imipramine
Article
imipramine is a recurring brand in the Astral Codex Ten archive, appearing 3 times across 3 issues between March 31, 2021 and December 22, 2021. The archive places it in contexts such as “maximum doses of those medications are 60 mg and 80 mg … convert these to mg imipramine equivalents”; “imipramine, nortriptyline, and clomipramine are all reasonable choices”; “100 mg imipramine-equivalent dose”. It most often appears alongside FDA, escitalopram, SSRI.
Metadata
- Category: Brands
- Mention count: 3
- Issue count: 3
- First seen: March 31, 2021
- Last seen: December 22, 2021
Appears In
- Oh, The Places You’ll Go When Trying To Figure Out The Right Dose Of Escitalopram
- Peer Review Request: Depression
- The FDA Has Punted Decisions About Luvox Prescription To The Deepest Recesses Of The Human Soul
Related Pages
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- FDA (3 shared issues)
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- escitalopram (2 shared issues)
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- SSRI (2 shared issues)
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- SSRIs (2 shared issues)
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- US (2 shared issues)
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- 2002 meta-analysis by Cochrane Collaboration (1 shared issues)
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- 5-HTP (1 shared issues)
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- 5-HTP (1 shared issues)
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- amitriptyline (1 shared issues)
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- Andrea Cipriani (1 shared issues)
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- Apple (1 shared issues)
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- aripiprazole (1 shared issues)
External Links
Source Context
Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.
16.7 mg Lexapro equals 20 mg of paroxetine (Paxil) or fluoxetine (Prozac). But the maximum approved doses of those medications are 60 mg and 80 mg, respectively. If we convert these to mg imipramine equivalents like the study above uses, Prozac maxes out at 400, Paxil at 300, and Lexapro at 120. So Lexapro has a very low maximum dose compared to other similar antidepressants. Why?
They find antidepressants are most effective (the first graph, marked "response") at doses equivalent to 30 mg of fluoxetine (aka Prozac; 1 fluoxetine-equivalent = 5 of the imipramine-equivalents the other study uses). If that were true, the most effective dose of every SSRI would be:
Amitriptyline is my preferred tricyclic, a large and sprawling class of older antidepressants. Other people might have different preferred tricyclics; imipramine, nortriptyline, and clomipramine are all reasonable choices in different situations. It can also cause tiredness and weight gain, and has a small risk of heart problems in vulnerable/older people. On the other hand, in Andrea Cipriani’s massive meta-analysis of antidepressant efficacy, it ranked first out of 21 different drugs (my third- tier suggestions weren’t studied, because the researchers were cowards).
For some reason the same experts who don’t mind prescribing SSRIs when people have mild depression freak out about prescribing them when they’re the only evidence-based oral medication for a deadly global pandemic. “What about SSRI withdrawal?”, they ask. After a ten day course? On 100 mg imipramine-equivalent dose? Minimal. “What about long QT syndrome?” The VA system took 35,000 high-risk older patients off of an unusually-likely-to-cause-QT-syndrome SSRI in 2011, and were unable to find any evidence that this prevented even a single case of the syndrome, let alone any negative outcome!
Inline links: even a single case of the syndrome