![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Andy on December 9, 1999, at 9:32:36
My 13 year old son is depressed. SSRI's pooped out and Wellbutrin failed. He just started Nortrip.
What are the side effects ? How long does it usually take to get some benefit ?
Posted by Noa on December 9, 1999, at 11:03:54
In reply to Nortriptyline, posted by Andy on December 9, 1999, at 9:32:36
While you are waiting for responses from folks who know about nortriptyline, try a search. Go to the top of the page, click on search. I know there have been threads dealing with nortriptyline. Good luck.
Posted by S. Suggs on December 9, 1999, at 11:56:41
In reply to Nortriptyline, posted by Andy on December 9, 1999, at 9:32:36
Andy:
I've taken nortriptyline in the past. It will typically cause some constipation, some sedation and dry mouth. These were noted in my case. I had to drop it due to the GI problems, I have GERD and this drug slows down peristalsis (movement of your small and large intestines, resulting in constipation and heartburn, and heartburn is a major problem with GERD (gastro esophageal reflux diease). Nortriptyline is closely related to amitriptyline, and actually is a first pass metabolite of amitriptyline. It is a good drug, works on serotonin and norep. If the side effect profile is not too much to deal with, you will probably see some decent results.
Best of luck and Blessings,
S. Suggs
Posted by ChrisK on December 10, 1999, at 6:06:29
In reply to Nortriptyline, posted by Andy on December 9, 1999, at 9:32:36
I never responded to the SSRI's either. Now I take 100mg of Nortriptyline daily. The worst side effect is the dry mouth. Try www.rxlist.com and search for Nortriptyline or Pamelor. They usually have good info.
Good Luck with it. I know that it seems to be working for me.
Posted by S. Suggs on December 10, 1999, at 7:06:09
In reply to Re: Nortriptyline, posted by S. Suggs on December 9, 1999, at 11:56:41
In follow up to my previous post, when I was taking Pamelor 75mg at 7p, I was also taking Zoloft in the am, with absolutely fantastic results. Again, the reason for quitting were previously mentioned and Zoloft in and of itself was of no lasting effect, even augmented with lithium. If I can recall, Bob, regular poster, has tried this combo in the past with some success. Blessings,
S. Suggs
Posted by JohnL on December 10, 1999, at 13:37:36
In reply to Re: Nortriptyline, posted by S. Suggs on December 10, 1999, at 7:06:09
> In follow up to my previous post, when I was taking Pamelor 75mg at 7p, I was also taking Zoloft in the am, with absolutely fantastic results. Again, the reason for quitting were previously mentioned and Zoloft in and of itself was of no lasting effect, even augmented with lithium. If I can recall, Bob, regular poster, has tried this combo in the past with some success. Blessings,
>
> S. SuggsI must say the best therapy I ever had was Zoloft+Nortriptyline. I was actually totally euthymic for a little while, and nearly euthymic most other times. That is a very nice combination, if one can handle the TCA side effects. It was the total destruction of sex life by Zoloft that eventually spelled doom for this combination with me. I often wonder about returning to Nortriptyline either by itself or with something else. There really was something special about it when combined with Zoloft.
Posted by Bob on December 12, 1999, at 21:51:44
In reply to Re: Nortriptyline, posted by JohnL on December 10, 1999, at 13:37:36
Yeah, I first got on nortrip as an augmentor to zoloft ... turns out the zoloft wasn't doing that much for me in the first place. Thankfully (or maybe not), I really can't say what side effects nortrip has on me -- I only know its fewer and of lesser intensity than what SSRIs do to me. As for how long it took to kick in ... well, I was trying to wash out of lithium as an augmentor when, after a week, I really started to crash moodwise. So, I started the nortrip a little sooner than planned, and it brought me back up to an even keel immediately. It took maybe two months before things actually leveled off higher than where I had been on zoloft+lithium. Again, another two months after easing off zoloft and I'm still functioning better on just nortrip and clonazepam. Some areas, I've seen some backsliding -- some OCD-like behaviors I have that SSRIs eliminated are back in moderation. I'm still seeing Ann Hedonia ;^) more than my girlfriend as well. So there's much room for improvement.
