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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on August 30, 2012, at 9:41:30
In reply to Re: Nortriptyline, Buspar, Serotonin, posted by jono_in_adelaide on August 30, 2012, at 6:58:01
> Yeah, as lennin said, everything is connected to everything else
>
> I realy like the combo of sertaline and nortriptyline,It sounds like a nice combination in theory.
> I think it gives a robust antidepressant response with fairly mild side effects
How do you know this for sure? Have you ever seen it done?
I am not aware of anyone employing sertraline and nortriptyline as a treatment except for me. It didn't work. However, I thought it was a great combination on paper. I had more luck combining Effexor with nortriptyline. My response was moderate at best, but the therapeutic effect persisted. I also liked my initial response to Viibryd in combination with nortriptyline.
I have no reason to think that sertraline + nortriptyline wouldn't work. However, I would like to see some evidence that at least one person responded robustly to it.
- Scott
Posted by schleprock on August 30, 2012, at 11:00:14
In reply to Re: Nortriptyline, Buspar, Serotonin » jono_in_adelaide, posted by SLS on August 30, 2012, at 2:08:03
> > Buspar blocks seretonin receptors, it soesnt inhibit reuoptake, so I doubt nortriptyline + buspar would = clominramine
> >
> > nortriptyline + sertaline or another ssri *might* work, but realy, the only substitute for clomipramins is more clomipramine
>
> Buspar is infrequently used as an augmenter to SSRIs. It is a partial agonsist at serotonin 5-HT1a receptors, as is Viibryd. Viibryd might therefore confer anxiolytic as well as antidpressant properties. The SSRI component of Viibryd is fairly potent, and from reports, acts to alleviate OCD. Viibryd is like a combination of SSRI + Buspar, but without the D2 antagonism. Personally, I found Viibryd to be a rather clean drug without the usual SSRI side effects of apathy and flat affect. Happily, there were no sexual side effects either. In combination with nortriptyline, Viibryd might act much like clomipramine. On paper, it is an interesting proposition. I believe the therapeutic window for this combination will be wider than with clomipramine, as side effects often limit clomipramine use. Studies of adding nortriptyline to a SSRI - or even clomipramine - demonstrates an earlier onset of clinical improvement and greater reduction in symptoms of OCD.
>
> journals.tums.ac.ir/pdf/3511
>
> http://www.ncbi.nlm.nih.gov/pubmed/9786103
>
> www.irmj.ir/browse.php?a_id=131&slc_lang=en&sid=1...
>
>
> - ScottI'm still not sure, but by being an "agonist" would Buspar, however slightly, raise the amount of serotonin? I already had a bad experience trying to switch over to clomipramine, I think I have to try something more mild. I have a lot of symptoms that are consistant with low serotonin, but not OCD.
SLS, are you currently on an effective regimen that includes nortriptyline?
Posted by brynb on August 30, 2012, at 11:01:15
In reply to Nortriptyline, Buspar, Serotonin, posted by schleprock on August 29, 2012, at 20:20:19
schleprock-
how about adding lexapro? my pdoc tried adding nortriptyline to my lexapro and lithium combo. unfortunately, i couldn't handle nortriptyline (i generally don't do well with nris), but theoretically, lexapro and nortriptyline make sense. for me, tramadol has been better (i guess its nri effects are "lighter"). i find lexapro to be very clean, especially in the way it solely targets serotonin.
-b
Posted by SLS on August 30, 2012, at 15:42:12
In reply to Re: Nortriptyline, Buspar, Serotonin » SLS, posted by schleprock on August 30, 2012, at 11:00:14
> > > Buspar blocks seretonin receptors, it soesnt inhibit reuoptake, so I doubt nortriptyline + buspar would = clominramine
> > >
> > > nortriptyline + sertaline or another ssri *might* work, but realy, the only substitute for clomipramins is more clomipramine
> >
> > Buspar is infrequently used as an augmenter to SSRIs. It is a partial agonsist at serotonin 5-HT1a receptors, as is Viibryd. Viibryd might therefore confer anxiolytic as well as antidpressant properties. The SSRI component of Viibryd is fairly potent, and from reports, acts to alleviate OCD. Viibryd is like a combination of SSRI + Buspar, but without the D2 antagonism. Personally, I found Viibryd to be a rather clean drug without the usual SSRI side effects of apathy and flat affect. Happily, there were no sexual side effects either. In combination with nortriptyline, Viibryd might act much like clomipramine. On paper, it is an interesting proposition. I believe the therapeutic window for this combination will be wider than with clomipramine, as side effects often limit clomipramine use. Studies of adding nortriptyline to a SSRI - or even clomipramine - demonstrates an earlier onset of clinical improvement and greater reduction in symptoms of OCD.
