Posted by Ritch on January 14, 2003, at 23:04:54
In reply to Sorry-message didn't show up, posted by Peter on January 14, 2003, at 16:44:30
> Wierd, my whole message didn't show up. Anyway, this is the outome of my session today: At first, he tried to push more AC's on me (Tegretol-the only one I hadn't tried yet). But I said no way, I'm sick of AC's. So, he gave me 4 AD options: Effexor, Wellbutrin, a TCA, or Strattera. I tried Effexor years ago, but only for a short while, and I was always getting wasted so I never knew if it had a good or bad effect on me. But I do recall hearing a lot about effexor being the hardest to wean off of. Wellbutrin I tried a few years ago for a short stint, but I do remember it making me very agitated. Strattera is too new and I'm no longer comfortable taking brand new meds, I told him-even though he said he's pretty sure they'll market it as an antidepressant down the road. Whatever, I'm not into it now. So it was down to the TCA's, which is good, because the last pdoc I went to for a consultation immediately recommended that I try a TCA because my main problem is not bipolar but depressive-anxiety, and she said TCA's work great for that, especially in those for whom SSRI's don't work well. My doc said the TCA's usually have a lot of antocholinergic (sp?) side-effects, but that they could help me fall asleep if I take them once every night; this would thereby help me to come off the sleeping pills and even lower my klonopin a bit. So we decided on low-dose nortriptyline (Pamelor)(10mg to begin), since he said it probably has the least side-effects in it's class, and it affects serotonin as well as NE, instead of only NE. Desipramine affects only NE, and, though it is great for many, I believe I benefit from something that has some serotonergic activities, since the SSRI's did help me , if only temporarily. As for MAOI's, it was his partner who discovered their efficacy for social anxiety. But he said that, although they are terrific drugs, he doesn't think I'd be comfortable with my neuroses and apprehensions about the dietary cautions, etc. Nortriptyline will not directly help my SP, he said, but it could to the extent that my SP is tied to GAD, which it very well might be-I worry all the time. I hope I made the right choice! Thanks,
> PeterOh, so he tried nortriptyline? That is the most tolerable TCA I have ever taken (dirt cheap too!). It didn't work as well for ADD as desipramine did, but it was much easier to tolerate. Hey, I managed to take it (at varying dosages with other meds) for nearly a year or so (that says a lot!). I don't know if you will find this helpful or if it will work for you or not, but I found (last wintertime depression) that a low-dose combo of nortriptyline (10-20mg/day) and wellbutrin (75mg/day) worked out fairly well. The NT seemed to "neutralize" the agitation from the WB considerably. You might find that down the road you can add some WB to the NT without the agitation you had previously (*maybe*). YES, the nortriptyline does help a lot with GAD, and that brings down the social anxiety several notches. Now, you have me wondering about a retrial of low-dose NT with the tiny bit of Effexor I take. I don't want to be on stims for my ADHD, and I don't want to spend the bucks for the Straterra. NT worked well for ADHD, but I had to combine it (in my case-a tiny bit of Zoloft), but I wonder if I could throw it back in with a tiny bit of Effexor instead? Dont' know. I think you made a decent choice. OH, BTW, you got to wait on TCA's for sure. Two weeks minimum. You will cruise along and feel absolutely no benefit except maybe for some reduced anxiety, for quite a while and then they rapidly start kicking in (if they are going to). ---good luck, Mitch
poster:Ritch
thread:135759
URL: http://www.dr-bob.org/babble/20030113/msgs/135909.html