Posted by jedi on May 1, 2006, at 0:47:07
In reply to Tricyclics Revisited (desipramine, nortriptyline), posted by circusboy on April 30, 2006, at 12:08:27
Hi,
I'm on a revisit of the tricyclics also. Currently I'm taking 150mg of nortriptyline with no anticholinergic side effects. I believe I'm a rapid metabolizer because I was never able to get a blood level above 30ng/ml while on 100mg. So far the nortrip seems to be holding off the major depression. Just at a low level dysthymia at this time. In the past when my major depression hit the only med that worked was Nardil. I've even mixed 100mg Nortrip with 90mg of Nardil with no problems. But it did not seem to help with the depression more than the Nardil alone. As far as the tricyclics go, I believe that nortriptyline is a fairly clean med. Now if I can just get up to the therapeutic level of between 50 & 150ng/ml maybe the stuff will do some good. I'll have it tested again in a couple of weeks.
Take care,
Jedi> In January of this year, my psychiatrist started to wean me off Prozac and add in desipramine.
>
> At 50mg, the results were dramatic. And...disconcerting. My noisy, buzzing head quieted down. My anxeity -- and along with it most of my nervous, self-depricating humor -- was gone. I was afraid I wouldn't think Woody Allen was funny anymore. My friends liked being around me more, even though I felt like I was kinda boring. At work, I was more confident, direct, organized. My sinuses even cleared up! I felt what I suspected "normal" might be like. I wasn't sure I liked it, but it was so much better than before.
>
> Unfortunately, I was exhausted all the time. I think the desipramine was disturbing my sleep by raising my heart rate and perhaps blood pressure. I tried dividing the dose, backing down to 37.5, 25mg... Nothing helped. We had my blood levels checked. I metabolize the stuff normally.
>
> My pdoc and I thought we were on to something, though, so we switched to nortriptyline. I was sleeping again & my mood was good, but nortriptyline was causing serious cognitive dysfunction. I felt like a saturated sponge -- I couldn't absorb new ideas, listen to the radio and work at the same time, etc. Still, my doctor wanted me to stay on it at 25mg for a month.
>
> A week later, evidence of cognitive decline mounting, I quit. I've been off nortriptyline for about a week now and feel so much better. Considering my history of lifelong low-level depression punctuated by major episodes (at least 4, each lasting 6-9 months), I'm probably going to have to take meds again someday.
>
> I still take Ritalin (20-30mg), fish oil (500mg) and a multivitamin.
>
> I'm writing this long post -- for comment, yes, but also because I haven't given back in so long (I used to post as "pellmell" but my password seems unrecoverable), and other peoples' detailed stories on this board have helped me so much in the past.
>
> I'd also like to bounce these ideas:
>
> 1. My primary depressive symptoms have always been cognitive (and come on fast and strong): poor concentration, pseudodementia, etc. Of all the SSRIs I've tried, perhaps Prozac worked the best because of its noradrenergic activity?
>
> 2. My anxeity has not returned. I'm starting to think that Prozac was CAUSING it, perhaps through its actions as a 5HT2C agonist.
>
> 3. I felt all of the classic anticholinergic effects on desipramine: dry mouth, constipation, blurry vision, etc. They were virtually nonexistent on nortriptyline. Is it possible that nortriptyline is "stickier" at central cholinergic receptors (at least in my brain)?
>
> 4. The next logical antidepressant choice would seem to be imipramine. From the posts on this board, I'm suspicous of Cymbalta. Maybe Strattera is worth a try?
>
> I could say so much more -- especially on the long-term effects of SSRIs, especially Prozac ('cause it's the one I know best)... but I'll save it.
>
> Thanks for reading... I hope this has been more interesting than tedious. :)
>
> -cb
>
>
poster:jedi
thread:638384
URL: http://www.dr-bob.org/babble/20060429/msgs/638652.html