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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by bleauberry on July 19, 2009, at 13:48:04
The following is based on patient descriptions and ratings at askapatient.com. There will be some built-in bias in any specific sample population, so I was more curious of trends than actual numbers. MAOIs in this list, but Parnate and Nardil scored in the 4's.
On a 1 - 5 scale, patients rated their meds. Most common antidepressants have an average rating of 3.1 to 3.8. Ranking from best to worst were:
Parnate 4.2
Nardil 4.1
Desipramine 3.8
Zoloft 3.4
Prozac 3.4
Nortriptyline 3.4
Lexapro 3.3
Luvox 3.3
Paxil 3.1
Effexor 3.1
Remeron 3.1Back to the title of this thread.
A closer examination of Nortriptyline was performed, separating the ratings of patients who tried it for depression alone, anxiety/panic alone, or both together. Patients using Nort for Fibromyalgia, migraines, pain, and other conditions were weeded out to focus on depression/anxiety/panic. Nortriptyline's scores in those categories:Depression alone 3.3
Anxiety/Panic alone 4.1
Depression and Anxiety together 4.2Patients who had depression without anxiety had an average chance of success with Nort compared to other ADs, with a score of 3.3 which was better than Effexor or Remeron.
Patients who had just anxiety/panic did surprisingly well with Nort, better than most of the commonly prescribed meds for anxiety/panic, with a score of 4.1.
Patients who had depression with anxiety at the same time did the best at 4.2, which is right in line with MAOIs.
When was the last time anyone heard of a doctor prescribing Nortriptyline for anxiety/panic? Paying attention to the trends of patient side effect comments, Nort appeared to be significantly easier to tolerate than SSRIs and I do not recall seeing sexual dysfunction mentioned even once.
As with all meds there were a few cases of outright failures where patients commented it was the worst med ever. Others, best med ever.
An interesting sidenote is how old-timer Desipramine performed better than any common med by a good margin, second only to Nardil and Parnate.
I became interested in this because I have been on a very low dose of Nort for a short time. Lyme aches and pains improved 90% beginning day 2, anxiety/panic/social nervousness/social withdrawal/waking nervousness/fearfulness/paranoia kind of stuff is a mere whimper compared to what it was in such a short time. I was surprised to see how many people found Nort a great med for anxiety/panic in addition to depression, but most especially for those with both conditions.
Anyway, I had two reasons for doing all the calculations and posting this:
1. For the potential benefit of those patients who are having difficulty in the anxiety/panic area and not happy with their SSRI/benzo/antipsychotic experiences for whatever reasons.
2. To present a reminder that options exist which are not commonly prescribed, but are time-tested, cheap, and in many cases better tolerated. There is a promising world outside the arena of the "newer better" meds.
Posted by Phillipa on July 19, 2009, at 13:57:52
In reply to Interesting Anxiety/Panic Medication, posted by bleauberry on July 19, 2009, at 13:48:04
I feel it all depends on the particular person as ads never relieved anxiety in me only benzos. Tried the others long before joining babble. Phillipa
Posted by Zana on July 19, 2009, at 14:10:13
In reply to Interesting Anxiety/Panic Medication, posted by bleauberry on July 19, 2009, at 13:48:04
This is really interesting to me especially since my primary AD combo is Pristiq (effexor) and remeron (California Rocket Fuel.) I augmented some SSRI with amytrip. and it made me agitated. Is there any reason why it would be more stimulating and less helpful with anxiety and panic than nort.?
Zana
Posted by Zana on July 20, 2009, at 15:15:23
In reply to Re: Interesting Anxiety/Panic Medication, posted by Zana on July 19, 2009, at 14:10:13
Why would nort help with panic and anxiety since it has such a potent NE blockade? Imipramine (monotherapy) did nothing for me and Amitriptyline was way too stimulating. I'd have to check my records to see what else I was on at the time.
Thanks for your thoughts. I've printed out your post to take to my next appointment.
Zana
Posted by bleauberry on July 20, 2009, at 18:14:56
In reply to Re: Interesting Anxiety/Panic Medication))Bleauber, posted by Zana on July 20, 2009, at 15:15:23
> Why would nort help with panic and anxiety since it has such a potent NE blockade? Imipramine (monotherapy) did nothing for me and Amitriptyline was way too stimulating. I'd have to check my records to see what else I was on at the time.
> Thanks for your thoughts. I've printed out your post to take to my next appointment.
> ZanaI don't know why it would help so much. Probably because the mechanisms we know of are only a tiny fraction of the many molecular/genetic mechanisms of meds. In other words, what we think we know about meds is actually practically nothing compared to what there is to know that we don't.
I was surprised at the results. Didn't even consider it or think about it, so it kind of took me by surprise.
The whole med choice game is like gambling. We take our best shot, but it is an odds game. We could choose a med with good odds but still lose, or choose a med with low odds and still win. I prefer to play with good odds though. Nortriptyline appears to be one of those.
Posted by Jimmyboy on July 21, 2009, at 9:50:24
In reply to Re: Interesting Anxiety/Panic Medication))Bleauber, posted by bleauberry on July 20, 2009, at 18:14:56
interesting find. The fact Nortryptaline is so good for anxiety as well of lack of sexual se's could be due the fact that is is a 5ht2a antagonist..
Posted by Dima on July 24, 2009, at 9:38:57
In reply to Interesting Anxiety/Panic Medication, posted by bleauberry on July 19, 2009, at 13:48:04
But what are the scores for all the other meds using only depression with anxiety. You can't compare the score of a drug rated by depression/anxiety patients with the scores of other drugs rated by any depression or anxiety combination.
And how many people are in the sample for the depression/anxiety nortriptyline rating?
This is the end of the thread.
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