Posted by bleauberry on March 10, 2008, at 21:26:41
In reply to TCA's are they similar? Tried nortryp.nada, posted by francineus on March 10, 2008, at 20:54:46
There is a thing called the Methylphenidate challenge test. A patient is given 20mg Ritalin. If they respond positively to that, it fairly reliably predicts a response to Desipramine. If the Ritalin test is not positive it fairly reliably predicts a response to Nortriptyline.
Does this test really work? Well in a small clinical study it had significance. In the real world, I don't know. But the real point here is...yes, the TCAs are different. In that small trial most of the patients who did not respond to Nortriptyline did respond to Desipramine, and vica versa.
Considering the issues of side effects, Nortriptyline and Desipramine have fewer side effects than most of the others. So if Nortriptyline didn't work, then maybe Desipramine would be considered next.
Old proven add-ons such as Lithium should not be ruled out. I generally shy away from antipsychotics, but they do have good antidepressant potential when added to antidepressants of all kinds. The most anecdotal reliable one I know of is Zyprexa. Second to that would be Risperdal. Others work also, but it seems more hit and miss.
When logic fails you, when things that seem to make sense don't work, then maybe it makes sense to try things that are illogical and don't make sense. For example, a minority of people find Neurontin stimulating and powerfully antidepressant, where with most people it is sedating and not much of an antidepressant. Same with Depakote. I know a guy who got a little bit of response to Lexapro, a little bit more with Risperdal added to it, and then a perfect robust response with Depakote added to that. So sometimes you just gotta try different stuff whether it makes sense or not.
poster:bleauberry
thread:817194
URL: http://www.dr-bob.org/babble/20080303/msgs/817211.html