Are Tricyclics bad?

[PierreC]

Why do Tricyclics have such a bad reputation?

[panic_down_under]

Why do Tricyclics have such a bad reputation?

Ignorance, mostly.

[KK77]

Tricyclics are dangerous to OD on and at therapeutic levels have some unpleasant side effects, especially cognitive dysfunction. They're now mainly used in low doses for pain conditions and/or sleep disorders.

[panic_down_under]

Tricyclics are dangerous to OD on

So are two SSRIs, one SNRI and a noradrenaline-dopamine reuptake inhibitor. However, relatively few choose their antidepressant to OD on.


and at therapeutic levels have some unpleasant side effects, especially cognitive dysfunction.

All antidepressants may impede cognitive function, but not as much as anxiety disorders and depression do.

Given that TCAs are not as homogeneous a group as the SSRI which all have basically the same effects on the brain, but differ considerably in the way they work ranging from almost pure antihistamines, through to serotonin reuptake inhibitors, noradrenaline reuptake inhibitors and both serotonin and noradrenaline reuptake inhibitors, blanket conclusions really shouldn't be drawn about them as a class.

[KK77]

Are you a doctor Panic? You seem to get angry when contradicted.

Even cit which has now been shown to cause prolonged QT interval at high doses is nowhere near as dangerous as amit/nortrip. My GP explained that even below therapeutic levels many TCAs can cause dangerous tachycardia and sudden cardiac death, esp amit and imipramine. As I said, it's why many are relegated to pain management use at far below therapeutic levels.

And at >50mg amit's cognitive dysfunction compared to SSRIs is marked and significant. Look it up before you jump up and down and try to blind people with selective info. Do you take TCAs for your anxiety/ depression?

https://www.ncbi.nlm.nih.gov/pubmed/15345781

---------- Post added at 14:23 ---------- Previous post was at 13:40 ----------


I've been battling panic disorder, mostly successfully, for almost 30 years and been participating in anxiety forums for nearly as long, most recently in AZ.

Along the way I've picked up a few clues on how to manage these disorders which might help others, and hopefully I'll get new ideas here too.

Ian

30 years of armchair pharmacology Ian? :lac:

[MyNameIsTerry]

Ian,

You are a much respected member of the forum, as can be seen from all the positive feedback you get on here. You've clearly got the most knowledge on here about meds by far.

I always appreciate your knowledge.

You've never once tried to mislead anyone about being the same as everyone else here and your posts have never been emotional.

You are a credit to this place. I wouldn't hesitate advising someone to post a thread on here and looking out for your response, as I have done a few times.

[panic_down_under]

Are you a doctor Panic?

No


You seem to get angry when contradicted.

How do you draw that conclusion?


Even cit which has now been shown to cause prolonged QT interval at high doses is nowhere near as dangerous as amit/nortrip.

As I said earlier is this thread, there is a lot of ignorance about tricyclics. Credible Meds (https://crediblemeds.org/index.php/drugsearch) maintains the QTc drug data base for the FDA (https://crediblemeds.org/index.php?cID=222).

Their advice for amitriptyline is:

Conditional Risk of TdP - These drugs are associated with TdP BUT only under certain conditions of their use (e.g. excessive dose, in patients with conditions such as hypokalemia, or when taken with interacting drugs) OR by creating conditions that facilitate or induce TdP (e.g. by inhibiting metabolism of a QT-prolonging drug or by causing an electrolyte disturbance that induces TdP).

For nortriptyline:

Possible Risk of TdP - These drugs can cause QT prolongation BUT currently lack evidence for a risk of TdP when taken as recommended. This is the same rating as for fluoxetine, fluvoxamine, paroxetine and sertraline.

OTOH, citalopram (and escitalopram) has the more serious warning:

Known Risk of TdP - These drugs prolong the QT interval AND are clearly associated with a known risk of TdP, even when taken as recommended


My GP explained that even below therapeutic levels many TCAs can cause dangerous tachycardia and sudden cardiac death, esp amit and imipramine.

The CredibleMeds lists imipramine as:

Possible Risk of TdP - These drugs can cause QT prolongation BUT currently lack evidence for a risk of TdP when taken as recommended.
which, as above, puts it on par with most of the SSRIs and much better than citalopram and escitalopram.


And at >50mg amit's cognitive dysfunction compared to SSRIs is marked and significant. Look it up before you jump up and down and try to blind people with selective info.

So challenging a claim which seems incorrect is "jump up and down"?

And here's some more selected info:

Carrière I, 2017, Antidepressant use and cognitive decline in community-dwelling elderly people" (https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28424070/)

[i]Compared to non-users, the TCA users showed lower baseline performances of 9% for verbal fluency, 5% for visual memory (BVRT) and 9% for psychomotor speed (TMTA), and the SSRI users of 3% for verbal fluency and 7% for psychomotor speed. On the other hand, no significant differences were found at baseline for global cognitive performances (MMSE) or executive function (TMTB) irrespective of the treatment groups.

...However, the effect of TCAs on baseline cognitive visual memory may be more related to psychological comorbidity as it became statistically non-significant when participants with a history of MDE [major depression episode] were excluded.

...Hence, our study indicates that TCAs and SSRIs are principally associated with relatively weak cognitive impairment at baseline, mainly related to verbal fluency, visual memory and psychomotor skills, but the question remains as to whether this occurred before or at treatment initiation.

...CONCLUSIONS:
In this large elderly general population cohort, we found no evidence for an association between antidepressant use and post-treatment cognitive decline over 10 years of follow-up in various cognitive domains.

Podewils LJ, 2002, "Tricyclic antidepressants and cognitive decline." (https://www.ncbi.nlm.nih.gov/pubmed/11927755):

These findings failed to support the concept that TCA use is related to concurrent measurable cognitive deficits, and TCA use does not appear to significantly compromise memory over a substantial time span.

OTOH, there is some evidence (https://www.ncbi.nlm.nih.gov/pubmed/21876440) TCAs reduce dementia risk.


Do you take TCAs for your anxiety/ depression?

