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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 Bob on August 16, 2008, at 11:53:45
Why does Nortriptyline seem to be a more popular choice of AD than Desipramine, considering that the latter might be considered a slightly cleaner or more pure norephinephrine enhancer than Nortriptyline? There are recommendations for combining Nortriptyline with SSRI's, but I haven't really seen the same for Desipramine.
Posted by SLS on August 16, 2008, at 12:09:24
In reply to Nortriptyline vs. Desipramine, posted by Bob on August 16, 2008, at 11:53:45
> Why does Nortriptyline seem to be a more popular choice of AD than Desipramine, considering that the latter might be considered a slightly cleaner or more pure norephinephrine enhancer than Nortriptyline? There are recommendations for combining Nortriptyline with SSRI's, but I haven't really seen the same for Desipramine.
>Sometimes "dirty" is better. Unlike desipramine, nortriptyline blocks 5-HT2a/c receptors in addition to being a modest 5-HT reuptake inhibitor. I find nortriptyline to be a more pleasant drug than desipramine. Desipramine is certainly a good drug, and many people will respond to it and not respond to nortriptyline.
- Scott
Posted by Phillipa on August 16, 2008, at 12:14:03
In reply to Nortriptyline vs. Desipramine, posted by Bob on August 16, 2008, at 11:53:45
Seems like the TCA's are becoming popular again. Good question. I think I'll google search it and see what some sites say. Are you thinking of going on one. I did try a few two don't remember their name but pamelar at l0 plastered me to the bed couldn't move was so tired it was unbelieveable to me as no meds even in combos have let me sleep for more than four hours. I'm older and the profile of TCA's And heart problems concerns as heart disease runs in my family. Phillipa
Posted by Bob on August 16, 2008, at 12:20:19
In reply to Re: Nortriptyline vs. Desipramine » Bob, posted by Phillipa on August 16, 2008, at 12:14:03
> Seems like the TCA's are becoming popular again. Good question. I think I'll google search it and see what some sites say. Are you thinking of going on one. I did try a few two don't remember their name but pamelar at l0 plastered me to the bed couldn't move was so tired it was unbelieveable to me as no meds even in combos have let me sleep for more than four hours. I'm older and the profile of TCA's And heart problems concerns as heart disease runs in my family. Phillipa
I'm fiddling with this SSRI + TCA idea and decided to try Nortriptyline added to the Celexa I'm already taking. I took 10mg last night and didn't want to get out of bed this morning. Finally pushed myself out but and still real groggy at 1:15. I'm reading on hear that Desipramine produces less sedation.I realize that the sedation I got from the Nortriptyline might lessen, but I don't have a good track record with AD's and wakefullness, so I'm wondering if I should go with the Desipramine first.
I hate making these decisions.
Posted by Bob on August 16, 2008, at 12:22:58
In reply to Re: Nortriptyline vs. Desipramine » Bob, posted by SLS on August 16, 2008, at 12:09:24
> > Why does Nortriptyline seem to be a more popular choice of AD than Desipramine, considering that the latter might be considered a slightly cleaner or more pure norephinephrine enhancer than Nortriptyline? There are recommendations for combining Nortriptyline with SSRI's, but I haven't really seen the same for Desipramine.
> >
>
> Sometimes "dirty" is better. Unlike desipramine, nortriptyline blocks 5-HT2a/c receptors in addition to being a modest 5-HT reuptake inhibitor. I find nortriptyline to be a more pleasant drug than desipramine. Desipramine is certainly a good drug, and many people will respond to it and not respond to nortriptyline.
>
>
> - Scott
>
Scott,When you say that sometimes dirtier is better, are you referring to a definable attribute, or just an unpredictable response for some people with certain drugs? In other words, does the dirtiness have some specific effect that people desire? My main concern here is the possibility of developing intractable sedation with Nortriptyline.
- Bob
Posted by ricker on August 16, 2008, at 12:55:11
In reply to Re: Nortriptyline vs. Desipramine » SLS, posted by Bob on August 16, 2008, at 12:22:58
My main concern here is the possibility of developing intractable sedation with Nortriptyline.
>
> - Bob
>
>Hi Bob,
Ive been taking the nortrip. for a couple weeks now. So far so good. I basically swapped it for my remeron and have been taking it at night - 50mg.
The last thing I'm concerned about is sedation. Actually, I am having trouble falling to sleep and do not feel the least bit tired in the a.m.
I'm still taking zoloft 50mg. and klonopin 0.5mg/bid.
I see my pdoc next week so I'm hoping my sleep improves by then. I need at least 7-8 hrs of quality sleep or my life is pure hell. So, since starting nortrip. I've been averaging 6-7 hrs a night. Remeron was much better for me with no sedation in the a.m. so I may be starting on it again.
