Posted by SLS on February 12, 2005, at 11:58:20
In reply to Re: need TCA advice » linkadge, posted by SLS on February 12, 2005, at 10:57:45
I forgot to mention to those who are not familiar with tricyclic antidepressants (TCA) that amitripyline is converted to nortriptyline in the body. Nortripyline is an active metabolite of amitriptyline that produces milder side effects while retaining much of the therapeutic benefit of the parent compound.
Drugs like imipramine and amitripyline are considered to be tertiary tricyclics while their metabolites, desipramine and nortriptyline respectively, are labelled secondary. The tertiary compounds exert a stronger anticholinergic side effect profile as well as being more serotonergic than the secondaries. They are sometimes considered to be more potent antidepressants. Tertiary versus secondary describes molecular structure. Most of the TCAs are tertiary. I believe protriptyline is the only other secondary TCA available as a medication. I don't know if it is derived from a tertiary compound and how its side effect profile might compare to one.
- Scott
> > Seeing psychiatrist soon. Going to push for a TCA trial.
> >
> > My problems are: Sleep, anxiety, depression, migrane.
> >
> > But. I would like to avoid amitryptaline if possable since am in university and having enought cognative problems as is.
> >
> > Can anyone who knows TCA's help me ??
> >
> > Linkadge
> >
>
>
> Perhaps nortriptyline should be your first choice. It might retain the anti-migraine properties of amitripyline while sparing you the antimuscarinic effects (both cognitive and peripheral) and the sedation/somnolence that most often accompanies amitriptyline.
>
> If your brain is medication-naive (a virgin) to nortripyline and amitripyline, you might experience sedation or somnolence at the beginning of nortriptyline treatment. This should pass withing a week or so. You might want to start it on a Friday night, and hope that any somnolence that might occur abates by Monday.
>
> Although lower dosages can be used for migraine, I would suggest making your initial target dosage of nortriptyline to be 75mg to treat depression. Wait 10-14 days after attaining this dosage and then test your blood levels. Of the TCAs, nortriptyline has been the most closely studied with regard to blood-levels and antidepressant response; the range being 50-150 ng/ml. You can see that with such a large range, the blood test should be used as a flexible guide rather than an absolute indication. Nortripyline is perhaps the only antidepressant that has a window of efficacy (as opposed to a therapeutic window). If you surpass your optimum dosage range (hopefully, you will have one), you can actually lose the antidepressant response. More is worse, not better. Either stick to the name brand Pamelor, or try to procure a generic for which the manufacturer remains the same when you fill your prescriptions.
>
>
> - Scott
poster:SLS
thread:456737
URL: http://www.dr-bob.org/babble/20050212/msgs/456771.html