Yes, mostly imipramine for the first 10 years at doses of 300-350mg/day for most of that period, the last 21 years I've continually been on 225mg dosulpin, aka dotheipin, which is the most cardio toxic antidepressant by a considerable margin. Despite being under greater than normal pressure as a result of having had a lung removed, my almost 70yo heart remains fine. Nor has 30 years of TCA use at very high doses addled my brain.

---------- Post added at 11:50 ---------- Previous post was at 09:50 ----------


You are a credit to this place.

:blush: Thank you for the vote of confidence. I don't take these things personally. I've been around support groups long enough to know that things can be misinterpreted, even with the use of emoticons, etc. All just part of the rich tapestry of life.

[MyNameIsTerry]

Ian,

Here is one of our local NHS trust's prescribing guidelines:

https://www.google.co.uk/url?sa=t&source=web&rct=j&url=http://www.sussexpartnership.nhs.uk/node/1436/attachment&ved=0ahUKEwit6b_T6LnUAhWRLlAKHTIkBFsQFgikATAT&usg=AFQjCNHNFuLB-THGczK_HIgptP2LxtLJUQ&sig2=5JPlnKX2Yj9JHCy3RejRkw

TCA's being third line may mean a hand off to a psychiatrist but plenty of GP's play around with Mirt & Ven so it's difficult to say.

But it's very clear in these current guidelines that several TCA's are on the menu. And NICE guidelines for OCD also include the use of Clomipramine where SSRI/SNRI's have failed.

As can be seen, there are requirements set to ensure patient safety.

The NHS clearly aren't against using them.

[panic_down_under]

The NHS clearly aren't against using them.

And I don't have a problem with the guidelines generally, though I remain unconvinced by mirtazapine and agomelatine for anxiety. The next person to tell me how great agomelatine is working for him/her will be the first.

Mine default suggestion is to try citalopram/escitalopram first as they generally have the best side-effects profile, although as with everything about antidepressants, that isn't a guarantee. Switching to sertraline is second, and then, given NHS restrictions, duloxetine or a TCA as the third option.

Outside the NHS framework, I think adding some nortriptyline to the sertraline to create a bespoke SNRI would be worth a shot ahead of a SNRI/TCA switch if there is even a small positive response from the sertraline as this might produce the fastest outcome with the least trauma.

BTW-I was shocked at the price premium quoted for duloxetine and venlafaxine compared to most of the SSRIs. The TCAs seem to be at a considerable premium too, especially clomipramine.

Though perhaps I shouldn't be. I was discussing MAOIs with a British psycho pharmacologist a while back and he explained they are pretty much off the table because of cost. Apparently, the NHS is paying more than £200 for a box of 28 tablets. That is <expletive> outrageous for drugs which have been out of patent for 50 years and probably cost only pennies to make!! But with only one or two companies still making them they can charge whatever they want. Dick Turpin had nothing on these guys!! :mad:

[lliiaamm0099]

So are two SSRIs, one SNRI and a noradrenaline-dopamine reuptake inhibitor. However, relatively few choose their antidepressant to OD on.

I am a doctor and have been a doctor for 12 years, mainly as a neurologist, and whilst studying Medicine I worked part time as what is now known as an anatomical pathology technician (morgue technician) carrying out post mortem examinations and I can say plenty of people who were depressed would overdose on their antidepressants with intentions of killing themselves. I can also say the ones who were successful in ending their lives were the ones on tricyclics and many of the times they were the only drugs in their system. I never did and autopsy were just an SSRI or SNRI was the only drug to contribute to someone's death that is almost unheard of. I have also worked in A&E in my job and plenty of people to this day still overdose on just antidepressants alone.

[Bike Rider]

Hi Ian.

As MyNameisTerry has said, you are a very respected member on here and I have found your advice very good indeed.

Anyone can claim to be anybody on here and I think you probably have as much knowledge about these meds as most GP's have, plus you listen and try to offer advice, which in my experience, some GP's do not.

[panic_down_under]

and try to offer advice, which in my experience, some GP's do not.

I can be as critical as anyone about GPs at times, but I also have considerable sympathy for them too. Their training often leaves them pathetically unequipped to deal with psych disorders. Despite these disorders being the real reason many of the patients in a doctors waiting room are there, med schools devote little time to them, literally just a few weeks scattered through the years. Graduates leave knowing more about obscure tropical diseases most will never encounter than they do about the 'mental' disorders which fill their waiting rooms, recognised or not. The reason many GPs treat their patients like mushrooms on these disorders is they are just as much in the dark and believers of male bovine manure.

Nor does they way they are paid allow them to devote the time these disorders often demand. GPs don't really practice medicine these days, they are more like triage nurses, quickly band-aiding the paper cuts and sending everything more serious to the end of interminable specialists' queues after which they just follow the "expert's" treatment recipe until either the patient recovers enough to lose interest and stops coming, or falls of the perch.

[KK77]

I am a doctor and have been a doctor for 12 years, mainly as a neurologist, and whilst studying Medicine I worked part time as what is now known as an anatomical pathology technician (morgue technician) carrying out post mortem examinations and I can say plenty of people who were depressed would overdose on their antidepressants with intentions of killing themselves. I can also say the ones who were successful in ending their lives were the ones on tricyclics and many of the times they were the only drugs in their system. I never did and autopsy were just an SSRI or SNRI was the only drug to contribute to someone's death that is almost unheard of. I have also worked in A&E in my job and plenty of people to this day still overdose on just antidepressants alone.

Thank you for sharing your knowledge. Many doctors and studies have confirmed this and it's one of reasons they're not now prescribed for depression/anxiety as first/second-line treatment.

---------- Post added at 14:11 ---------- Previous post was at 13:48 ----------


No



How do you draw that conclusion?



As I said earlier is this thread, there is a lot of ignorance about tricyclics. Credible Meds (https://crediblemeds.org/index.php/drugsearch) maintains the QTc drug data base for the FDA (https://crediblemeds.org/index.php?cID=222).

