Posted by Bob on January 25, 2013, at 13:37:34
In reply to Re: Dr Ken Gillman on - SLS » Bob, posted by SLS on January 24, 2013, at 19:09:48
> It would be a good idea to get a blood level of nortriptyline if you haven't already done so. It is possible to take too much as well as too little.
>
> Just a few ideas:
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> Desipramine might be worth trying in place of nortriptyline. It is substantially more potent as a NE reuptake inhibitor. It is possible that you would need a 5-HT2a antagonist, too, when attempting to substitute for the nortriptyline. A very low dose of Risperdal or one of the other AAPs could serve this purpose. Hmm... Adding Remeron to desipramine or nortriptyline would be an interesting alternative. It would be a way to get the 5-HT2a antagonism and shift NE into overdrive. Sedation is a problem at lower dosages, so you might want to go up to at least 45 mg/day.
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> - Scott
I forgot to mention that I have been getting blood levels for nortriptyline all along. It briefly spiked up to 105ng/mL after titrating up to a dose of 175mg/day but then settled down to 85ng/ML again. Now I'm actually taking 200mg/day and awaiting another blood level. I realize that is above the normal maximum dose, but my pdoc says that if we follow the blood levels then it should be fine.
poster:Bob
thread:1036144
URL: http://www.dr-bob.org/babble/20130124/msgs/1036471.html