Yes, everyone certainly reacts different to meds. I was hoping the nortriptyline would be more sedating...just the opposite "for me".
I will probably try taking it in the morning when I take my zoloft or noon at the latest.Regards, Rick
Posted by Phillipa on August 16, 2008, at 13:00:17
In reply to Re: Nortriptyline vs. Desipramine » Phillipa, posted by Bob on August 16, 2008, at 12:20:19
Is pamelar nortriptalline? Jeez my ignorance is showing. Sorry Phillipa
Posted by Phillipa on August 16, 2008, at 13:02:33
In reply to Re: Nortriptyline vs. Desipramine » Bob, posted by Phillipa on August 16, 2008, at 13:00:17
Didn't read the rest of thread but yup nortriptyline is pamelor. So that's why it's sedating and you were sedated at same dose? Phillipa
Posted by Phillipa on August 16, 2008, at 13:05:25
In reply to Re: Nortriptyline vs. Desipramine » Bob, posted by SLS on August 16, 2008, at 12:09:24
Scott why would pamelor sedate me? If you're using it for depression is it for calming. Boy the science of these meds is complicated for me but never was good at science or math call me ding bat. Phillipa
Posted by bulldog2 on August 16, 2008, at 13:06:02
In reply to Re: Nortriptyline vs. Desipramine » Bob, posted by Phillipa on August 16, 2008, at 12:14:03
> Seems like the TCA's are becoming popular again. Good question. I think I'll google search it and see what some sites say. Are you thinking of going on one. I did try a few two don't remember their name but pamelar at l0 plastered me to the bed couldn't move was so tired it was unbelieveable to me as no meds even in combos have let me sleep for more than four hours. I'm older and the profile of TCA's And heart problems concerns as heart disease runs in my family. Phillipa
Seems like you overeact to meds. I've had pamelor up to 75 mg and was not plastered to the bed. At 10 mg mild sedation to help with sleep. Plastered to the bed on 10 mg? At low dosages should not affect the heart. Wonder if you're what is know as a neurotic in terms of your reaction to meds. Burns describes it in his book. Neurotic depressives can't tolerate meds due to a neurotic overreaction to meds and hence have a bad prognosis in general.
Posted by bulldog2 on August 16, 2008, at 13:09:01
In reply to Re: Nortriptyline vs. Desipramine » Phillipa, posted by Bob on August 16, 2008, at 12:20:19
> > Seems like the TCA's are becoming popular again. Good question. I think I'll google search it and see what some sites say. Are you thinking of going on one. I did try a few two don't remember their name but pamelar at l0 plastered me to the bed couldn't move was so tired it was unbelieveable to me as no meds even in combos have let me sleep for more than four hours. I'm older and the profile of TCA's And heart problems concerns as heart disease runs in my family. Phillipa
>
>
> I'm fiddling with this SSRI + TCA idea and decided to try Nortriptyline added to the Celexa I'm already taking. I took 10mg last night and didn't want to get out of bed this morning. Finally pushed myself out but and still real groggy at 1:15. I'm reading on hear that Desipramine produces less sedation.
>
> I realize that the sedation I got from the Nortriptyline might lessen, but I don't have a good track record with AD's and wakefullness, so I'm wondering if I should go with the Desipramine first.
>
> I hate making these decisions.
>
>
>
>Sedation should lessen in time. Very good to help with sleep. But you should get used to low doses and be very functional in the morning.
Posted by SLS on August 16, 2008, at 13:36:14
In reply to Re: Nortriptyline vs. Desipramine » SLS, posted by Bob on August 16, 2008, at 12:22:58
> > > Why does Nortriptyline seem to be a more popular choice of AD than Desipramine, considering that the latter might be considered a slightly cleaner or more pure norephinephrine enhancer than Nortriptyline? There are recommendations for combining Nortriptyline with SSRI's, but I haven't really seen the same for Desipramine.
> > Sometimes "dirty" is better. Unlike desipramine, nortriptyline blocks 5-HT2a/c receptors in addition to being a modest 5-HT reuptake inhibitor. I find nortriptyline to be a more pleasant drug than desipramine. Desipramine is certainly a good drug, and many people will respond to it and not respond to nortriptyline.
> When you say that sometimes dirtier is better, are you referring to a definable attribute, or just an unpredictable response for some people with certain drugs? In other words, does the dirtiness have some specific effect that people desire? My main concern here is the possibility of developing intractable sedation with Nortriptyline.
"Dirty" is a popular term to call a drug that exerts effects in addition to its therapeutic activity. They are usually undesirable side effects. So, regarding the 5-HT2a/c blockade, this is not yet fully understood to be a beneficial property, even though I feel strongly that it is. Desipramine is "clean" because it just inhibits the reuptake of norepinephrine.If you have never tried nortriptyline before, it might be soporiphic (sleep-inducing) in the beginnig. I would consider it a startup side effect because it usually disappears.
