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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by ace on April 24, 2003, at 22:43:21
OK, it will now be Anafranil that replaces the Nardil.
Anafranil, besides the brilliant MAOIs, is known to be the most potent antidepressant (in addition to being THE anti-OCD med, and a derealization med, and a phobia med) - it does the job of the TCA's AND the SSRIs.
I feel very happy about this choice and it won't be changing. Period. For too long OCD has tormented me.
Ace.
Posted by Janelle on April 24, 2003, at 23:20:41
In reply to My mind has changed again - for the LAST time!, posted by ace on April 24, 2003, at 22:43:21
I hate to ask this, but I have not followed your saga so I have no idea if you have tried it or not - but what about Luvox? I believe it is an SSRI, but works on OCD far more than depression. I bet you have and it didn't work?
Anafranil, from what I have heard, is still the *gold standard* for OCD. I took it a long time ago for mild OCD tendencies; the only side effect I had from it way back was extreme sedation. I should have given it a longer trial and that s/e probably would have worn off, but I was young and impatient in those days!
Posted by McPac on April 24, 2003, at 23:41:54
In reply to My mind has changed again - for the LAST time!, posted by ace on April 24, 2003, at 22:43:21
Good choice Ace. I hope it works out well for you. Keep me posted about any side effects. I took it years ago. Take care my courageous and very brave OCD fighting comrade! I'm praying for you!
Posted by ace on April 24, 2003, at 23:45:02
In reply to Re: My mind has changed again - for the LAST time! » ace, posted by Janelle on April 24, 2003, at 23:20:41
> I hate to ask this, but I have not followed your saga so I have no idea if you have tried it or not - but what about Luvox? I believe it is an SSRI, but works on OCD far more than depression. I bet you have and it didn't work?
Thanks for the reply Jen.
To answer your qstn I tried Luvox fro 2 days but had very bad insomnia. Of course I could have tried it at morning, but at that time I needed to get back to uni and couldn't screw around. I tried Zoloft for a long time - it did little for anything. To be honest I have little faith in newer drugs. I love the old faithfuls! But I must say I have heard of good responses to Luvox.
But after critical reading I've done (and I mean thousands of pages and many placebo controlled trials) i've seen Anafranil CONSISTENTLY comes out on top - much better than any SSRI. Of course some trials don't say this, but the VAST majority do. Most people choose SSRIs cause of s/effects, but s/effects hardly ever worry me.> Anafranil, from what I have heard, is still the *gold standard* for OCD. I took it a long time ago for mild OCD tendencies; the only side effect I had from it way back was extreme sedation. I should have given it a longer trial and that s/e probably would have worn off, but I was young and impatient in those days!
What are you on now? Also can I ask how Anafranil affected your sleep. For me, when I tried before (only very short term ie 2 days) it put me to sleep very quickly, but at about 4am, during REM sleep, I awoke suddenly. I am going to post a question about this, but did you notice anything like that?
Once again, thanks for your reply and take care!Ace.
Posted by ace on April 24, 2003, at 23:46:15
In reply to Re: My mind has changed again - for the LAST time!, posted by McPac on April 24, 2003, at 23:41:54
Posted by Jack Smith on April 25, 2003, at 12:31:48
In reply to My mind has changed again - for the LAST time!, posted by ace on April 24, 2003, at 22:43:21
> Anafranil, besides the brilliant MAOIs, is known to be the most potent antidepressant (in addition to being THE anti-OCD med, and a derealization med, and a phobia med) - it does the job of the TCA's AND the SSRIs.
I know it is supposed to be great for OCD but I have heard nothing about it being the most potent AD besides the MAOI's. Can anyone back this up with either personal experience or clinical evidence?
Posted by Janelle on April 25, 2003, at 12:50:58
In reply to Re: My mind has changed again - for the LAST time! » Janelle, posted by ace on April 24, 2003, at 23:45:02
Interesting response to Luvox that you had - Insomnia - for me it was the opposite - I could hardly stay awake on it; had to take it at night. Hated it. Didn't help OCD stuff one cotton pickin' bit!
FWIW I had also tried Zoloft for a long time - it did little for anything - I got to a plateau and didn't continue to improve from there.
Anafranil is still the GOLD STANDARD for OCD, even more than the so-called *new and improved* SSRI's because of their reduced s/e profiles.
I am not on anything right now specifically for OCD because mine is driven by depression and anxiety, so I'm on meds for those two things and mood stabilization.
I am so sorry that I cannot be of much help with how Anafranil affected my sleep because it was so long ago that I took it, I took it for such a short time (few days) that I don't remember! My memory is shot from one of my current meds, although I doubt I'd recall even if it was still in-tact!
What I do remember is taking the Anafranil in the morning and feeling very, very drowsy and sleepy all day. I probably did not sleep well at night. Should have switched it to pm, but was impatient back then and just got off it and onto Zoloft if I recall!
Sorry can't be more informative, but you have raised a good question!
take care,
Janelle
Posted by McPac on April 25, 2003, at 13:23:15
In reply to Re: My mind has changed again - for the LAST time! » Janelle, posted by ace on April 24, 2003, at 23:45:02
"Also can I ask how Anafranil affected your sleep. For me, when I tried before (only very short term ie 2 days) it put me to sleep very quickly,
...but at about 4am, during REM sleep, I awoke suddenly. I am going to post a question about this, but did you notice anything like that?"
>>>>>>>>Ace, that is EXACTLY what Anafranil did to me! I'd wake up suddenly, wide-eyed at 3 or 4 a.m.....if that happens again to you take a LOW-DOSE Remeron (7.5 mg)...AWESOME for my terrible insomnia!
