# Best Tricyclic



## BearFan (Mar 22, 2008)

Anyone know what tends to be the best tricyclic that is still widely used? The ones I tend to hear the most about are Pamelor and Elavil. I remember a pdoc saying they tend to have less or no sexual side effects compared to the SSRIs. Looking specifically the most efficacious Tricyclic in regards to anxiety/depression without weight gain and sexual issues. Or just one that is useful from people on this board.


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## Ehsan (Mar 21, 2009)

Palemor is a popular Norepinephrine Reuptake Inhibitor thus is activating, antidepressant and has little side effects.
however Palemor hasn't much use in anxiety treatment coz they increase extracellular NE. serotonergic TCAs are more effective in anxiety and depression but are sedating and have more side effects(dry mouth, sexual dysfuction,..)
Anfranil(clomipramine) is indicated for OCD and has many off-label uses but its side effects are Slightly higher than other TCAs and SSRI.


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## UltraShy (Nov 8, 2003)

No TCA is widely used in 2010. They were almost entirely killed off by SSRIs over the last 20+ years.

The only common use for TCAs today is as sleep aids. I've tried Elavil & Doxepin for that: problem -- they don't sedate me at all, even at max recommended dose. They do produce one hell of a dry mouth though.

I tried imipramine for 28 days as an anxiety treatment. That ended after 4 weeks, because even this trooper who will consume damn near any pill presented as a potential "cure" could no longer stand the side effects. It produces *EXTREME* dry mouth (you don't know what dry is till you take this pill from hell). But that's the nicer of the side effect. Just imagine walking into your bathroom to pee. Then imagine standing there for 15 minutes and being unable to get out even a drop such that you give up to try again later. It's enough to make atheists start praying, praying to simply pee! You have no idea how important urination is till you can't.


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## BearFan (Mar 22, 2008)

There were a few tricyclics still in the top 10 depression medications prescribed in recent years. If one must be used, which ones are still clinically useful?


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## UltraShy (Nov 8, 2003)

BearFan said:


> There were a few tricyclics still in the top 10 depression medications prescribed in recent years. If one must be used, which ones are still clinically useful?


While TCAs are antidepressants, I'm sure any on that top 10 list are actually being used as sleep aids in almost all cases. Despite all the med discussions I've seen here over the years, I can't think of anyone here who is using a TCA to treat anxiety.

I'm guessing you're looking into TCAs as you're not too happy with the sexual side effects of SSRIs?


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## Ehsan (Mar 21, 2009)

in my experience, majority of TCAs are not hypnotic.
Palemor is activating instead.
anfranil is slightly sedating but not hypnotic at all and is useful for anxiety as a potent SRI and 5-HT2 antagonist.
doxepin and amitriptyline may be hypnotic due to strong H1 antagonism.


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## Heuer (Sep 7, 2009)

BearFan said:


> Anyone know what tends to be the best tricyclic that is still widely used? The ones I tend to hear the most about are Pamelor and Elavil. I remember a pdoc saying they tend to have less or no sexual side effects compared to the SSRIs. Looking specifically the most efficacious Tricyclic in regards to anxiety/depression without weight gain and sexual issues. Or just one that is useful from people on this board.


Hi,

I've been on Elavil for 37 years.
This drug is a very good sleep aid.

Now I'm on Remeron and Lyrica for sleep.
Wellbutrin sweeps my tiredness away.

Best regards,
Heuer


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## euphoria (Jan 21, 2009)

Amineptine. lol.


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## meyaj (Sep 5, 2009)

Pamelor helped my sleep quality and daytime energy a lot. It's been the best antidepressant I've tried so far (it + wellbutrin were the only ones that were positive AT ALL), but my own personal response to it was still pretty incomplete, my depression and SA being classified as severe, so I had to move on. I'm on an MAOI now but not really at a proper therapeutic dose yet, so I have to reserve judgment on it. BUT, I have to be honest, I actually miss Pamelor, lol. It might not have done everything I needed it to, but it was a positive experience with very little in the way of side effects (dry mouth). 

It IS rather activating most of the time, but immediately after taking a dose, it will be somewhat sedating, which is why it's taken pretty much always taken before bed. It's not that icky antihistamine kind of sedation though which feels so horrible that it's counterproductive for me, but pretty subtle. I didn't really feel knocked out or anything, but it seemed to put my mind and body at ease, making it easier to fall asleep. I was able to cut my sleep meds in half while on it with no problem. Since I got off it, I had to double up again. And as I mentioned before, it really seemed to improve my overall sleep quality and I've never woken up so refreshed. Lately I've been waking up feeling hungover every morning, which really sucks :blank


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## jim_morrison (Aug 17, 2008)

meyaj said:


