or does the depression stay gone permanently.

I don’t understand the end game of this ketamine therapy.

It was originally intended for ppl that were about to kill tjemselves and had tried everything else to jolt them out of the suicide track hopefully.

Now it’s a normal mainstream thing. Even being given to hardcore drug addicts like Matthew Perry.

I haven’t researched the outcomes and I don’t have. Clinical depression so I don’t understand it but the whole thing seems fishy like another money grab by plying people with big problems with hard narcotics like we saw with opioids being prescribed to drug addict and depressed ppl that had no injury or physical disease.

I don’t understand what the end game of casual ketamine therapy is in the non suicidal non-institutionalized patient.

I support everyone’s should be right to use whatever drug they want for whatever reason but a lot of ppl don’t make decisions on their own health or research anything they just do whatever their doctor says and that doctor (in the US) is driven by profits not positive outcomes.

The end game of the ketamine therapy is morphological changes in NMDA and other receptors that disrupt the physical neural pathways and associated negative engrams that have precipitated and been reinforced by the severely depressed mind state.

Ketamine produces a profound and long-lasting neuroplasticity after infusion or consumption. This can allow morphological changes that can act as prophylaxis against future depressive states.

Rapid neuroplasticity changes and response to intravenous ketamine: a randomized controlled trial in treatment-resistant depression - Translational Psychiatry

Intravenous ketamine is posited to rapidly reverse depression by rapidly enhancing neuroplasticity. In human patients, we quantified gray matter microstructural changes on a rapid (24-h) timescale within key regions where neuroplasticity enhancements post-ketamine have been implicated in animal...

www.nature.com

So they want to actually rewire the brain of treatment resistant depressed patients with ketamine co-administered (Not at the same time) pharmacological and cognitive therapy treatments.

 

[snmfmy]

I support everyone’s should be right to use whatever drug they want for whatever reason but a lot of ppl don’t make decisions on their own health or research anything they just do whatever their doctor says and that doctor (in the US) is driven by profits not positive outcomes.

Well, I'd beg to differ with your statement that doctors in the US are driven by profits and not positive outcomes.

Some doctors maybe, but any doctors that are in addiction medicine, family practice, general practitioners, and ones that take Medicare patients are in it because they love what they do and they genuinely care about the well-being of their patients.

I expect your cynicism with respect to medical professionals and doctors stems from unfortunate exposure to some of the more greedy doctors.

All you got to do is find a good one and I've never had a problem with that.

In the US a doctor can actually prescribe you ketamine off label, administer it to you for whatever reason they deem in their opinion medically necessary, and there's not much anybody can do about it.

Now if you somehow were injured or died from that administration then They could potentially face some negative consequences. However, if everything proceeds just fine there's literally nothing the authorities can do to stop them.

The main impediment to the use of off label medications today is the malpractice Sue-happy environment in the United States making many doctors fearful of being sued if they help a patient through off label drug administration.

I mean just look at gabapentin. It's only on label uses are as an anti-convulsant for epilepticseizures and for post herpetic neuralgia.

Yet it's prescribed in the millions for diabetic neuropathy, reduction of alcohol, cravings, reduction of stimulant abuse disorder, cravings, and a bunch of others.

One of the real easy ways to figure out if your doctor is in it for the money or in it for you is if they prescribe a brand named drug that has a generic equivalent, or if they prescribe that generic.

Doctors don't get kickbacks for generics.

 

[Man67]

The end game of the ketamine therapy is morphological changes in NMDA and other receptors that disrupt the physical neural pathways and associated negative engrams that have precipitated and been reinforced by the severely depressed mind state.

Ketamine produces a profound and long-lasting neuroplasticity after infusion or consumption. This can allow morphological changes that can act as prophylaxis against future depressive states.

Rapid neuroplasticity changes and response to intravenous ketamine: a randomized controlled trial in treatment-resistant depression - Translational Psychiatry

Intravenous ketamine is posited to rapidly reverse depression by rapidly enhancing neuroplasticity. In human patients, we quantified gray matter microstructural changes on a rapid (24-h) timescale within key regions where neuroplasticity enhancements post-ketamine have been implicated in animal...

www.nature.com

So they want to actually rewire the brain of treatment resistant depressed patients with ketamine co-administered (Not at the same time) pharmacological and cognitive therapy treatments.

We are talking about Spravato nasal spray, right?