![[dr. bob]](/dr-bob-sm.gif)
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 linkadge on August 23, 2009, at 10:34:57
The doctor switched me to amitriptyline. I have a little more hope for this medication.
Nortriptyline gave me energy, but did not hit some of the core depression (i.e. feeling worthless, inability to find peace in anything, feeling like I don't exist, *wanting* to live).
Wish me luck.
If it is anything more like clomipramine it should would.
Linkadge
Posted by bulldog2 on August 23, 2009, at 11:59:27
In reply to Switch to Amitriptyline, posted by linkadge on August 23, 2009, at 10:34:57
> The doctor switched me to amitriptyline. I have a little more hope for this medication.
>
> Nortriptyline gave me energy, but did not hit some of the core depression (i.e. feeling worthless, inability to find peace in anything, feeling like I don't exist, *wanting* to live).
>
> Wish me luck.
>
> If it is anything more like clomipramine it should would.
>
> Linkadge
>
>Last summer my doc(rheumatologist) gave me 25 mg amitriptyline tablets for fibromyalgia.
Took one at night which helped me sleep well. The next day the pain was gone and I really felt well mentally (good mood) and did a 3 mile hike.
Certainly a powerful med. I have also taken nortriptyline for fibro and I must say I like amitriptyline better. Amitriptyline has more of a serotogenic feel to it than nortriptyline and it better against anxiety.
But like nortriptyline there may be some cognitive dulling. Now I only used a dose of 25 mg for fibro and initially had some cognitive dulling which did totally go away after a couple weeks. So if you get this side you may have to give it awhile and it will probably eventually dissapate.
Yes good luck.
Posted by SLS on August 23, 2009, at 12:10:52
In reply to Switch to Amitriptyline, posted by linkadge on August 23, 2009, at 10:34:57
> The doctor switched me to amitriptyline. I have a little more hope for this medication.
>
> Nortriptyline gave me energy, but did not hit some of the core depression (i.e. feeling worthless, inability to find peace in anything, feeling like I don't exist, *wanting* to live).
>
> Wish me luck.
>
> If it is anything more like clomipramine it should would.
>
> LinkadgeThe tertiary TCAs are generally more effective than the secondary ones, but have more robust side effects. Your doctor knows what he is doing. He is trying to give you the best chance of responding. If you get "stuck" you can always give lithium a short trial. Quite often, people respond to the same drugs that first degree relatives do.
I hope amitriptyline treats you better than nortriptyline did.
- Scott
Posted by Phillipa on August 23, 2009, at 12:20:45
In reply to Re: Switch to Amitriptyline, posted by SLS on August 23, 2009, at 12:10:52
Good luck link the lithium didn't relative respond well to it? It's a though. Phillipa
Posted by bulldog2 on August 23, 2009, at 14:26:35
In reply to Switch to Amitriptyline, posted by linkadge on August 23, 2009, at 10:34:57
> The doctor switched me to amitriptyline. I have a little more hope for this medication.
>
> Nortriptyline gave me energy, but did not hit some of the core depression (i.e. feeling worthless, inability to find peace in anything, feeling like I don't exist, *wanting* to live).
>
> Wish me luck.
>
> If it is anything more like clomipramine it should would.
>
> Linkadge
>
>By the way I would say this should be really called the "Gold Standard" for ads. Back in the old days before the invention of ssrs this was the go to ad for severe depression. Docs usually use nortriptyline because for most people it is the most tolerable of the tcas. If you can deal with the sides which should get better with time. I know most studies say 66% rate of success for ads but I read a study one that had an 88% rate of success for amitriptyline.
Posted by Phil on August 23, 2009, at 14:39:02
In reply to Switch to Amitriptyline, posted by linkadge on August 23, 2009, at 10:34:57
Took amitriptyline pre prozac for 5 years, 250mg.
I'm a fast metabolizer.
Lived on Senokot(god bless it)
Could sleep thru a hurricane and wake up refreshed.
Weird side....exercised like mad. Running and bike.
Gained 10-12% but fit!
That's all I was on....cost, about $3.00 a month.
Posted by jms600 on August 23, 2009, at 14:53:46
In reply to Switch to Amitriptyline, posted by linkadge on August 23, 2009, at 10:34:57
Amitriptyline didn't do much for my anxiety - but then again that's not what it's meant for. It certainly helped my depression. Didn't get rid of it, bit it did help.
The side effects are somewhat troublesome, especially, excessive sweating, constipation, blurred vision, sedation... but if the drug helps the depression these are bearable.
Good luck!
Posted by SLS on August 23, 2009, at 15:54:01
In reply to Re: Switch to Amitriptyline, posted by jms600 on August 23, 2009, at 14:53:46
> Amitriptyline didn't do much for my anxiety.
Had you thought to try doxepin?
- Scott
Posted by floatingbridge on August 23, 2009, at 15:55:11
In reply to Switch to Amitriptyline, posted by linkadge on August 23, 2009, at 10:34:57
Posted by linkadge on August 23, 2009, at 16:47:49
In reply to Re: Switch to Amitriptyline » jms600, posted by SLS on August 23, 2009, at 15:54:01
I figured that amitriptyline and doxapin would probably be very similar in terms of effect and side effect profile. Doxapin is genotoxic, wherase amitriptyline appears not to be?
Linkadge
Posted by maxime on August 23, 2009, at 17:12:43
In reply to Switch to Amitriptyline, posted by linkadge on August 23, 2009, at 10:34:57
I hope it helps you and that you find relief.
