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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 Mtom on August 1, 2020, at 11:38:43
I know theres been a recent thread on Amitriptyline. But hoping to stimulate more conversation. Would like to hear from those who have tried Amitriptyline for Depression (with or without anxiety). A large 2018 review of 21 Antidepressants rated amitriptyline as #1 the most effective for depression, although #6 for tolerability due to side-effects. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext
I cant tolerate SSRIs intense side effects (anxiety-agitation-jitteriness that doesnt go away over time, disordered sleep and other SEs) plus little to no efficacy. My Doctors think I would react with jitteriness syndrome even worse with SNRIs or Wellbutrin. From what Ive read, I agree. Im now taking Mirtazapine (Remeron), which was rated #2 for efficacy in the above study (but 11 for tolerability) but for me is more tolerable than SSRIs, still side effects, but some efficacy although intermittent with better weeks and worse weeks. Im taking a low dose because when I increased, so did my anxiety I guessed the Norepinephrine (Noradrenaline) effect had maybe kicked in and overshot.
Many years ago I took Amitriptyline for about 6-7 months. I remember some start-up effects like dizziness and increased anxiety which went away (I was taking a fairly low dose). I did put on an unacceptable amount of weight, and had trouble getting out of bed in the morning. The latter may have improved a bit over time, I dont remember. As to weight right now my weight is low-normal, in fact I was underweight until I started Mirtazpine which put on 10 lbs. I could accept a small amount of weight gain.
I dont know if the Amitriptyline helped way back then because I had been undergoing intense situational stress. I resolved the situation soon after starting the Amitriptyline, started quickly feeling better, and stopped the Amitriptyline and remained good for many years.
I have a sense that Amitriptyline is not prescribed much these days for just Depression, more so for pain syndromes and perhaps sleep disorders with or without depression. Maybe due to side effects and over-dose dangers?
Very interested in hearing your experiences with this medication. One problem, as has been noted in some past posts, is that those who find something that works stop following and posting.
Posted by linkadge on August 1, 2020, at 18:22:51
In reply to Would like to hear all Amitriptyline experiences, posted by Mtom on August 1, 2020, at 11:38:43
Yeah, in terms of sleep, mood and energy I would rate amitriptyline as probably my #1 antidepressant. If I ever stopped responding to other meds, I might return to this. The feel is a bit dirtier, but in terms of being 'not depressed', I would rate it as #1.
That being said, an amitriptyline escitalopram combination was pretty good too (and allowed a lower dose of amitriptyline).
Linkadge
Posted by Skeletor on August 2, 2020, at 6:26:11
In reply to Would like to hear all Amitriptyline experiences, posted by Mtom on August 1, 2020, at 11:38:43
> I know theres been a recent thread on Amitriptyline. But hoping to stimulate more conversation. Would like to hear from those who have tried Amitriptyline for Depression (with or without anxiety). A large 2018 review of 21 Antidepressants rated amitriptyline as #1 the most effective for depression, although #6 for tolerability due to side-effects. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext
https://psychotropical.com/lancet-21-antidepressants-meta-analysis/
Posted by Skeletor on August 2, 2020, at 6:57:19
In reply to Would like to hear all Amitriptyline experiences, posted by Mtom on August 1, 2020, at 11:38:43
You might wanna consider Amitriptyline's metabolite Nortriptyline. Its pharmacological profile is similar, but it is less sedating (less anticholinergic effects, less antihistamine effects)
Posted by SLS on August 2, 2020, at 9:24:37
In reply to Re: Would like to hear all Amitriptyline experiences » Mtom, posted by Skeletor on August 2, 2020, at 6:57:19
> You might wanna consider Amitriptyline's metabolite Nortriptyline. Its pharmacological profile is similar, but it is less sedating (less anticholinergic effects, less antihistamine effects)
Nortriptyline is MUCH more tolerable than amitriptyline. The difficulty with nortriptyline is that it takes awhile to find the best dosage. A lot of people who respond well at 100 mg/day will lose the improvement if they increase the dosage to 150 mg/day. Blood tests are available to measure blood levels of nortriptyline. It helps for finding the right dosage more quickly.
- Scott
Posted by Mtom on August 2, 2020, at 11:42:42
In reply to Would like to hear all Amitriptyline experiences, posted by Mtom on August 1, 2020, at 11:38:43
Thanks. Adding more food for thought (this is long, sorry):
I forgot that TCAs can prolong cardiac QT interval and sometimes cause other cardiovascular irregularities. I take Hydroxychloroquine (for Lupus, not Covid!) which can also prolong QT interval. Although interestingly, this was not generally considered a common adverse effect until it became widely publicized in regards to trials of HCQ for Covid. However those where prolonged QT interval was observed seem to have also included Azithromycin which can also prolong QT interval. (As an aside, as QT prolongation seems to be a rather uncommon, even rare, event with Lupus and Rheumatoid Arthritis patients on long-term hydroxychloroquine therapy, I wonder if not only the combination with Azithromycin but also the fact that these drugs were mostly administered to the most severely ill COVID patients who were often either elderly or had comorbidities associated with CVD and may have also been experiencing additional heart damage due to the illness might have contributed to a much higher occurrence of QT prolongation than is commonly seen in Lupus and RA patients on HCQ).
Anyway, sorry for the digression, back to antidepressants. Mirtazapine can also potentially prolong QT interval (risk compared to TCAs unknown?), and as I was on Hydroxychloroquine (for 20 years) when I started Mirt, my doctor did an EKG just before, and several months after starting Mirt all was fine.
However TCAs also are documented to potentially cause other detrimental cardiovascular effects.
The study I linked in my OP did not include Nortriptyline as one of the 21 antidepressants reviewed. Im guessing this is because there were insufficient studies comparing it to other ADs. Ive been trying to research it, and some articles state it is generally better tolerated than Amitriptyline (as pointed out by SLS above). However many hits show it being used for neuroleptic pain, rather than depression. One article noted that older research had found it less effective than Amitriptyline for depression.
I have found Mirtazapine more tolerable than SSRIs, at least at low doses, and with some efficacy although inconsistent, better weeks alternating with worse weeks. When I increased my dose hoping to achieve better efficacy, anxiety (and some other side effects) increased (similar to SSRIs although somewhat less intense) and I had to decrease dose. I attributed this to increased norepinephrine activity associated with higher doses of Mirt. But I had also still been taking Escitalopram, though at very low doses, and it like other SSRIs increased my anxiety, which was partially offset by lower doses of Mirt. I have recently weaned off Esc and am thinking that perhaps this will allow me to increase Mirt to a more consistently therapeutic dose with less chance of anxiety exacerbation?
Although that study showed Amitriptyline as the most effective AD, reading about all its adverse effects is giving me second thoughts....
Posted by linkadge on August 2, 2020, at 12:44:53
In reply to Amitriptyline experiences and Mirtazapine thoughts, posted by Mtom on August 2, 2020, at 11:42:42
I didn't find nortriptyline as effective as amitriptyline in terms of depression. It worked, although it felt a bit thin compared to amitriptyline.
Linkadge
This is the end of the thread.
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