> >
> > journals.tums.ac.ir/pdf/3511
> >
> > http://www.ncbi.nlm.nih.gov/pubmed/9786103
> >
> > www.irmj.ir/browse.php?a_id=131&slc_lang=en&sid=1...
> >
> >
> > - Scott
>
> I'm still not sure, but by being an "agonist" would Buspar, however slightly, raise the amount of serotonin?- Receptor = a site upon which specific molecules bind to.
- Ligand = a molecule that attaches to a receptor.
- Agonist = a ligand that stimulates a receptor to act.
- Antagonist = a ligand that blocks a receptor and inhibits it from acting.
- Partial agonist = a ligand that acts as a buffer at the receptor. It can both stimulate and inhibit it, depending on the receptor location, conformational state, and synaptic neurotransmitter concentration.http://www.healthieryou.com/mhexpert/exp1041502a.html
> I already had a bad experience trying to switch over to clomipramine
What happened?
> I think I have to try something more mild. I have a lot of symptoms that are consistant with low serotonin,
Which symptoms?
> but not OCD.
Okay.
> SLS, are you currently on an effective regimen that includes nortriptyline?
Yes.
Parnate 80 mg/day
nortriptyline 150 mg/day
Lamictal 200 mg/day
lithium 300 mg/day
Abilify 10 mg/day
minocycline 100 mg/dayI am currently experiencing a moderate antidepressant response that seems to be improving day by day. It is the addition of minocycline that has accelerated the rate of my recovery. I have been able to discontinue prazosin for now. I am doing better on minocycline than I was on prazosin. If the course of my improvement stalls, I will add back the prazosin. There is evidence that minocycline can work to augment an anti-glutamatergic drug (Lamictal) and a pro-noradrenergic drug (nortriptyline).
- Scott
Posted by SLS on August 30, 2012, at 16:43:25
In reply to Re: Nortriptyline, Buspar, Serotonin » SLS, posted by Phillipa on August 29, 2012, at 23:10:39
> Why afraid of supplements? As long as water soluable? Phillipa
"Supplements" are biologically active substances that some people take to manipulate their physiological functions. Supranutritional amounts of some of these substances exert pharmacological activity. Deplin, P-5-P, fish oil, NAC, and calcium make my depression significantly worse. If people were to self-medicate with their prescription drugs the way some do with their supplement substances, we would call them reckless.
I have nothing against supplements. On the contrary. I'm glad they exist. They can be indispensable tools.
- Scott
Posted by schleprock on August 30, 2012, at 17:03:58
In reply to Re: Nortriptyline, Buspar, Serotonin » schleprock, posted by SLS on August 30, 2012, at 15:42:12
> > > > Buspar blocks seretonin receptors, it soesnt inhibit reuoptake, so I doubt nortriptyline + buspar would = clominramine
> > > >
> > > > nortriptyline + sertaline or another ssri *might* work, but realy, the only substitute for clomipramins is more clomipramine
> > >
> > > Buspar is infrequently used as an augmenter to SSRIs. It is a partial agonsist at serotonin 5-HT1a receptors, as is Viibryd. Viibryd might therefore confer anxiolytic as well as antidpressant properties. The SSRI component of Viibryd is fairly potent, and from reports, acts to alleviate OCD. Viibryd is like a combination of SSRI + Buspar, but without the D2 antagonism. Personally, I found Viibryd to be a rather clean drug without the usual SSRI side effects of apathy and flat affect. Happily, there were no sexual side effects either. In combination with nortriptyline, Viibryd might act much like clomipramine. On paper, it is an interesting proposition. I believe the therapeutic window for this combination will be wider than with clomipramine, as side effects often limit clomipramine use. Studies of adding nortriptyline to a SSRI - or even clomipramine - demonstrates an earlier onset of clinical improvement and greater reduction in symptoms of OCD.
