Quote:
Originally Posted by
Barnabas75
Surprised this med is not used more often.
It is partly because SSRIs are considered safer in *overdose, but mostly because most GPs and even many psychiatrists have little experience of older antidepressants these days.
* most antidepressant overdoses are accidental, not deliberate
The TCAs are much underutilized meds, imho. They are often more effective than SSRIs, are less prone to poop-out and generally produce less severe initial side-effects and withdrawal symptoms.
The same is true of the even older MAOIs which could/should be due for a revival now that modern food processing techniques have greatly reduced the need for a restricted diet (adding a small dose of a noradrenaline reuptake inhibitor such as nortriptyline or reboxetine would remove nearly all food restrictions), but which almost certainly won't become popular again because being long out of patent and thus cheap as chips there is no incentive to promote them. Pity, because many, perhaps most, older psychiatrists who practiced through the MAOI, TCA and SSRI/SNRI eras would choose tranylcypromine (Parnate) if they personally needed an antidepressant. TCAs, mostly Anafranil, would be their second choice.
