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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by mtom on March 29, 2019, at 11:48:52
A large review study published in Lancet 2018 found amitriptyline most effective AD. But seems rarely prescribed these days. I realize more potential toxicity issues "if" not careful. Also side effects of somnolence and weight gain. But some others have similar side effects and worse, and effectiveness is important too.
Why rarely prescribed these days? Anyone have experience with it?
Posted by Christ_empowered on March 29, 2019, at 13:59:46
In reply to Study said amitriptyline most effective?, posted by mtom on March 29, 2019, at 11:48:52
not elavil, but tofranil. kinda...rough drugs. there's an old combo pills still out there..etrafon, triavil...perphenazine (old school tranq) plus elavil...
i just mention that because at -low- doses, perphenazine can help counter the start up activation some people get from antidepressants. its also an effective drug for nausea, if thats an issue for you with psych drugs. in most cases, the recommendation is to switch to normal elavil, no perphenazine, asap.
Posted by bleauberry on March 30, 2019, at 10:46:36
In reply to Study said amitriptyline most effective?, posted by mtom on March 29, 2019, at 11:48:52
These kinds of studies are not reliable for individual prognosis.
For one thing, the studies are flawed. Each one has its own flaws, depending on who paid for it, who the sponsors were, how the patients were screened, how the data was gathered, how the data was interrupted. There is a great deal of human error, both purposeful and accidental, in all of that.
Amytrip has some of the harshest side effects for most people. It does not restore anybody to the person they used to be.
In these studies, they judge something as "statistically significant" but that doesn't mean it is "actually significant". For example a study may show that Paxil is statistically significantly more effective than placebo, except when you look at the detailed numbers, which are usually hidden, you find that 50% of people on placebo improved a little bit, not a lot, and that 56% of med people improved a little bit, not a lot. 50% versus 56% is statistically significant. But in the real world, that is not significant. So these studies have a way of producing fake pictures in your mind based on twisted numbers games. In those same Paxil studies, 3 patients committed suicide during the study. They don't mention that part.
I saw a study once that said Prozac plus Zyprexa increased serotonin, norepinephrine, and dopamine dramatically in the brain, more than any other cocktail, and was good for treatment resistant depression. Despite what I just said above about the flaws of these studies, there was enough there that I wanted to find out for myself. So I did. And that combo ended up being better than any other combo I ever tried.
So sometimes we have to just go by our instincts.
Posted by linkadge on March 31, 2019, at 12:24:14
In reply to Study said amitriptyline most effective?, posted by mtom on March 29, 2019, at 11:48:52
Doctors are perhaps concerned with liability (i.e. TCAs are more lethal in overdose) and / or compliance than they are about effectiveness.
I would agree that amitriptyline or imipramine are probably the most effective (perhaps alongside the TCAs), but the effectiveness is offset by a higher dropout rate. In terms of improving the depression itself, amtitriptyline is effective.
Linkadge
Posted by baseball55 on April 1, 2019, at 18:28:32
In reply to Re: Study said amitriptyline most effective? » mtom, posted by linkadge on March 31, 2019, at 12:24:14
My doctor/s wouldn't prescribe TCAs to me because of suicide attempts. Can be fatal in an overdose.
Posted by mtom on April 4, 2019, at 12:58:09
In reply to Re: Study said amitriptyline most effective?, posted by baseball55 on April 1, 2019, at 18:28:32
Here's a link to the Study in Lancet Feb 2018:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext
Scroll down for tables comparing efficacy and acceptability.
They compared drugs to placebo and head to head.Maybe someone good at analysing the statistics could comment......
Posted by SLS on April 4, 2019, at 21:48:45
In reply to Link to Lancet 2018study comparing antidepressants, posted by mtom on April 4, 2019, at 12:58:09
Thanks!
- Scott
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