> > >
> > > journals.tums.ac.ir/pdf/3511
> > >
> > > http://www.ncbi.nlm.nih.gov/pubmed/9786103
> > >
> > > www.irmj.ir/browse.php?a_id=131&slc_lang=en&sid=1...
> > >
> > >
> > > - Scott
> >
> > I'm still not sure, but by being an "agonist" would Buspar, however slightly, raise the amount of serotonin?
>
> - Receptor = a site upon which specific molecules bind to.
> - Ligand = a molecule that attaches to a receptor.
> - Agonist = a ligand that stimulates a receptor to act.
> - Antagonist = a ligand that blocks a receptor and inhibits it from acting.
> - Partial agonist = a ligand that acts as a buffer at the receptor. It can both stimulate and inhibit it, depending on the receptor location, conformational state, and synaptic neurotransmitter concentration.
>
> http://www.healthieryou.com/mhexpert/exp1041502a.html
>
> > I already had a bad experience trying to switch over to clomipramine
>
> What happened?
>
> > I think I have to try something more mild. I have a lot of symptoms that are consistant with low serotonin,
>
> Which symptoms?
>
> > but not OCD.
>
> Okay.
>
> > SLS, are you currently on an effective regimen that includes nortriptyline?
>
> Yes.
>
> Parnate 80 mg/day
> nortriptyline 150 mg/day
> Lamictal 200 mg/day
> lithium 300 mg/day
> Abilify 10 mg/day
> minocycline 100 mg/day
>
> I am currently experiencing a moderate antidepressant response that seems to be improving day by day. It is the addition of minocycline that has accelerated the rate of my recovery. I have been able to discontinue prazosin for now. I am doing better on minocycline than I was on prazosin. If the course of my improvement stalls, I will add back the prazosin. There is evidence that minocycline can work to augment an anti-glutamatergic drug (Lamictal) and a pro-noradrenergic drug (nortriptyline).
>
>
> - ScottI'm currently suffering from most of the symptoms associated with meloncholic depression (except psychomotor disturbance) and some degree of anxiety. I've usually had most of these symptoms in tandem if I was in a high GAD phase; but this is the first time that I'm suffering from a high degree of ahedonia and a moderate degree of anxiety. For all I know this might be some atypical form of GAD rather than depression.
This seems to have come out of nowhere about four months ago. I'd had some initial relief from atenolol and\or slight raise in nortriptyline dosage, then some relief through a llow dose clanazepam, which I have continuously increase, then some short term relief through risperidone until that med started making me worse.
The clomipramine I jusr couldn't handle. I woke up with a severe panic attack following my second dose (only 25mg) and some really bad sedation and anxiety after my fourth dose. This really put me off from my plan of replacing my 150mg nortriptyline with an equivalent dose of clomipramine.
Next up is Lyrica. I tried a few just before I came up with my clomipramine idea. I tried it at the smallest dose, and it may have been slightly helping. Took one last night, but I don't feel as much.
I just can't tell whether all this is due strictly to anxiety (which has been my primary problem), or some additional depression related imbalance. I don't think I've ever felt this way before, and certainly not for so long...
Posted by jono_in_adelaide on August 30, 2012, at 18:46:36
In reply to Re: Nortriptyline, Buspar, Serotonin » jono_in_adelaide, posted by SLS on August 30, 2012, at 9:41:30
I responded robustly to it, after failing several other drugs
The Australian Psychiatrist Ken Gillman (psychotropical.com) is a big fan of the combo, claims to have treated hundereds of SSRI failed patients with it to good effect.
I'd think that sertraline + bupropion would also make a good combination
Posted by jono_in_adelaide on August 30, 2012, at 18:55:36
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS, posted by jono_in_adelaide on August 30, 2012, at 18:46:36
I changed to reboxetine + sertraline because the nortriptyline had contributed to weight gain (or maybe I had just gained weight and blamed the nortriptyline).... I found them about equal in antidepressant effect.
It makes more sense to me to use an SSRI + nortriptyline/reboxetine than Effexor, because the SSRI will be a robust inhibitor of seretonin reuptake and the nortriptyline will be a robust inhibitor of noradrenalin reuptake, where as Effexor is a strong inhibitor of seretonin and only a weak inhibitor of noradrenalin reuptake in the usualy used doseages.
