Posted by Keith Talent on May 3, 2004, at 22:36:58
In reply to Re: which plan sounds more reasonable, posted by zeugma on May 3, 2004, at 16:14:23
>the H-1 blockade helped me to sleep, though for some reason it works much better when I take 15 mg buspirone about 3 hours after my nortriptyline dose (it potentiates the sedative effects).
This is messy - you have the potential here for more drug-drug interactions and more side effects than you should.
> being severely underweight (people who see me routinely wonder if I have an eating disorder) I can't take stimulants, because every time I have taken ANY stimulant in the past I have been yanked right off two weeks into treatment, because the weight-loss effect on my already emaciated frame
I don't know if you have time, with work committments and all, but could you pump some iron (and take a stimulant instead of atomoxetine)?
> if I can tolerate 75 mg nortriptyline plus 80 mg atomoxetine.
Because the atomoxetine competes much more effectively than nortriptyline for the same target (the noradrenaline transporter), the nortriptyline is doing nothing at that target for you. It is giving you some sedation via h-1 antagonism.
> If clomipramine is more energizing than nortriptyline,
If you're the kind of person who finds noradrenergic antidepressants energising, then I suppose you would find clomipramine that way.
> because I am fatigued all the time.
People on this board have complained that atomoxetine made them fatigued.
> wondering is if atomoxetine has any special potency re inattentive ADD, apart from its NE reuptake blocking properties
The noradrenaline transporter in the higher centres of the brain (frontal/prefrontal cortex) "vacuums" up dopamine as well as noradrenaline - but only in these higher centres. It is believed that this is why atomoxetine causes improved focus/concentration, but does not cause psychomotor stimulation. The latter needs a drug which acts directly on dopamine transporters in lower brain centres (which the amphetamines and methylphenidate do). To my very limited knowledge, this would be the only way that atomoxetine would have any "special potency" for inattentive ADHD.
> anxiety, and anxiety-induced depression, isn't. I've raised the clonazepam to .75 mg
This is still a very low dose.
> but while it helps with some aspects of anxiety, it doesn't give me any energy or desire to socialize, and doesn't help the frquent dysphoria I feel due to my social inhibition
A lot of posters here with Social Phobia swear by a combination of clonazepam plus either dextroamphetamine or mixed amphetamine salts (Adderall). Seeing as you have ADHD, it might be worth enduring the weight loss.
> How do you find clomipramine compares with other TCA's (I assume you've taken a few?)
Oh, I've taken a few: doxepin, clomipramine, amitriptyline, and nortriptyline. Doxepin, in my view, shouldn't ever be used as an antidepressant - it's basically an antihistamine (also used in allergy creams). Amitriptyline has a problem: its number one target is the histamine-1 receptor, meaning that no matter how much you take, you'll never get as much noradrenaline- and serotonin-transporter blocking as histamine-1 blocking (though not quite as bad as doxepin). All the early studies in the sixties were done with this and imipramine. I wouldn't bother with it. Nortriptyline did nothing for me, but it works for others, such as yourself. I would have gone on desipramine, except it's not available anymore in Oz (it's stronger than nortriptyline at the target that matters). Clomipramine was, for me, the best drug ever; however, I couldn't have orgasms and my resting heart rate was 110. Life's such a compromise, right? So I went back to Zoloft, and am about to get clonazepam and dextroamphetamine added.
> I think that by trading in the nortriptyline, I would at least make a start at streamlining my meds.
This is very important. The older we get, the more drugs get added (for things like blood pressure and cholesterol). The potential for interactions and side effects increases approximately exponentially with the number of drugs we are on.
> maybe some buspirone for sleep.
Isn't that for anxiety? I would have thought (depending on your insurance coverage) that temazepam, Ambien or triazolam would be better. Best of luck, buddy.
poster:Keith Talent
thread:341936
URL: http://www.dr-bob.org/babble/20040429/msgs/343064.html