Their advice for amitriptyline is:


For nortriptyline:
This is the same rating as for fluoxetine, fluvoxamine, paroxetine and sertraline.

OTOH, citalopram (and escitalopram) has the more serious warning:




The CredibleMeds lists imipramine as:

which, as above, puts it on par with most of the SSRIs and much better than citalopram and escitalopram.



So challenging a claim which seems incorrect is "jump up and down"?

And here's some more selected info:

Carrière I, 2017, [i]Antidepressant use and cognitive decline in community-dwelling elderly people" (https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28424070/)


Podewils LJ, 2002, "Tricyclic antidepressants and cognitive decline." (https://www.ncbi.nlm.nih.gov/pubmed/11927755):


OTOH, there is some evidence (https://www.ncbi.nlm.nih.gov/pubmed/21876440) TCAs reduce dementia risk.



Yes, mostly imipramine for the first 10 years at doses of 300-350mg/day for most of that period, the last 21 years I've continually been on 225mg dosulpin, aka dotheipin, which is the most cardio toxic antidepressant by a considerable margin. Despite being under greater than normal pressure as a result of having had a lung removed, my almost 70yo heart remains fine. Nor has 30 years of TCA use at very high doses addled my brain.

---------- Post added at 11:50 ---------- Previous post was at 09:50 ----------



:blush: Thank you for the vote of confidence. I don't take these things personally. I've been around support groups long enough to know that things can be misinterpreted, even with the use of emoticons, etc. All just part of the rich tapestry of life.

You generally do give good advice but on this issue you are way out of your depth. You are also biased as you yourself take this class of meds. I have no interest either way, apart from the truth. Read about the spiral of death TCAs can cause in the video by an MD below.

I don't have a problem with knowledgeable sufferers giving their experience-based advice but your style is far more didactic: forensically breaking down someone's post and answering with terse comments. That you do this points to either your concentration/memory being an issue or having blunted emotions, hence compartmentalising and breaking down the whole so it's easier for you to assimilate emotionally. Also, why did you initially answer the OP's question with a few words? Why didn't you explain why you thought there was so much "ignorance" re TCA? Perhaps all this is a consequence of years of TCA use. Who knows?

https://www.youtube.com/watch?v=L3V-B_0S444

And Terry... The obsessive, prolific poster who cannot fight the urge to stay out of something that doesn't concern him. You lurk on this forum to 5-6 in the morning, sleep during the day, and think you've achieved something. You remind me of the Timothy character from the old series Sorry. Big gob, lots of bravado, single and lives with mummy and daddy. Get an alternate life :lac:

[Elen]

Differences of opinion and healthy debate is good but there is no need for the personal comments

[MyNameIsTerry]

I'm sorry if my mental health is something you disprove of, KK.

To be honest, I would rather be the perceived loser you seem to believe I am living with my loving family than an aggressive person who rather than helps others prefers to get their kicks trying to make others feel bad. We actually have threads on here by members, some which I've posted in, where we are upset by nasty judgemental people saying this.

And remind me, KK, what are your achievements? Why are you so much better than the rest of us? I don't actually want or need to know because ultimately you are here for a reason and I respect that, would support you and would wish you well. It says everything that you are too selfish to do the same for others and I wonder what your outburst shows the rest of the forum? I thought we were in a safe, non judgemental place? Unfortunately, my experience has been that anxiety can lead to anger but for some it's really only amplifying their previous nature. I'm hardly the only one on here you have acted this way with. Who next, I wonder? Hopefully not somebody who may take your aggressive behaviour badly.

Yes, my anxiety has kept me living with my parents. Yes, I am on here at what you might perceive as strange times. But a few years ago I was spending all day sitting on the settee afraid to eat, drink or even brush my teeth. What a disgrace to humanity you must think I was. I'm a lot better now and like to help others improve their anxiety based on what I have learnt. I'm sorry you see anxiety sufferers helping each other being a bad thing, I'll glad I'm not bitter.

Sorry Elen but if someone is going to act in such a disrespectful way then it's time they experience perhaps just a little of their behaviour back.

---------- Post added at 16:41 ---------- Previous post was at 16:35 ----------


And I don't have a problem with the guidelines generally, though I remain unconvinced by mirtazapine and agomelatine for anxiety. The next person to tell me how great agomelatine is working for him/her will be the first.

Mine default suggestion is to try citalopram/escitalopram first as they generally have the best side-effects profile, although as with everything about antidepressants, that isn't a guarantee. Switching to sertraline is second, and then, given NHS restrictions, duloxetine or a TCA as the third option.

Outside the NHS framework, I think adding some nortriptyline to the sertraline to create a bespoke SNRI would be worth a shot ahead of a SNRI/TCA switch if there is even a small positive response from the sertraline as this might produce the fastest outcome with the least trauma.

BTW-I was shocked at the price premium quoted for duloxetine and venlafaxine compared to most of the SSRIs. The TCAs seem to be at a considerable premium too, especially clomipramine.

Though perhaps I shouldn't be. I was discussing MAOIs with a British psycho pharmacologist a while back and he explained they are pretty much off the table because of cost. Apparently, the NHS is paying more than £200 for a box of 28 tablets. That is <expletive> outrageous for drugs which have been out of patent for 50 years and probably cost only pennies to make!! But with only one or two companies still making them they can charge whatever they want. Dick Turpin had nothing on these guys!! :mad:

Yes, I'm on Duloxetine and I remember seeing it was closer to £30 power month when Cit was around £120 per year. But I think this was the Eli Lilly price because of you have a look at last year's data the price is now much lower which suggests generics.

http://www.nomorepanic.co.uk/showthread.php?t=196761&page=2&highlight=Perry

So, it seems the NHS were paying over the odds for years, most likely an inefficiency caused by some drug reps throwing them some free gifts?

Ven standard is very cheap as a generic but the prolonged release costs a lot more. GP's tend to not mention it exists knowing they could save you harsher side effects.

It's like you say though, they have a very difficult job balancing budgets and so they have my sympathy there too.

[KK77]

Dear Terry. You know nothing about my motives for being here.

