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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by linkadge on February 20, 2010, at 12:30:30
Hi, I spoke with my pdoc today. We decided to add 5mg of escitalopram to the amitriptyline to help with anxiety.
30mg amitriptyline
5mg escitalopram
20mg methylphenidate.Wish me luck
Linkadge
Posted by Phillipa on February 20, 2010, at 12:50:32
In reply to New combo, posted by linkadge on February 20, 2010, at 12:30:30
Link good luck. Low doses also interesting. Are the docs going to lower doses now? Love Phillipa
Posted by gman22 on February 20, 2010, at 15:13:32
In reply to New combo, posted by linkadge on February 20, 2010, at 12:30:30
Sounds like an awesome mix. Each of these drugs alone are among the most effective AD's out there. Amitriptyline is the most effective of the older drugs, and lexapro probably the best of the new. Methylphenidate is a great add on too. I may try this some day if my current regime quits working.
Tim
Posted by Brainbeard on February 20, 2010, at 15:53:02
In reply to New combo, posted by linkadge on February 20, 2010, at 12:30:30
I'm on this same combo currently, except for the methylphenidate, and I'm also taking 1800mg of gabapentin. (So effectively I'm on a rather different combo.)
I'm hoping to have methylphenidate prescribed again some day, but that will have to wait for now. It was a rather harsh drug for me anyway, but it was able to give me some euphoria, enhanced social functioning and a better ability to perform boring tasks. For motivation and drive, 2.5-10mg of selegiline actually worked better for me.
Now that I'm rambling away anyway, I'm planning to increase my amitriptyline because of chronic pain that is not properly addressed by the gabapentin, and also because amitriptyline is a marvelous drug in my opinion, once you get over the antihistaminergic threshold. It's an inverse 5HT2C-agonist, which comes down to it being a 5HT2C-antagonist, and a 5HT2A-antagonist, which all means more dopamine and noradrenaline, good, deep sleep and a healthy appetite. It's dirty and good.
I read some reports lately by the way - like I said, I started rambling anyway - about some cases of people using amitriptyline recreationally in doses of up to more than 800mg at a time! I didn't even know it was possible to take such doses without deceasing. Not that I'm planning to imitate this irresponsible behavior.
Linkadge: Good Luck Sailor!
Posted by linkadge on February 20, 2010, at 17:01:54
In reply to Re: New combo - Good Luck Sailor!, posted by Brainbeard on February 20, 2010, at 15:53:02
I am actually hoping to be able to decrease the amitriptyline to about 10mg. I want to keep it on board as it counteracts some of the SSRI side effects, i.e. insomnia.
I will keep people updated.
Linkadge
Posted by g_g_g_unit on February 21, 2010, at 22:50:29
In reply to Re: New combo - Good Luck Sailor!, posted by linkadge on February 20, 2010, at 17:01:54
linkadge, what do you find the best time of night to be to take the amitrip?
i'm using it to counteract prozac insomnia ... my GP said i should take it about 4 hours before i want to sleep, which works okay (i.e. just after dinner), but then if i'm out i'm worried about driving while on it. i find if i take it too late (like 1am), i'm kinda hungover the next morning
Posted by Brainbeard on February 22, 2010, at 3:23:37
In reply to Re: New combo - Good Luck Sailor! 03 linkadge, posted by g_g_g_unit on February 21, 2010, at 22:50:29
Amitriptyline's half-life is 12-25 hours for the mother drug and 36 hours for the metabolite, nortriptyline. Whatever time you take it, there will always be some sedation in your system. Especially with low doses you'll probably be able to adjust to it. Reaction time may be delayed though with antihistamines. But I know people who've done lots of driving while under the influence of benzo's - without ever getting involved in an accident. YMMV.
For me, getting a driver's license is very problematic while being on meds that have an indication of possibly influencing driving in a negative way. Our Dutch Central Bureau of Driveability (free translation) will throw up all kinds of fences even if you have just a HISTORY of taking meds. While, once you got a driver's license, you can take any legal medication you want. Although medication might play a negative role in jurisdiction if you would cause an accident.
