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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Jackster on March 19, 2003, at 3:13:58
Just saw my PDoc about the blood test of my nortriptyline levels. Even though I'm under the therapeutic level (basically I need to double the dose) - he was surprised that I hadn't had any effect from it. I was under the impression that with nortrip you didn't get any good effect until you had blood levels in the therapeutic window. Anyone had any experience with this med?
Thanks
Jackie
Posted by SLS on March 19, 2003, at 6:02:58
In reply to nortriptyline - under therapeutic level, posted by Jackster on March 19, 2003, at 3:13:58
> Just saw my PDoc about the blood test of my nortriptyline levels. Even though I'm under the therapeutic level (basically I need to double the dose) - he was surprised that I hadn't had any effect from it. I was under the impression that with nortrip you didn't get any good effect until you had blood levels in the therapeutic window. Anyone had any experience with this med?
Hi Jackie.In my experience, the therapeutic window for nortriptyline (50-150) is rather hard. That is to say, nothing happens below 50, and any positive effect disappears above 150. Keep in mind that each person's window is slightly different. I needed 100mg - blood level 123 - to get a response. Just being above 50 was not sufficient. Most people respond to 75mg.
- Scott
Posted by johnj on March 19, 2003, at 10:17:54
In reply to Re: nortriptyline - under therapeutic level, posted by SLS on March 19, 2003, at 6:02:58
Hi Scott:
I was wondering if you are still taking nortrypline? I am on 50 mg and it doesn't seem to be working as well. In addition, I can't excercise on it or I feel terrible the next day or so. I tried to go down to 40 mg and after 3 days I felt terrible, if I up it to 70 I feel like crap too. It is quite the quandry right now. Lexapro really made my anxiety worse, but I am thinking of trying celexa. Thanks
johnj
Posted by stjames on March 19, 2003, at 16:19:36
In reply to Re: nortriptyline - under therapeutic level, posted by SLS on March 19, 2003, at 6:02:58
For me, the lower limit for an TCA is 75 mgs,
anything less does nothing at all. Also, blood level is not always the best predictor of outcome.
It does let one know if they clear TCA's quickly or not.
Posted by SLS on March 20, 2003, at 10:52:53
In reply to Re: nortriptyline - under therapeutic level » SLS, posted by johnj on March 19, 2003, at 10:17:54
> I was wondering if you are still taking nortrypline?
Hi John.
No, I do not take nortriptyline. I couldn't seem to find one single dosage that worked. I would feel better momentarily when I changed dosages withing the range of 50 and 100mg, but would lose the positive effect within a day or two.
How long did you try 70mg for?
- Scott
Posted by johnj on March 20, 2003, at 14:43:34
In reply to Re: nortriptyline - under therapeutic level, posted by SLS on March 20, 2003, at 10:52:53
I have tried nort at 70 for a week in the past, or 75 mg, but the side effects were killing me. The last time I went to 70 for 2 or 3 days, but felt worse by the 3rd night. I really felt terrible really depressed. I tried to lower my dose and felt bad too. I just don't know if it is the depression returning or withdrawl. Did you have trouble quitting nort? How did you do it and what do you take now. Have you take any AD that has helped? thanks
johnj
Posted by SLS on March 20, 2003, at 15:43:50
In reply to Re: nortriptyline - under therapeutic level » SLS, posted by johnj on March 20, 2003, at 14:43:34
> I have tried nort at 70 for a week in the past, or 75 mg, but the side effects were killing me. The last time I went to 70 for 2 or 3 days, but felt worse by the 3rd night. I really felt terrible really depressed. I tried to lower my dose and felt bad too. I just don't know if it is the depression returning or withdrawl. Did you have trouble quitting nort? How did you do it and what do you take now. Have you take any AD that has helped? thanks
Hi John.It is not rare that someone has trouble finding a therapeutic dosage of nortriptyline, yet be partially or transiently responsive to it. There is a tendency for people to respond well to either nortriptyline or desipramine, but not both. This is not a rule, of course. If you have had no luck with everything else, and have been somewhat responsive to nortriptyline, you might consider desipramine.
