How To Combat The Drying Out From Anticholinergics

[SarahBeara]

Hi guys,

I'm about to start on amitriptyline for digestive issues and I already have dry skin, eyes and am prone to constipation and tooth decay.

Unfortunately the anticholinergic drugs are known to worsen all of the above. Are there any supplements/foods I can take to counteract the drying effect of the medication?

 

[jb116]

Sarah your symptoms are pretty classic hypothyroid. Have you tried addressing that ?
Ray has even mentioned low t3 causing dry eyes.
Things like niacinamide, pregnenolone, supportive diet and possibly thyroid
supplement if needed down the road. Have you tried this path yet?

 

[SarahBeara]

Hi JB,

Yeah, I'm trying to address anxiety and gut issues first. Then was hoping to ramp up metabolism with diet and coffee.

Currently niacinamide bothers my gut and pregnenalone seems like it does nothing.

I have low TSH (<.75) good temps and ok heartrate (about 80-85 Don't want to raise it more while I have anxiety)

 

[postman]

Yeah, I'm trying to address anxiety and gut issues first. Then was hoping to ramp up metabolism with diet and coffee.

That's a mistake. Those issues are often caused by low metabolism. Amitriptylineis a bad drug as well, because it raises serotonin. Low metabolism causes digestive issues.

 

[postman]

Did you ever try thyroid? It cured my "IBS".

 

[SarahBeara]

That's a mistake. Those issues are often caused by low metabolism. Amitriptylineis a bad drug as well, because it raises serotonin. Low metabolism causes digestive issues.

Are you sure we're talking about the same drug? Amitriptyline is a tricyclic compound, known to be antiserotinergic. Ray Peat has recommended it.

 

[postman]

Tricyclics inhibit reuptake of serotonin. If Ray ever recommended it I think he made a mistake. I read up a little bit about the drug and it seems that while it does inhibit reuptake of serotonin, it also acts as an antagonist on some serotonin receptors. I still think it's a bad idea to take the drug - there have been recorded cases of serotonin syndrome following amitriptyline administration, so it definitely increases serotonin.

 

[Noel Gallagher]

I think it's about the net effect. Amitriptyline is successfully used to treat IBS and migraines, which both are caused by serotonin. It is also been used successfully for chronic fatigue syndrome and depression. These are also caused by serotonin. So while Amitriptyline may raise serotonin a bit, the net effect is an overwhelming reduction in serotonin. Ray has said it to be safe. LSD can raise serotonin a bit too, if I'm not mistaken. See this post....

I've suffered from depression for a very long time. I still trying to figure out an answer. I've tried cyproheptadine (periactin) after reading that it can lower serotonin and can be effective in treating depression. However, I haven't really noticed any improvement. My doctor has recommended that I try amitriptyline, a drug that has been around since the 1950's. Everything I read says that it works similiarly to serotonin inhibitors, increasing serotonin in the brain to "promote positive feelings." But I am confused because I read that it is in the same family as cyproheptadine, a drug that is supposed to reduce serotonin. They are both chemical compounds with the tryclic structure.

"In recent times, the TCAs have been largely replaced in clinical use in most parts of the world by newer antidepressants which typically have more favorable side-effects profiles such as the selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and the norepinephrine reuptake inhibitors (NRIs) like reboxetine, though they are still sometimes prescribed for certain indications."

In addition, I asked Ray if he thought this drug is safe and he said the following:


Me:
Hi Dr. Peat,

I wanted to know if amitriptyline would be a safe option for treating depression/anxiety in your opinion. My doctor is recommending that I take it.

Thanks.
Ray:
I think it's safe. Compare the structure with cyproheptadine. Have you tried niacinamide, pregnenolone, and thyroid?

Me:
I currently take cyproheptadine. From my understanding, amitriptyline and cyproheptadine have opposing effects on serotonin. Is this true, and could this be problematic, if so?

Thanks.

Ray:
Both of those are appetite stimulants that tend to cause weight gain. Serotonin tends to cause anorexia. The drug industry generates noise in the process of selling drugs, and "serotonin" is one of their favorite noises.




What is the deal with this drug? Is all the crap I read on the internet B.S. Why would ray say it's "safe" it is increases serotonin? I'm losing my mind here, and I don't know what to make of all this. Any advice or insight would be greatly appreciated. Thank you in advance.

 

[Drareg]

I think it's about the net effect. Amitriptyline is successfully used to treat IBS and migraines, which both are caused by serotonin. It is also been used successfully for chronic fatigue syndrome and depression. These are also caused by serotonin. So while Amitriptyline may raise serotonin a bit, the net effect is an overwhelming reduction in serotonin. Ray has said it to be safe. LSD can raise serotonin a bit too, if I'm not mistaken. See this post....

I've suffered from depression for a very long time. I still trying to figure out an answer. I've tried cyproheptadine (periactin) after reading that it can lower serotonin and can be effective in treating depression. However, I haven't really noticed any improvement. My doctor has recommended that I try amitriptyline, a drug that has been around since the 1950's. Everything I read says that it works similiarly to serotonin inhibitors, increasing serotonin in the brain to "promote positive feelings." But I am confused because I read that it is in the same family as cyproheptadine, a drug that is supposed to reduce serotonin. They are both chemical compounds with the tryclic structure.

"In recent times, the TCAs have been largely replaced in clinical use in most parts of the world by newer antidepressants which typically have more favorable side-effects profiles such as the selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and the norepinephrine reuptake inhibitors (NRIs) like reboxetine, though they are still sometimes prescribed for certain indications."

In addition, I asked Ray if he thought this drug is safe and he said the following:


Me:
Hi Dr. Peat,

I wanted to know if amitriptyline would be a safe option for treating depression/anxiety in your opinion. My doctor is recommending that I take it.

Thanks.
Ray:
I think it's safe. Compare the structure with cyproheptadine. Have you tried niacinamide, pregnenolone, and thyroid?

Me:
I currently take cyproheptadine. From my understanding, amitriptyline and cyproheptadine have opposing effects on serotonin. Is this true, and could this be problematic, if so?

Thanks.

Ray:
Both of those are appetite stimulants that tend to cause weight gain. Serotonin tends to cause anorexia. The drug industry generates noise in the process of selling drugs, and "serotonin" is one of their favorite noises.




What is the deal with this drug? Is all the crap I read on the internet B.S. Why would ray say it's "safe" it is increases serotonin? I'm losing my mind here, and I don't know what to make of all this. Any advice or insight would be greatly appreciated. Thank you in advance.

Did you try niacinamide ,pregnenolone and thyroid?

 

[postman]

I think it's about the net effect. Amitriptyline is successfully used to treat IBS and migraines, which both are caused by serotonin. It is also been used successfully for chronic fatigue syndrome and depression. These are also caused by serotonin. So while Amitriptyline may raise serotonin a bit, the net effect is an overwhelming reduction in serotonin. Ray has said it to be safe. LSD can raise serotonin a bit too, if I'm not mistaken. See this post....

I think that's a silly line of reasoning. SSRIs are being used to treat all of those conditions, it doesn't mean it's good or healthy or even effective. I doubt the net effect is a reduction because there have been cases of serotonin syndrome, if you overdose on it you get serotonin syndrome and could die.

I've suffered from depression for a very long time. I still trying to figure out an answer. I've tried cyproheptadine (periactin) after reading that it can lower serotonin and can be effective in treating depression. However, I haven't really noticed any improvement. My doctor has recommended that I try amitriptyline, a drug that has been around since the 1950's. Everything I read says that it works similiarly to serotonin inhibitors, increasing serotonin in the brain to "promote positive feelings." But I am confused because I read that it is in the same family as cyproheptadine, a drug that is supposed to reduce serotonin. They are both chemical compounds with the tryclic structure.

Just because drugs have similar chemical structures doesn't mean they work the same. Tianeptine, for example, also looks like a tricyclic, but its action is completely different from every other tricyclic.

"In recent times, the TCAs have been largely replaced in clinical use in most parts of the world by newer antidepressants which typically have more favorable side-effects profiles such as the selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and the norepinephrine reuptake inhibitors (NRIs) like reboxetine, though they are still sometimes prescribed for certain indications."

In addition, I asked Ray if he thought this drug is safe and he said the following:


Me:
Hi Dr. Peat,

I wanted to know if amitriptyline would be a safe option for treating depression/anxiety in your opinion. My doctor is recommending that I take it.

Thanks.
Ray:
I think it's safe. Compare the structure with cyproheptadine. Have you tried niacinamide, pregnenolone, and thyroid?

Me:
I currently take cyproheptadine. From my understanding, amitriptyline and cyproheptadine have opposing effects on serotonin. Is this true, and could this be problematic, if so?

Thanks.

Ray:
Both of those are appetite stimulants that tend to cause weight gain. Serotonin tends to cause anorexia. The drug industry generates noise in the process of selling drugs, and "serotonin" is one of their favorite noises.




What is the deal with this drug? Is all the crap I read on the internet B.S. Why would ray say it's "safe" it is increases serotonin? I'm losing my mind here, and I don't know what to make of all this. Any advice or insight would be greatly appreciated. Thank you in advance.

The part about appetite is intersting, but if that is his only evidence for it being a net negative on serotonin levels I think it's weak. Some people get increased appetite from SSRI's, even the most selective ones like lexapro. Some people get decreased appetite from Amitriptyline.

Did you ever try thyroid or tianeptine?

 

[Noel Gallagher]

Did you try niacinamide ,pregnenolone and thyroid?

That was not me.

 

[Drareg]

That was not me.

How do you mean?
I thought it was his response to your question?

 

[Noel Gallagher]

How do you mean?
I thought it was his response to your question?

No I pulled it from a post on the forum. Google "Ray peat Amitriptyline"

 

[Drareg]

No I pulled it from a post on the forum. Google "Ray peat Amitriptyline"

It might be relevant still to your situation if you haven't tried them yet.
Most ssri's that give people an effect is probably from allopregenolone which pregnenolone can increase in enough a dose.
Thyroid helps create pregnenolone.
T3 as in triiodothyronine has had very good effects on depression that resisted treatment.
Type t3 depression into pubmed.
Pregnenolone can increase conversion of t4 into t3 as well as many other positive effects.

 

[SarahBeara]

Now I'm more confused than ever. Anyone found an online source of tianeptine? Seems like there's less side effects to that.

 

[Dan W]

Anyone found an online source of tianeptine?

I have a list here: Tianeptine sources - Toxinless

Dry mouth still seems somewhat common with tianeptine though. Although I've tried it in small doses and haven't noticed a change either way in dry mouth / eyes.

 

[tara]

Everything I read saysthat it works similiarly to serotonin inhibitors, increasing serotonin in the brain to "promote positive feelings." But I am confused because I read that it is in the same family as cyproheptadine, a drug that is supposed to reduce serotonin.

This might be what you meant, but it's the "Selective Serotonin Reuptake Inhibitors (SSRIs)" that they promote for raising serotonin (not serotonin inhibitors). Though there is some doubt about whether they do actually raise serotonin in the longer-term, and if so whether this is what makes them effective.

What is the deal with this drug? Is all the crap I read on the internet B.S. Why would ray say it's "safe" it is increases serotonin? I'm losing my mind here, and I don't know what to make of all this. Any advice or insight would be greatly appreciated. Thank you in advance.

I think Peat might be saying you can't trust much of what you read about serotonin on the Internet, and that he is not convinced that it raises serotonin?

Personally, I used low dose amitriptiline for a while in the hope of migraine prophylaxis. Not very effective for me. Even the low dose made me sleep long and have trouble rising. I was prescribed 10mg (typical prescribed anti-depressive dose is more like 75-150mg). After I stopped using it regularly I started feeling more myself again. But for a while I still occasionally used a third of a tablet as an effective sleep aid over the following year. I can't tell if it had any longer-term effects on me.

 

[Noel Gallagher]

I think that's a silly line of reasoning. SSRIs are being used to treat all of those conditions, it doesn't mean it's good or healthy or even effective. I doubt the net effect is a reduction because there have been cases of serotonin syndrome, if you overdose on it you get serotonin syndrome and could die.


Just because drugs have similar chemical structures doesn't mean they work the same. Tianeptine, for example, also looks like a tricyclic, but its action is completely different from every other tricyclic.



The part about appetite is intersting, but if that is his only evidence for it being a net negative on serotonin levels I think it's weak. Some people get increased appetite from SSRI's, even the most selective ones like lexapro. Some people get decreased appetite from Amitriptyline.

Did you ever try thyroid or tianeptine?

Can you please provide evidence of a case of serotonin syndrome with Amitriptyline without an SSRI being involved? The medication has been around for 50 years, like Cyproheptadine. It was the leading antidepressant in the world for a time. It can be used to treat a wide range of conditions, like cypro. SSRIs don't have these wide array of uses. It is unsafe in higher doses because it is incredibly sedating and anticholinergic. Not because of serotonin syndrome. Amitriptyline has been lumped in with SSRIs as an old med with "bad side effects" to promote the newer drugs but I have yet to see any clinical evidence to show it is serotenergic to the extent you suggest, if at all. Ray has said it to be safe, as it increases appetite and causes weight gain. I think because the drug doesn't get discussed much around here, it is dismissed as not okay, but I'd be interested to see if @haidut has come across any research regarding it, positive or negative, and what his thoughts are.

 

[Noel Gallagher]

This might be what you meant, but it's the "Selective Serotonin Reuptake Inhibitors (SSRIs)" that they promote for raising serotonin (not serotonin inhibitors). Though there is some doubt about whether they do actually raise serotonin in the longer-term, and if so whether this is what makes them effective.


I think Peat might be saying you can't trust much of what you read about serotonin on the Internet, and that he is not convinced that it raises serotonin?

Personally, I used low dose amitriptiline for a while in the hope of migraine prophylaxis. Not very effective for me. Even the low dose made me sleep long and have trouble rising. I was prescribed 10mg (typical prescribed anti-depressive dose is more like 75-150mg). After I stopped using it regularly I started feeling more myself again. But for a while I still occasionally used a third of a tablet as an effective sleep aid over the following year. I can't tell if it had any longer-term effects on me.

Thank you Tara, very insightful.

 

[postman]

Can you please provide evidence of a case of serotonin syndrome with Amitriptyline without an SSRI being involved?

Why would I have to? It causing serotonin syndrome in combination with other serotonergic chemicals proves that it itself increases serotonin in the blood. If the effect would be a net negative it wouldn't cause serotonin syndrome in combination with other serotonergic drugs. Tianeptine, a drug that actually lowers serotonin in the blood, can not cause serotonin syndrome no matter what drug you mix it with. Instead it has been shown that combining tianeptine and fluoxetine cancels out some of the good effects of tianeptine.

The medication has been around for 50 years, like Cyproheptadine. It was the leading antidepressant in the world for a time. It can be used to treat a wide range of conditions, like cypro. SSRIs don't have these wide array of uses.

It doesn't matter how long it has been around. Other leading antidepressants have been things like fluoxetine and effexor, and those are absolutely awful, I don't see how the mainstream view of a drug is relevant. But if you wanna talk about that kind of thing, according to conventional doctors and the literature, SSRIs do have the same wide array of uses as amitriptyline. Depression, chronic fatigue syndrome, anxiety disorders, digestive problems (IBS), migraines, fibromyalgia, multiple chemical sensitivity etc.

It is unsafe in higher doses because it is incredibly sedating and anticholinergic. Not because of serotonin syndrome.

Can you prove it? So far the only evidence in your favour is "the molecule looks somewhat like cyproheptadine". Unless anyone has taken cyproheptadine, amitriptyline, and some other tricyclic/ssri/serotonergic medicine, and can compare the effects of these, I don't understand how you can argue your point.

Amitriptyline has been lumped in with SSRIs as an old med with "bad side effects" to promote the newer drugs but I have yet to see any clinical evidence to show it is serotenergic to the extent you suggest, if at all. Ray has said it to be safe, as it increases appetite and causes weight gain. I think because the drug doesn't get discussed much around here, it is dismissed as not okay, but I'd be interested to see if @haidut has come across any research regarding it, positive or negative, and what his thoughts are.

Another piece of evidence is that amitriptyline supresses REM sleep, like most serotonergic drugs seem to do. Cyprohepadine, conversly, increases REM sleep.