All the same, my latest soapbox here in Babbleland is how TCAs are as dirty for some of us as Common Wisdom would have us believe.
Bob
Posted by JohnL on December 13, 1999, at 4:23:29
In reply to Re: Nortriptyline, posted by Bob on December 12, 1999, at 21:51:44
I'm still seeing Ann Hedonia ;^) more than my girlfriend as well. So there's much room for improvement.
>
> All the same, my latest soapbox here in Babbleland is how TCAs are as dirty for some of us as Common Wisdom would have us believe.
>
> BobI know Ann too! I know her all too well. She hangs around with me 24 hours a day. Wish I could just tell that *&%^*% to get lost.
One comment on Nortriptyline. It has a rather narrow therapeutic window. I saw a graph on Nortrip that was the shape of a bell curve. Response to this drug is in the narrow range at the top of that bell curve. Doses to the left (too low) and doses to the right (too high) produced profoundly diminished response. It might be a good idea to get a blood test to measure your current plasma level of Nortrip to see whether your dose is too low. The correct levels are well known and documented. So your doc and/or the place that does the testing should be able to tell you where your dose stands at this time.
I'm finally off Remeron (that was a hard thing to get off of, almost like an addiction), and don't really like the benzo Xanax much, so yesterday I took some leftover Nortrip just out of curiosity. (insomnia issue) I slept OK, but I was surprised yet puzzled at the lack of side effects with a one-time 50mg dose. I remember when I used to take it with Zoloft it was incredibly sedating. It was just a one time one day dose yesterday, but it was much smoother than a one time one day dose of anything else I can think of I've ever tried. Didn't seem 'dirty' at all. My pdoc wants to add Desipramine to my Prozac in a couple weeks, but heck, with all this leftover Nortrip and lack of side effects, maybe I'll just keep going with it and see how things develop. But then again, back to the first part of this post, I too would have to get the dose into that narrow therapeutic range. That's even trickier when mixed with Prozac. Desipramine on the other hand has a linear response without that narrow window. Just didn't know if you were aware of Nortrip's narrow therapeutic window. FYI. JohnL
Posted by Bob on December 13, 1999, at 16:22:03
In reply to Re: Nortriptyline, posted by JohnL on December 13, 1999, at 4:23:29
Geez, and I still have my extra 40 pounds from zoloft ... how the hell am I supposed to fit thru a narrow window? ;^)
Nope, didn't know about it. Seeing my pdoc next week. Guess I should give him a call and see if he wants this test done. (Can't see why not)
On a more general nortriptyline note, has anyone used it in combination with wellbutrin? That's what my pdoc wants to try next. I didn't tolerate it well my first trial on it, but I had to jump on fast (to combat some wicked nasty paxil withdrawal) and my pdoc thinks that might be the reason. He also wants to try me at low levels -- 50 to 100 mg/d. He's had good success with other patients of his doing this. So, anyone out there on nortrip (or "trippin'" on any other TCA) have any experience with wellbutrin in combination?
Thanks,
Bob
Posted by JohnL on December 13, 1999, at 16:53:50
In reply to Narrow windows ... & Nortrip/Wellbutrin Combo?, posted by Bob on December 13, 1999, at 16:22:03
> Geez, and I still have my extra 40 pounds from zoloft ... how the hell am I supposed to fit thru a narrow window? ;^)
>
> Nope, didn't know about it. Seeing my pdoc next week. Guess I should give him a call and see if he wants this test done. (Can't see why not)
>
> On a more general nortriptyline note, has anyone used it in combination with wellbutrin? That's what my pdoc wants to try next. I didn't tolerate it well my first trial on it, but I had to jump on fast (to combat some wicked nasty paxil withdrawal) and my pdoc thinks that might be the reason. He also wants to try me at low levels -- 50 to 100 mg/d. He's had good success with other patients of his doing this. So, anyone out there on nortrip (or "trippin'" on any other TCA) have any experience with wellbutrin in combination?
