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Melancholya

Looking for general info/experiences on tricyclics

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Hello all. 

I have been on various ssris for the past 12 years with limited success. Most recently tried escitslopram + aripiprazole, dropped the aripiprazole after a while cos it didn't bring much (if any) benefit and felt yuck. So am just back on 20mg of escitalopram. 

My psychiatrist wants to try me on TCAs but hasn't yet because I am breastfeeding and he said they're not safe. However my daughter is over 3 and my general doctor (a breastfeeding mother herself) pointed me to some info on TCAs actually being considered safe in breastfeeding. And since my daughter is 3 she can metabolise drugs a lot better than an infant (the studies on safety are all done on newborns and infants). She is encouraging me to talk to my psych about trying TCAs anyway, so I would like to do that. 

I am just wanting to hear from those who have tried TCAs and how you found them. I have atypical depression, characterised by overeating, oversleeping, lack of motivation and interest, constant fatigue. Are TCAs likely to be a good option for me after ssris have failed? 

And side effects - do they affect sex drive the way ssris do? 

Any information is hugely appreciated. I am in a deep dark hole right now and desperate to get out. 

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Have you tried SNRI(s)?

The noradrenaline action is activating, which is probably a good option for your type of depression.

Wellbutrin (with or without SSRI) is also an option I'd look into before going on a TCAs

TCAs generally have more side-effects because they hit a lot more receptors than SSRIs/SNRIs. They may also cause sexual side effects as SSRIs (“may” because they “should” but you may react differently to different meds).

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Thanks Hydrocat. Wellbutrin isn't an option for depression here unfortunately. I have tried venlafaxine in the past but it was probably 10 years ago. I might ask about trying it again. 

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Before I was dx’d BP, I tried desipramine. Found it to be extremely activating (I.e., sleep immediately was no longer an option), but it might be worth a try for depressive oversleeping. 

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Posted (edited)

I found an article on antidepressants for breastfeeding mothers:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902256/

Now this is a pretty long article, but according to the article, the TCAs that are safest to use while breastfeeding are nortriptyline (Pamelor) and imipramine (Tofranil)......The article also mentions the SSRIs sertraline (Zoloft), and paroxetine (Paxil), as relatively safe to use.......I realize that your daughter is 3 years old, and not an infant, but thought this info would be of some help......

Quote from article:

"Sertraline and paroxetine (among SSRIs) and nortriptyline and imipramine (amongTCAs) are the most evidence-based medications for use during breastfeeding because of similar findings across multiple laboratories, usually undetectable infant serum levels and no reports of short term adverse events."

Edited by CrazyRedhead
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Thank you everyone, I really appreciate these responses. 

I am not really convinced tricyclics will help for my kind of depression, but I don't know. I guess it's just worth a try. I'll also ask about duloxetine, I'm just not sure it's available here. 

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I took imipramine (Tofranil) for a while. I can't say it made much of an impact on my depression, but I didn't have trouble with side effects either. The only thing was that it was the first time in years I was able to reliably sleep without a sleep aid. Not that it made me groggy or tired or anything - I could just... fall asleep at bedtime, and stay asleep through the night. 

I have chronic suicidal ideation, and my pdoc (who knows me very, very well) would not let me have more than 2 weeks of imipramine on hand. I don't tend to think about OD-ing (which she knows), but her position was the same regardless. After a while, I got her to rx 30 days at a time as long as I agreed to let a friend pick it up and hold it for me, filling a med box for me weekly. It was annoying, but *shrug*

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Have you tried Wellbutrin ? That would be a reasonable next step. I would save the TCA for after  once you have failed more meds.

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I too have atypical depression and have tried all the tricyclics except imipramine. I found that tricyclics come with a lot of side effects. All the while I was on them I felt spaced out. Also, I was very sedated and slept a lot. The sedation never went away for me like it did for Remeron. I found that even the tricyclics which are supposed to be stimulating were sedating to me. It was a monumental struggle to get up in the morning.

Now some people swear by tricyclics. My aunt was one who did well on Elavil. They are good meds with a proven track record. However, I would not want to take a tricyclic until I tried every other antidepressant out there with the possible exception of the MAOIs.

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On 3/16/2019 at 8:22 AM, jt07 said:

I too have atypical depression and have tried all the tricyclics except imipramine. I found that tricyclics come with a lot of side effects. All the while I was on them I felt spaced out. Also, I was very sedated and slept a lot. The sedation never went away for me like it did for Remeron. I found that even the tricyclics which are supposed to be stimulating were sedating to me. It was a monumental struggle to get up in the morning.

Now some people swear by tricyclics. My aunt was one who did well on Elavil. They are good meds with a proven track record. However, I would not want to take a tricyclic until I tried every other antidepressant out there with the possible exception of the MAOIs.

Out of curiosity, what HAS worked for you? have you found anything?
EDIT: sorry, I only just noticed your signature which has your current meds in it. 

On 3/16/2019 at 6:45 AM, notloki said:

Have you tried Wellbutrin ? That would be a reasonable next step. I would save the TCA for after  once you have failed more meds.

I think it's only prescribed as a smoking cessation drug here, but I will ask my psych if I can get it. I am a little worried about the risk in breastfeeding, and my psych knows next to nothing about breastfeeding, so it's hard to get him to let me try things.

Edited by Melancholya

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