- Scott
Posted by Bob on August 16, 2008, at 16:17:46
In reply to Re: Nortriptyline vs. Desipramine, posted by bulldog2 on August 16, 2008, at 13:09:01
>
> Sedation should lessen in time. Very good to help with sleep. But you should get used to low doses and be very functional in the morning.
>
What do you consider to be an acceptable low dose?
Posted by Bob on August 16, 2008, at 16:23:06
In reply to Re: Nortriptyline vs. Desipramine, posted by bulldog2 on August 16, 2008, at 13:06:02
>
> Seems like you overeact to meds. I've had pamelor up to 75 mg and was not plastered to the bed. At 10 mg mild sedation to help with sleep. Plastered to the bed on 10 mg? At low dosages should not affect the heart. Wonder if you're what is know as a neurotic in terms of your reaction to meds. Burns describes it in his book. Neurotic depressives can't tolerate meds due to a neurotic overreaction to meds and hence have a bad prognosis in general.
>
We have to be careful he, I think, not to blame the patient for a treatment they cannot tolerate. I for one have had outrageous reactions to unbelievably small doses of certain medications. I can't imagine that it's my neuroticism considering that some of these problems were things I couldn't have imagined beforehand. Either way, if it was neuroticism, it is often indistinguishable from the "real" thing and we are dealing with psychological/brain issues.
Posted by bulldog2 on August 16, 2008, at 18:26:38
In reply to Re: Nortriptyline vs. Desipramine » bulldog2, posted by Bob on August 16, 2008, at 16:23:06
>
> >
> > Seems like you overeact to meds. I've had pamelor up to 75 mg and was not plastered to the bed. At 10 mg mild sedation to help with sleep. Plastered to the bed on 10 mg? At low dosages should not affect the heart. Wonder if you're what is know as a neurotic in terms of your reaction to meds. Burns describes it in his book. Neurotic depressives can't tolerate meds due to a neurotic overreaction to meds and hence have a bad prognosis in general.
> >
>
>
> We have to be careful he, I think, not to blame the patient for a treatment they cannot tolerate. I for one have had outrageous reactions to unbelievably small doses of certain medications. I can't imagine that it's my neuroticism considering that some of these problems were things I couldn't have imagined beforehand. Either way, if it was neuroticism, it is often indistinguishable from the "real" thing and we are dealing with psychological/brain issues.
>I'm ujsing the term neurotic as a psychological condition as opposed to a judgement. The neurotic personality seems to overreact to many situations.
You should be able to titrate Nortriptyline from 10 mg to 50 mg with few problems. Every week bump by 10 mg or every few days. After a dose bump my notice increasd sides for a few days.
Posted by Phillipa on August 16, 2008, at 20:35:54
In reply to Re: Nortriptyline vs. Desipramine, posted by bulldog2 on August 16, 2008, at 13:06:02
Guess you'd have to ask my husband who wittnessed it. Phillipa
Posted by sukarno on August 17, 2008, at 4:06:06
In reply to Re: Nortriptyline vs. Desipramine » bulldog2, posted by Phillipa on August 16, 2008, at 20:35:54
Desipramine (Norpramin) is the active metabolite of nortriptyline (Pamelor).
I was on 25mg of nortriptyline at bedtime and for the first few mornings I woke up feeling so tired that I did not want to get up out of bed. I think I slept at least 10 hours. I quickly developed a tolerance to the sedative effects though.
You might be a slow metabolizer if low doses of nortriptyline affect you adversely. I think I am because after a few weeks of taking 25mg q.h.s. I experienced irregular heartbeats along with tachycardia.
That said, it was very effective for my anxiety, panic attacks and depression and had fewer side effects than imipramine (Tofranil). It was also highly motivating and I could focus more easily on tasks, excelling in school. I have never been as motivated in my life as I was when I took nortriptyline. That was 19 years ago and I just wish I could tolerate that medication. Maybe if I would have taken a 10mg dose instead I could have avoided the adverse cardiac effects, but that episode of irregular heart action scared me to death and I just quit taking it at that point.
I have read that lofepramine has fewer side effects and it too is metabolized into desipramine by the liver. Lofepramine is the least toxic of the conventional tricyclic antidepressants and is available in the UK. It, like nortriptyline, inhibits the reuptake of norepinephrine.
I like Stablon, but maybe someday I'll try lofepramine if an online pharmacy will sell it to see if it gives me the results that nortriptyline did.
Posted by Phillipa on August 17, 2008, at 20:05:23
In reply to Re: Nortriptyline vs. Desipramine, posted by sukarno on August 17, 2008, at 4:06:06
So sorry to hear this. Phillipa
This is the end of the thread.
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