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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on March 4, 2016, at 18:01:48
In reply to Nortriptyline weight gain?, posted by SLS on March 4, 2016, at 8:29:58
Nortriptyline could produce more weight gain than desipramine. I would consider Nortriptyline to be a safer medication overall, however. I know that desipramine has been linked to more cardiovascular events than nortriptyline.
I took notriptyline up to 75mg with little increase in appetite. That being said, I've never gained a pound on any psychiatric medication.
Nortriptyline would likely produce less weight gain than remeron.
Linkadge
Posted by J Kelly on March 4, 2016, at 19:48:42
In reply to Re: Nortriptyline weight gain?, posted by linkadge on March 4, 2016, at 18:01:48
>
> I've never gained a pound on any psychiatric medication.
>
>
> LinkadgeCan I say that I hate you?
Jade :)
Posted by Bob on March 5, 2016, at 0:54:50
In reply to Nortriptyline weight gain?, posted by SLS on March 4, 2016, at 8:29:58
> I am having a difficult time deciding whether or not I should switch from desipramine to nortriptyline. I am worried that nortriptyline will produce weight gain. Can anyone offer some feedback?
>
> Thank you.
>
>
> - Scott
>
>Why do you want to go back to nortriptyline? I thought you preferred desipramine.
Bob
Posted by SLS on March 5, 2016, at 2:16:24
In reply to Re: Nortriptyline weight gain? » SLS, posted by Bob on March 5, 2016, at 0:54:50
> Why do you want to go back to nortriptyline? I thought you preferred desipramine.
Things became complicated once I discontinued prazosin. Prazosin produces significant weight-gain and causes my sex-drive to disappear. The tendency for prazosin to produce weight gain I discovered accidentally after discontinuing it and losing 10 pounds without changing my diet. I researched it and discovered it to be a recognized side effect. I had no idea. I was completely surprised that that my depression remitted upon prazosin discontinuation. I thought the nightmare was over. Well, it wasn't. Within a few days, I relapsed and now continue to deteriorate. I'm not sure what to do.
Any ideas?
Parnate 80 mg/day
desipramine 300 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 10 mg/day
- Scott
Posted by J Kelly on March 5, 2016, at 7:43:47
In reply to Re: Nortriptyline weight gain? » Bob, posted by SLS on March 5, 2016, at 2:16:24
Hi Scott,
> I thought the nightmare was over. Well, it wasn't. Within a few days, I relapsed and now continue to deteriorate. I'm not sure what to do.
>
No ideas, but you're not alone. I sure know how that feels. Its infuriating. Hope you get some answers soon.Jade
Posted by Bob on March 5, 2016, at 13:34:48
In reply to Re: Nortriptyline weight gain? » Bob, posted by SLS on March 5, 2016, at 2:16:24
> > Why do you want to go back to nortriptyline? I thought you preferred desipramine.
>
> Things became complicated once I discontinued prazosin. Prazosin produces significant weight-gain and causes my sex-drive to disappear. The tendency for prazosin to produce weight gain I discovered accidentally after discontinuing it and losing 10 pounds without changing my diet. I researched it and discovered it to be a recognized side effect. I had no idea. I was completely surprised that that my depression remitted upon prazosin discontinuation. I thought the nightmare was over. Well, it wasn't. Within a few days, I relapsed and now continue to deteriorate. I'm not sure what to do.
>
> Any ideas?
>
> Parnate 80 mg/day
> desipramine 300 mg/day
> Lamictal 300 mg/day
> lithium 300 mg/day
> Abilify 10 mg/day
>
>
> - Scott
I'm very sorry to hear that. When you say you're deteriorating what exactly is getting worse?Bob
Posted by SLS on March 5, 2016, at 15:43:07
In reply to Re: Nortriptyline weight gain? » SLS, posted by Bob on March 5, 2016, at 13:34:48
> I'm very sorry to hear that.
Thanks.
> When you say you're deteriorating what exactly is getting worse?
Energy, concentration, reading, memory, thought speed, anhedonia, loss of interest and motivation. Sadness and depressed mood or melancholia are not problmes for me.
It is possible that a recent infection produced a setback. I'm still coughing.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919277/
I'm still hoping...
- Scott
Posted by linkadge on March 6, 2016, at 7:13:47
In reply to Re: Nortriptyline weight gain? » linkadge, posted by J Kelly on March 4, 2016, at 19:48:42
>Can I say that I hate you?
You can. Although the blessing is also a curse. I am 6-2 and weigh under 125 pounds. I get sick easily, and take very long to recover from small stressors.
Linkadge
Posted by linkadge on March 6, 2016, at 7:16:22
In reply to Re: Nortriptyline weight gain? » Bob, posted by SLS on March 5, 2016, at 15:43:07
If it's any consolation, I am just getting over this nasty flu that has been going around. I haven't been 'well' for about 3-4 weeks.
