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Anyone willing to talk about tricyclics?


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I see my neurologist a week from today, and with the backing of my p-doc, I am going to insist upon starting a tricyclic. For those of you who have not been following my saga, I am not just randomly trying to medicate myself, my p-doc is 100% on my side. It has become clear to both of us that my neurologist is incompetent. I plan to end my relationship with him anyway, but want to try to get a script first, if possible. If he says no to this next week, I will call my p-doc for a referral, and get in to see a new neuro as fast as I can.

Anyway, I swear I have researched on the internets and CBs, but I cannot find anything truly helpful about tricyclics. I have looked up brand names and generics, in relation to migraine and depression, and I feel like I am just reading the standard Big Pharma spiel they include with all of their anti-depressants, and that it is not specific to those particular meds. The choices of my p-doc would be pamelor as my first attempt, and then elavil if that doesn't work.

There must be a reason that tricyclics have fallen out of favor? Unusual risks? Side effects? Just because p-docs like the "next new thing?"

I would appreciate hearing people's experiences with tricyclics, good and bad. Any of that class of med, but of course I am most interested in Pamelor and Elavil. Just so I can hear some real life side effects, including the ones that "aren't real."

Please don't try to convince me not to take it, I have few options left to me. But if you had an awful experience, I want to hear it. If you had a fantastic or neutral experience, that would be helpful as well.

I really appreciate it, this is so frustrating.

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Thanks for that info. Actually, my understanding is that for migraine patients, the dosages are much lower than they are for treating depression, so if that is true, it should mean I wouldn't have to worry about overdose (unless it is super individual specific).

And I swear, EVERYTHING I take is constipating. I drink about 3+ liters of water a day. lol!

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I've tried Amitriptyline (on it now) and Desipramine. Tofranil (Imipramine) is mainly the same as Norpramine (Desipramine) - the latter is simply the metabolite of the former meaning it's the working part of Tofanil - so you can ignore the Tofanil and stick to the Desipramine if you'd like. I had no side effects from the Desipramine, but I was on a very low dose b/c I was taking Amitriptyline at the same time. The side effects of the Amitryiptyline (for me) are sedation, fast heartrate, orthostatic hypotension (dizziness upon standing), and acne.

The others are right about an OD of these meds being particularly dangerous and therefore rx'd with care.

I've been on Pamelor too, but I don't remember the side-effects, just that it didn't work for me. Sorry.

Trying Pamelor than [Edit: Then] Amitriptyline if the former doesn't work sounds like a great idea.

As for my personal opinion.. I love Amitriptyline.. yeah the heart thing isn't great, but it does help my depression and is the only true AD I have. Also the orthostatic hypotension has gotten better over time.

So yeah, give them a shot and see which one works best for you.

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Thanks. Cetkat, just curious, why do you not think trying them in that order is a good idea?

Thanks for the word to look up, sylvan, I don't think I have seen it before. Although I may have been scanning too quickly.

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Thanks. Cetkat, just curious, why do you not think trying them in that order is a good idea?

Simply because Pamelor is a metabolite of Amitriptyline and therefore, is supposed to be just as good with less side effects. So you might as well try that one first. It didn't do anything for me personally, Amitriptyline is my drug, but you may as well start with a "better" one first. Who knows, it may work for you and you may not have to try the other.

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There must be a reason that tricyclics have fallen out of favor? Unusual risks? Side effects? Just because p-docs like the "next new thing?"

Mainly side effects. You can also off yourself with a small supply of a TCA but not with a SSRI.

nf

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I don't know if the fact that I am going to be taking a small dose lessens my chance of overdosing or not, maybe it is specific to each individual.

Is there one out of the multitude of side effects that means: "Get yourself to an ER now," say the equivalent of a lamictal rash? I see there are a *lot* of side effects under "anticholinergic" that I wasn't finding elsewhere. But I have to give it a shot, and I sometimes luck out with side effects.

This is better info than anything I had found so far, thanks guys.

I am glad that people seem to like them. I am interested in the range of responses. If you had a negative response, let me know. As I said, it won't prevent me from trying them, and I understand statistics well enough that it won't freak me out, I just would like to hear what it is like.