You didn't contribute to this thread as an unbiased member would - you posted in order to discredit and invalidate my posts. I have no desire to argue or associate myself with you. You are the one who feels compelled to chip in when you feel there is a chance to score points. You are, let's face it, ultra competitive. Even taking a look at the Games Forum says as much. But that is not the problem. The problem is your agenda to take over this forum with your opinionated crap re politics and intervening where perhaps admin should in trying to create your own order.

And TBH, I have no interest in your personal life. I was simply drawing a comparison to how you appear on this forum.

NEXT...

[MyNameIsTerry]

Nope. I was supporting a much respected member who you attempted to discredit, one of your usual tactics on here. Ian is a good guy who plenty appreciate. Your points were challenged, respectfully, and you reacted in your normal aggressive manner. You did the same to another member a few days ago when they questioned your harsh posts. Now your accuse someone of bias because they take a TCA, in which case we must all be based to the pills we take, and you go lower by attempting to suggest the person has some level of cognitive decline. Based on what? Are you a doctor?

Oh boo hoo, I post on a few boards. What next? Adding links? Typing too much in a thread? I've heard them all before from members spitting their dummies.

I've always found it hilarious that a certain minority on here bleat on about others "taking over" there club or not following the rules because they are always the ones being disrespectful as can be seen yet again here.

If you want to bleat on about me taking over the forum, why not head off to a certain little thread on Misc. You know, the one I let go, the one other members said they saw no basis for this?

[KK77]

Nope. I was supporting a much respected member who you attempted to discredit, one of your usual tactics on here. Ian is a good guy who plenty appreciate. Your points were challenged, respectfully, and you reacted in your normal aggressive manner. You did the same to another member a few days ago when they questioned your harsh posts. Now your accuse someone of bias because they take a TCA, in which case we must all be based to the pills we take, and you go lower by attempting to suggest the person has some level of cognitive decline. Based on what? Are you a doctor?

Oh boo hoo, I post on a few boards. What next? Adding links? Typing too much in a thread? I've heard them all before from members spitting their dummies.

I've always found it hilarious that a certain minority on here bleat on about others "taking over" there club or not following the rules because they are always the ones being disrespectful as can be seen yet again here.

If you want to bleat on about me taking over the forum, why not head off to a certain little thread on Misc. You know, the one I let go, the one other members said they saw no basis for this?

Angry now are we Terry? Oh dear. What do you suggest we do about it?

There are plenty of vocal members on here who dislike you because of your pig-headed and argumentative ways. I am one of them. So keep calm, carry on and complain :D

[MyNameIsTerry]

I'm not angry in the slightest, that's you trying your tired old routine again. The only anger in this thread has been from you. Blimey, you've even tried the veiled threat...from the safety of your keyboard. :roflmao: (I would be lying if I said my anxiety is not always affected by personal insults but you're not the kind of person to remotely care so...)

It really is boring, very transparent. The worst part is this is an anxiety forum and you see this behaviour as appropriate. I can only apologise to any anxiety sufferers reading this and hope you understand this behaviour isn't indicative of NMP, the vast majority of members have always been really good people from my experience.

Oh boo hoo again, some people don't like me. Isn't that just life? The only people ever saying this nonsense are dummy spitters on a rant. You are entitled to your opinion, why would I be interested in what a disrespectful small minded person thinks? I'm more interested in the opinions of the good people on here, the nice people who understand how to respect each other.

---------- Post added at 18:21 ---------- Previous post was at 18:17 ----------


I am a doctor and have been a doctor for 12 years, mainly as a neurologist, and whilst studying Medicine I worked part time as what is now known as an anatomical pathology technician (morgue technician) carrying out post mortem examinations and I can say plenty of people who were depressed would overdose on their antidepressants with intentions of killing themselves. I can also say the ones who were successful in ending their lives were the ones on tricyclics and many of the times they were the only drugs in their system. I never did and autopsy were just an SSRI or SNRI was the only drug to contribute to someone's death that is almost unheard of. I have also worked in A&E in my job and plenty of people to this day still overdose on just antidepressants alone.

Are you aware of this study?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862059/

TCA's may be more toxic but it's far from unheard of that other classes have caused poisoning and death.

That's just a small number of hospitals.

Is it also worth noting the even higher rates (I'm assuming here, not checked the figures) for other drugs such as analgesics, paracetamol, etc.

[KK77]

Your manipulative shite doesn't wash dear boy. You go from victim to clown in a matter of a few posts. I find your responses beyond crass. And now I believe you are breaking NMP Rules and Elen's comment earlier re "personal" attacks... *Disrespectful and small-minded* eh? I don't really care much for rules being such an *aggressive* person but you pretend to bend over backwards till your head's up your own a*se talking about forum rules and order. You are hypocritical to boot :lac:

And who are these other members who "spit the dummy out"? Spit it out Tim ;)

[MyNameIsTerry]

Why do Tricyclics have such a bad reputation?

Sorry for how your thread has gone, Pierre. Bumping back to this in the hope we can get back on topic.

[KK77]

Sorry for how your thread has gone, Pierre. Bumping back to this in the hope we can get back on topic.

You have some feckin' nerve Tim :lac:

[lliiaamm0099]

Are you aware of this study?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862059/

TCA's may be more toxic but it's far from unheard of that other classes have caused poisoning and death.

That's just a small number of hospitals.

Is it also worth noting the even higher rates (I'm assuming here, not checked the figures) for other drugs such as analgesics, paracetamol, etc.

That study appears to be carried out in England and Wales alone, I live, studied and work in Scotland so there is probably quite a difference in what has been prescribed in England and Wales compared to Scotland. I was also stating that I have never carried out a post mortem were the single cause of death has been a result of an SSRI/SNRI and even still to this day as a neurologist I still haven't come across it personally unless the person has added other serotonergic drugs which could have lead to serotonin toxicity (serotonin syndrome) but that could be easy to identify as it usually resembles delirium/mania. Also this study talked about individual toxicity of specific drugs but it didn't talk about the people who took them, for example there is no mention of people who had personality disorders such as borderline personality disorder.