>
> Thanks,
> BobHi again Bob. No experience here with the two combined. However I did read an abstract describing the combination used successfully for refractory depression. It seems like it should be a great combination. JohnL
Posted by ChrisK on December 14, 1999, at 5:23:38
In reply to Re: Narrow windows ... & Nortrip/Wellbutrin Combo?, posted by JohnL on December 13, 1999, at 16:53:50
Bob,
I take Nortrip with Celexa (and Naltrexone and Zyprexa). After I started getting the benefits of Naltrexone I stopped the Celexa. After two weeks I had to go back on it because I could feel the shift in my moods. Obviously the Celexa was complementing the Nortrip somehow. I'm currently taking 100mg of Nortrip and 20mg of Celexa. Hope this helps.
Chris
Posted by S. Suggs on December 14, 1999, at 15:36:10
In reply to Re: Nortriptyline, posted by Bob on December 12, 1999, at 21:51:44
Bob, I have taken both of these at different times with decent results, but never at the same time. Sounds like a great idea-let us know if it works. Blessings,
S. Suggs
Posted by JohnL on December 17, 1999, at 3:16:21
In reply to Re: Narrow windows ... & Nortrip/Wellbutrin Combo?, posted by JohnL on December 13, 1999, at 16:53:50
> Hi again Bob. No experience here with the two combined. However I did read an abstract describing the combination used successfully for refractory depression. It seems like it should be a great combination. JohnLOK, so this got my interest. I am now taking Nortrip+Wellbutrin and we'll see how it goes. Prozac+whatever was useless on my anhedonia/melancholia after a year of trying. I saw another abstract that showed that patients experiencing melancholia while on SSRIs responded when switched to Nortrip, Wellbutrin, or ECT. Clearly it seems the melancholic subtype requires a different approach than other forms of depression. Lots of research and anecdotal evidence seems to support TCAs or Wellbutrin or both over SSRIs for melancholic depression. If the measuring criteria is 50% reduction of Hamilton depression score, all antidepressants are equally effective. But if the criteria is changed to a more stringent requirement of 10 points or less on the Hamilton score, TCAs blow SSRIs in the weeds.
This is the route my psychiatrist has always wanted me to take, but I couldn't because of severe tinnitus on Wellbutrin. What I have discovered is that Wellbutrin does not produce tinnitus since the Remeron was removed. Something about that combo caused severe tinnitus. Strange. I am taking 50mg of Lamictal too, which seems to be a factor in quieting the tinnitus. And I plan on continuing Prozac, perhaps 20mg every three days or so, just because.
So, Nortrip+Wellbutrin it is, with a sprinkle of Lamictal and Prozac in the background for tinnitus control. So far the only side effects are dry mouth and insomnia. Nortrip has always seemed quite sedating to me, but Wellbutrin overcomes that strongly enough to cause insomnia. Hope that passes. In theory this seems like an excellent combo for melancholia in a sexually active patient. We'll see. So far so good. Thanks for starting this thread. I was in need of more ideas after abandoning Remeron. :) JohnL
Posted by Andy on December 20, 1999, at 9:42:47
In reply to Re: Nortrip/Wellbutrin Combo, posted by JohnL on December 17, 1999, at 3:16:21
Hello again John L
Prozac is a miracle drug for my depression I need 50mg. If I was on prozac alone the side effects of anxiety and insomnia would make it intolerable. Buspar 60mg gets the anxiety under control, with additional benefits as well. Insomnia continues to be a real problem.
A couple of months ago I posted a query looking for augmentation strategy that could help me reduce the prozac. Ended up with Naltrexone. Naltrex made me calmer and did improve sleep. It did not permit me to lower the prozac as I had hoped. I am not entirely satisfied with it because it causes fatigue and seems to require that I sleep 10-11 hours a night to feel moderately rested. I'm going without it for a while.
Thoughts on adding Nortrip to the mix with the objective of improving sleep and possibly getting by on less prozac ?
What's the story with weight gain ?
