SSRIs Vs tricyclics

[monkey2010]

Hi, can anyone help. I've taken citalopram before. I found the initial few weeks really really tough but then did find them helpful. I feel I need some help again and have spoken to my GP about starting medication again. I don't want to go on citalopram again but he has suggested trying a different SSRI or changing to a tricyclic. Has anyone tried both types - I know there are a range of drugs within these types but wondered if there are anygeneral trends? What are the different side effects? Would anyone be able to recommend anything that has better initital side effects than citalopram?

thanks xx

I've taken a tricyclic (lofepramine) for years for SAD. The common side effects that put people off tricyclics are dry mouth and constipation (in my case alleviated by eating my 5-a-day and carrying a small bottle of water), and in the first week or so being very sleepy (they were prescribed partly to combat the waking-at-4am problem).
Older tricyclics had the issue that if you OD on them it's more toxic than SSRIs, but lofepramine is supposed to be not too bad - but that's one reason GPs were recommended to move to SSRIs.

Given how many people I know have had stomach upsets and mood swings on SSRIs, I'm sticking to the tablets I know. It has taken a while with any new doc to convince them to give me more than a couple weeks' worth at a time though.

I can recommend dosulepin. It's a sedating tricyclic that I've been taking for about two years. I had a bit of a dry mouth initially but that wears off quite quickly. I take it at night and one of the side effects is a great nights sleep. I was having problems sleeping before this.

As notcitrus has mentioned, tricyclics are easier to overdose on so are often not prescribed first by doctors.

I have experienced citalopram as this was prescribed to me when I was first diagnosed with depression. Unfortunately I suffered for six weeks with unpleasant side effects. I lost a good half a stone in weight as I had no appetite and felt sick. I also still couldn't sleep. My doctor decided the citalopram was doing more harm than good and I was given mirtazapine next - an SNRI. I took one of these and ended up in hospital due to having a very rare reaction to this AD.

The problem is that people react differently to ADs, so it can be trial and error. A lot of people do very well on citalopram and mirtazapine. However due to my previous experiences, I would be extremely reluctant to change from dosulepin.

I think that the problem here is that ADs act differently on different people and side effects will also vary enormously, so in a way it is a case of trial and error and GPs/Psychiatrists will admit this. I am on imipramine (a tryclic) which had suited me in a major episode of depression 15 years ago) and suffered a further major episode last year. The GP wanted to prescribe citalopram (seems to be the drug of choice these days) or sertraline. I said I wanted imipramine as it had worked the first time, so she prescribed it. It has worked but my recover took/is taking much longer.

I have heard many women on here praising citalopram to the heavens "they gave me back my life etc" so who knows - if the medics don't know, how are we supposed to know. Sorry not much help but I am sure that is the reality.