Posted by g_g_g_unit on September 24, 2011, at 9:27:27
In reply to Re: nortriptyline with lexapro? + depersonalization » g_g_g_unit, posted by SLS on September 24, 2011, at 6:46:59
> 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.
Yeah. It sucks because meds that improve my hedonic tone (e.g. stimulants), and hence one of the markers of the DP/DR, do nothing for the hypervigilance and phobic avoidance that's resulted from it. Lexapro, on the other hand, curtails the anxiety but leaves me feeling more internally lost. I would like to hopefully achieve a balance between the two.
>
> 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.Thanks for your advice. I didn't realize Lexapro wasn't known to be effective in OCD. Prozac causes terrible akathisia, unfortunately. I experience some on the Lexapro, but the anxiolysis masks the worst of it.
I'll suggest Nortriptyline to my psychiatrist at our next meeting. I remember trying it at a low dose for sleep a few years ago and incidentally noticing an improvement in my executive function (I have ADD as well).
My track record with NE-targeting drugs (Mirtazapine, Buspar, Strattera, clomipramine, Ritalin) is terrible though, as far as mood and anxiety goes. Would it be to treat nortrip as its own unique entity?
poster:g_g_g_unit
thread:997487
URL: http://www.dr-bob.org/babble/20110914/msgs/997742.html