[KK77]

That study appears to be carried out in England and Wales alone, I live, studied and work in Scotland so there is probably quite a difference in what has been prescribed in England and Wales compared to Scotland. I was also stating that I have never carried out a post mortem were the single cause of death has been a result of an SSRI/SNRI and even still to this day as a neurologist I still haven't come across it personally unless the person has added other serotonergic drugs which could have lead to serotonin toxicity (serotonin syndrome) but that could be easy to identify as it usually resembles delirium/mania. Also this study talked about individual toxicity of specific drugs but it didn't talk about the people who took them, for example there is no mention of people who had personality disorders such as borderline personality disorder.

Thanks for your input Liam. So would you say my answer below to the OP's question of Are Tricyclics bad? was a reasonable one?



Tricyclics are dangerous to OD on and at therapeutic levels have some unpleasant side effects, especially cognitive dysfunction. They're now mainly used in low doses for pain conditions and/or sleep disorders.

[Catherine S]

A qualified honest to God doctor of neurology...Boom! Liam, now you've come out, you do realise you're now going to be inundated with messages from all our ALS phobics don't you :wacko: Take a deeeeep breath lol! Great to meet you and thanks for your 'professional' knowledge here.

And for any doubters, I'd say this man is the real thing because he talks about doing his bit in the morgue. If a person was only pretending to be a neurologist, they probably wouldn't give that side of it a thought, they'd go for the brain surgery angle just to impress everybody.

:D

[lliiaamm0099]

Thanks for your input Liam. So would you say my answer below to the OP's question of Are Tricyclics bad? was a reasonable one?

I would agree that they are dangerous to overdose on, that study also verifies that they are the most dangerous group to overdose on. And you are right about the cognitive effects too, most Tricyclics antagonise histamine in the brain which can make thinking a bit more clouded and also can impair skilled tasks. Their antagonism of acetylcholine is perhaps their most worrying factor as drugs that antagonise these receptors used to be referred to as "deliriants" as they cause confusion and people become disorientated. That is why they shouldn't be prescribed to elderly people especially those over 70.

[MyNameIsTerry]

That study appears to be carried out in England and Wales alone, I live, studied and work in Scotland so there is probably quite a difference in what has been prescribed in England and Wales compared to Scotland. I was also stating that I have never carried out a post mortem were the single cause of death has been a result of an SSRI/SNRI and even still to this day as a neurologist I still haven't come across it personally unless the person has added other serotonergic drugs which could have lead to serotonin toxicity (serotonin syndrome) but that could be easy to identify as it usually resembles delirium/mania. Also this study talked about individual toxicity of specific drugs but it didn't talk about the people who took them, for example there is no mention of people who had personality disorders such as borderline personality disorder.

Regardless of the numbers, the point is that there are other antidepressant groups other than TCA's involved in suicide & poisoning. Is there empirical evidence to support this in the same way that it supports TCA's?

I'm pretty sure Ven, Mirt, Cit and the others are prescribed in Scotland so does it matter that much? It's very easy to check the prescribing volumes per our populations if needed.

The NHS certainly still use them though, with clear guidance to ensure safety.

[lliiaamm0099]

A qualified honest to God doctor of neurology...Boom! Liam, now you've come out, you do realise you're now going to be inundated with messages from all our ALS phobics don't you :wacko: Take a deeeeep breath lol! Great to meet you and thanks for your 'professional' knowledge here.

:D

Oh dear that's no good :scared15: I do hope everyone here does realise the difference between neurology and psychiatry though. I specialise in conditions such as Parkinson's, dementia and as you say ALS. Although I do have the occasional patient with an uncommon disorder such as Tourette's syndrome so as for psychiatric advice I am probably not the best person on this forum, unless a person is being treated with an anticonvulsant for there anxiety which seems to be becoming more common with Pregabalin (Lyrica)

[KK77]

A qualified honest to God doctor of neurology...Boom! Liam, now you've come out, you do realise you're now going to be inundated with messages from all our ALS phobics don't you :wacko: Take a deeeeep breath lol! Great to meet you and thanks for your 'professional' knowledge here.

And for any doubters, I'd say this man is the real thing because he talks about doing his bit in the morgue. If a person was only pretending to be a neurologist, they probably wouldn't give that side of it a thought, they'd go for the brain surgery angle just to impress everybody.

:D
I'm not so sure. Some Doubting Tims will say I made him up just to prove KK right :roflmao:

[Catherine S]

I don't even pretend to understand how these meds work..or don't work, I only know its serious stuff, but just wanted to say you've been a breath of fresh air here tonight Liam. So thanks for that at least.

Carry On Doctor :D

[MyNameIsTerry]

Regardless of the numbers, the point is that there are other antidepressant groups other than TCA's involved in suicide & poisoning. Is there empirical evidence to support this in the same way that it supports TCA's?

I'm pretty sure Ven, Mirt, Cit and the others are prescribed in Scotland so does it matter that much? It's very easy to check the prescribing volumes per our populations if needed.

The NHS certainly still use them though, with clear guidance to ensure safety.

Just to add to this, a study worth discussion as it includes the difference between non TCA-to-SSRI combos which brings in the Serotonin Syndrome issue, plus a 7% shortfall.

https://www.ncbi.nlm.nih.gov/pubmed/14702226

Sorry for the rest on this thread, hopefully Admin can reign in the kids.

[Catherine S]

How VERY dare you call our doctor Liam a kid...Pfft :lac: Don't you listen doctor Liam, hands over ears and sing ok? :D

[MyNameIsTerry]

How VERY dare you call our doctor Liam a kid...Pfft :lac: Don't you listen doctor Liam, hands over ears and sing ok? :D

I didn't. That simple.

[KK77]

How VERY dare you call our doctor Liam a kid...Pfft :lac: Don't you listen doctor Liam, hands over ears and sing ok? :D

ABSOLUTELY DISGOOOSTING BEHAVIOUR Catherine! Disrespectful swine I say :lac:

[Catherine S]

Lol, sorry Pierre, just having a bit of fun...gotta have a laugh sometimes. But I'll be off and leave you in the capable hands of KK and doctor Liam. Hope your question was answered anyway.