Plus nortriptyline hts the 5HT2 receptor, which gives some additional antidepressant and anxiolytic effect
Posted by schleprock on August 30, 2012, at 19:31:28
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS, posted by jono_in_adelaide on August 30, 2012, at 18:46:36
> I responded robustly to it, after failing several other drugs
>
> The Australian Psychiatrist Ken Gillman (psychotropical.com) is a big fan of the combo, claims to have treated hundereds of SSRI failed patients with it to good effect.
>
> I'd think that sertraline + bupropion would also make a good combinationMay I ask what your sertraline and nortriptyline dosages were during this period, and whether you were on only these two meds at the time.
Also, were you having your nortriptyline levels monitored, and have to make any adjustments? And did you start these two meds simultaneously?
Posted by Phillipa on August 30, 2012, at 21:08:46
In reply to Re: Nortriptyline, Buspar, Serotonin » Phillipa, posted by SLS on August 30, 2012, at 16:43:25
Scott is seems that many are doing just that self medicating increasing decreasing meds at will. I haven't seen you do this but others do. Can't handle fish oil reved me up. Deplin was to me if not missing the gene worthless and was prescribed by old pdoc. Phillipa
Posted by jono_in_adelaide on August 30, 2012, at 21:27:01
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS » jono_in_adelaide, posted by schleprock on August 30, 2012, at 19:31:28
I started them similtaniously - started out on nortriptyline 75mg and sertraline 50mg, and went upto nortriptyline 75mg and sertraline 100mg to try and coltrol residual panic attacks
I didnt have my nortriptyline blood levels monitored, because the excelent response seemed evidence enough that I was in "the zone". If my response hadnt been so stelar, we would have done bloods to ascertain serum levels.
I responded quickly, felt significantly better within 2 weeks.
I'm not saying that sertraline + nortriptyline is the "ultimate" combo, its just a logical one, equaly logical would be an SSRI + Welbutrin, an SSRI or Effexor plus Remeron, and I'm sure there are others.
Posted by jono_in_adelaide on August 30, 2012, at 21:28:10
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS » jono_in_adelaide, posted by schleprock on August 30, 2012, at 19:31:28
oh, as for other meds, I was taking Valium 5mg prn anxiety, maybe 2 or 3 pills a week
Posted by SLS on August 30, 2012, at 23:37:02
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS, posted by jono_in_adelaide on August 30, 2012, at 18:46:36
> I responded robustly to it, after failing several other drugs
This is a good thing. Are you still taking it?
> I'd think that sertraline + bupropion would also make a good combination
"Welloft"
:-)
Yes, it works for some people. However, I have seen great results with a combination of Pristiq and Wellbutrin.
- Scott
Posted by jono_in_adelaide on August 31, 2012, at 0:58:59
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS » jono_in_adelaide, posted by SLS on August 30, 2012, at 23:37:02
Currently taking sertraline 100mg/day and reboxetine 4mg twice a day, and alprazolam 1mg twice a day..... after a period of a couple of years of being well, things went bad again, and since then I havent gone off of meds.
Posted by SLS on August 31, 2012, at 8:45:27
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS, posted by jono_in_adelaide on August 31, 2012, at 0:58:59
> Currently taking sertraline 100mg/day and reboxetine 4mg twice a day, and alprazolam 1mg twice a day..... after a period of a couple of years of being well, things went bad again, and since then I havent gone off of meds.
:-(
That really sucks.
Were there any psychosocial stressors associated with your relapse?
I'm sure you have already considered crossing back over from reboxetine to a TCA and raising the dosage of sertraline to 200 mg/day. I would probably be dubious that doing these things would help, but I don't like leaving any stone unturned. Have you already tried Wellbutrin with sertraline?
I'm sure you know that there are things you have not yet tried.
If you decide to discontinue medical treatment, what would you do?
- Scott
Posted by phidippus on August 31, 2012, at 20:23:12
In reply to Nortriptyline, Buspar, Serotonin, posted by schleprock on August 29, 2012, at 20:20:19
Buspar is kind of a weak drug, designed more for anxiety. But I imagine if you boosted the dosage high enough you could get some effect. Besides the antidepressants, their are few drugs that boost seratonin-Zonegran is one that I can think of-oh, and stimulants.
