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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by mtom on May 29, 2019, at 9:18:26
A large review and meta-analysis study was published in Lancet in 2018 comparing 21 Antidepressants for efficacy and acceptability.
Amitriptyline came out best for efficacy, but had a high drop-out rate.
https://www.thelancet.com/action/showPdf?pii=S0140-6736%2817%2932802-7They included 522 double blind studies with 117,000 patients. However the number of patients/studies for each drug varied considerably which impacted the quality of evidence, as did risk of bias (all discussed in the paper).
Scroll down to pages 1363 for table if you don't want to read the whole thing (although worthwhile). There is also a table on p 364 which I'm finding difficult to interpret.
Also see "Findings" on the first page.
Doctors seem unwilling to prescribe this these days. I know there are toxicity issues with high doses, also somnolence and weight gain side effects - which seem to be the main reason for drop outs.
I took amitriptyline low dosage many years ago when a period of situational stress started bringing on depression and panic attacks. I felt rough with side-effects the first couple of weeks, then these improved - except I did continue to experience somnolence (worse in the mornings) and considerable weight gain. However I did also start feeling better BUT I concurrently resolved the situational stresses which may have had more to do with my improvement than the drug. I stopped taking it after 8 months.
I was depression free for many years until it came on very suddenly and for no apparent reason just prior to being diagnosed with an autoimmune disorder, which I believe caused the depression.
I have tried other antidepressants since, with little to no benefit, and lots of side-effects including intense anxiety which does not resolve over time.
I'm interested in hearing of others experiences with amitriptyline.
Posted by Lamdage22 on May 29, 2019, at 12:37:48
In reply to Study:Amitriptyline most effective, experiences?, posted by mtom on May 29, 2019, at 9:18:26
I got a boost out of Trazodone while other meds failed. Go figure. It's supposed to be weak
Posted by mtom on May 29, 2019, at 13:14:19
In reply to Re: Study:Amitriptyline most effective, experiences?, posted by Lamdage22 on May 29, 2019, at 12:37:48
Yes, go figure how we're all different. I tried very low dose Trazodone several years ago for insomnia, and it brought on intense anxiety and tinnitus, plus other side effects, even at very low dose. (Did improve insomnia but not worth it). Stuck with it a couple months anyway hoping would improve, didn't get better, so tapered for about 6 weeks before going off. Tinnitus remained for several months after.....
> I got a boost out of Trazodone while other meds failed. Go figure. It's supposed to be weak
Posted by linkadge on May 31, 2019, at 15:23:55
In reply to Re: Study:Amitriptyline most effective, experiences? » Lamdage22, posted by mtom on May 29, 2019, at 13:14:19
I could concur that amitriptyline is a very effective antidepressant. It was probably the only drug I have taken where I would say all core depressive symptoms vanished.
I would also say that the rate of anxiety is much lower than with SSRIS. By blocking certain serotonin receptors, histamine etc. it has a more calming effect (IMO) than SSRIs.
I would say that it is less sedating than mirtazpaine, and probably a stronger antidepressant. Although, it can have more side effects. The TCAs are considered 'dirtier' drugs in the sense that they have multiple targets. You may feel a bit more 'wonky' on amitriptyline than other drugs, but it does work for depression and anxiety for sure.
Linkadge
Posted by Christ_empowered on June 1, 2019, at 8:20:15
In reply to Re: Study:Amitriptyline most effective, experiences?, posted by linkadge on May 31, 2019, at 15:23:55
never taken elavil, but tofranil 'got the job done' with less apathy and Stepford-ization than cymbalta.
Posted by Lamdage22 on June 8, 2019, at 12:41:04
In reply to Re: Study:Amitriptyline most effective, experiences?, posted by linkadge on May 31, 2019, at 15:23:55
Yeah, but it makes you flaccid and anorgasmic
Posted by mtom on June 8, 2019, at 13:28:05
In reply to Re: Study:Amitriptyline most effective, experiences?, posted by Lamdage22 on June 8, 2019, at 12:41:04
> Yeah, but it makes you flaccid and anorgasmic
My Doctor seems to prefer trying Mirtazapine (Remeron), but it also has 2 similar side-effects as Amitryptyline - somnolence and weight gain....
1 study published in Lancet showed it #2 for effectiveness after Amitriptyline, but research seemed limited, and drop out rate was a bit higher for Mirtazapine (don't know why).
