QUESTION:
Dear Dr. Heller,
They appear to work extremely well in subtypes of depression, such as severe and melancholic types. The side-effects are bad, but not really bad at all in certain tricyclics such as desipramine and nortriptyline. You must have used them in your practice prior to the approval to Prozac in 1988, I think. They can be "dirty" drugs, dangerous in overdose, but do they have a place in this time of SSRI's and the rush for newer, "better" drugs? The studies are conflicting as to SSRI's vs. TCA's. What's the deal?
ANSWER:
In terms of effectiveness in treating regular depressions, there is no difference
between the tricyclics (TCA's) and the SSRI's.
Safety and side effects are why the SSRI's have taken over. Even desipramine and
nortriptyline can cause a dry mouth, constipation, blurred vision, urinary retention,
heart problems, and grogginess. I've had patients who took large quantities of
SSRI's in an overdose attempt - and they did very well. I've taken care of many
patients who died on just a week's worth of TCA's.
I believe Prozac in particular is superior for those with the BPD and those who are
chronically unhappy ("fractured enjoyment") in "Biological Unhappiness." There are some individuals who do better with TCA's for panic,
headaches, and some other conditions.
