Posted by SLS on March 7, 2016, at 22:45:42
In reply to Re: Nortriptyline weight gain? » SLS, posted by Uncouth on March 7, 2016, at 18:29:28
> Hi Uncouth.
I tried taking 120 mg/day of Parnate a year ago. I experienced a nice surge of energy upon each dosage increase that would disappear after a week or so. I would then raise the dosage again. In other words, I found myself in a situation of dosage escalation. In the end, I profit as much at 80 mg/day as I did at 120 mg/day.
After giving it some thought, I have decided to continue with desipramine 300 mg/day for now, along with Parnate 80 mg/day.
> Curious as to your experience being on both desipramine and nortryptiline.
If the question is which of the two drugs is best, the answer is whichever of the two produces a *true* robust and global antidepressant response. Many people respond to one drug and not the other. Unfortunately, a great many people do not respond fully to either drug, but plateau at some point short of remission.
I have been a partial responder to both desipramine and nortriptyline when combined with a MAOI. Nortriptyline seems to be smoother and is more of a "mood brightener" than desipramine. It produces a more pleasant feeling. Desipramine feels harsh by comparison. It is strangely energizing early in treatment, and can make you feel tense or wired. These things mitigate over time. So, if I am to remain a partial responder to both drugs, I would take nortriptyine. But obtaining a partial response is not my goal. I am remaining on desipramine, hoping that I will achieve full remission with it.
I am acting on the premise that it is going to take months rather than weeks to respond to any treatment. After being on desipramine for over four months, I began to feel better and better. It had been a very gradual improvement, but it was measurable. Just as I was feeling the onset of a true antidepressant effect, I contracted a systemic infection. It's always something. I guess I'm one of those people who experience an exacerbation of depression or a relapse in association with such an infection. It caused a true setback. It was if I relapsed. I thought that desipramine had pooped-out on me. I even questioned whether or not I ever responded to it at all. After all, I felt better for only a few days before getting sick. I began to believe that switching back to nortriptyline was my best move if I were to be stuck with a partial response. I decided that staying with desipramine was the logical more.
Your sources of information are wrong regarding the dosages of desipramine to be used in depression. I am intimately familiar with TCAs. In my estimation, the dosage of desipramine to be used for mild depression is 50-100 mg/day; moderate depression 125-200 mg/day; severe depression 200-300 mg/day. These are not absolutes, of course, but they help as a guidelines. When in doubt, use a blood test as a guideline. Dosages between individuals can vary according one's rate of metabolizing the drug. For me, 300 mg/day is the minimum that produces a stable improvement. I don't do as well at 250 mg/day. 300 mg/day should be enough according to a blood test and the observed clinical improvement.
Do whatever you can get on desipramine. Start low and go slow. I started at 50 mg/day, but your doctors might not be comfortable starting that high. 25 mg/day should be low enough as an initial dosage. If your doctors want to start at 10 mg/day, I couldn't fault them. If your doctors insist on EKG tests or close monitoring of blood pressure in the beginning, I think it would be worth it.
* The dosages of nortriptyline to be used are roughly 50% of those of desipramine. I think that the risk of cardiac toxicity is lower with nortriptyline.
** The dosage of a TCA must be cut by 50% when combined with Prozac, Paxil, or Wellbutrin. The same is true in geriatric patients.
What will be your criteria for choosing between desipramine and nortriptyline?
I'll be happy to answer any more question if I can.
--------------------------------------------
My current treatment regime:
Parnate 80 mg/day
desipramine 300 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 10 mg/day--------------------------------------------
- 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:1086706
URL: http://www.dr-bob.org/babble/20160306/msgs/1086870.html