Posted by DSCH on October 3, 2003, at 11:06:48
In reply to Re: Thoughts on Elavil?, posted by Penny on October 3, 2003, at 8:12:10
> My depression has no clear pattern - no worse time of day (it depends on the day), and I'm all over the board with mood swings. Don't have too much problem with anxiety, except when spurred by the SSRIs. A couple of the SSRIs (Celexa, Zoloft) were effective for my depression for a while but then stopped working, even with augmentation. Effexor worked for me the first time around but then didn't work when I took it the second time. My history is that I might initially have a good response to a med, but then it will stop working.
>
> My doc mentioned the TCAs, though he doesn't like the side effects, and also mentioned Lithium with my "favorite of the serotonergic meds." Ha. I told him I didn't have a favorite... :-(
>
> We'll see.
>
> Thanks!
> PLITHIUM
This is what SLS reports on Li on his chart:
http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.html
5-HT autoreceptor antagonist (serotonin)
GLU decreased (glutamate)
PI turnover decreased (phosphoinositide)
PKC decreased (protein kinase-C)
GSK-3b decreased (glycogen synthase kinase)
MAP kinase increase (mitogen-activated protein)
Bcl-2 increase (B-cell lymphoma protein-2)
BDNF increase (brain derived neurotrophic factor)
NFG increase (nerve growth factor)Don't expect me to explain any of that right now. I haven't gotten beyond the monoamines yet. :-)
DIAGNOSIS
Are you hypersomniac, insomniac, or bounce between those? You might want to see what the formal definitions of 'dysthymia' and 'cyclothymia' are to see if they fit well or not.
TRICYCLICS
Desipramine and nortriptyline are generally the best tolerated of the TCs according to D. Perrine (less beta blocking, less anti-histamine, less anti-acetylcholine). I believe both are more weighted towards norepinepherine rather than serotonin (seeing as you've already gone through many SSRIs this might be a point in their favor).
poster:DSCH
thread:264904
URL: http://www.dr-bob.org/babble/20030928/msgs/265201.html