Right now, I am taking desipramine 300mg, Lexapro 10mg, and Lamictal 150mg. I have seen only minimal results, but I only started Lexapro a few days ago.
I once responded well to a combination of Parnate + desipramine.
- Scott
Posted by zeugma on March 20, 2003, at 20:57:31
In reply to Re: nortriptyline - under therapeutic level » SLS, posted by johnj on March 20, 2003, at 14:43:34
> I have tried nort at 70 for a week in the past, or 75 mg, but the side effects were killing me. The last time I went to 70 for 2 or 3 days, but felt worse by the 3rd night. I really felt terrible really depressed. I tried to lower my dose and felt bad too. I just don't know if it is the depression returning or withdrawl. Did you have trouble quitting nort? How did you do it and what do you take now. Have you take any AD that has helped? thanks
>
> johnjHi Johnj,
Which side effects have you had? At first on nortriptyline (a very low dose) I had lowered blood pressure and orthostatic hypotension, but that hasn't been a problem for a while. I found that when I increased the dosage from 40 to 50 mg the fatigue kicked in and now I am sleeping a lot more than I was on the lower dose. I plan to get up to 75 mg because I feel that it has had some antidepressant and anti-ADD effects and I want to give it its best chance to work. Do you think it's the sedative effect that is making you feel terrible after you exercise?
Posted by johnj on March 21, 2003, at 13:48:31
In reply to Re: nortriptyline - under therapeutic level » johnj, posted by zeugma on March 20, 2003, at 20:57:31
The SE that get me the most are dry mouth and orthostatic hypotension. If I excercise generally it is a day later that I get increased orthostatic hypotension and kind of bump into walls. Acutally nortryptline is not the most sedating TCA, it's properties are supposed to be somewhat moderate in that department.
The problem with excercise is a mystery. Not only do I get SE increase but I feel terrible and have sleep disturbances and definite depression. It is like the med is causing me to feel worse. I don't think the sedation affects the workout since the all around disturbance is so profound.
I do think I am experiencing a poop out effect too. Things sure do seem bleak at times and it is hard to carry on. take care
johnj
Posted by hopko on March 21, 2003, at 19:37:02
In reply to nortriptyline - under therapeutic level, posted by Jackster on March 19, 2003, at 3:13:58
Nortriptyline did not work for me at all and in fact caused my insomnia to worsen. I switched to Elavil and have never felt better in my life. My depression is gone, I am sleeping, I am not hungry (have lost ALL of my Remeron weight gain)and for once I actually feel happy. I am at 75mg at bedtime + 1.5mg Klonopin. I do have dry mouth and sometimes orthostatic hypotension (usually only in the morning) but that is about it for side effects and I can live with that. I notice that my heart rate is higher when I work out (cardio) so I monitor it quite closely and just go a bit slower. I have tried every other AD out there and this is a success story for me. Perhaps you might consider Elavil or another in this class of meds. Good luck.
Posted by Neo on March 22, 2003, at 6:52:16
In reply to Re: nortriptyline - under therapeutic level, posted by hopko on March 21, 2003, at 19:37:02
Posted by johnj on March 22, 2003, at 15:15:31
In reply to Re: nortriptyline - under therapeutic level, posted by hopko on March 21, 2003, at 19:37:02
Thanks for the information. Amitriptline is the "mother" drug of nortryptline. I need some change that is for sure. I took some magnesium last night and slept well.
What sort of SE do you have on amit? So working out is no problem for you? Thanks for the info
johnj
Posted by hopko on March 22, 2003, at 16:38:53
In reply to Re: nortriptyline - under therapeutic level » hopko, posted by johnj on March 22, 2003, at 15:15:31
Can you tell me what SE is?? I work out 3-4 days a week and although I probably sweat a little more than before, I feel fine. The increased heart rate thing is all I have to be careful about but I do 45 minutes of cardio + lift weights.
