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Logical TCA for peristant depressive symptoms

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I believe it was called "Dysthymia" in the older DSM IV.

Me and my pdoc have an absolute coin toss down to either doxepin or nortriptyline. I had doxepin once at 10mg at night and it was benign as far as side effects and gave higher quality sleep. I also had nortriptyline which actually was great for motivation, ruminations and hyperfocus but caused leg swelling, but I believe this was because the dose was too high. I heard the antidepressant of doxepin effect does not have much effect until you go on the 75mg then the 150mg etc. but with nortriptyline brought relief after the first 10mg capsule.

I would like to know your experiences with these two tricyclics. Thank you!

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Doxepin is a sedative, does not have substantial antidepressive properties. Nortriptyline is good, especially when combined with an SSRI.

Amitriptyline, Clomipramine and Imipramine are the most effective ones, with Clomipramine probably being the most effective one (statistically speaking), because it is the strongest SNRI.

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15 minutes ago, Blahblah said:

@Skeletor  Which TCA's do you feel are the least sedating or apt to cause side effects?

All my pdocs have said that TCA's have mostly been discarded the last decade or more, and replaced by newer SSRIs / SNRIs which have less side effects, less cardiotoxicity, and dementia risks..

From the classical trio?

Least sedating: Clomipramine and Imipramine... Amitriptyline is more sedating.
Least side effects? Probably Imipramine.

TCA's have mostly been discarded because you can overdose on them. They are still more effective than SSRIs. There are some side effects involved, but it all depends on the constitution of the patient. 


Least sedating and least side effects overall: Nortriptyline, Desipramine...

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I would add that protriptyline is not only not sedating but even stimulating, but it is not very widely available anymore. Nortriptyline and desipramine can also be somewhat stimulating depending on the dose and the individual.

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