From: dyer@spdcc.com (Steve Dyer)
Subject: Re: Zoloft?
Organization: S.P. Dyer Computer Consulting, Cambridge MA
Date: Thu, 27 Aug 1992 22:46:39 GMT

In article <27AUG199215063322@lims02.lerc.nasa.gov> afkazan@lims02.lerc.nasa.gov (The Dinky Ukie) writes:
>Because the results are so great, I'd be willing to take [Zoloft] the rest of
>my life, even though the pills are pricey (almost $2 apiece), but because my 
>doctor feels it's a relatively new antidepressant and all its side effects 
>are not documented, he wants to switch me to a more proven drug, Tofranil, 
>which he says I can take indefinitely.

It is generally prudent to choose a drug for initial therapy which has
been around for a long time; clinical experience counts for a lot when
it comes to understanding a drug's safety and side effects.  Tofranil
(imipramine) has been around for more than 30 years, and it's really
one of the benchmark antidepressants.

HOWEVER, it seems to me that a cardinal rule of any kind of chronic
therapy, and especially antidepressant drug therapy is: "Don't mess
around with what works."  Zoloft has only recently approved been in the
US; it's been used more widely in Europe.  All the evidence we have so
far is that it's safe and effective.  If your doctor agrees with you
that you've responded favorably to Zoloft (and, I'd imagine that the
only way he'd disagree is if you're manic, and feeling _too_ good :-)),
that's a strong argument for continuing it, in the absence of any
problems which you report, or serious side effects reported in clinical use.

On the other hand, I'm not a doctor, and it's hard to second guess someone's
clinical judgement over the net, so take these comments in that light.

>Does anyone have any experience with or information about Tofranil, i.e., its 
>effectiveness, side effects, etc.?  I have to admit I'm concerned about 
>changing medication for fear of sinking back into a deep depression, which 
>would be pure h*ll!  Thanks for any and all replies.

Imipramine (Tofranil) is an effective antidepressant.  In fact, it's
difficult to point to any drug which is MORE effective than imipramine
on average.  The choices between one drug and another (at least in the
initial treatment of simple major depression) usually are made based on
a doctor's own clinical experience with the drug (s/he might have a
"favorite"), general clinical experience, and an evaluation of the
patient's particulars (tricyclics might be avoided in patients with
certain heart problems, or the suicide-prone, or...and so on.)  I could
be arch and add "...and also the visit from the last drug salesman",
but I won't do that. :-)

Imipramine was the first antidepressant of the class now known as the
"tricyclics", referring to their chemical structure.  Other tricyclics
include Elavil, Pamelor, and Pertofrane/Norpramin; there are a few additional
ones.  All these drugs generally work very well, although there always seems
to be 25-30% of those given any particular antidepressant who won't
respond to it (but who might respond to others.)  The tricyclics tend to
have rather marked anticholinergic ("drying") activity; even the least
anticholinergic, Pertofrane/Norpramin, still leaves many people with
a chronic dry mouth.  Some of these have a mild-to-moderate sedative
effect, and high doses are sometimes reported to make people feel "spacey".
All of the tricyclics are toxic when taken in overdose in an suicide attempt.

Drugs like Prozac and Zoloft, which are not tricyclic antidepressants,
but members of a chemically heterogeneous class of drugs known as serotonin
reuptake inhibitors, are notable because they lack the characteristic
side effects of the tricyclics.  The ones in use currently are much less
toxic in overdose than the tricyclics.  On the other hand, they have side
effect profiles of their own, such as nausea, diarrhea and anxiety
and insomnia.  (Which isn't to say that everyone on these drugs will
experience any of these side effects.)

-- 
Steve Dyer
dyer@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer