Posted by JohnX2 on May 3, 2002, at 2:58:42
In reply to Re: Nortriptyline Augmentation..Questions » JohnX2, posted by Ritch on May 3, 2002, at 0:13:01
> > Hi Mitch,
> >
> > I've been toying with the idea of adding in low dose
> > Nortriptyline to me Lamictal+Serzone+Klonopin.
> >
> > I bumped the Serzone dose to upper limits and dropped
> > topamax on a hunch that this would stabilize me and
> > still be anti-depressant. The Serzone generally doesn't
> > induce hypomania and helps with myofacial pain.
> >
> > Unfortunately I am still feeling a bit of atypical
> > depression symptoms.
> >
> > I always wake up in the morning feeling like crap.
> >
> > Do you think a Nortriptyline add on would help with
> > A) pscyhomotor agitation (ADD or hypomania...?)
> > B) atypical depression symptoms
> > C) myofacial pain
> >
> > I have found that anti-cholinergic medicines also
> > help with my pain.
> >
> > -John
>
>
> Hi John,
>
> Well, the good part about adding on nortriptyline (just an opinion), *might* be further reduction of the myofacial pain (or at least not aggravate it). Also, I found it to be generally helpful for inattentive/limbic ADD-type symptoms. You mentioned that anticholinergics seem to help. Also in some of your previous posts you mentioned chlortrimeton? helping as well. You are going to get an NE reuptake blockade+anticholinergic+antihistaminic action with the nortrip. with a mild sedative feeling (that's what I noticed anyhow).
>
> Ok, here's the possible *bad* stuff that might happen. It might trigger dysphoria (TCA's in bipolars), I got it with doxepin and desipramine, but not with amitriptyline or nortriptyline.
>
> Another possible minus: TCA's generally aren't looked at as meds helpful for "atypical depression". If you had it combined with Serzone+Lamictal that could likely be a very different story.
>
> And yet another *possible* minus: TCA's are going to play around with liver enzymes and Serzone is already doing that. Plasma levels of Serzone and TCA will be changed (possibly a bunch) from the add-on. So, that will make how you subsequently feel difficult to attribute to what meds.
>
> The psychomotor agitation thing? All you can do is try it and see what happens.
>
> Wow, feeling like crap when you get up every day...It makes me wonder whether it is meds? What is the *timing* of your doses? If you take a truckload of one med at bedtime-but little or none during the day-that might be a possible culprit. You might try to spread out *everything* evenly throughout the day, and then see how you are feeling *all* day long.
>
> hope this helps,
>
> MitchHi Mitch,
Thanks for the long well thought out reply.
As far as feeling like crap in the morning, this has
always been a problem with me. I usually need caffeine
or substantial excersize to get out of it. I think it
is an indicator of atypical depression (worse in morning,
better later in day)?I've noticed that increasing my lamictal dose a bit
and the higher dose Serzone is substantially alleviating
the psychomotor agitation. However I still have some
myofacial pain (which may be alleviated by lowering lamictal).
And I get "SSRI" apathy syndrome..I feel very numb
emotionally. I can ride this out and maybe it will wear
off?Well, sounds like nortrip add-on might be a tough sell.
Unless I swapped out Serzone for nortrip. I would need
to have good evidence that nortrip would erase the
myofacial pain.Adderall helped my myofacial pain. It seems medicines that
can increase dopamine in an area of the brain called the
prefrontal cortex alleviate my myofacial pain (the dopamine
counteracts acetylcholine that induces muscle contraction).
The dopamine release is gated by serotonin 5-ht2 receptors.
Blocking those receptors increases dopamine.
The prefrontal cortex extends into the frontal cortex.
Its thought that the "negative psychosis" (emotional blunting)
seen in schizophrenia is caused by a hypodopaminergic state
in these brain areas. Serzone blocks that 5-ht2a receptor
and decreases serotonin firing..I believe this helps release
more dopamine. Zoloft,fyi, makes things *really* bad.I'm still balking on lithium for some reason. But I feel
I need some sort of add-on and Serzone is a tough med
to work with drug-interaction wise.Oh, I'll see how this goes over the next few days and
then crater to lithium (which may change the whole face
of the ballgame, I bet).Thanks,
John
poster:JohnX2
thread:104434
URL: http://www.dr-bob.org/babble/20020425/msgs/104902.html