Are Tricyclics bad?

[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 maintains the QTc drug data base for the FDA.

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[ing] up and down"?

And here's some more selected info:

Carrière I, 2017, Antidepressant use and cognitive decline in community-dwelling elderly people"


Podewils LJ, 2002, "Tricyclic antidepressants and cognitive decline.":


OTOH, there is some evidence 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 ----------



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

[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!!

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/showthr...ighlight=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

[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. (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

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