Posted by SLS on September 24, 2011, at 6:46:59
In reply to Re: nortriptyline with lexapro? + depersonalization » SLS, posted by g_g_g_unit on September 24, 2011, at 5:00:48
> > Depersonalization and derealization often occur when both anhedonia and anxiety are present.
> >
> >
> > - Scott
>
> Yeah, I think my first genuine episode was triggered by the sheer alienation surrounding severe depression. Since then, though, it's evolved into a chronic problem, (thanks to OCD) such that it's difficult to really determine whether I'm still experiencing it or just afraid of the thoughts it gave rise to.
>
> I have noticed, though, that Lexapro does make me feel noticeably spacey and disconnected.
>
> Do you think nortriptyline would be a worthwhile drug to trial in order to offset the emotional numbness and insomnia from Lexapro? As an NRI, does it have the potential to increase anxiety?
OCD is really driven by anxiety. It makes sense that you would be particularly vulnerable to dp/dr while you are in the midst of severe depression. Lexapro might exacerbate the dp/dr if it places you in a more anhedonic and mentally numb state. Some people like to attribute this blunted affect to "dopamine depletion". I really don't see how this can happen, though.Maybe add nortriptyline and target a dosage of 75mg or 150mg, depending on your rate of metabolism of this drug as determined by taking blood tests to determine the therapeutic dosage. If you are not happy, you could then switch from Lexapro to a SNRI drug like Effexor or a SSRI known to be effective for treating OCD. If you choose Prozac or Paxil, you will need to reduce the dosage of nortriptyline by approximately 1/2.
Good luck.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:997487
URL: http://www.dr-bob.org/babble/20110914/msgs/997734.html