Eric
Posted by schleprock on August 31, 2012, at 20:56:00
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS, posted by jono_in_adelaide on August 30, 2012, at 21:27:01
> I started them similtaniously - started out on nortriptyline 75mg and sertraline 50mg, and went upto nortriptyline 75mg and sertraline 100mg to try and coltrol residual panic attacks
>
> I didnt have my nortriptyline blood levels monitored, because the excelent response seemed evidence enough that I was in "the zone". If my response hadnt been so stelar, we would have done bloods to ascertain serum levels.
>
> I responded quickly, felt significantly better within 2 weeks.
>
> I'm not saying that sertraline + nortriptyline is the "ultimate" combo, its just a logical one, equaly logical would be an SSRI + Welbutrin, an SSRI or Effexor plus Remeron, and I'm sure there are others.Just one last question, did you take the nortriptyline and zoloft at the same time of day, ore one at an earlier time than the other?
Posted by jono_in_adelaide on September 1, 2012, at 21:16:07
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS » jono_in_adelaide, posted by schleprock on August 31, 2012, at 20:56:00
No, the relapse came when evrything was right in life - good job, financialy secure, good circle of friends - given my family history my shrink siad he thought it was totaly biochemical.
I used to take the sertraline in the morning, and the nortriptyline at night, not sure why, I could probably have taken them both at night.
Now, I take sertraline in the morning, and reboxetine and alprazolam twice a day (and occasionaly add a third alprazolam in extremis)
Depression was very well controlled on both nortriptyline/sertraline and reboxetine/sertraline, anxiety much less so, hence the Xanax.
I also tried sertraline and Welbutrin once (it was a self trial, I brought the welbutrin from the US off of the net.... it worked about the same as the other two, but was far more expensive, so I went back to reboxetine)
Posted by Phillipa on September 1, 2012, at 23:52:46
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS, posted by jono_in_adelaide on September 1, 2012, at 21:16:07
So the xanax controls the anxiety. What if you didn't take the others. Not debating just wondering? Phillipa
Posted by jono_in_adelaide on September 2, 2012, at 0:30:55
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS » jono_in_adelaide, posted by Phillipa on September 1, 2012, at 23:52:46
Xanax controls the anxiety/panic, the Zoloft and Edronax keep the depression at bay.
I wish there was just one pill i could take every morning that would control everything with no side effects!
Unfortunatly the SSRI's dont help my anxiety, hence the Xanax
Posted by phidippus on September 3, 2012, at 14:55:18
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS, posted by jono_in_adelaide on September 1, 2012, at 21:16:07
>Now, I take sertraline in the morning, and >reboxetine and alprazolam twice a day
Did you know that reboxetine is not aapproved in the US because of lack of proof that it is effective. Maybe this is a weak link in your chain.
Eric
Posted by phidippus on September 3, 2012, at 21:57:42
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS, posted by jono_in_adelaide on September 2, 2012, at 0:30:55
A drug that did everything! That's what I need.
Eric
Posted by JohnWatford on April 23, 2016, at 0:23:25
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS, posted by jono_in_adelaide on August 30, 2012, at 21:27:01
I have been on lexapro and have had a response but not enough so dr added 10mg nortriptylene with a view to go to 25mg. Do you think this might have similar success you experienced with sertralne and nortriptylene?
Posted by JohnWatford on April 23, 2016, at 0:23:44
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS, posted by jono_in_adelaide on August 30, 2012, at 21:27:01
I have been on lexapro and have had a response but not enough so dr added 10mg nortriptylene with a view to go to 25mg. Do you think this might have similar success you experienced with sertralne and nortriptylene?
Posted by SLS on April 23, 2016, at 6:12:52
In reply to Re: Nortriptyline, Buspar, Serotonin - SLS, posted by JohnWatford on April 23, 2016, at 0:23:25
> I have been on lexapro and have had a response but not enough so dr added 10mg nortriptylene with a view to go to 25mg. Do you think this might have similar success you experienced with sertralne and nortriptylene?
I doubt it, but you might as well give your doctor a chance to do it his way before asking him to raise the dosage of nortriptyline to that which is typically therapeutic. Use blood tests along the way to help guide your dosing.
I had partial success with a combination of venlafaxine 300 mg/day and nortriptyline 75 mg/day. I probably would have responded better had we gone up to 150 mg/day on the nortriptyline, which we subsequently learned is what is therapeutic for me based upon clinical response and blood levels.
I have never had success with combination treatments unless each drug is administered at full therapeutic dosages. I am just one case, though.
- Scott
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