Posted by bleauberry on December 23, 2009, at 18:20:39
In reply to Nortriptyline questions, posted by morganator on December 22, 2009, at 22:33:48
Everything is experimental and no one is an expert. That said, I can offer what I believe.
I only took 5mg Nortriptyline. It helped noticeably with social comfort, social ease, and general anxiety. The first few nights I had some heart palpitation, disturbed sleep, and waking anxiety, which all subsided within days. Then I entered a new comfort zone which was better than where I had been prior to Nortriptyline.
I believe Nortriptyline is far more complicated in its functions that anyone knows. We generally think of it as a NRI, maybe a weak NSRI, with a little bit of antihistamine anticholinergic stuff. I think it does a ton more than that which we don't even have a clue of.
Why do I say that? Because it relieves migraines amazingly. It relieves Lyme pains, arthritis pains, all kinds of pains, remarkably. It actually helps to heal nerve damage from MS. It is a very helpful med for those with autoimmune diseases...MS, Lupus, Lyme, mercury/lead burden, amalgam illness. It helps sleep, while not being an outright sedative. It reduces the desire for cigarettes. It is clearly doing a whole lot more than what we know it does. NRI mechanism alone cannot explain all those things. Because no other NE drug can duplicate as reliably what Nortriptyline does.
Damage to the brain from SSRIs? Well, in the real world, we know it happens. In the laboratory world of white coats, it is called a quackery idea. Debates on both sides. There is clinical evidence, but not biological evidence. Not because it doesn't exist, but because it hasn't been explored. Some believe it, some don't. I do.
No explanation, though I would roughly guess that artificically increasing only one neurotransmitter dramatically at the expense of the others HAS to have repurcussions down the road. I'm sure the truth involves a whole lot more than that. Genetic coding, receptor shape, density, and function change. Stuff like that.
So would adding Nortriptyline worsen that? My instinct says no, it would do the opposite. It would restore and repair it. It would equalize the imbalance, in addition to all the other mysteriously beneficial stuff Nortriptyline seems to do. I favor the idea. If it is such a benefit to so many people with all kinds of nervous system disorders and diseases, something good is going on. Pure logic, but no reasoning. That's just how I feel.
Agitation as I see it, as my doctor sees it, is too high of a dose too fast. Simple as that. If agitation is induced even at a tiny miniscule custom dose, that is probably not a good sign, but for sure would take at least 3 days to see how it plays out.
Depakote. I don't know. It actually worsened agitation for me. Caused insomnia. Felt like an apathetic lethargic stimulant, if that makes any sense.
In most clinical trials, Depakote had lost its effectiveness fairly quickly...3 months common. When used primarily for seizure control, which is what it is really intended for, along with other antiseizure meds, it can last indefinitely for years. But that's for seizures, not psychiatry.
My take is to avoid as many drugs as possible, but put the focus on dosing strategy of the core meds instead. Each patient is unique and requires a customized approach in terms of starting dose, ending dose, escalation rate (if any), and such. I generally believe it is all too common to start at doses that are too high (usually the minimum dose...yeah, that's too much), and to increase doses at too rapid of a pace, without getting a chance to see what the lower dose will do.
I do not accept commonly held practices with as much blind faith as most people do. That's just me. I allow reason and logic to take part, rather than blindly following the crowd. If the crowd were demonstrating impressive results, that would be different and I would change my tune. But since they don't, I have to ask myself, what is the crowd doing wrong that they so casually without a thought believe to be correct?
I like Nortriptyline. I like Nortriptyline added to Zoloft a lot. The key is to ignore dosing guidelines. Instead, start very low and step up gradually without any hurry.
Depakote 1500mg for that long will be tricky to come off or reduce. It is clearly problematic and needs to be dealt with. Do it slowly in tiny steps. Add-ons to help would be magnesium supplements, test the waters with low-modest lithium, glycine+gaba supplements.
> I may have asked this question already but I can't remember. Has anyone experienced anxiety relief on Nortriptyline?
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> Blueaberry, do you think a medication like Nortriptyline can cause the same changes/damage to the brain that SSRIs can?
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> Also, I'm bipolar and was amazingly able to function at a fairly high level and feel pretty darn good for a very long time on Zoloft alone. Should I be concerned that adding Nortriptyline to a smaller dose of Zoloft or other SSRI would destabilize me and make me more anxious and even less focused than I already am? I do take Depakote but it really does not seem to help me like it did when I was first hospitalized 2 years ago. Maybe taking depakote would protect me from becoming too agitated. I'm on 1500 mg now and I feel pretty agitated and anxious. One thing I am not concerned about is becoming hypomanic for a while. As long as I was functioning well and didn't have this awful anxiety, a little hypomania would be welcome and I am aware of what's going on with me enough that I could control it somewhat. It's feeling good that I care most about.
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poster:bleauberry
thread:930446
URL: http://www.dr-bob.org/babble/20091217/msgs/930585.html