Posted by zeugma on January 8, 2005, at 0:05:05
In reply to Re: Some advice needed (hopefully last time) » jujube, posted by KaraS on January 7, 2005, at 22:30:03
> > Ok, I am, no doubt, beginning to seem like a pain in the butt with my indecision and insecurities about my meds, but I am in need of some advice and guidance again. I'll try to keep this brief.
>
> Don't be ridiculous! That's what we're here for. And you of all people, who is always there for everyone else, should not think twice about asking for some advice.
>Of course not.
>And (not to be a long-winded bore myself) these meds are serious and should be taken seriously. The Prozac mythology fostered by Peter Kramer has given the world the false idea that psych meds are harmless toys that should be added to the water supply. (Since I don't want to get banned I'm not going to say any more about Peter kramer.I'm the pain in the butt around here...)
> > Since last Friday, I have not been able to take anything. This is really because of how my body reacts to aneastetic (had unplanned surgery on Friday) which results in, among other things, my already low blood pressure really dropping, my temperature remaining low, my skin feeling like a block of ice, and it taking days and days for things to get back to normal. Then there is the effect that pain killers, which I had to take, have on me after a few days of use.
> >
> > Anyways, I had been taking Anafranil for the past 7 weeks, and had managed to go up to 75 mg for a few days before my accident by taking salt tablets to increase my blood pressure so that I could tolerate the higher dose. However, after 7 weeks (mostly at 50 mg), there has only been a modest improvement in mood, general and social anxiety relief and motivation. I was to have continued taking Celexa with the Anafranil, but kept forgetting to take it. I was happy to have experienced some increased energy and motivation and what I thought (hoped) was the beginnings of a return to my old self prior to Christmas after adding some natural supplements (Vitex, NADH and DMAE), but, since the surgery, those are not helping as much and I am feeling empty, scared and anxious. I feel like such a hopeless loser, and have been on the verge of tears all day.
>
> You are not a hopeless loser. You're just going through a really difficult time. You were making some progress (albeit incomplete) and then you suffered a terrible setback. No wonder you're upset. This can all turn around again soon when you get on something you can tolerate that will work for you better. Once all of the pain medication is out of your system you will probably respond better to your supplements as well.That's a good point, which I wasn't sharp enough to pick up myself. Pain medications make people feel awful.
And nortriptyline is definitely much better tolerated than anafranil. Anafranil, by common consent, is one of the least well-tolerated meds out there. It's a coin toss as to whether nortriptyline is less well tolerated than Peter kramer's favorite drug- do you prefer anorgasmia and flattened emotions, or dry mouth and a good night's sleep?
Nortriptyline is reasonably safe to combine with celexa. I have Lexapro samples sitting on my kitchen table which my pdoc gave me in response to my own request for Anafranil. it was his opinion that the combination of nortrip and lex is safer and less side-effect ridden than Anafranil. By the way, he also said that a mg for mg swap of nortrip for anafranil was feasible, so presumably it would work the other way around too. It's something you could mention to your pdoc which would eliminate the necessity of a long titration, since you'd start with a dose in the therapeutic range.
It's also possible to combine Provigil with nortriptyline. I had a lot of side effects, but if you want to talk about motivation, I was running five miles a day on 100 mg of both nortriptyline and Provigil. Now I can't even make it up the stairs without seeing stars, but that's another issue entirely. I'll give you a link to an article on provigil augmentation:
http://jrnlappliedresearch.com/articles/Vol4Iss2/Bransfield-Jar-spring.pdf
My experience tallies with the gist of the article, and I wish I could be on Provigil instead of lots of ritalin right now. I notice that the article mentions combos with citalopram and desipramine (very similar to nortrip), so maybe you could also think about augmenting with desipramine and Provigil instead of nortriptyline, since the s/e I experienced may not have occurred if I'd been on desip.
Sorry I've gone on so long myself! I hope some of this will be useful to you.
-z
poster:zeugma
thread:438552
URL: http://www.dr-bob.org/babble/20050103/msgs/439256.html