Take care
:)

[lliiaamm0099]

I sort of get the feeling that whatever I say to people they will try and prove me wrong. I am just curious why people are questioning what I say about tricyclic antidepressants on this thread? I graduated from the University of St Andrew's with a first class BSc (Hons) degree in Neuroscience, I then graduated several years later with a Bachelor of Medicine, Bachelor of Surgery (MBChB) degree from the University of Edinburgh. I trained for a further 2 years in Neurology at the Edinburgh Royal Infirmary and then became a General Medical Council specialist in Neurology and have done this job now for 12 years and I have treated thousands of patients. Although there seems to be a great deal of self confessed medical experts on here I have noticed.

[KK77]

I sort of get the feeling that whatever I say to people they will try and prove me wrong. I am just curious why people are questioning what I say about tricyclic antidepressants on this thread? I graduated from the University of St Andrew's with a first class BSc (Hons) degree in Neuroscience, I then graduated several years later with a Bachelor of Medicine, Bachelor of Surgery (MBChB) degree from the University of Edinburgh. I trained for a further 2 years in Neurology at the Edinburgh Royal Infirmary and then became a General Medical Council specialist in Neurology and have done this job now for 12 years and I have treated thousands of patients. Although there seems to be a great deal of self confessed medical experts on here I have noticed.

Don't think you should post here any more as there is an agenda on this thread to disprove my original response re TCAs. I am not questioning anything you say or your qualifications. Thanks again for input.

[bottleblond]

:sofa:

I absolutely respect the professional member/s replying to this post but I certainly don't claim to have knowledge of any medication other than the one I am on just now and have been on for many years. (Venlafaxine). So thank you!. I actually found reading this thread quite fascinating and enlightening.

Going slightly off topic, I would really like to ask Admin, why does one member get told off for "personal" comments when another can freely do the same X 100 and not a word of protest is said to them. As I remember it, It's one rule for all, not selective judgement which I certainly see happening here.

Genuine question and a reply would be greatly appreciated.

[MyNameIsTerry]

I sort of get the feeling that whatever I say to people they will try and prove me wrong. I am just curious why people are questioning what I say about tricyclic antidepressants on this thread? I graduated from the University of St Andrew's with a first class BSc (Hons) degree in Neuroscience, I then graduated several years later with a Bachelor of Medicine, Bachelor of Surgery (MBChB) degree from the University of Edinburgh. I trained for a further 2 years in Neurology at the Edinburgh Royal Infirmary and then became a General Medical Council specialist in Neurology and have done this job now for 12 years and I have treated thousands of patients. Although there seems to be a great deal of self confessed medical experts on here I have noticed.

It's not the case, Liam, I'm not suggesting you aren't who you say you are. But I noticed your post was based on personal experience where you made the point that you've never heard of cases outside of TCA's but this contradicts things I have seen and since this is a discussion forum, can't it be discussed?

You're definitely not the only medical professional on here I've seen.

---------- Post added at 23:35 ---------- Previous post was at 23:35 ----------


:sofa:

I absolutely respect the professional member/s replying to this post but I certainly don't claim to have knowledge of any medication other than the one I am on just now and have been on for many years. (Venlafaxine). So thank you!. I actually found reading this thread quite fascinating and enlightening.

Going slightly off topic, I would really like to ask Admin, why does one member get told off for "personal" comments when another can freely do the same X 100 and not a word of protest is said to them. As I remember it, It's one rule for all, not selective judgement which I certainly see happening here.

Genuine question and a reply would be greatly appreciated.

Agreed. I like to know too. Would Pierre though?

[bottleblond]

Terry, With all due respect, I am not addressing you so please show me the same courtesy. Many thanks.

[Bike Rider]

Well I am going to stick with Ian and Terry, they seem to know what they are on about and as has been mentioned, they are respected on this site.

Whether Lliiaamm 0099 is or is not a doctor, I don't really much care, as during my 63 yrs on this planet I have come across some bloody awful doctors both in hospitals and surgeries, whom you may trust to apply a plaster, but not much else.

Ian and Terry have actual experiences in these matters and over many years have experienced a lot and learned a lot. That's what counts.

My current GP though is fantastic and during his training worked for a while in psychiatry, I have mentioned to him things that both Ian and Terry have told me (without mentioning names) and he has confirmed their thoughts.

So finally a GP with some training in this subject, whom I trust, has confirmed things told to me by other sufferers on here who I respect.

That will do for me, keep going Terry and Ian.

[lliiaamm0099]

Nobody on this forum is questioning whether or not I am a doctor I don't think, I can't tell people what my GMC number is because it would breach my own anonymity and it could seem unprofessional for me to be on this site. Also as part of the Medicine and Surgery degree you need to study Psychiatry for at least 6 months which I have done and I have plenty of experience dealing with drugs that affect the nervous system as a neurologist, mainly tricyclic antidepressants for neuropathy which I have used in at least hundreds of people. I have also used antipsychotic medication in people with delirium/mania and severely agitated dementia patients. I have used anticonvulsants in epileptics, stimulants in Parkinson's etc

The only reason I am on this forum is to research the difference between anxiety disorders and people who suffer from paranoid personality disorder. I can honestly say for a forum that is supposed to be looking out for one another it just seems to be full of people who spend their entire day reading medical journal abstracts and then claiming to be experts in the pharmacology of the nervous system. Or people who tell others to take/not take certain medicines because they had a good or bad experience which is totally biased and not how evidence based medicine works. Has anybody else here treated patients before as a prescribing doctor? Or is all this knowledge you have purely based on what drugs you have taken?

