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Mental Health Tricyclics for Depression

Rybee

Bluelighter
Joined
May 29, 2013
Messages
1,305
Hey BL,

Soon, I should be going back on Tricyclics, though most probably either Amitrip or Nortrip instead of Dosulepin/Dothiepin, for neuropathic pain control. I do suffer from depression (MDD) and have used Citalopram/Fluoxetine/Venlafaxine/Duloxetine/Agomelatine in the past to try and ease it, but with little to no improvement in my mood. However, I do find SSRI/SNRIs to be quite sedating, so my anxiety always subsided which was quite nice.

Alternatively, I do actually have the choice to go onto anticonvulsants such as Sodium Valproate/Verapamil/Valproic Acid for migraine prophylaxis instead of Tricyclics, because they demonstrate pretty good efficacy with fewer side effects. However, I'm edging towards Tricyclics because my mood has been very low lately, so I'm pondering over the possibility of killing two birds with one pill.

So I was wondering... Does anybody actually still use any of the Tricyclics or Tetracyclics to 'treat' their depression, over the newer generation of SSRI/SNRI/Atypical Antidepressants?

I was on Dosulepin/Dothiepin for ~6 months for neuropathic sciatic nerve pain and it appeared to be pretty effective for that so I find that quite encouraging. I'm just curious as to their anti-depressant efficacy.

Please do share your experiences, particularly if you could help me choose between Amitrip and Nortrip, since my mind on this is still not made up. Both seem to have their pro's and con's... see my other thread on that here.

Rybee x
 
I have been on amitriptyline and trimipramine for bipolar depression as well to help my nerve pain I don't get along well at all with the newer SNRI's but the tricyclics actually worked. so it's worth a shot
 
I´m amazed how your doctors confirmed your bipolar depression. They could have said something different.
I believe you had a great diagnosis and now it enables you to have that treated.
 
I was on Amitriptyline for depression and severe GAD for a couple of weeks, and it was the worst medication I have ever been on, but different meds work for different people, obviously. Just because I had a bad experience with it, does not mean you will.

Before I started taking it, I spoke to a pharmacist that is close friends with one of my parents and they said it has been found to be pretty effective in treating Anxiety/Anxiety related disorders, but isn't very effective in treating depression. I can see how that would be the case, as it made me more depressed than I ever have been. Unlike SSRI's and SNRI's that make me feel like a zombie and induce episodic DP and chronic DR, it just made me horribly sad and lethargic all of the time. Not the kind of sadness that makes you upset, but more of a sadness that makes everything seem meaningless and dark. I eventually got off of it due to suicide contemplation.

I quit it cold turkey and had some pretty nasty psychological WD's, but they only lasted a couple of days. Constant panic attacks that Benzo's could not take care of. In fact, the only thing that seemed to get rid of them was hydrocodone, strangely enough. I guess it gave me that warm content feeling and seemed to desensitize me to my anxiety problems.

Best of luck to you, though! I hope they work.
 
I have been on Anafranil in the past. It blew the snris and ssris straight out of the water. I felt it taking effect almost immediately, and I was on a fairly low dose of 25mg I believe. I've been on the psyche merry-go-round in the past, and have been on just about any antidepressant, mood stabilizer, and benzo you can imagine, and this was the one med I found effective, and it was extremely effective. I've been off for years all meds, but if I were to go back, it would be to Anafranil.
 
I have imipramine, clomipramine, and amitriptyline here, as well as chemically related antipsychotic chlorpromazine.

Imo imipramine is not strong enough and clomipramine is too serotonergic. Amitriptyline is probably the better one of the 3 compounds.

Be careful not to OD though.
 
Thanks for all the replies guys, I'll try and keep it short and sweet.

I've just been on 25mg this week, looking to increase that to 50mg as of tomorrow.

I was on Amitriptyline for depression and severe GAD for a couple of weeks, and it was the worst medication I have ever been on, but different meds work for different people, obviously. Just because I had a bad experience with it, does not mean you will.

Why do you say that it's was the worst medication you've taken? That's the one thing putting me off from taking them. I last took Amitrityline 10 years ago when I was 15 for daily chronic migraine and I just couldn't tolerate it at all. Though it it was possibly an age thing though, I guess that between 15-25y/o is where most of my mental and physical health is kicking in, changing and adapting.

Before I started taking it, I spoke to a pharmacist that is close friends with one of my parents and they said it has been found to be pretty effective in treating Anxiety/Anxiety related disorders, but isn't very effective in treating depression. I can see how that would be the case, as it made me more depressed than I ever have been. Unlike SSRI's and SNRI's that make me feel like a zombie and induce episodic DP and chronic DR, it just made me horribly sad and lethargic all of the time. Not the kind of sadness that makes you upset, but more of a sadness that makes everything seem meaningless and dark. I eventually got off of it due to suicide contemplation.
obviously not a neurologist or pharmacist but I do agree. My list is pretty short compared to others but I've gone to my GP in the bast with depression & anxiety and they've given me 60mg Citalopram, 80mg Fluoxtine, 450 Venlafaxine, 120mg Duloxetine, and 40mg Agomelatine. Whilst I do feel they helped with my anxiety, I don't ever think that they did anything for my 'depression'. The doctors just anaesthetised me with "anti-depressants" to the point I was so dis coordinated and sedated that when I went in for a review, they'd clap their hands and say what a miracle it was... Not hard to achieve huh? Funnily enough, I never felt any of the mediations have an impact of my depression either.

