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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by sl on June 19, 2001, at 21:56:21
Okay. This is wk 3 on Nortriptyline and all I feel is tired. Thought-patterns are bad, depression is bad, this should have kicked in by now, right?? Wk 1 was 25mg/day, wk 2 was 50mg/day, and this wk is 75mg/day. And it's DAMN-good I'm all but unemployed cuz I couldn't function in a workplace.
SO, y'all told me it was likely if Nortrip didn't work, Desipramine would. So that's next on the list (obviously upon approval by my doc). So how do I go about getting from one to the other? Do I need to take 3 weeks to get back off Nortriptyline and then another 3 to get up to speed on Desipramine???
The other thing: I'm going to try to talk them into a small dose of Zyprexa to control those nasty pervasive thoughts. Can this be combined with Nortrip and Desip (as I go from one to the other)?
As always, any input is welcome....
sl
Posted by SalArmy4me on June 19, 2001, at 22:39:32
In reply to From Nortriptyline to Desipramine...?, posted by sl on June 19, 2001, at 21:56:21
I don't think you have waited long enough for the nortriptyline to work. Ideally, you should give it 6 weeks. But switching from nortriptyline to desipramine can be done immediately (since there's no chance of a serotonin syndrome with desipramine), and I'm sure you will like the desipramine a lot better.
Yes, you can take Zyprexa with desipramine or nortriptyline.
Posted by Sunnely on June 20, 2001, at 1:00:30
In reply to From Nortriptyline to Desipramine...?, posted by sl on June 19, 2001, at 21:56:21
Hi sl,
Three weeks is considered not long enough for an adequate antidepressant trial. If you are taking nortriptyline (Pamelor) as an antidepressant, the "therapeutic" dose is generally guided by the blood level. Nortriptyline as antidepressant has a "therapeutic window," the range in blood levels considered effective, which is between 50 to 150 ng/ml. Too low and you lose or do not achieve the antidepressant effect. Too high and you lose the antidepressant effect but increased side effects. So, before you give up on nortriptyline, have that blood level checked, and adjust the dose accordingly.
If you decide to switch from nortriptyline to desipramine (Norpramin), do the transition gradually to avoid anticholinergic toxicity.
********************************
> Okay. This is wk 3 on Nortriptyline and all I feel is tired. Thought-patterns are bad, depression is bad, this should have kicked in by now, right?? Wk 1 was 25mg/day, wk 2 was 50mg/day, and this wk is 75mg/day. And it's DAMN-good I'm all but unemployed cuz I couldn't function in a workplace.
>
> SO, y'all told me it was likely if Nortrip didn't work, Desipramine would. So that's next on the list (obviously upon approval by my doc). So how do I go about getting from one to the other? Do I need to take 3 weeks to get back off Nortriptyline and then another 3 to get up to speed on Desipramine???
>
> The other thing: I'm going to try to talk them into a small dose of Zyprexa to control those nasty pervasive thoughts. Can this be combined with Nortrip and Desip (as I go from one to the other)?
>
> As always, any input is welcome....
> sl
Posted by sl on June 20, 2001, at 12:47:21
In reply to Re: From Nortriptyline to Desipramine...? » sl, posted by Sunnely on June 20, 2001, at 1:00:30
> Three weeks is considered not long enough for >an adequate antidepressant trial. If you are taking nortriptyline (Pamelor) as an
I'm taking generic. So not Pamelor. Just Nortripytline.
>considered effective, which is between 50 to 150 ng/ml. Too low and you lose or do not achieve the antidepressant effect. Too high and you lose the antidepressant effect but increased side effects. So, before you give up on nortriptyline, have that blood level checked, and adjust the dose accordingly.
I can't. I can't afford that kinda test. Right now I can't even afford to get to the Doctor's office. I know that I felt better at 50mg than I do now at 75mg.
Also, Nortriptyline seems to be sedating, and I've read that Desipramine is activating. I wish I would have done more research, we could have checked Desipramine first since extra energy would have been welcome.> If you decide to switch from nortriptyline to desipramine (Norpramin), do the transition gradually to avoid anticholinergic toxicity.
Could you be more specific?
Will I need to titrate off the nortrip and then onto the desip? How long a time-period are we talking here...?Sorry for all the questions, my nurse is out sick...
sl
> ********************************
>
> > Okay. This is wk 3 on Nortriptyline and all I feel is tired. Thought-patterns are bad, depression is bad, this should have kicked in by now, right?? Wk 1 was 25mg/day, wk 2 was 50mg/day, and this wk is 75mg/day. And it's DAMN-good I'm all but unemployed cuz I couldn't function in a workplace.
> >
> > SO, y'all told me it was likely if Nortrip didn't work, Desipramine would. So that's next on the list (obviously upon approval by my doc). So how do I go about getting from one to the other? Do I need to take 3 weeks to get back off Nortriptyline and then another 3 to get up to speed on Desipramine???
> >
> > The other thing: I'm going to try to talk them into a small dose of Zyprexa to control those nasty pervasive thoughts. Can this be combined with Nortrip and Desip (as I go from one to the other)?
> >
> > As always, any input is welcome....
> > sl
This is the end of the thread.
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