Posted by zeugma on January 29, 2005, at 10:58:22
In reply to Re: Amantadine for TRD. Anyone interested? SLS? » zeugma, posted by SLS on January 28, 2005, at 17:01:28
Hi Scott.
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> Does the stimulant affect the kinetics of nortriptyline, or do you feel their mechanisms of action are too synergistic for you to remain at the higher dosage?
>I suspect both. The synergism in terms of sympathomimetic stimulation was too much. I had a constant case of mydriasis when on an effective dose of Ritalin, and my heart rate was elevated, so I had to lower the nortriptyline. it's noteworthy that Provigil did not cause either of these effects. I first raised the nor dose to 100 mg when I experienced insomnia early in Provigil treatment, and was able to keep it there throughout the course of my Provigil trial without any of the symptoms I later encounter with Ritalin. It's a shame because I think the higher dose of nortriptyline was countering some of the anxiety from ritalin.
> Good luck. Anything good to report so far?
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The raising of nortrip from 50 to 75 mg has caused me to wake up in a better mood. the strattera also has had an antidepressant effect that wears off by early evening. It's also been confounded by the terrible drowsiness from stopping the ritalin, per my dr.'s orders, suddenly. The real problem with the ritalin was that it was causing terrible jitteriness, irritability, and a constant feeling of being 'on edge.' So I'm relying on caffeine to maintain wakefulness, and while it's far less effective, it also causes less anxiety. Obviously the situation is not optimal, but hopefully the strattera will control enough of the ADD for me to figure out how to distribute my energy in a more productive way. It's a difficult situation.
> > Very glad to hear you are feeling better!
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> A little, but I'll take all I can get. My combo manages to give me a bit more mental and physical energy, but is not really attacking the depression itself. I am still anergic with anhedonia and cognitive and memory deficits. But at least I vacuumed my apartment today. That is a big deal!
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that is. I did the dishes and took out the garbage last night. the ritalin would leave me comatose by the end of the day and nothing got done around the house. and i was depressed because of the lowered nortriptyline, so my energy level was down anyway. We'll see if I can manage the situation without stims. My goal is to keep the nortrip at 75 mg and get the strattera to 40 mg BID morning and noon. Since strattera is not anxiogenic I can keep the clonazepam at no higher than .5 mg BID, and maybe I can add 15 mg buspirone back in the AM (I currently take 15 mg hs to help with sleep induction).Hopefully, a lot of little things, like cleaning house etc., will add up to something beneficial for both of us, although given the chronicity and multifariousness of our symptoms I am quite realistic about the limitations of both of our current therapies. A little will have to go a long way.
-z
poster:zeugma
thread:446210
URL: http://www.dr-bob.org/babble/20050128/msgs/449726.html