> > Hi again Bob. No experience here with the two combined. However I did read an abstract describing the combination used successfully for refractory depression. It seems like it should be a great combination. JohnL
>
> OK, so this got my interest. I am now taking Nortrip+Wellbutrin and we'll see how it goes. Prozac+whatever was useless on my anhedonia/melancholia after a year of trying. I saw another abstract that showed that patients experiencing melancholia while on SSRIs responded when switched to Nortrip, Wellbutrin, or ECT. Clearly it seems the melancholic subtype requires a different approach than other forms of depression. Lots of research and anecdotal evidence seems to support TCAs or Wellbutrin or both over SSRIs for melancholic depression. If the measuring criteria is 50% reduction of Hamilton depression score, all antidepressants are equally effective. But if the criteria is changed to a more stringent requirement of 10 points or less on the Hamilton score, TCAs blow SSRIs in the weeds.
>
> This is the route my psychiatrist has always wanted me to take, but I couldn't because of severe tinnitus on Wellbutrin. What I have discovered is that Wellbutrin does not produce tinnitus since the Remeron was removed. Something about that combo caused severe tinnitus. Strange. I am taking 50mg of Lamictal too, which seems to be a factor in quieting the tinnitus. And I plan on continuing Prozac, perhaps 20mg every three days or so, just because.
>
> So, Nortrip+Wellbutrin it is, with a sprinkle of Lamictal and Prozac in the background for tinnitus control. So far the only side effects are dry mouth and insomnia. Nortrip has always seemed quite sedating to me, but Wellbutrin overcomes that strongly enough to cause insomnia. Hope that passes. In theory this seems like an excellent combo for melancholia in a sexually active patient. We'll see. So far so good. Thanks for starting this thread. I was in need of more ideas after abandoning Remeron. :) JohnL
Posted by Bob (back from the overworked_dead) on December 24, 1999, at 10:34:14
In reply to How about Nortrip and Prozac ?, posted by Andy on December 20, 1999, at 9:42:47
Here I am, day 2 of Nortrip and Wellbutrin and Clonazepam. To early to tell, of course ... so more later. I'm also on day 7 of having a CPAP machine to treat my sleep apnea, and that's slowly having an effect.
For those who suggested an SSRI for me--thanks but no thanks. Been there, done that. As others have pointed out, it seems there are some people and some types of depressions for which TCAs just blow SSRIs away. It's taken nearly three years, but I think I can now say I'm in that category. Of course, remember the SBD (that Standard Babble Disclaimer for you, dj ... how you been, bud?):
Your mileage may vary.
Anyway, the wellbutrin therapy for me is 75mg/d of the non-SR formula. Given how sedated and unenergetic I've been the last, oh, 8 months or so, plus my "zoloft 40", I'm really looking forward to some "side effects" that could do me some good -- I could use some Nortrip-mediated agitation plus some weight loss in my life right now.
Sorry, I can't remember who was asking about how sedating Nortrip was. I've taken zoloft, prozac, paxil, zyprexa, ativan, clonazepam, and perphenazine and only the perphenazine has been more sedating (damn well better be, too, as an anti-psychotic!). It also wound up doing more for me than 200mg/d of zoloft. I'm at the lowest therapeutic dose, 75mg/d, and my nortrip blood level is 3 points into the therapeutic range (50-150), and it's been more effective than any SSRI for me. Again, it has been quite sedating, so that's one reason why I wanted to mix in some wellbutrin rather than boosting my nortrip dosage. Besides, the sedation is the only side effect I've had from the nortrip ... no point tempting fate by going up to a higher level.
Anyway, I'll post here again in a week or so ... (non-SR) wellbutrin's supposed to kick in (and putter out! ... my pdoc said to count on 6-8 hours of action a day) pretty quickly, so I should have something to say by then.
