Anyone tried old style tricyclic meds?

[Sunnyscot80]

Hi all,

After a very long battle with postnatal depression which manifests as severe anxiety, including derealization, nocturnal panic attacks, nightmare, insomnia and horrific morning anxiety, my psych has now recommended I try a tricyclic med.

Ive tried pretty much all the ssri's (setraline, mirtazapine and lexapro) which just make the aggitation worse, or make me very sick. I also tried venlafaxine which was OK but I felt off my face (in an illegal drug kind of way!).

I'm desperate and feel theres not much left for me. I hate this anxiety. And the nocturnal panic attacks / waves of adrenaline are just the worst.

I was wondering if anyone has had similar symptoms and had any luck with tricyclics? I'd maybe try venlafaxine again (reluctantly) to see if the 'off my chops' feeling passed.

There was also talk of valdoxan but its hard to get here in Scotland on the NHS. Any advice appreciated 🙏❤️

I'm absolutely horrified you were given mirtazapine as mother. It's my nightmare and I think every psychiatrist should know they'll lose their license if they have given such glib reassurances without basis.

I've tried every SSRI and none have worked for me. Due to the severity of my mental illnesses, my drs decided to put me on tricyclics and antipsychotics. I came off the antipsychotics 5 years ago but I've been on Clomipramine for 6 years and it's an absolute godsend.
Absolutely the best medication I've ever been on.

The only downside is withdrawal. My doctors tried to take me off it over the course of a week (I was on a high dose) and I ended up in hospital as the withdrawals were so bad, they thought I had sepsis from how ill I was. Turns out you're meant to withdraw over 6-8 weeks so according to the hospital psychiatrist, my doctor could've killed me 🤦‍♀️
I'm now back on them on a low dose and once again my mental state is great.

@SouperNoodle I'm really pleased to hear that Clomipramine worked well for you.
I cannot believe they tried to take you off over a week! That must have been awful for you. I was taken off 45mg mirtazapine over the course of 2 weeks and I thought I may end up in hospital too.
Did you find Clomipramine made you gain lots of weight? Does it get rid of that jumpy nervous feeling? I still have such an over active startle response (amongst other things!) x

I'm hesitant to jump in with a 'polypharmacy' suggestion for what sounds like a tough case, but...possibly something for the depression + something else for the insomnia? My depression always manifests with agitation- the most recent bout, I went for over a week with only an hour or so sleep a night. Fortunately mirtazapine mostly did the job for me, no side effects- however I've recently added melatonin, sleep is more solid now. I get mine off t'Internets - I've used it before- but obviously in your case it would have to be from medical consultation. It's recognised by the NHS for insomnia in the elderly, but as with all these things 'off label ' prescription for other age groups seems to be growing.

Sunnyscot80, l really think Chlomipramine would suit you. Your reactions to meds sound similar to mine. How much l ❤️ that drug.

Chlomipramine and Paroxetine are similar as they have the most potent take up of serotonin. But Chlomipramine is stronger. Serotonin is calming. Why they put you on drugs that activate noradrenaline or dopamine is a mystery to me.

Are you seeing a pysciatrist? If you have agitation maybe a low dose anti psychotic would be better.

I had no problems coming off it either. The only side effects starting it were tiredness and k was a bit shakey. It all went though.

@ArseInTheCoOpWindow I see a psychiatrist yeah. The issue I had with antiphycotics is I couldn't stop eating on them! Even on a low dose quitiapine.
Antiphycotics tasks dompaine levels I thought?
I thought it you were low in dopamine it can make you feel very depressed.
I'll definitely ask about the Clomipramine on Wednesday when I've got my next appointment. Thanks so much to everyone who's replied with advice. Much appreciated. Strangely, I slept really well last night?! Feeling so much more hopeful today.

What dose of quetiapine were you on?

I meant noradrenaline on its own, not dopamine! Lofepramine which was suggested to you hits noradrenaline.

Lofepramine has been my lifesaver - I've been on it for nearly ten years now, after trying every SSRI

So glad you are feeling better today. There are so many medications that can help you.

Lofepramine was the only one that has ever helped me. Unfortunately, I couldn't handle the sweating which was relentless, so I had to come off it.

[quote Sunnyscot80]@SouperNoodle I'm really pleased to hear that Clomipramine worked well for you.
I cannot believe they tried to take you off over a week! That must have been awful for you. I was taken off 45mg mirtazapine over the course of 2 weeks and I thought I may end up in hospital too.
Did you find Clomipramine made you gain lots of weight? Does it get rid of that jumpy nervous feeling? I still have such an over active startle response (amongst other things!) x[/quote]
I'm definitely not jumpy anymore but I do still have anxiety (although it's the mildest it's ever been).
My weight has gone up and down over the years but I blame that on having children lol

I just wanted to say a massive thanks to all of you. This forum has been a real source of support to me. And it's really helped to hear of others who haven't got on well with the first line drugs. I'm really so grateful for your advice and input xx

I know it's very vain sounding.. But anyone taking the tryclics who hasn't put on weight?
Mirtazapine made pile it on and my appetite didn't even increase that much? I hated it and it made me feel so much worse.

I don't gain weight if I control myself but it does make me very munchy. Like whole bag of subway cookies munchy. Which defeated the point of the nice healthy salad somewhat...

I've had Paroxetine and it was brutal. Made me suicidal and gave me awful intrusive thoughts. I was queuing up in Primark and this kid was chucking a tantrum, he was only about 4 and it irritated me so much I was having this fantasy where I grabbed him by the hair and just smashed his face into the counter until he shut up. That was the point where I just thought I need to be off this drug.

It is so so unlike me, I worked in a preschool. I'm known in my family for having the patience of a Saint with kids misbehaving. It actually scared me how angry I felt at basically nothing. I'd never touch that drug again.

@Sunnyscot80

Dp takes valdoxan, it's not easy to get, 2 weeks we allow, though Lloyds online pharmacy has been good of late (gave up on local boots). England though, he had tried all the others first but been on this for 5 years very successfully

@gogohm when I last saw my psych I asked her about valdoxan. She had never heard of it! I don't think it's available on the NHS in Scotland, but I will find out when I see her next Wednesday. I'm hoping it is as id like to try it before trying a tryclic (prob .Clomipramine)
Does is help your partner with anxiety? Did your dp find it made things worse before better?

@Notanotherwindow that sounds awful. I know that feeling. I got like that a bit with mirtazapine and even quitiapine to an extent. Anytbing effecting histamine made me so irritable. So far from how I usually am.

If your pysch hadn’t heard of Valdoxan, then it means it’s not prescribed round you and you would have to go private to get it.

You have to have liver tests every 3 months with it.

@ArseInTheCoOpWindow I can see a private phychiatrist if they won't give me it. But yeah I know I'd need my liver tested too. I'll see what they say. Scared of the weight gain from the tryclics as everything I've read says it's more than likely. I've just lost lots after pregnancy followed by mirtazapine!

Lofepramine doesn’t cause weight gain.

@ArseInTheCoOpWindow nope but sounds like thats one that effects noradrenaline so might make the anxiety worse.

That’s what happens to me.

It was trial and error, but l realised anything that hit noradrenaline made me worse.

Until l tried Ven which is a SNRI and hits noradrenaline. 🙄

Yes dosulepin for very similar agitated depression as you described. Started on around 100-150mg and did have a small amount of weight gain but went down to 25mg fairly rapidly and lost the weight. now (7 years on) am still on 25mg and no weight gain at all. Such a good drug and it’s my safety crutch, scared to come off it totally.