![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by schleprock on August 12, 2012, at 18:16:06
Came across this drug for the first time (apparently an ADHD drug.) Any possibility this could augment my Nortriptyline's potency (which was once an extremely effective monotherapy for me.) I'm also very interested in this drug's effect on dopamine. I've just failed with risperidone as an augmentor and suspect low dopamine could be the cause.
Potential interactions are apparently "minor" according to drugs.com.
Posted by linkadge on August 12, 2012, at 18:20:11
In reply to Straterra as possible augment for Nortriptyline?, posted by schleprock on August 12, 2012, at 18:16:06
straterra and nortriptyline are both potent, and fairly selective (straterra) norepinephrine reuptake inhibitors. Its possible it could work, but there might be duplication of action.
Posted by SLS on August 12, 2012, at 19:02:09
In reply to Straterra as possible augment for Nortriptyline?, posted by schleprock on August 12, 2012, at 18:16:06
> Came across this drug for the first time (apparently an ADHD drug.) Any possibility this could augment my Nortriptyline's potency (which was once an extremely effective monotherapy for me.) I'm also very interested in this drug's effect on dopamine. I've just failed with risperidone as an augmentor and suspect low dopamine could be the cause.
>
> Potential interactions are apparently "minor" according to drugs.com.If you decide to take Strattera, you might want to test your liver enzymes before starting and during treatment.
- Scott
Posted by jono_in_adelaide on August 12, 2012, at 19:46:36
In reply to Re: Straterra as possible augment for Nortriptyline? » schleprock, posted by SLS on August 12, 2012, at 19:02:09
A more logicsl potentiator for nortriptyline might be sertaline, starting dose 50mg/day, increasing upto 100mg per day or even 200mg per day if needed (nortriptyline mainly effects noradrenalin, and sertraline mainly effects seretonin, so together they can give the "one-two" knockout punch the depression, anxiety etc
Also, get your blood levels of nortriptyline checked to make sure that you're in "the zone"
Posted by rjlockhart37 on August 12, 2012, at 20:19:08
In reply to Re: Straterra as possible augment for Nortriptyline?, posted by jono_in_adelaide on August 12, 2012, at 19:46:36
Yea....strattera or any kind of NRI would be helpful, also you may want to look into wellbutrin...it increases dopamine more than strattera in its actions....strat. increases NE causing more alertness and vigilence, dopamine is more motivation and intrest and doing repeative things....the focus chemical...and also pleasure.
Try checking out provigil too...
rj
Posted by Phillipa on August 12, 2012, at 23:09:54
In reply to Re: Straterra as possible augment for Nortriptyline?, posted by rjlockhart37 on August 12, 2012, at 20:19:08
Why all the side effects potential on staterra always thought a mild med? It targets norepenephine. So it's the other half of effexor, cymbalta. No serotonin like the others. Glad I googled this didn't know this. Phillipa
Posted by SLS on August 13, 2012, at 5:21:05
In reply to Re: Straterra as possible augment for Nortriptyline?, posted by jono_in_adelaide on August 12, 2012, at 19:46:36
> A more logicsl potentiator for nortriptyline might be sertaline, starting dose 50mg/day, increasing upto 100mg per day or even 200mg per day if needed (nortriptyline mainly effects noradrenalin, and sertraline mainly effects seretonin, so together they can give the "one-two" knockout punch the depression, anxiety etc
>
> Also, get your blood levels of nortriptyline checked to make sure that you're in "the zone"I found Effexor to be much better as an adjunct to nortriptyline than I found Zoloft. I'm not sure that any one SRI is going to be superior for everyone. The only caveat would be to use less nortriptyline if one chooses Prozac or Paxil as the adjunctive SRI - perhaps using only half the usual dosage. The blood tests would help to determine this.
- Scott
Posted by SLS on August 13, 2012, at 5:34:04
In reply to Re: Straterra as possible augment for Nortriptyline?, posted by rjlockhart37 on August 12, 2012, at 20:19:08
> increases NE causing more alertness and vigilence, dopamine is more motivation and intrest and doing repeative things....the focus chemical...and also pleasure.
This is a great way to think about things. Just don't forget that circuits are at least as important as the neurotransmitters that modulate the communication between them. I have deficits in everything that you listed above. Yet, Wellbutrin makes me feel significantly worse.
I found that Wellbutrin produced dysphoria for me. How would you interpret this?
Thanks for your feedback.
> Try checking out provigil too...Provigil was a disaster for me. Not only did it leave me dysphoric and in a cognitive fog while I was taking it, these things persisted for a few weeks after I discontinued it. It was quite painful. This seems to be an unusual reaction, though.
- Scott
Posted by schleprock on August 13, 2012, at 10:06:50
In reply to Re: Straterra as possible augment for Nortriptyline? » rjlockhart37, posted by SLS on August 13, 2012, at 5:34:04
Nice suggestions from everyone. I'm just concerned that the the drugs.com interactions checker already identifies major reactions with many of these (Paxil, Zoloft, wellbutrin, etc.) Also, my Nortriptyline level is already a little high (I blelieve about 3-5 points outside the reference range.)
