Posted by SLS on June 24, 2005, at 18:00:48
In reply to Desimpramine vs Nortriptyline, posted by TamaraJ on June 24, 2005, at 16:27:35
Hi.
I think the first thing you should do is to get a nortriptyline blood level and see if it makes sense to raise the dosage to 100mg. You might as well try pushing it now.
Some people respond better to desipramine than nortriptyline and vice versa. The initial anticholinergic side effects of desipramine might be a bit worse than nortriptyline because they are somewhat amplified by a more potent NE reuptake inhibition, but they do lessen over time, and are more tolerable than those of imipramine. In the case of desipramine versus nortriptyline, I wouldn't give side effects too much weight in making a decision. Desipramine could very well be the wrong drug for you, but if you are only a partial responder to nortriptyline, it might be worth a try.
All I can say about imipramine is, don't forget about it. It had been the gold standard by which others are compared. I don't know which is now used as the gold standard. Probably imipramine and Prozac. You haven't fully explored TCAs until you have tried imipramine or clomipramine. I wouldn't necessarily suggest them at this point because their anticholinergic side effects are so pronounced.
The nice thing about nortriptyline and desipramine is that they mix well with Parnate. With Nardil, I think I would limit the choice of TCA to desipramine. Even nortriptyline exerts too serotonergic an effect such that serotonin syndrome becomes a possibility with Nardil.
A few years ago, I found relief with a combination of nortriptyline + Effexor. Don't be afraid to mix TCA + SRI. You know, the more I think about alternatives for you, the more that seem to crop up. Wellbutrin + SRI can work very well. I have not heard so much about combining Wellbutrin + TCA. You can combine Wellbutrin with everything, even MAOIs. If you decide to go for Parnate at some point, definitely try adding Lamictal to it. Lithium too, in dosages of 300-600mg
One step at a time.
I am currently taking:Parnate 80mg
nortriptyline 100mg
Lamictal 150mg
Abilify 10mg
Trileptal 900mg
- Scott
poster:SLS
thread:518211
URL: http://www.dr-bob.org/babble/20050622/msgs/518259.html