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I don't know if the fact that I am going to be taking a small dose lessens my chance of overdosing or not, maybe it is specific to each individual.

Oh, no no. You have to take like the whole bottle. You don't have to worry about anything accidental.

Is there one out of the multitude of side effects that means: "Get yourself to an ER now," say the equivalent of a lamictal rash? I see there are a *lot* of side effects under "anticholinergic" that I wasn't finding elsewhere. But I have to give it a shot, and I sometimes luck out with side effects.

The OD side effects are:

The peripheral autonomic nervous system, central nervous system and the heart are the main systems that are affected following overdose.[6] Initial or mild symptoms typically develop within 2 hours and include tachycardia, drowsiness, a dry mouth, nausea and vomiting, urinary retention, confusion, agitation, and headache.[2] More severe complications include hypotension, cardiac rhythm disturbances, hallucinations, and seizures. Electrocardiogram (ECG) abnormalities are frequent and a wide variety of cardiac dysrhythmias can occur, the most common being sinus tachycardia and intraventricular conduction delay resulting in prolongation of the QRS complex and the PR/QT intervals.[7] Seizures, cardiac dysrhythmias, and apnea are the most important life threatening complications.[2]

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I was on Pamelor (nortryptaline) about a year ago. The effects were tolerable enough, but I still felt the familiar dissociation that I hated so much with the SSRIs. Unlike fluvoxamine or sertraline, my emotions were relatively stable. I did have one panic attack while on nortryptaline that I feels is worth mentioning because of its distinctive intensity (alprazolam cleared it up, however). I experienced a horridly negative interaction between nicotine and nortryptaline: after smoking I returned to work and started feeling highly "uncomfortable"... the boss told me that I looked very flush in the face and I was sent home early because he wasn't feeling well. Alprazolam also cleared up the issue.... I now wonder if these panic episodes were caused by the nortryptaline or by the alprazolam (or lack thereof in the blood stream).

Soon after the nicotine incident, I discontinued the nortryptaline, to give bupropion and clonazepam a try. I didn't have any negative side-effects, spare the two panic episodes (which again could have been from the alprazolam) and occasional bouts of clouded confusion.

Based on my experience with SSRIs, I'd say TCAs are far superior medications for anxiety/depression. Antidepressants just don't agree with me in general... at least until I find a suitable mood-stabilizer. Overall, though.. I'd recommend it.

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Thanks. Cetkat, just curious, why do you not think trying them in that order is a good idea?

Simply because Pamelor is a metabolite of Amitriptyline and therefore, is supposed to be just as good with less side effects. So you might as well try that one first. It didn't do anything for me personally, Amitriptyline is my drug, but you may as well start with a "better" one first. Who knows, it may work for you and you may not have to try the other.

I take amitriptyline to treat a rare sleep disorder, not so much as an AD, but I've found amitriptyline much more useful for that than nortriptyline. Of course, sedation is something I *want*, so if that's not the case for you, nortriptyline might be better to start with, yeah. In terms of orthostatic hypotension, I think nortriptyline and amitriptyline were about equal for me, but I'm prone to it anyway.

If overdose is a concern, you can probably get your doctor to write the prescription to be filled a week at a time. That's what my doc and I do because right now I don't trust myself with a lethal supply.

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i was on pamelor at 25mg/day as an AD. first i got slightly antsy, upped my lamictal, then by 6 weeks on it i was crazy manic - more manic than i've been in years.

i didn't really notice any AD effects on it b/c it's not supposed to kick in until about 6 weeks (when i went off of it). side effects wise, i gained about 5 lbs, but i think it was mostly water weight as it came right off after stopping. i'd assume that if you were on longer, your body would get used to it and let the excess water go after a while. who knows though. i also got really lightheaded when i stood up too fast, but was fine if i took it slower.

pamelor can cause heart problems, so if you have a history of it, you might want to consider that as well.

i think the tricylics have fallen out of favor mainly because they take longer to work and you can have more of a tendency to get the side effects (which are pretty much the same as the SSRIs).