Posted by zeugma on April 25, 2003, at 13:47:36
In reply to Anafrinil--most potent AD?????, posted by Jack Smith on April 25, 2003, at 12:31:48
> > Anafranil, besides the brilliant MAOIs, is known to be the most potent antidepressant (in addition to being THE anti-OCD med, and a derealization med, and a phobia med) - it does the job of the TCA's AND the SSRIs.
>
> I know it is supposed to be great for OCD but I have heard nothing about it being the most potent AD besides the MAOI's. Can anyone back this up with either personal experience or clinical evidence?\Anafranil is a very powerful 5-HT reuptake inhibitor, more powerful than most SSRI's. Its metabolite desmethylclomipramine is a secondary amine tricyclic, which means it's a powerful norepinephrine reuptake inhibitor. So it's actually a dual reuptake inhibitor, like Effexor, except that Anafranil is significantly more potent at each reuptake site. Check out this table: http://www.preskorn.com/books/ssri_s3.html#tab3-8 for comparison of clomipramine and desmethylclomipramine with SSRI's and their metabolites. Despite the fact that the most established mechanisms for antidepressant activity are 5-HT and NE reuptake inhibition, the drug that combines these mechanisms most powerfully is not licensed as an antidepressant, but an OCD treatment. I think that is the best illustration possible of the role that the accidents of marketing have played in the development and deployment of AD's.
Posted by Jack Smith on April 25, 2003, at 14:50:37
In reply to Re: Anafrinil--most potent AD?????, posted by zeugma on April 25, 2003, at 13:47:36
>
> Anafranil is a very powerful 5-HT reuptake inhibitor, more powerful than most SSRI's. Its metabolite desmethylclomipramine is a secondary amine tricyclic, which means it's a powerful norepinephrine reuptake inhibitor. So it's actually a dual reuptake inhibitor, like Effexor, except that Anafranil is significantly more potent at each reuptake site. Check out this table: http://www.preskorn.com/books/ssri_s3.html#tab3-8 for comparison of clomipramine and desmethylclomipramine with SSRI's and their metabolites. Despite the fact that the most established mechanisms for antidepressant activity are 5-HT and NE reuptake inhibition, the drug that combines these mechanisms most powerfully is not licensed as an antidepressant, but an OCD treatment. I think that is the best illustration possible of the role that the accidents of marketing have played in the development and deployment of AD's.
>Interesting. So, if it is stronger than effexor, and I suppose it is stronger than duloxetine, you would think it would be used more often. Side Effects of sedation, I guess, turn people off. By the way, it IS licensed for depression and also OCD.
Posted by McPac on April 25, 2003, at 15:46:48
In reply to Re: Anafrinil--most potent AD????? » zeugma, posted by Jack Smith on April 25, 2003, at 14:50:37
"which means it's a powerful norepinephrine reuptake inhibitor".
>>>>>>Doesn't that mean that it, in effect, INcreases the norepinephrine effect? And isn't norepinephrine like adrenaline (gets you going)? So, "IF" that is so then how come Anafranil 'oversedates' most people (it knocked me OUT!)
Posted by zeugma on April 25, 2003, at 16:11:13
In reply to Re: Anafrinil--most potent AD?????, posted by McPac on April 25, 2003, at 15:46:48
> "which means it's a powerful norepinephrine reuptake inhibitor".
>
> >>>>>>Doesn't that mean that it, in effect, INcreases the norepinephrine effect? And isn't norepinephrine like adrenaline (gets you going)? So, "IF" that is so then how come Anafranil 'oversedates' most people (it knocked me OUT!)The sedative effect of Anafranil comes from its antihistamine effect (Benadryl will do the same thing). The norepinephrine effect will essentially restore the noradrenergic system to relative balance, in the process causing stimulation, irritability, etc., as possible reactions. Clomipramine has still other actions, such as 5-HT2A antagonism, which can calm one down, so it's a complex drug, and can energize people through one pharmacological route while sedating them through another.
This is doubtless the reason why Effexor has been more widely used even though it's 'weaker.' The drug developers are trying to simplify the pharmacologies of the drugs so desired effects aren't balanced out by undesired ones. That's the theory, but I don't think it works exactly that way in practice. And it's also the case that the line between 'desired' and 'undesired' effects isn't always as clear to the person who takes the drug as it is to the drug company or prescriber.
Posted by michael73 on April 27, 2003, at 19:43:04
In reply to Re: Anafrinil--most potent AD????? » McPac, posted by zeugma on April 25, 2003, at 16:11:13
Anafranil is the only drug that works for me on OCD like worry and obsessions, depression, derealization and even dizziness, shyness and other odd symptoms. To anyone having problems with side effects - you might be surprised at the amount of benefit gotten by just 25mg a day. That's all I take - at 50 I'm bouncing off the walls and have troubling side effects. I have almost none at 25 but the benefit is profound for me. I've tried all of the SSRI's + Effexor and even bipolar and ADD drugs and an MRI. I just have so many symptoms I don't care what class of med might work - but only Anafranil does. It's in a class by itself as far as I'm concerened. Luvox and Prozac had a "good feeling" effect but they missed the mark on what was wrong with me and they both made me terribly sleepy. Anafranil targets whatever imbalance I have and doesn't effect my sleep at 25mg. (At 50mg it still wasn't too bad on sleep except that I never dreamed.) So if Anafranil is helpful to you mentally but has bad side effects you might want to try just a small dose such as 25mg a day. It works for me. Michael73
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