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Considering trying a tricyclic antidepressant....what should I ask for?


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I see my pdoc next week and thinking about asking to be put on a TCA. I'm currently doing TMS and having mild to moderate results and think I will still need to find a medication solution for my depression after it is over as I've decided against ECT.  The pdoc running TMS says you can't make major med changes during it as you could get a seizure. But I would start it after TMS. I have already tried clomipramine but none of the other TCAs. Are they all generally the same or are there differences? Seems most people try Amitriptyline. 

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3 hours ago, CeremonyNewOrder said:

I see my pdoc next week and thinking about asking to be put on a TCA. I'm currently doing TMS and having mild to moderate results and think I will still need to find a medication solution for my depression after it is over as I've decided against ECT.  The pdoc running TMS says you can't make major med changes during it as you could get a seizure. But I would start it after TMS. I have already tried clomipramine but none of the other TCAs. Are they all generally the same or are there differences? Seems most people try Amitriptyline. 

I’ll admit that I have less experience with TCAs than other med types, but id think that amitriptyline is a good as a starter as any barring previous issues- it might also just depend on your pdocs comfort level with certain meds. Do you need something more activating vs sedating? 

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Ok, I believe amitriptyline is one of the more sedating ones. My pdoc has told me they are totally off the table for me (and many with BP1) due to the mod  destabilizing risk 

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Posted (edited)
1 hour ago, CeremonyNewOrder said:

Sedating would probably be preferable

I've tried amitriptyline and doxepin, and I can say they were sedating for me.....Two more TCAs that are generally considered sedating are imipramine and trimipramine, although I've not tried those.

Although it's an SSRI, I noticed you haven't tried Paxil....It is considered to be one of the most sedating SSRIs......I've tried it, and it was definitely sedating for me.

Edited by CrazyRedhead
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For me, amitriptyline made me so dry—I could barely speak. It wasn’t a good drug for my system but I won’t catalog all my issues in case it’s different for you. It was on the sedating side but other TCAs were better for me—not good enough but better. So maybe one will be better for you. If you tend to dryness, maybe not the best, if that’s an issue for anyone but me. 

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Posted (edited)

Doxepin (300 mg) worked well for me the 1st time, but none of the times thereafter. I did a slow titration, starting at 50 mg, and going up another 50 mg every month. I didn’t feel results until maybe 200 mg, but they were quite good by 250 mg. I mostly just went up to 300 mg so that there were fewer pills to swallow (2 x 150 mg vs 5 x 50 mg).

Edited by Goofball
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  • 2 months later...

If you have OCD then Clomipramine might be worth a look. I've just started it. First few days were ok/good but things took a big turn for the worse today. It's early days tho and I'm highly atypical so remember that YMMV in such things. 

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