Posted by linkadge on February 22, 2010, at 15:06:48
In reply to Re: New combo - Sedating Meds And Driving, posted by Brainbeard on February 22, 2010, at 3:23:37
Yeah, amitriptyline is pretty sedating, but I find it lessens if it is taken every day.
I take it before bed, but I am going to try to get it down to 10mg.
A bit of coffee in the morning helps. Taking it earlier too could theoretically pull back the maximum blood level period. The metabolite nortriptyline is less sedating IMO.
Linkadge
Posted by floatingbridge on February 22, 2010, at 18:42:17
In reply to New combo, posted by linkadge on February 20, 2010, at 12:30:30
> Hi, I spoke with my pdoc today. We decided to add 5mg of escitalopram to the amitriptyline to help with anxiety.
>
> 30mg amitriptyline
> 5mg escitalopram
> 20mg methylphenidate.
>
> Wish me luck
>
> Linkadge
I do, I do--good luck! How long till effects are known?
Posted by willey on February 22, 2010, at 19:20:20
In reply to New combo, posted by linkadge on February 20, 2010, at 12:30:30
> Hi, I spoke with my pdoc today. We decided to add 5mg of escitalopram to the amitriptyline to help with anxiety.
>
> 30mg amitriptyline - Nortriplyine
> 5mg escitalopram - ssNri,pristiq,cymbalta
> 20mg methylphenidate -- adderallalso one additonal add on possably mirapex.
I wish u luck,and unluck usualy,i hope im wrong here,but my reason above, is amtrip,and i dont know where the other poster got the idea it was the bes of that time,doesent hold much history as as antidepressant as it does for sleep.
I think we all should just move on fromm ssris if we have not benifited from them personaly,how many will each of us try before we say STOP with the damn ssris.
ssNRIS are not potent ne uptake,but it is stilll there making it a little more stronger.PLus pristiq seems to be holding a good person comment record.
Adding a stimulant was a great idea,however adderall is usualy the stimulant that is known to have the most actual mood elevation at low doses.
Ive used both and i agree to that statement,but thats me.
Last,i dont see one more med being added as bad,it would deprend on knowing u more,but a much lower power med would be a good last touch,such as perhaps low dose mirapex,low dose lyrcia or the like.
But if u prove me wrong ill be very very happy,i wish u nothing but luck my friend.
>
> Wish me luck
>
> Linkadge
Posted by Brainbeard on February 23, 2010, at 8:45:08
In reply to Re: New combo, posted by willey on February 22, 2010, at 19:20:20
> I wish u luck,and unluck usualy,i hope im wrong here,but my reason above, is amtrip,and i dont know where the other poster got the idea it was the bes of that time,doesent hold much history as as antidepressant as it does for sleep.
Amitriptyline has been holding the track record of being the golden standard for depression in the US for decades, while imipramine or clomipramine were having that status elsewhere. At least for inpatients who are severely depressed, the TCA's are still superior to the SSRI's. Amitriptyline definitely is more than a sleep drug, although in lower doses, its antidepressant properties may be overshadowed by its sedative properties.
Posted by willey on February 23, 2010, at 9:42:12
In reply to Re: New combo - Amitriptyline IS An Effective AD, posted by Brainbeard on February 23, 2010, at 8:45:08
Well most know im not a doc,perhaps i should have made it more known it was my opinion sometimes i forget to,but i never mentioned the tca class,nortriplyine is the one ive always read and seen as the effective one,clomimprimine has always been the med for ocd,so i wasnt appying the tca class was any less effective,but as i said im always notice nortiplyine seemed to be one people responded to.
Its my opinion,not a fact,might be published data showing other wise,i know imiprimine was the drug used as standerd measure for others to compare to,so again it wasnt the tca i was referring to,just that particular one,i believe im allowed to have a view on which one i believe seems to be more used,i agree i should have made more clear its my opinion from years of just reading,but im allowed my opinion,and personaly i hope any one works,so please dont jump down my throat cause u dont agree with me.