Posted by SLS on August 23, 2009, at 18:07:30
In reply to Re: Switch to Amitriptyline, posted by linkadge on August 23, 2009, at 16:47:49
> I figured that amitriptyline and doxapin would probably be very similar in terms of effect and side effect profile. Doxapin is genotoxic, wherase amitriptyline appears not to be?
That's what has been reported.
I think you made the right choice. Again, I would just caution you that an elevated heart rate is the nature of the beast. I don't think it should be a deal-breaker, especially in light that it does moderate over time. My heart rate on nortriptyline is 80bpm at the moment. You should realize that with its more potent anticholinergic properties, you might see your HR go over 100bpm at times for the first few weeks. When I first tried a combination of Parnate and desipramine, I was at 120bpm for awhile. I didn't give a damn, though. I had too much to gain. The combination worked extremely well until my doctor had me discontinue the treatment, thinking that "mission accomplished". The same treatment never worked well for me again.
Amitriptyline might be soporific for the first few days, but that should subside.
- Scott
Posted by bulldog2 on August 23, 2009, at 18:40:28
In reply to Switch to Amitriptyline, posted by linkadge on August 23, 2009, at 10:34:57
> The doctor switched me to amitriptyline. I have a little more hope for this medication.
>
> Nortriptyline gave me energy, but did not hit some of the core depression (i.e. feeling worthless, inability to find peace in anything, feeling like I don't exist, *wanting* to live).
>
> Wish me luck.
>
> If it is anything more like clomipramine it should would.
>
> Linkadge
>
>Yes good luck once more. Here is a good read on tricyclics. It appears as if bethanechol might help greatly with the sides and help with compliance.
Posted by Bob on September 22, 2009, at 16:01:11
In reply to Re: Switch to Amitriptyline, posted by bulldog2 on August 23, 2009, at 11:59:27
I assume that Amitriptyline is associated with weight gain and lethargy as well as significant sexual side effects, correct?
Posted by Brainbeard on September 27, 2009, at 12:30:12
In reply to Re: Switch to Amitriptyline, posted by Bob on September 22, 2009, at 16:01:11
> I assume that Amitriptyline is associated with weight gain and lethargy as well as significant sexual side effects, correct?
Weight gain - yes.
Lethargy - not necessarily. Sedation is not lethargy. One can become quite tolerant to antihistaminergic sedation.
Sexual side-effects - less likely with amitriptyline than with clomipramine or imipramine, since amitriptyline's SRI isn't that strong.
Also, amitriptyline's affinity for 5HT2A-receptors (as an antagonist) is pretty close to its affinity for serotonin receptors, and 5HT2A-antagonism is likely to counter SRI-induced sexual side-effects. (See http://www3.interscience.wiley.com/cgi-bin/fulltext/121665024/HTMLSTART?CRETRY=1&SRETRY=0, table 3).
Posted by Bob on September 27, 2009, at 19:09:03
In reply to Re: Switch to Amitriptyline, posted by Brainbeard on September 27, 2009, at 12:30:12
> > I assume that Amitriptyline is associated with weight gain and lethargy as well as significant sexual side effects, correct?
>
> Weight gain - yes.
>
> Lethargy - not necessarily. Sedation is not lethargy. One can become quite tolerant to antihistaminergic sedation.
>
> Sexual side-effects - less likely with amitriptyline than with clomipramine or imipramine, since amitriptyline's SRI isn't that strong.
>
> Also, amitriptyline's affinity for 5HT2A-receptors (as an antagonist) is pretty close to its affinity for serotonin receptors, and 5HT2A-antagonism is likely to counter SRI-induced sexual side-effects. (See http://www3.interscience.wiley.com/cgi-bin/fulltext/121665024/HTMLSTART?CRETRY=1&SRETRY=0, table 3).
>
>Thanks for that info. Very informative.
Posted by plumptonramsey on October 3, 2009, at 18:09:15
In reply to Switch to Amitriptyline, posted by linkadge on August 23, 2009, at 10:34:57
In almost the exact same situation (so decided to register/post). Nortrip (at 100 mgplasma level of 120 ng/ml) was well tolerated and certainly helped with a sort of mental energy; without much change in anxiety or mood (or any sedation after the first few days), I became, however, agitated and angry instead of nervous and mopey.
PDoc is in diapers, so though I thought an MAOI better, amitrip was what I could convince him of. Quite wary of cognitive effects; weight and hypotension are par for the course, so I'm not too concerned. At 50mg, it's better than NT at helping fall asleep (even after acclimating to the histamine blocking), sporadically a decent anxiolytic (and, unexpectedly, a libido booster), but not much mood-wise. No worsening in memory/concentration, though.
Upping to 100 this coming week. Whee.
Posted by Brainbeard on October 4, 2009, at 6:37:54
In reply to Re: Switch to Amitriptyline, posted by plumptonramsey on October 3, 2009, at 18:09:15
I was on 25mg of sertraline (Zoloft), 30mg of buspirone (Buspar) and bits of amitriptyline and imipramine, (plus starting up Neurontin - currently taking 600mg).
I have now upped the amitriptyline to 50mg - slowly, to adjust to the antihistaminergic sedation - and I feel great. This combo appears to both calm me down and give me motivation and energy, even boosting my libido.
I think it's the combination of SRI (sertraline+amitriptyline), 5HT1A-agonism (buspirone) and 5HT2A/C-antagonism (amitriptyline) that accounts for this succes (cf. Steven Stahl).
Although it's really too early to call it a success.. I sure hope I'll stay cool on this combo!
Wishing you luck too, Linkadge. As far as I can tell now, amitriptyline is a great med - at least for me.
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.