Happy holidays,
Bob
Posted by Scott L. Schofield on December 29, 1999, at 13:36:38
In reply to Nortrip, Wellbutrin & Prozac -- Oh MY!, posted by Bob (back from the overworked_dead) on December 24, 1999, at 10:34:14
> Sorry, I can't remember who was asking about how sedating Nortrip was. I've taken zoloft, prozac, paxil, zyprexa, ativan, clonazepam, and perphenazine and only the perphenazine has been more sedating (damn well better be, too, as an anti-psychotic!). It also wound up doing more for me than 200mg/d of zoloft. I'm at the lowest therapeutic dose, 75mg/d, and my nortrip blood level is 3 points into the therapeutic range (50-150), and it's been more effective than any SSRI for me. Again, it has been quite sedating, so that's one reason why I wanted to mix in some wellbutrin rather than boosting my nortrip dosage. Besides, the sedation is the only side effect I've had from the nortrip ... no point tempting fate by going up to a higher level.I guess the sedation experienced with nortriptyline (Pamelor) is a carry-over of sorts from its parent compound, amitriptyline (Elavil). Amitriptyline really sucks as far as sedation is concerned. It felt like I was encased in blob of sludge. This sedation/malaise did not wear off appreciably over the course of six weeks. On the other hand, I found that the sedation I experienced with nortriptyline abated over time. I guess it took between one and two weeks.
It's a good drug worth sticking with.
- Scott
Posted by Pat on January 20, 2000, at 19:42:38
In reply to Re: Nortrip, Wellbutrin & Prozac -- Oh MY!, posted by Scott L. Schofield on December 29, 1999, at 13:36:38
> I just stopped taking Welbutrin combined with prozac because i developed insomnia, anxiety, and inability to concentrate from the welbutrin...today i have started a combination of prozac and nortrip, so do not know what it will do for me...has anyone tried this combo? is there automatic weight gain and lethargy from the nortrip?...fill me in. Thanks..PAT
Posted by Andy on January 21, 2000, at 9:17:50
In reply to Re: Nortrip, Wellbutrin & Prozac -- Oh MY!, posted by Pat on January 20, 2000, at 19:42:38
I'm taking 50mg of prozac and 25mg of Nortrip. The Nortrip was added to help sleep, though I think I am getting some additional benefit from it (even though I'm probably below customary therapeutic level). First week on Nortrip I felt a bit washed out, but that passed. Only side effect now is dry mouth. Weight gain does not seem to be a problem.
> > I just stopped taking Welbutrin combined with prozac because i developed insomnia, anxiety, and inability to concentrate from the welbutrin...today i have started a combination of prozac and nortrip, so do not know what it will do for me...has anyone tried this combo? is there automatic weight gain and lethargy from the nortrip?...fill me in. Thanks..PAT
Posted by this dude lamanamanewme on November 28, 2000, at 0:04:50
In reply to Nortrip, Wellbutrin & Prozac -- Oh MY!, posted by Bob (back from the overworked_dead) on December 24, 1999, at 10:34:14
hey, i found a whole bunch of nortrip that has an expiration date of August of 1997. I wanna know if i can still take it and what it will do to me.
Posted by Raoul on March 6, 2001, at 11:31:35
In reply to Nortriptyline, posted by Andy on December 9, 1999, at 9:32:36
Anybody experience weight gain with Nortriptyline?
I just went from 125 to 150 and I feel I'm the
fatter for it.About the therapeutic window: does it matter
where you fall within it?Thanks,
Raoul
Posted by Cece on March 6, 2001, at 13:42:51
In reply to Re: Nortriptyline and weight and levels, posted by Raoul on March 6, 2001, at 11:31:35
Hi Raoul-
There are 2 significant previous threads on this for you to check out:
Re: Nortriptyline Hcl weight gain/loss to Gene (from me) on March 2, and
Nortriptyline Hcl and weight gain/loss, Feb 13-20.About the therapeutic window- I guess you mean in terms of weight gain? I found that I was able to slow my weight gain by dropping to the lowest dose that had beneficial effects, which for me is 40mg/day.
Good luck,
Cece
> Anybody experience weight gain with Nortriptyline?
> I just went from 125 to 150 and I feel I'm the
> fatter for it.
>
> About the therapeutic window: does it matter
> where you fall within it?
>
> Thanks,
> Raoul
Posted by jamesprice on November 24, 2003, at 12:00:40
In reply to Re: Nortrip/Wellbutrin Combo, posted by JohnL on December 17, 1999, at 3:16:21
If the measuring criteria is 50% reduction of Hamilton depression score, all antidepressants are equally effective. But if the criteria is changed to a more stringent requirement of 10 points or less on the Hamilton score, TCAs blow SSRIs in the weeds.
Thanks
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.