Posted by phidippus on August 13, 2012, at 12:46:31
In reply to Straterra as possible augment for Nortriptyline?, posted by schleprock on August 12, 2012, at 18:16:06
Strattera is a selective norepinephrine reuptake inhibitor. It has no affinity for dopamine. I don't think this drug would aaugment your nortryptaline therapy.
Eric
Posted by phidippus on August 13, 2012, at 12:49:49
In reply to Re: Straterra as possible augment for Nortriptyline? » schleprock, posted by SLS on August 12, 2012, at 19:02:09
BTW,
Parkinson's is caused by insufficient formation and activity of dopamine produced in certain neurons within parts of the midbrain.Eric
Posted by schleprock on August 13, 2012, at 13:58:16
In reply to Re: Straterra as possible augment for Nortriptyline? » schleprock, posted by phidippus on August 13, 2012, at 12:46:31
> Strattera is a selective norepinephrine reuptake inhibitor. It has no affinity for dopamine. I don't think this drug would aaugment your nortryptaline therapy.
>
> EricWould you suggest Lamictal?
Posted by phidippus on August 13, 2012, at 16:13:18
In reply to Re: Straterra as possible augment for Nortriptyline?, posted by schleprock on August 13, 2012, at 13:58:16
Lamictal would be an interesting choice. Some studies show it boosts dopamine and seratonin. So, it has antidepressant qualities.
Are you looking to augment the antidepressant qualities of the nortryptaline?
Eric
Posted by schleprock on August 13, 2012, at 17:11:35
In reply to Re: Straterra as possible augment for Nortriptyline? » schleprock, posted by phidippus on August 13, 2012, at 16:13:18
> Lamictal would be an interesting choice. Some studies show it boosts dopamine and seratonin. So, it has antidepressant qualities.
>
> Are you looking to augment the antidepressant qualities of the nortryptaline?
>
> EricYes. Hopefully the antianxiolytic too. Just can't tell which I'm suffering more from at the moment...
Posted by rjlockhart37 on August 13, 2012, at 21:58:48
In reply to Re: Straterra as possible augment for Nortriptyline? » rjlockhart37, posted by SLS on August 13, 2012, at 5:34:04
Wellbutrin really ... I mean really can be a agitation medicaton, it depends on the person, but what it does is it increases NE more than DA, i researched this a couple years ago...Rililin and focalin are stronger on dopamine reptake...still 450mg of Wellbutrin is about 5-10mg to adderall or ritilin, that's just what I rerember, but there's no rush stimulation. I once took 650mg of it and I got aura rushes and came vary close to feeling I was going to have a siezure. It only happened once...but still even at higher doses above 450mg it doesnt have strong dopamine effects, it has mild psychostimulant [repeative, hyperfocus, vigilince stuff]
....methyphendiate should be used in this situation after it is maxed out on 450. Lamictal with wellbutrin would be a great combination because it prevents both siezure like symptoms and levels out the anxiety wellbutrin can produce. I really don't know why its untolerable with people with anxiety issues...the only thing I can think is because of NE properties.Provigil is good for me....even thought I should be on Vyvanse or Focalin right now...its gonna be a long while until then.
Any further questions....just shoot them out to me:)
rj
Posted by phidippus on August 13, 2012, at 22:29:12
In reply to Re: Straterra as possible augment for Nortriptyline?, posted by schleprock on August 13, 2012, at 17:11:35
Lamictal will help a bit with the anxiety too.
Erric
Posted by jono_in_adelaide on August 14, 2012, at 1:13:00
In reply to Re: Straterra as possible augment for Nortriptyline?, posted by SLS on August 13, 2012, at 5:21:05
I suggested sertraline because it doesnt block the enzymes that metabolise nortriptyline, and has generaly been shown to be among the best of the SSRI's. Of course, some might be better on citralopram or escitralopram, paroxetine and fluoxetine would seem to be bad ideas, because of their interaction with nortriptyline metabolism.
Effexor could be good - realy, whatever works, do it!
> > A more logicsl potentiator for nortriptyline might be sertaline, starting dose 50mg/day, increasing upto 100mg per day or even 200mg per day if needed (nortriptyline mainly effects noradrenalin, and sertraline mainly effects seretonin, so together they can give the "one-two" knockout punch the depression, anxiety etc
> >
> > Also, get your blood levels of nortriptyline checked to make sure that you're in "the zone"
>
> I found Effexor to be much better as an adjunct to nortriptyline than I found Zoloft. I'm not sure that any one SRI is going to be superior for everyone. The only caveat would be to use less nortriptyline if one chooses Prozac or Paxil as the adjunctive SRI - perhaps using only half the usual dosage. The blood tests would help to determine this.
>
>
> - Scott
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.