Posted by Brainbeard on February 23, 2010, at 17:26:08
In reply to Re: New combo - Amitriptyline IS An Effective AD, posted by willey on February 23, 2010, at 9:42:12
I'm not jumping at your throat. You are allowed to have your opinion. It's just that amitriptyline has a track record of being an effective antidepressant. It's also a very effective drug for many types of pain. And it can help a great deal with sleep. That it may not have been effective for you and/or for some people you encountered on the internet, doesn't change its general effectiveness.
Amitriptyline gets good ratings on Ask A Patient: http://www.askapatient.com/searchresults2.asp
Reviews on Revoltion Health are also generally positive: http://www.revolutionhealth.com/drugs-treatments/rating/amitriptyline?ipc=B00232
I don't mind that you think amitriptyline stinks, not at all, I just like to mention that you can't generalize your opinion as something that counts for everyone.
Feel free to have your opinion, and please allow me to have mine. It would get rather boring if everyone had the same opinion around here.
Posted by willey on February 23, 2010, at 18:30:42
In reply to Re: New combo - Debating CAN Be Constructive, posted by Brainbeard on February 23, 2010, at 17:26:08
Very cool,i think we both agree on one thing,that it does work,so thanks for the post,sorry i came off as downplaying the drug,text sometimes can express how you mean it,but lets hope it works we can use some success around here.
Posted by sigismund on February 24, 2010, at 20:32:08
In reply to Re: New combo - Debating CAN Be Constructive, posted by Brainbeard on February 23, 2010, at 17:26:08
Perhaps you do get used to the antihistamine effect?
When I tried it I took 25mg and was so wrecked the next day I never repeated it.
Posted by Brainbeard on February 25, 2010, at 3:30:28
In reply to Re: New combo - Debating CAN Be Constructive, posted by sigismund on February 24, 2010, at 20:32:08
> Perhaps you do get used to the antihistamine effect?
>
> When I tried it I took 25mg and was so wrecked the next day I never repeated it.Oh yes, you can become tolerant to the antihistaminergic effect. I also took 25mg of amitriptyline the first time and was an irritable zombie the next day.
Then I started anew with 6mg, going up in steps of 6mg. That worked fine. With every raise in dose, I would be a little more irritable than I normally am, but that would last only a day.
I have currently worked my way up again to 50mg of amitriptyline, without much trouble. I don't experience much sedation, while I also take 2400mg of Neurontin. I've taken larger steps this time, of approximately 10mg every one or two days, and I encountered no problems except for the mentioned temporary irritability.
Posted by linkadge on February 26, 2010, at 15:34:39
In reply to Re: New combo, posted by willey on February 22, 2010, at 19:20:20
>doesent hold much history as as antidepressant >as it does for sleep.
Amitriptyline? Are you thinking trazodone? Amitriptyline is statistically superior (believe it or not) to other antidepressant agents. Amitriptyline is considered the "gold standard". Although the side effects can be nasty.
Linkadge
Posted by linkadge on February 26, 2010, at 15:37:21
In reply to Re: New combo - Debating CAN Be Constructive, posted by willey on February 23, 2010, at 18:30:42
Besides the sedation, amitriptyline has been the most effective Ad I've taken. Note, the side effects are high, but it eliminates my depression.
I added the cipralex/lexapro to try and lower the effective dose needed of the amitriptyline. Hopefully I can find a ballance of side effects : efficacy.
Linkadge
Posted by conundrum on February 26, 2010, at 18:14:13
In reply to Re: New combo - Debating CAN Be Constructive, posted by linkadge on February 26, 2010, at 15:37:21
Does it help with anhedonia? It would be nice if there were one substance that just obliterated it to smithereens.
Posted by SLS on February 26, 2010, at 19:38:05
In reply to Re: New combo - Debating CAN Be Constructive, posted by linkadge on February 26, 2010, at 15:37:21
> I added the cipralex/lexapro to try and lower the effective dose needed of the amitriptyline. Hopefully I can find a ballance of side effects : efficacy.
Good strategy. I'm glad that you persevered with the tricyclic.
- Scott
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