Imipramine or Clomipramine

[SideFX]

It is partly due to the combination of receptors each effect in addition to the serotonin and noradrenaline/norepinephrine transporters and also TCA starting doses tend to be lower relative to their therapeutic range.



TCAs are generally a little more effective for anxiety and significantly more effective for depression than SSRIs. SSRIs are generally better at mitigating anxiety than depression...provided you can get past the initial heightened anxiety they often trigger.



There is only biological anxiety and depression (and every other 'mental' illness, a term I dislike because it misleads folk). These disorders are the emotional manifestation of biological changes (PDF) in the hippocampal regions of the brain caused by an auto-immune type response, not of the mind. The mind has no independent existence, it is a construct of the brain and so can't be independently diseased, or otherwise damaged. ADs reverse the hippocampal changes. So can the mind. Therapies such as CBT, REBT and mindfulness work by the same process as ADs, neurogenesis.

Again thank you Ian

I didn’t mention that the Brintellix has caused bruxism right from day one, but the Pregabalin masked it till it wore off (circa 6.5hr half life) Pdoc thinks that reducing Mirtazipine would help...I disagreed as Mirt has little to no affinity for serotonin.

But I was sick and tired of changing meds and have never felt that it truly helped over the past 2 plus years...I feel it has raised serotonin as you would expect it to do, but that has come at a cost of SideFX. I need a med that suits me, without the horrendous effects that SSRI’s give me and I’ve never properly tried a therapeutic dose of a TCA for a reasonable time.

I don’t really count 2 days on amitriptyline and they were with doluxatine, so that muddied the waters. And as my mum did so well for so many years on imipramine, after withdrawal from an MAOI, I don’t know why the Pdocs haven’t tried it...I’ve told him many times (They seem to be so passive) and state it’s not all about meds you know...Hey tell me something I don’t know, but when your fighting against your meds, there’s something wrong.

Also because I’m a high functioning person with depression and anxiety, they just pay lip service to our 3 monthly appointments. And point blank refuse Nardil or Parnate !!! But are happy to go with any TCA I suggest.

Thanks for all your little nuggets of knowledge and any more would be welcomed, particularly around imipramine thanks John

Ps
I know you were on imipramine for a number of years...I’ve read some previous posts. How did you find it and what condition(s) was it prescribed for ???? Many Thanks

[panic_down_under]

I didn’t mention that the Brintellix has caused bruxism right from day one

Bruxism is a relatively common side-effect of ADs, but anxiety can trigger it too.

I feel it has raised serotonin as you would expect it to do, but that has come at a cost of SideFX.

SSRIs may not be doing what you think they do: Serotonin - The 'chemical imbalance' myth

I don’t really count 2 days on amitriptyline and they were with doluxatine, so that muddied the waters.

Yep, you can't really judge a med under that circumstance. Duloxetine is the pick of the common SNRIs because it actually is one, but it can produce severe side-effects at the beginning. The less common SNRIs milnacipran and levomilnacipran may be the pick of the bunch, although data is scarce.

And as my mum did so well for so many years on imipramine, after withdrawal from an MAOI, I don’t know why the Pdocs haven’t tried it...I’ve told him many times (They seem to be so passive) and state it’s not all about meds you know...

They all have their individual box of tricks which they use on everyone and soon get lost when the patients don't do what is expected of them by failing to get better. That's when many go into poly-pharmacy mode. Plus, unless they are offering therapy isn't it actually "all about the meds"?

Also because I’m a high functioning person with depression and anxiety, they just pay lip service to our 3 monthly appointments. And point blank refuse Nardil or Parnate !!! But are happy to go with any TCA I suggest.

Don't let them get away with it. You're paying for their time, directly or indirectly, so insist on getting your money's worth.

I'm not surprised at the refusal to prescribe MAOIs. Unless they are in the sixties they've likely never been exposed to them and the data on MAOIs is way out of date. Unfortunately, there is no pressing reason for the powers to be to change this. Ken Gillman is about the only one trying to drum up interest and he'll almost certainly fail, just as his efforts to correct the BS about serotonin syndrome has mostly fallen on deaf ears among the WHO, FDA, MHRA, TGA, etc, decision makers and med journals.

I know you were on imipramine for a number of years...I’ve read some previous posts. How did you find it and what condition(s) was it prescribed for ???? Many Thanks

It was the first med I was put on for panic disorder back in early 1987. No SSRIs back then, which was fortunate as they don't mesh well with my biology. I was on it, off and on, for about 8 years mostly at 300-350mg/day (which would horrify most psychiatrists these days, but the bloke that developed it took 1,000mg/day for a while without issue - that was back in the good ol' days when drug developers were their own guinea pigs). It worked well and the only side-effects of note was dry-mouth and moderate sexual dysfunction, plus a slight head shake at 350mg which seemed to be only apparent to me. I switched to dosulepin in ~1996 because the common wisdom of the time was that it was the safest TCA and produced fewer side-effects. Turns out the first was 210% wrong, it is the most cardio-toxic AD by a significant margin, but the second is true. I have no discernable side-effects.