From: "eliot gelwan" <eliot.gelwan@channel1.com>
Newsgroups: alt.psychoactives
Subject: pamelor
Date: 1 Oct 92 03:53:53 EST
Reply-To: "eliot gelwan" <eliot.gelwan@channel1.com>
Distribution: alt
Organization: Channel 1 Communications

On 09-30-92 SBRACKSTONE wrote:

SCan someone provide a short, non-technical, summary of
SPamelor (nortriptyline HCI)?

Broadly speaking, there are three classes of antidepressant
medications in use - - the tricyclics (or heterocyclics), the
monoamine oxidase (MAO) inhibitors and the newer, so-called
second-generation agents by and large developed in the 1980 's.  While
there is considerable overlap in their actions and uses,  these diffe
rent categories of antidepressants work by distinct mechanisms, have
different s ide effect profiles, and may be favored for varying
indications.  For these reas ons, they will be discussed separately
below.

The tricyclics began to see broad use in psychiatry in the early
 1950's with the introduction of imipramine (Tofranil and others),
 still one of the most-used me dications in this group.  Other
 tricyclics (see table 1) include amitriptyline ( Elavil, Endep),
 desipramine (Norpramin, Pertofrane), nortriptyline (Pamelor and
 Aventyl), trimipramine (Surmontil), protriptyline (Vivactil), and
 doxepin (Adapi n, Sinequan). Clomipramine (Anafranil) is a somewhat
 specialized tricyclic agen t only recently introduced into the United
 States and approved specifically for the treatment of
 obsessive-compulsive disorder, in contrast to the other members of
 this class which have a broader range of accepted uses. Tricyclics
 also app ear in fixed-dose combination with other agents (Etrafon,
 Triavil, Limbitrol) al though many psychiatrists frown on these
 preparations as not allowing enough ind ividual titration of the
 doses of the component medications.

For what are the tricyclics used? The tricyclics, while accepted first
and foremost for the treatment of depressiv e conditions and primarily
referred to as "antidepressants," are useful in a wid e range of
disorders.  Their effectiveness is agreed upon for major depressive e
pisodes, some so-called atypical depression (see further discussion of
this belo w under the monoamine oxidase inhibitors), panic disorder,
social phobia, bulimi a, narcolepsy, attention deficit disorder (ADHD)
with or without hyperactivity, migraine headache and various other
chronic pain syndromes, enuresis in children , and
obsessive-compulsive disorder.  Depressive symptoms occurring in the
conte xt of other major mental illnesses such as manic depressive
disorder, schizophre nia and schizoaffective disorder, are also
treated with tricyclics, with certain caveats discussed below.  These
medications  are possibly useful as well for a broader range of
depressive conditions not meeting strict criteria for major dep
ressive episodes (such as so-called "dysthymia" or depressive
neurosis; and even prolonged or pathological mourning), for
agoraphobia without panic attacks, and for some of the symptoms (such
as intrusive nightmares) in post-traumatic stres s disorder.

What will it feel like to be taking a tricyclic? It is a common
supposition that taking an antidepressant produces some kind of "
high."  In fact, this is not the case; usually the recipient will not
be aware a t all subjectively of being on a medicine except that one's
depression, panic di sorder, etc. will be lessened in intensity or
one's ability to function in the f ace of it (including in one's
therapy) will be enhanced.  Except for the side ef fects, a person who
does not have a disorder treatable with an antidepressant wi ll not
feel any different when taking one.

Often, the benefits will not be apparent except in retrospect over
some time.  I n other cases relief, especially from depressive
symptoms, may be more dramatic; only in the sense of this dramatic
relief do responders feel elated.  Certainly , one does not "escape,"
ignore or become numb to one's problems or sadnesses th rough taking
an antidepressant.  Being aware of this in advance will often be of
great assistance in the realistic appraisal with one's caregivers of
whether it is advantageous to take an antidepressant medication.  To
know this will be a r elief to some and may well be disappointing to
others!

Two corollaries of the above are that the antidepressants are not
"addictive" an d that they have low abuse potential.  Taking more than
the prescribed dose of a tricyclic is not an attractive but rather a
disagreeable experience.  In additi on, patients do not describe
craving or yearning for the experience of being on the medication
after it is stopped. (Of course, it is possible to have a reboun d of
depressive symptoms, especially if the medication is stopped
prematurely. Furthermore, there is a "withdrawal" syndrome, with
malaise, nausea and headache s, if the medication is stopped too
abruptly, although this is not indicative of dependency.)


When a person benefits from a tricyclic in the treatment of
depression, some of the discernable effects include sounder or more
restful sleep, decreased dreamin g (particularly a decrease in
troubling dreams), increased energy and ability to concentrate, and
correction of appetite disturbance.

How do these medicines work? Over time, the tricyclics enhance the
concentrations in certain regions of the C NS of two neurotransmitter
chemicals, norepinephrine and serotonin, whose undera ctivity has been
implicated in depression and other disorders.  When these neuro
transmitters, known as monoamines, have been secreted,  they must then
     * * * C O N T I N U E D   T O   N E X T   M E S S A G E * * *
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EZ 1.39 #178 [in Brookline MA  7:55 pm, Wednesday 09/30/92]
--
Channel 1 (R)   Cambridge, MA

Newsgroups: alt.psychoactives