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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Emma28 on September 22, 2009, at 16:58:25
I've been through the ringer lately. I was on Celexa, klonopin and seroquel for unipolar depression, GAD and sleep. I also have Lyme disease.The celexa pooped out so.....
First we tried cymbalta in hopes that it would give me more energy and less pain. I couldn't tolerate it- it made me EXTREMELY anxious (I gave it about a month and the anxiety just got worse). So, I came off the cymbalta (withdrawal was NOT fun).
For the last six weeks I have been on 100mg of notriptyline and the klonopin (we stopped the seroquel for sleep)which has given me more energy, less pain but a LOT of anxiety. If I go above 100 mg I get constant anxiety.
So we are adding back in a small dose of celexa (20 mg) to see if it will help.
I thought tricyclics were sedating but a pdoc I spoke to told me that nortriptyline can be very activating. I do NOT do well with activating medications (Wellbutrin, cymbalta etc).
has anyone taken nortriptyline and had their anxiety go through the roof? I'm getting so frustrated and starting to doubt my doc who I've been seeing for 20 years!
Posted by bulldog2 on September 22, 2009, at 18:07:30
In reply to Can nortriptyline make GAD/panic worse?, posted by Emma28 on September 22, 2009, at 16:58:25
> I've been through the ringer lately. I was on Celexa, klonopin and seroquel for unipolar depression, GAD and sleep. I also have Lyme disease.The celexa pooped out so.....
>
> First we tried cymbalta in hopes that it would give me more energy and less pain. I couldn't tolerate it- it made me EXTREMELY anxious (I gave it about a month and the anxiety just got worse). So, I came off the cymbalta (withdrawal was NOT fun).
>
> For the last six weeks I have been on 100mg of notriptyline and the klonopin (we stopped the seroquel for sleep)which has given me more energy, less pain but a LOT of anxiety. If I go above 100 mg I get constant anxiety.
>
> So we are adding back in a small dose of celexa (20 mg) to see if it will help.
>
> I thought tricyclics were sedating but a pdoc I spoke to told me that nortriptyline can be very activating. I do NOT do well with activating medications (Wellbutrin, cymbalta etc).
>
> has anyone taken nortriptyline and had their anxiety go through the roof? I'm getting so frustrated and starting to doubt my doc who I've been seeing for 20 years!Nortriptyline works primarily on norepinephrine which might not be ideal for Gad/panic. Possibly lower the dose of nortriptyline and use an ssri as suugested. The good thing about a tca is you can move the doses around as needed and use them with an ssri.
Posted by Emma28 on September 22, 2009, at 18:38:31
In reply to Re: Can nortriptyline make GAD/panic worse?, posted by bulldog2 on September 22, 2009, at 18:07:30
Thanks Bulldog- I was thinking that myself. Lowering to 75 mg of nortriptyline might lessen my anxiety but still retain the energy/pain benefits and then I'd still be able to play with an SSRI.
Posted by bulldog2 on September 22, 2009, at 19:02:38
In reply to Re: Can nortriptyline make GAD/panic worse?, posted by Emma28 on September 22, 2009, at 18:38:31
> Thanks Bulldog- I was thinking that myself. Lowering to 75 mg of nortriptyline might lessen my anxiety but still retain the energy/pain benefits and then I'd still be able to play with an SSRI.
>
>This particular p-doc likes to mix ssris with tcas because there is flexibility which fixed ratio snris do not offer. His particular favorite is zoloft plus nortriptyline. So you can move doses around until you get the serotonin norepinephrine that is beneficial to you. Because you have gad/panic your balance may tilt more towards serotonin.He also likes the maoi parnate but that's another story.
Posted by Emma28 on September 22, 2009, at 19:16:38
In reply to Re: Can nortriptyline make GAD/panic worse?, posted by bulldog2 on September 22, 2009, at 19:02:38
Thanks again bulldog- I think that's why I did horribly on cymbalta (talk about an anxiety nightmare). It had a profound effect on my norepinephrine and no effect (or not enough) on my serotonin. My doc mentioned this as one of the things he disliked about it.
I did really well on celexa for 10 years so maybe tweaking that dose with the added boost of nortriptyline for energy and pain will be what I need.
I really appreciate your response as things have NOT been good lately. It's always nice to have someone respond!
Posted by Phillipa on September 22, 2009, at 22:02:58
In reply to Re: Can nortriptyline make GAD/panic worse?, posted by Emma28 on September 22, 2009, at 19:16:38
Since I really did have confirmed chronic lymes what med antibiotic did you use and for how long for the lymes. Some antibiotics cause anxiety levoquin was a nightmare for me not taken for lymes. If nortriptalline is pamelor is knocked me out at l0mg so maybe low dose? Phillipa
Posted by Emma28 on September 23, 2009, at 10:04:25
In reply to Re: Can nortriptyline make GAD/panic worse? » Emma28, posted by Phillipa on September 22, 2009, at 22:02:58
I tried going down to 75 mg of nortriptyine last night and I think it helped. I don't understand how something can knock you out at night but make you so anxious during the day. Ugh!
Phillipa- I've been on Biaxin, Plaquenil, minocycline, rifampin, avelox, ketek and I did IV rocephin as well.
Right now I'm not on anything. I can't tolerate anything in the quinolone family- I either get depressed or my tendons freak out.
They don't want to put me back on antibiotics unil I get my depression/anxiety worked out.
Posted by bulldog2 on September 23, 2009, at 15:07:54
In reply to Re: Can nortriptyline make GAD/panic worse? » Emma28, posted by Phillipa on September 22, 2009, at 22:02:58
> Since I really did have confirmed chronic lymes what med antibiotic did you use and for how long for the lymes. Some antibiotics cause anxiety levoquin was a nightmare for me not taken for lymes. If nortriptalline is pamelor is knocked me out at l0mg so maybe low dose? Phillipa
Phillip you cannot make recommendations on pamelor (nortriptyline) based on your experience which is unique as many of your med experiences are unique!! I've been on nortriptyline up to 100 mg and many others here have been on nortriptyline without any problems. For the great majority of people 10 mg of will not knock them out. I don't think it is ethical to make a med recommendation based on your experience.
One should look up studies based on hundreds of people for a valid conclusion.
Phillip whenever someone mentions starting nortriptyline you tell your scare story about your nortriptyline experience.
If you scare someone off a med with your story you potentially may have them abort their nortriptyline trial which may be the med that leads to remission.
Posted by Emma28 on September 23, 2009, at 15:22:58
In reply to Re: Can nortriptyline make GAD/panic worse?, posted by bulldog2 on September 23, 2009, at 15:07:54
I'm not familiar with Phillipa's story but I do know that 10 mg of nortriptyline would NOT knock me out. I don't think it woould do anything.
I come to this board (I just haven't been on in awhile-dealing wiith Lyme disease) knowing that everyone has different reactions to different meds and what is a horror show for me might work great for someone else.
I am definitely not abandoning nortriptyline because it has done some really good things for me- more energy, less depression and a lot less pain. I'm just trying to figure out the right dosage and what it needs to be combined with to get me back to stability.
I'm making progress, it's just slow going (as anyone with depression or anxiety knows all too well!)
Posted by Phillipa on September 23, 2009, at 20:49:50
In reply to Re: Can nortriptyline make GAD/panic worse?, posted by Emma28 on September 23, 2009, at 15:22:58
Emma good for you just shared my own experience which wasn't a frightening one. Just pointed out that different people react differently to different meds. I'm sure you know that and as a smart lady no one is the gospel. Just glad you're making good progress and please keep us posted Love Phillipa
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