Posted by zeugma on March 22, 2003, at 16:40:07
In reply to nortriptyline acts on NA and DA only? (nm), posted by Neo on March 22, 2003, at 6:52:16
Posted by johnj on March 22, 2003, at 22:23:58
In reply to Re: nortriptyline - under therapeutic level, posted by hopko on March 22, 2003, at 16:38:53
The SE (side effects) I get are much more pronounced when I work out. If you don't feel abnormal, and I mean depressed, insomnia, dizziness, etc., after working out that is great. Just shows we all respons differently to each med.
johnj
Posted by hopko on March 23, 2003, at 8:37:03
In reply to Re: nortriptyline - under therapeutic level » hopko, posted by johnj on March 22, 2003, at 22:23:58
I can work out just fine and am actually more motivated to do so since I have been on Elavil. This has been a true miracle drug for me with minimal side effects: dry mouth, constipation that I take fiber for and some orthostatic hypotension in the morning. No sexual side effects. I have tried about every other AD out there (all of the SSRIs, Remeron, etc.) with either side effects I could not deal with or no response. Actually, when I started Elavil I was getting to the bottom of the list of meds before trying the “atypical” stuff. With Nortriptyline, I could not sleep at all and one of my most fearsome problems was insomnia. On Elavil, I am sleeping better than I ever have in my entire life and I feel like a real person again. It is an amazing feeling. I hope you get it worked out and find the right med. Like many of you, I am sure, it took a LONG time of trial and error to get to this point!
Posted by johnj on March 23, 2003, at 21:33:12
In reply to Re: nortriptyline - under therapeutic level, posted by hopko on March 23, 2003, at 8:37:03
That is a little suprising that amtriptline didn't give your more SE, or I guess a higher severity. Can I ask what is your dose? Insomnia was/is my big problem. I get somewhat irritable when I feel a little better mood wise, but when I am down I just am kind of passive. I hate snapping at people and my wife doesn't like it one bit. I have felt decent this weekend and I started some magnesium supplements on Friday night. I did some working out on Friday and Sat and thought I would feel worse, but maybe the magnesium helped? take care
johnjj
Posted by hopko on March 24, 2003, at 8:26:53
In reply to Re: nortriptyline - under therapeutic level » hopko, posted by johnj on March 23, 2003, at 21:33:12
You know, that is what everyone said...that it would give me intolerable side effects, which is why I started with Nortriptyline. But, I am doing great. I take 1.5mg of klonopin 1/2 hour before I want to go to sleep and 75mgs of Elavil at bedtime. I usually wake up once during the night and am now routinely getting 7-8 hours of good sleep, which is a miracle to me. Ever since my early 20’s, (or even earlier) I have been waking up at least 6 times a night but my true insomnia only started about 3 years ago. With my last bad episode, I was sleeping maybe 1-2 hours a night for over 5 months.
I have OCD and general anxiety disorder. I resisted drug treatment for both until I developed insomnia. Then, I went for help. My depression (while always around) recently worsened to the point that I was almost suicidal for a while. I had just gone off Remeron (due to side effects and weight gain) and within 3 days of stopping the drug, I stopped sleeping. I just could not go through that again. Previously, even taking Remeron + Klonopin, I still couldn't sleep without drinking (alcohol) and that situation was getting out of control. I am not drinking at all now and had no trouble stopping.
Talk about irritability! Remeron made me so snappy and almost hostile that I am lucky to still be married!
I know that the Elavil + Klonopin helps reduce my anxiety level so much that my OCD symptoms are much less. (I obsess more rather than show compulsive behavior, although I do have some of that as well.) Anxiety has always had been a huge trigger for my OCD stuff. While my OCD is not gone, it is much better. I feel calmer inside, more accepting of other people and not at all irritable (but you might want to check with my husband about that one!)
I am 46 now and this is the first time since childhood that my anxiety and OCD seem to be under control....and I AM SLEEPING! I do not feel groggy at all in the morning. I know many people do not like Elavil but I WANT to stay on it. I have never felt better. Anyway, I really hope things work out for you.
This is the end of the thread.
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