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i was on pamelor at 25mg/day as an AD. first i got slightly antsy, upped my lamictal, then by 6 weeks on it i was crazy manic - more manic than i've been in years.

Yeah, not surprising.. it hits 5-HT. That has a tendency to cause mania just like SSRI's.

i think the tricylics have fallen out of favor mainly because they take longer to work and you can have more of a tendency to get the side effects (which are pretty much the same as the SSRIs).

I took the same amount of time for me as the SSRI's.. but to each their own. ;)

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Amitryptaline worked for me after a lot of meds didn't. I'm on 175mg which is enough that my mouth and eyes are dry but I can manage that with OTC eyedrops. I haven't noticed it being particularly constipating.

My pdoc was wary to put me on it because I have heart problems, but my Cardiologist said I'm young and my heart is relatively healthy so it's absolutely fine. The suicide risk can be a big problem, if you have ideation you probably need a safety plan that includes handing excess meds over to somebody you trust.

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I'm on 175mg which is enough that my mouth and eyes are dry but I can manage that with OTC eyedrops.

175?? I though 150 was the max.. did the increase provide a better result? Any special considerations for going over the max dose?

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You have no idea how much better this is making me feel. Even though I know Elavil and Pamelor are ancient in "pharmacology years," I wasn't finding anything. And I don't have access to peer reviewed studies.

I do have a mitral valve prolapse for which I take anti-biotics before dental work, but for every other procedure, my drs. have always said it isn't important. I am pretty sure the concern with dentistry is about injecting plaque infections right into the blood stream with the dental equipment.

Oops, how much you want to bet that I just came up with the reason my neuro won't prescribe it to me? He is a freak about side effects, he always expects the absolute worse case scenario. But my dad knows about the murmur, and wasn't concerned, hmmm. Well, if my neuro says no, I will double check and make sure that my p-doc realizes I have the mv prolapse. Most of my drs. have dismissed it as a genetic variation within the population.

It seems so far everyone's complaints here are pretty minor (in the grand scheme of things, I know they are never fun). It makes me feel better to know that it isn't a guarantee I will be knocked over by side effects.

I am pretty sure everyone who has posted here has taken it for depression (except in one case, a sleep disorder); if anyone HAS taken it for migraine, please tell all. There are a couple of people on here who say they know someone trying it, but no one who has used it themselves.

But seriously, if this is as much information as I get, I feel like I know much more than I did this morning.

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Have you recently checked with a Cardiologist about the prophylactic antibiotics?

As far as I know the guidelines are changed so if you only have mild regurgitation they generally aren't required for cleaning. If your Neurologist is concerned maybe you could revisit a cardiologist, perform an echo and ask him about the amitryptaline.

Hope you can find all the info you need.

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if anyone HAS taken it for migraine, please tell all. There are a couple of people on here who say they know someone trying it, but no one who has used it themselves.

I've used it. It was during a migraine & nothing over the counter was helping.. so I googled around and saw that it and Nadolol are sometimes used.

I took 100mg Amitriptyline and 40mg Nadolol. It helped. After that, I had my pdoc give me a second script for 50mg on top of the 100mg as a just in case measure. Then I realized that it was helping my depression and moved to 150mg Amitriptyline permanently.

I plan to get with my gdoc and get some real migraine meds, but for now, I'm very glad I have the TCA.

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I took imipramine for several years ...years ago and really liked it ..it curbed my eating issues...I slept like a baby ..it took me a month to get used to it but they started me low and then increased to a moderate dosage ..the problem for me is ..even though I rarely drink (like two a month if that) my liver enzymes shot through the roof ..we tested ..I went off ..they went down ..I went back on and they flew back up ..the doctor was worried at how high they went for me ..he said it was "impossible" that was all it was but I was not taking so much as a tylenol at the time and lived a pretty "clean life" due to my migraines I was also on a very wholistic diet ..

bottom line I was bummed when they took me off ...twice ..and yes it did help my migraines break a life time cycle ..also keeped me level ..and I slept like a dream ..ate perfectly with out the crazy ...and once the side effects receded I was fine on it

but that first month was a bit like being on heavy doses of benadryl ..everything was foggy and I could sleep at the drop of a hat!

good luck

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