> Pamelor helped my sleep quality and daytime energy a lot. It's been the best antidepressant I've tried so far (it + wellbutrin were the only ones that were positive AT ALL), but my own personal response to it was still pretty incomplete, my depression and SA being classified as severe, so I had to move on. I'm on an MAOI now but not really at a proper therapeutic dose yet, so I have to reserve judgment on it. BUT, I have to be honest, I actually miss Pamelor, lol. It might not have done everything I needed it to, but it was a positive experience with very little in the way of side effects (dry mouth).
> 
> It IS rather activating most of the time, but immediately after taking a dose, it will be somewhat sedating, which is why it's taken pretty much always taken before bed. It's not that icky antihistamine kind of sedation though which feels so horrible that it's counterproductive for me, but pretty subtle. I didn't really feel knocked out or anything, but it seemed to put my mind and body at ease, making it easier to fall asleep. I was able to cut my sleep meds in half while on it with no problem. Since I got off it, I had to double up again. And as I mentioned before, it really seemed to improve my overall sleep quality and I've never woken up so refreshed. Lately I've been waking up feeling hungover every morning, which really sucks :blank


Are you considering adding pamelor back to parnate soon? I know you've discussed this option before. Since pamelor works well for you it might actually be a decent combo for you.


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## meyaj (Sep 5, 2009)

jim_morrison said:


> Are you considering adding pamelor back to parnate soon? I know you've discussed this option before. Since pamelor works well for you it might actually be a decent combo for you.


I'd like to but I kind of hinted at it to my psychiatrist and I really don't think there's a chance in hell she'd go for it. Because I'm taking Dexedrine and Parnate at the same time she's already taking it extra slow, but I'll wait until I'm at a decent dose of the latter for a few weeks before I really push the idea. No use getting ahead of myself :lol


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## phob33 (Mar 31, 2007)

I have been on low dose anafranil for 20 years. It saved my life. The way I was living for probably 5 years was aweful! If I would see someone I knew in a store, I would blush and shake and couldn't even look them in the eye. Just sitting around a table having coffee at work was pure hell! I would blush any time someone would look at me. I didn't want to live like that, that's for sure. After 2 weeks on anafranil I found myself actually laughing for the first time in about 5 years. I wouldn't "Obsess" about how people looked at me. I got my life back!! So please don't say nobody uses Tricylic... they have a place. And for me, there are literally ZERO side effects. I remember when I first started taking them I had dry mouth but that's about it.


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## Ehsan (Mar 21, 2009)

phob33 said:


> I have been on low dose anafranil for 20 years. It saved my life. The way I was living for probably 5 years was aweful! If I would see someone I knew in a store, I would blush and shake and couldn't even look them in the eye. Just sitting around a table having coffee at work was pure hell! I would blush any time someone would look at me. I didn't want to live like that, that's for sure. After 2 weeks on anafranil I found myself actually laughing for the first time in about 5 years. I wouldn't "Obsess" about how people looked at me. I got my life back!! So please don't say nobody uses Tricylic... they have a place. And for me, there are literally ZERO side effects. I remember when I first started taking them I had dry mouth but that's about it.


it worked great for me too.
i thought i'm the only one who has found Anfranil great for SAD.


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## phob33 (Mar 31, 2007)

My doctor waaayy back then said the results he had with anafranil were amazing. Years later when I had to switch docs, he thought I was crazy using anafranil (it was so "yesterday"). The pharmaceutical companies deal the cards and if they say SSRIs are best, physician's don't blink an eye.... yes, I think it would be quite difficult for a person to get anafranil unless you go to a few doctors and one has an open mind.


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## Ehsan (Mar 21, 2009)

phob33 said:


> My doctor waaayy back then said the results he had with anafranil were amazing. Years later when I had to switch docs, he thought I was crazy using anafranil (it was so "yesterday"). The pharmaceutical companies deal the cards and if they say SSRIs are best, physician's don't blink an eye.... yes, I think it would be quite difficult for a person to get anafranil unless you go to a few doctors and one has an open mind.


i'm not sure but i think it dose not work only as a SNRI. i read somewhere that it works on oxytocin and CRF too.
further evidences and experiences needed.
there are few researches considering effectiveness of TCAs in SAD.


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## quat (Sep 27, 2006)

I'm taking endep at a very low dose, really just as a sleep aid at night. It brings me down and when it wears off during the day i'm on an upper. Then I take Parnate during the day.


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## BearFan (Mar 22, 2008)

I took it at night for the first days, it does kind of feel like an NRI which is not what I want. Does it get more calming later, because I had a bit of that 'crawling out of my skin feeling' (though not as bad as pristiq) I tend to do the best on heavier serotonin drugs with a bit of the NE kick (ie Prozac, Effexor, Cymbalta). Which Tricyclic is more like those with the least side effects?


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## meyaj (Sep 5, 2009)

BearFan said:


> Which Tricyclic is more like those with the least side effects?


Clomipramine...


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## Arisa1536 (Dec 8, 2009)

I dont know if reviving old threads is allowed but i was interested in what everyone posted here regarding TCAs and which ones worked for them.

i find pamelor good 
hardly any side effects and i am prone to side effects it would seem with most medications. The "Weight gain" might be a scare tactic i am not sure but i know SSRI's were much worse in terms of weight, emotions, sexual dysfunction and all round lethargy than pamelor has been.