[KK77]

Nobody on this forum is questioning whether or not I am a doctor I don't think, I can't tell people what my GMC number is because it would breach my own anonymity and it could seem unprofessional for me to be on this site. Also as part of the Medicine and Surgery degree you need to study Psychiatry for at least 6 months which I have done and I have plenty of experience dealing with drugs that affect the nervous system as a neurologist, mainly tricyclic antidepressants for neuropathy which I have used in at least hundreds of people. I have also used antipsychotic medication in people with delirium/mania and severely agitated dementia patients. I have used anticonvulsants in epileptics, stimulants in Parkinson's etc

The only reason I am on this forum is to research the difference between anxiety disorders and people who suffer from paranoid personality disorder. I can honestly say for a forum that is supposed to be looking out for one another it just seems to be full of people who spend their entire day reading medical journal abstracts and then claiming to be experts in the pharmacology of the nervous system. Or people who tell others to take/not take certain medicines because they had a good or bad experience which is totally biased and not how evidence based medicine works. Has anybody else here treated patients before as a prescribing doctor? Or is all this knowledge you have purely based on what drugs you have taken?

There is a lot of cognitive dissonance here, as I'm sure you can see throughout this thread Liam. There is also a lot of armchair pharmacology going on. While it is good to be clued up about our condition and mental health, sharing erroneous information is dangerous, and it seems to be happening more and more frequently.

[Bike Rider]

"Has anybody else here treated patients before as a prescribing doctor? Or is all this knowledge you have purely based on what drugs you have taken?"


Well speaking for myself, my knowledge is limited to my own symptoms, conditions and experiences, plus different medication I have taken and their effects. And this is all I pass on to anyone interested, plus encouragement.

As regards prescribing doctors, I have experience with 2 at surgeries and 1 in a hospital who I wouldn't give the time of day too and based on their diagnosis of me and a member of my family, would question their judgement every time were I still with them and still alive.

[lliiaamm0099]

As regards prescribing doctors, I have experience with 2 at surgeries and 1 in a hospital who I wouldn't give the time of day too and based on their diagnosis of me and a member of my family, would question their judgement every time were I still with them and still alive.

You are entitled to a second opinion by another doctor if you disagree with a diagnosis or if you think something has been overlooked.

[MyNameIsTerry]

Nobody on this forum is questioning whether or not I am a doctor I don't think, I can't tell people what my GMC number is because it would breach my own anonymity and it could seem unprofessional for me to be on this site. Also as part of the Medicine and Surgery degree you need to study Psychiatry for at least 6 months which I have done and I have plenty of experience dealing with drugs that affect the nervous system as a neurologist, mainly tricyclic antidepressants for neuropathy which I have used in at least hundreds of people. I have also used antipsychotic medication in people with delirium/mania and severely agitated dementia patients. I have used anticonvulsants in epileptics, stimulants in Parkinson's etc

The only reason I am on this forum is to research the difference between anxiety disorders and people who suffer from paranoid personality disorder. I can honestly say for a forum that is supposed to be looking out for one another it just seems to be full of people who spend their entire day reading medical journal abstracts and then claiming to be experts in the pharmacology of the nervous system. Or people who tell others to take/not take certain medicines because they had a good or bad experience which is totally biased and not how evidence based medicine works. Has anybody else here treated patients before as a prescribing doctor? Or is all this knowledge you have purely based on what drugs you have taken?

Liam,

You've really got no need to try to justify yourself. I take people based on what I see and I've come across you before on here and seen you have a lot of knowledge on the subject.

I hope you look around the site to see all the support we give each other on here. I've met some friends and had plenty if support and try to give it back. I've also gone from knowing next to nothing about these meds to learning a fair bit that helped me understand the experience I had on my meds, something which my GP made a pig's ear of. But I suspect you know more than most about the many errors within the NHS when it comes to mental health care.

When I attended self help groups they wouldn't allow any of this on here. Discussing meds beyond anything very basic was stopped and members were advised to see their GP. It's more free online so it brings it's good & bad points.

---------- Post added at 01:29 ---------- Previous post was at 01:23 ----------


Well I am going to stick with Ian and Terry, they seem to know what they are on about and as has been mentioned, they are respected on this site.

Whether Lliiaamm 0099 is or is not a doctor, I don't really much care, as during my 63 yrs on this planet I have come across some bloody awful doctors both in hospitals and surgeries, whom you may trust to apply a plaster, but not much else.

Ian and Terry have actual experiences in these matters and over many years have experienced a lot and learned a lot. That's what counts.

My current GP though is fantastic and during his training worked for a while in psychiatry, I have mentioned to him things that both Ian and Terry have told me (without mentioning names) and he has confirmed their thoughts.

So finally a GP with some training in this subject, whom I trust, has confirmed things told to me by other sufferers on here who I respect.

That will do for me, keep going Terry and Ian.

Thank you for your kind words, BR. I grealy appreciate them.

It's great to hear you have a fantastic GP! We need more of them. Mine is a great GP and very understanding, always has been but his experience in mental health care is poor given the things I've later found out to nonsense.

I wish they would train them up more on these meds so we aren't experimented on so much. Some GP's have clearly learnt from experience was it shows in how they approach meds very cautiously and are flexible.

I've only ever said I'm just another sufferer on here. When I joined I learned much from talking to guys on the Ven board and from people like hanshan & SmilingAlbert who were knowledgeable on meds they have been on. Prior to this I relied solely on my GP.

[akb]

I've never liked this forum, and this discussion reminded me why. Its as if nobody has learnt any of the positive lessons that mindfulness meditation should bring. I'm trashing my account now, something I should have done a long time ago. Compassionate my ass, hypocrites is the best word I can think of. さよなら！

[Mermaid16]

This thread really got out of hand. Everyone is entitled to their opinion, but this has turned nasty. At the end of the day you are all entitled to your opinion and as readers, it is up to us how we interpret that information. We all know that none of you are doctors and maybe like myself, take some of the information you suggest and run it past our own psychiatrist. It's not about outdoing each other, it's about providing information that may help the OP.

[MyNameIsTerry]

Mermaid & akb, I'm sorry for what you have witnessed here and my part in it. You're right, Tracy.

And akb I hope you don't leave due to this, it's a great shame if you feel you have to, but I wish you all the best in your recovery & future in your very difficult situation if you feel it is what you need to do. Good luck.