Posted by Christ_empowered on June 11, 2019, at 6:48:35
In reply to Re: Study:Amitriptyline most effective, experiences? » Lamdage22, posted by mtom on June 8, 2019, at 13:28:05
i keep saying it, and its probably obnoxious, but...-if- a tca comes up, consider Tofranil or the new(er) one, Tofranil-PM.
its lethal in overdose, causes dry mouth, can cause weight gain...all the fun tca stuff...-but- I found that it worked within about 1 month and i just felt...no miserable...vs wired and apathetic on cymbalta.
the whole dose can be taken at night. I forget why the PM (pamoate) is/was such a big deal, but I do seem to recall that version being easier to tolerate...
Posted by alchemy on June 27, 2019, at 19:34:30
In reply to Study:Amitriptyline most effective, experiences?, posted by mtom on May 29, 2019, at 9:18:26
Your statement:
I was depression free for many years until it came on very suddenly and for no apparent reason just prior to being diagnosed with an autoimmune disorder, which I believe caused the depression.- The immune system link continues to fascinate me. Its so complicated and science can't figure it out. Any ideas...?
Posted by chumbawumba on August 26, 2019, at 23:33:57
In reply to Re: Autoimmunity and depression, posted by alchemy on June 27, 2019, at 19:34:30
I have Hashimoto's thyroiditis and is clearly linked to my depression. My thyroid is essentially dead and I have to take 200 mcg T4 and 40 mcg of T3 a day as replacement.
Posted by mtom - on August 27, 2019, at 9:45:45
In reply to Re: Autoimmunity and depression, posted by chumbawumba on August 26, 2019, at 23:33:57
> I have Hashimoto's thyroiditis and is clearly linked to my depression. My thyroid is essentially dead and I have to take 200 mcg T4 and 40 mcg of T3 a day as replacement.
Yes they checked my thyroid when I developed depression, especially as I have another autoimmune condition and people with one autoimmune condition have higher risk for developing others. Have the replacement hormones had any effect on the depression?
People with Celiac Disease (also autoimmune) have a higher risk of developing Hashimoto's. Celiac by itself can cause depression. Have you been tested for it? Most people with Celiac have other symptoms including gastrointestinal, but it's recently been found that "silent Celiac" is more common than previously thought where some people don't have the typical overt symptoms.
I'm speculating that even if the hormones are replaced, the autoimmune process may still be active, i.e. inflammation? There are other threads discussing the inflammatory and autoimmune theories of depression you might look at.
Some of the anti-inflammatory supplements that have been discussed include omega-3's e.g. fish oil, especially EPA. I've seen other posters say it hasn't helped, but there are a number of research studies which did seem to find these were helpful at higher doses. While some studies did not - but I think studies often may not be long enough, I think it could take some time for the EPA to kick in, if it's going to.
Posted by chumbawumba on August 27, 2019, at 10:27:24
In reply to Re: Autoimmunity and depression » chumbawumba, posted by mtom - on August 27, 2019, at 9:45:45
I was tested for celiac but it was along time ago. Perhaps a sybsyndromal celiac condition could have blown up in between now and then.
The high dose thyroid was the turning point for me. Before getting on it I only had a 50% response to antidepressants (Parnate) and now it is 100% . I've tried fish oil but with no change. I was taking about 900 mg. I'm not sure if that is high dose but it was about all I could stomach of those horse pills.
Posted by mtom - on August 27, 2019, at 11:38:16
In reply to Re: Autoimmunity and depression, posted by chumbawumba on August 27, 2019, at 10:27:24
> I was tested for celiac but it was along time ago. Perhaps a sybsyndromal celiac condition could have blown up in between now and then.
>
> The high dose thyroid was the turning point for me. Before getting on it I only had a 50% response to antidepressants (Parnate) and now it is 100% . I've tried fish oil but with no change. I was taking about 900 mg. I'm not sure if that is high dose but it was about all I could stomach of those horse pills.If the thyroid hormones are working for you, this is probably a moot point. But fyi I had trouble with those big capsules too, now buy my Fish Oil in a liquid form - it's virtually tasteless, slight citrus, no fishiness. It's 1500 EPA, 500 DHA per tsp. I'm not sure it helps, I have been feeling some improvement but I've also changed up my medications 3 times in last 15 months so may be my most recent AD that is helping. But omega-3's good for other things too, cardiovascular, etc., so I'll keep taking it anyway.
This is the end of the thread.
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