Best of luck to you, though! I hope they work.
Thanks buddy, something has to!



And as for the 'A-typical' choices below:

I have been on Anafranil in the past. It blew the snris and ssris straight out of the water. I felt it taking effect almost immediately, and I was on a fairly low dose of 25mg I believe. I've been on the psyche merry-go-round in the past, and have been on just about any antidepressant, mood stabilizer, and benzo you can imagine, and this was the one med I found effective, and it was extremely effective. I've been off for years all meds, but if I were to go back, it would be to Anafranil.
I have imipramine, clomipramine, and amitriptyline here, as well as chemically related antipsychotic chlorpromazine.

Imo imipramine is not strong enough and clomipramine is too serotonergic. Amitriptyline is probably the better one of the 3 compounds.

Be careful not to OD though.

I'm actually tolerating Amitriptyline quite well, apart from some sleepy mornings so I plan on upping my dosage from 25mg to 50mg tomorrow night.

If it works for the pain, I'll be chuffed, if a higher dose helps ease the depression, well that's just the icing on the cake really :)
 
Well as per my above post I was put on 25mg Amitriptyline for my chronic daily migraines, and miraculously, today is the first day in 8 weeks that I have not had a migraine or felt nauseous!

I know that Tricyclics can take ~3-6 weeks to alleviate symptoms of depression, with greatest efficacy peaking at 4-6 months, but I can't actually find out how long they usually take to work for neuropathic pain? I'm just incredibly sceptical that after 8 weeks of severe pain and constant nausea day after day after day - that just 9 days use of a low dose Tricylcic can be so effective?

As I had envisaged, the side effects have been awful. I've been asleep for ~14 hours of the day every day, and do feel very zoned out and have very little motivation to get on with anything in life. I've never tolerated Tricylics very well but I hope I can shake this off and acclimatise to them better. If I can get them to settle to a point in which I can actually function properly, then I'd seriously consider slowly titrating up my dose to try and help with my current bout of depression as that's been really troubling me lately. Though its use for alleviating depression seems to be dosed at 75mg-125mg, significantly higher than my current 25mg dose - so it concerns me whether I could tolerate that kind of dose?

I don't know... I'm shocked that enduring severe pain and nausea for 8 weeks can be completely alleviated by just 9 days use of 25mg Amitriptyline?

Thoughts, anyone?
 
Oh also, what's the best time of day to take it to tolerate the next-day fatigue/drowsiness? Most medical advice literature generically says 'take before bedtime', but I'm thinking that if I take it 3/4 hours earlier, such as 6PM, then I might wake up a little less drowsy.

Whilst it does make me drowsy the next day, it doesn't make me feel at all drowsy after taking it, would taking it in the morning/lunchtime be better in my case? I've read that some patients split their doses throughout the day?

Last question... promise! I know it may be hard to judge, but in terms of neuropathic pain relief, what dose of Amitriptyline is equipotent to 75mg of Dosulepin?
 
Oh also, what's the best time of day to take it to tolerate the next-day fatigue/drowsiness? Most medical advice literature generically says 'take before bedtime', but I'm thinking that if I take it 3/4 hours earlier, such as 6PM, then I might wake up a little less drowsy.

Whilst it does make me drowsy the next day, it doesn't make me feel at all drowsy after taking it, would taking it in the morning/lunchtime be better in my case? I've read that some patients split their doses throughout the day?

Last question... promise! I know it may be hard to judge, but in terms of neuropathic pain relief, what dose of Amitriptyline is equipotent to 75mg of Dosulepin?

Considering that it is supposed to last 24 hours, and doesn't really have "peak" but more of a flat line, I don't know that taking it any earlier would really make a difference. It's supposed to take about two hours before it takes effect, so if you don't feel drowsy after taking it, it might be that it doesn't kick in until after you're already asleep.
 
I´m amazed how your doctors confirmed your bipolar depression. They could have said something different.
I believe you had a great diagnosis and now it enables you to have that treated.

I was originally diagnosed with unipolar Major depressive disorder but a psychiatrist noticed that i had mod swings as well as mixed states and highs not consistent with unipolar depression. I was diagnosed Bipolar NOS and had seroquel and eventually Divalproex aka depakote aka Epival added to it. Eventually my doc wanted to try me on Wellbutrin after the Amitriptyline stopped working so i stopped taking the Amitriptyline at the max dose of 150mg's a day cold turkey with no wd symptoms thankfully.

The Seroquel and Wellbutrin worked ptretty good but the Epival didnt do shit so i switched to Lamictal eventually which works well.
 
Just like to say thanks very much to all who've contributed to this thread. I'm getting on quite well with Amitriptyline now.
 
Just like to say thanks very much to all who've contributed to this thread. I'm getting on quite well with Amitriptyline now.

Glad the Amitriptyline is getting along good with you. Drink plenty of water with it as the dry mouth can be a killer on the teeth and it can cause constipation due to it's anti-cholinergic effects. So yeah drink more water then normal.
 
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