> I have a follow-up meeting with my psychiatrist tomorrow. I haven't had much difficulty in terms of side effects with the addition of nortriptyline to the sertraline and tryptophan, but I also haven't had much positive response, either. I'd like to try increasing the nortriptyline, though it's only been a little over a week and I'm wondering what the maximum safe dosage would be. From what I read on psychotropical, sertraline in high doses only increases nortriptyline levels by about 30% and the highest recommended dose is 150 mg, so I was thinking 100 to 125 mg would be safe, though I wouldn't immediately increase to that. THoughts?
It might be a good plan to test for blood levels of nortriptyline to help guide dosage decisions. Nortriptyline has a therapeutic window of blood concentrations of 50 - 150 ng/ml. Plasma levels outside this range result in a diminished antidepressant effect. It is possible to take too much, even if toxic levels are not reached.
- Scott
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