Like meyaj, i have the best sleep EVER on these and do not need sleeping pills anymore, there is also no hangover side effect in the morning and aside from dry mouth (not that bad really when compared to Seroquel) they have been good.

I found mixing them with 150 mg of effexor is exactly what i need but *everyone is different* and usually people find another antidepressant helpful when using a TCA if you have severe depression and seasonal affective disorder. TCAS are great for different types of depression like melancholic and Major but it would seem that MAOI's work better for Atypical


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## jim_morrison (Aug 17, 2008)

BearFan said:


> Looking specifically the most efficacious Tricyclic in regards to anxiety/depression without weight gain and sexual issues. Or just one that is useful from people on this board.


The secondary amine tricyclics; nortriptyline, desipramine and protriptyline would be the least likely to cause weight gain or sexual problems.


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## Melinda (Feb 5, 2009)

Cyclobenzaprine helped me quite a bit. It was initially prescribed as a sleep aid/nerve pain reducer, but I quickly found that it took the edge off my depression as well. And unlike all the SSRI's I'd tried in the past, it didn't give me excruciating migraines, make me gain 20 lbs in a month, make me feel like an emotionless zombie, or kill what little libido I have. I took a very low dose, but I'm extremely sensitive to meds. Everyone's different. At any rate, hope you find something that works for you!


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## upndownboi (Oct 7, 2010)

sounds like clomipramine is leading as the best 'all-rounder' with nortryptiline if you only need NRI


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## Arisa1536 (Dec 8, 2009)

Yeah true but i think Cyclobenzaprine is a lot harder to get prescribed 
we only have a limited number of TCAs available in the country as it is (i checked the CMI new zealand drug database for TCAs) so i guess nortrip and possibly clomipramine are it in New Zealand although Cyclobenzaprine is more of a potent muscle relaxer right?


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## jim_morrison (Aug 17, 2008)

Cyclobenzaprine might not have shown up in the database because it's not a tricyclic antidepressant (just a tricyclic compound). TCA antidepressants only make up a portion of the tricyclic compounds in use.

http://en.wikipedia.org/wiki/Tricyclic



> *Tricyclics* are chemical compounds that contain three interconnected rings of atoms.
> Many compounds have a tricyclic structure, but in pharmacology, the term has traditionally been reserved to describe heterocyclic drugs. Among these are antidepressants, antipsychotics, and antihistamines of the dibenzazepine, dibenzocycloheptene, dibenzothiazepine, dibenzothiepin, phenothiazine, and thioxanthene chemical classes, and others.


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## Inshallah (May 11, 2011)

Clomi- and Imipramine are the undisputed best or 'best' if you want to take some side effects into account. Nortriptyline is the most side effect friendly.

I've been on Clomi for a few weeks but my blood pressure got too low in comvination with the Oxycontin I was also on then. A shame really because I wanted to give it the full 6-8 weeks.

I am on Imi since 3 days and titrating up fast, no BP issues yet but of coursecI'm not on Oxycontin now.

So far no side effects with Imipramine and I'm on 100 mg on day 3. Not seeing where all the complaining always comes from


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## Burnaby (Feb 13, 2013)

Ehsan said:


> it worked great for me too.
> i thought i'm the only one who has found Anfranil great for SAD.


Are you still on Anfranil Ehsan? Do you suffer from regular panic attacks ?


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## zeusko87 (Sep 30, 2014)

what is the best TCA for pain and anxiety?

i have tried only melitracen so far but it didn"t work well.


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## Hordak (May 5, 2017)

UltraShy said:


> No TCA is widely used in 2010. They were almost entirely killed off by SSRIs over the last 20+ years.
> 
> The only common use for TCAs today is as sleep aids. I've tried Elavil & Doxepin for that: problem -- they don't sedate me at all, even at max recommended dose. They do produce one hell of a dry mouth though.
> 
> I tried imipramine for 28 days as an anxiety treatment. That ended after 4 weeks, because even this trooper who will consume damn near any pill presented as a potential "cure" could no longer stand the side effects. It produces *EXTREME* dry mouth (you don't know what dry is till you take this pill from hell). But that's the nicer of the side effect. Just imagine walking into your bathroom to pee. * Then imagine standing there for 15 minutes and being unable to get out even a drop such that you give up to try again later. It's enough to make atheists start praying, praying to simply pee! You have no idea how important urination is till you can't.*


:O



> Urinary retention often occurs without warning. It is basically the inability to pass urine. In some people, the disorder starts gradually but in others it may appear suddenly. Acute urinary retention is a medical emergency and requires prompt treatment. The pain can be excruciating when urine is not able to flow out. Moreover, one can develop severe sweating, chest pain, anxiety and high blood pressure. Other patients may develop a shock-like condition and may require admission to a hospital. Serious complications of untreated urinary retention include bladder damage and chronic kidney failure.[1] Urinary retention is a disorder treated in a hospital, and the quicker one seeks treatment, the fewer the complications.
> 
> In the longer term, obstruction of the urinary tract may cause:
> 
> ...


And it's dangerous


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