[Bike Rider]

You are entitled to a second opinion by another doctor if you disagree with a diagnosis or if you think something has been overlooked.

Luckily Liam I did, a chiropractor put my twisted pelvis back into line, getting me pain free again, as opposed to my Doctor at the time prescribing arthritis tablets without even examining me.

Whilst another claimed that my high blood pressure was due to alcohol and I should abstain to see it reduced. The fact as I explained to him, that I was on 24 hr call out and therefore could not drink didn't matter. Again, another GP sent me for tests, all was ok, Just one of those things and put me on meds to get it down. Perhaps back then if they had realised that I am a worrier and get anxiety which we now think causes the raise, I wouldn't be in the mess I am now.

---------- Post added at 10:59 ---------- Previous post was at 10:49 ----------


I've never liked this forum, and this discussion reminded me why. Its as if nobody has learnt any of the positive lessons that mindfulness meditation should bring. I'm trashing my account now, something I should have done a long time ago. Compassionate my ass, hypocrites is the best word I can think of. さよなら！
If you have NEVER liked it, why have you stayed? doesn't make sense to me.

Mermaid, this will always happen I think, different opinions, but I agree there are nice ways to say something. I play on a chess site and there forums are vitriolic and cruel towards each other, I mean really nasty, so I keep of those and just play chess, badly. But some people just like to cause animosity among others.

---------- Post added at 11:07 ---------- Previous post was at 10:59 ----------


Liam,

You've really got no need to try to justify yourself. I take people based on what I see and I've come across you before on here and seen you have a lot of knowledge on the subject.

I hope you look around the site to see all the support we give each other on here. I've met some friends and had plenty if support and try to give it back. I've also gone from knowing next to nothing about these meds to learning a fair bit that helped me understand the experience I had on my meds, something which my GP made a pig's ear of. But I suspect you know more than most about the many errors within the NHS when it comes to mental health care.

When I attended self help groups they wouldn't allow any of this on here. Discussing meds beyond anything very basic was stopped and members were advised to see their GP. It's more free online so it brings it's good & bad points.

---------- Post added at 01:29 ---------- Previous post was at 01:23 ----------



Thank you for your kind words, BR. I grealy appreciate them.

It's great to hear you have a fantastic GP! We need more of them. Mine is a great GP and very understanding, always has been but his experience in mental health care is poor given the things I've later found out to nonsense.

I wish they would train them up more on these meds so we aren't experimented on so much. Some GP's have clearly learnt from experience was it shows in how they approach meds very cautiously and are flexible.

I've only ever said I'm just another sufferer on here. When I joined I learned much from talking to guys on the Ven board and from people like hanshan & SmilingAlbert who were knowledgeable on meds they have been on. Prior to this I relied solely on my GP.

Just speaking as I find it Terry and thats all that matters to me.

My GP is fantastic Terry, he is a Christian and he talks openly and listens, I don't know where I would be now without his help, advice and guidance.

[Catherine S]

So some doctors aren't up to doing their job properly..we get it BR, we can see how angry you are about your past experience, but why make Liam feel bad about that? It's hardly his fault is it. All he did was answer Pierre's origional question, giving his honest professional opinion as a neuro-scientist. But he reckoned without certain members getting all puffed up didn't he.

Leave the man alone for goodness sake, he was only trying to help The OP, and instead he finds he is having to constantly defend himself. I dont mean to interrupt the Terry show, but you guys peeing up a few trees to mark your territory isnt pleasant to watch. Far better to perhaps accept that the man just might know what he's talking about. If you don't agree with him thats fine, but no need to bash him because of a few bad doctors is there?

:)

[Bike Rider]

Catherine S. Try to desist from barging into thread's solely to cause animosity. Just saying.......

[Catherine S]

Nah BR, barging in has already been covered by others. I'm just trying to get Liam out from under the scrum.

:lac:

[Bike Rider]

Nah BR, barging in has already been covered by others. I'm just trying to get Liam out from under the scrum.

:lac:

If Liam is who he says he is, he won't need your help.:doh:

[Catherine S]

Ahahahahaha....priceless. He is exactly who he says he is BR, so time to get over it

:D

[Duckbruck]

How about "BACK TO TOPIC"?

[Catherine S]

Yes I agree absolutely Duckbruck...however, I think alot of the topic was discussed on the first few pages of the thread, so I hope you found the information given helped you. Not sure if anything more will be discussed as Pierre seems to have disappeared. Can't really blame him.

:)

[MyNameIsTerry]

How about "BACK TO TOPIC"?

Agreed. Pierre said:


Why do Tricyclics have such a bad reputation?

TCA's as a group can't be solely judged on the toxicity issue when there are drugs in other more mainstream classes that also have toxicity issues above certain TCA's.

So, ignorance can be factor there because it's important to look at the finer details. The NHS have guidance on what TCA's should be treated more cautiously and above what dosages or age groups.

If we generalise we might as say all SSRI/SNRI's have a bad reputation for withdrawal when we need to consider the outliers, Ven & Paroxetine.

And what about efficiency? Some work better than others and obviously that influences whether they the risk outweighs the benefits or whether the added risk adds on top of the lack of benefit.

The NHS are happy to prescribe them. Doctors aren't stupid, they will look at whether patients are at risk of suicide. And these meds aren't prescribed until others have been tried first which shows they have a greater understanding of the patient in front of them.

And really, if you are going to harm yourself, you can easily obtain enough paracetamol.

If we asked "are Benzo's bad?" we would be discussing the pros & the cons to have a balanced debate. I'm sure Googling "are TCA's bad?" would bring all manner of scaremongering sites on the net.

[KK77]

Doctors are stupid, they will look at whether patients are at risk of suicide.

Freudian Slip reveals what you really think of our resident Dr Liam :lac:

NEXT!

[MyNameIsTerry]

I'm typing on my phone so mistakes do happen.

No, I don't think Liam is stupid. That's just more pathetic game playing.

I believe Liam will have a bit more maturity. It was obvious what I was saying from rest of the sentence.