I backed out of a job opportunity because I was in the middle of this flu and couldn't think straight. I am now depressed because I made this decision.
Linkadge
Posted by SLS on March 6, 2016, at 8:19:30
In reply to Re: Nortriptyline weight gain?, posted by linkadge on March 6, 2016, at 7:16:22
> If it's any consolation, I am just getting over this nasty flu that has been going around. I haven't been 'well' for about 3-4 weeks.
Me, too. I couldn't think straight and I think my depression got worse. I am in my third week, and I am just coming out of it.
There is a relatively new field of study called psychoneuroimmunology.
infection -> inflammation -> brain inflammation -> depression
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919277/
- Scott
Posted by J Kelly on March 6, 2016, at 8:37:45
In reply to Re: Nortriptyline weight gain? » J Kelly, posted by linkadge on March 6, 2016, at 7:13:47
> >Can I say that I hate you?
>
> You can. Although the blessing is also a curse. I am 6-2 and weigh under 125 pounds. I get sick easily, and take very long to recover from small stressors.
>
> LinkadgeWow. I take it back :(
I'm curious, have you ever taken Zyprexa? I have never had anything make me want to eat like Zyprexa does.
Hope you feel better soon.
Jade
Posted by SLS on March 6, 2016, at 8:56:23
In reply to Re: Nortriptyline weight gain? » J Kelly, posted by linkadge on March 6, 2016, at 7:13:47
> >Can I say that I hate you?
>
> You can. Although the blessing is also a curse. I am 6-2 and weigh under 125 pounds. I get sick easily, and take very long to recover from small stressors.
>
> LinkadgeYou've been tracking your thyroid function?
- Scott
Posted by Bob on March 7, 2016, at 11:51:24
In reply to Re: Nortriptyline weight gain? » Bob, posted by SLS on March 5, 2016, at 15:43:07
> > I'm very sorry to hear that.
>
> Thanks.
>
> > When you say you're deteriorating what exactly is getting worse?
>
> Energy, concentration, reading, memory, thought speed, anhedonia, loss of interest and motivation. Sadness and depressed mood or melancholia are not problmes for me.
>
> It is possible that a recent infection produced a setback. I'm still coughing.
>
> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919277/
>
> I'm still hoping...
>
>
> - Scott
Yeah, I'd hang as long as I can with the desipramine and if you really have to change you may want to go back to nortriptyline. My doc feels it has a less harsh aspect to it vs. desipramine.Also, what about doing another trial of Nardil?
Posted by SLS on March 7, 2016, at 14:47:16
In reply to Re: Nortriptyline weight gain? » SLS, posted by Bob on March 7, 2016, at 11:51:24
> Yeah, I'd hang as long as I can with the desipramine
Okay. Good advice. That's the direction I'll take for now. I see my doctor in a few days.
> Also, what about doing another trial of Nardil?
I would not discount it. I just don't like the weight-gain, dizziness, urinary retention, and sweating. I find that Parnate is more forgiving when I add a TCA with respect to side effects.
- Scott
Posted by Uncouth on March 7, 2016, at 18:29:28
In reply to Re: Nortriptyline weight gain? » Bob, posted by SLS on March 7, 2016, at 14:47:16
Hey Scott
Curious as to your experience being on both desipramine and nortryptiline. I have been on Parnate 130mg + 50mg desipramine the past month (desipramine was to replace bupropion, which I was on for a few months after strattera...) but it has not been effective. I have talked to Doc Gilman recently and he mentioned (and also has written) that people typically dramatically overdose desipramine because they compare it to other TCAs, but that if you do the math on the affinity data, you're getting total NRI at doses as low as 10-25mg--he claims desipramine is typically overdosed almost 10x.
Have you experienced marginal benefit to higher dose desipramine? I asked him point blank on Skype the other night in fact (been helping him with some other stuff for his website) whether there was any reason to go higher than 50mg on desipramine and he said "No!".
So I'm curious as to how you worked out your dosage of desipramine and what your doctor's reasoning is. And also how you can compare it to Nortryptiline.
I won't hijiack this thread but am going to post another topic about switching off of desipramine (or perhaps raising the dose if there is some reason to independent of Gilman's guidance) and i would love your thoughts on.
Also: why not just push up the Parnate as far as it can go?
Posted by SLS on March 7, 2016, at 22:45:42
In reply to Re: Nortriptyline weight gain? » SLS, posted by Uncouth on March 7, 2016, at 18:29:28
> Hi Uncouth.
I tried taking 120 mg/day of Parnate a year ago. I experienced a nice surge of energy upon each dosage increase that would disappear after a week or so. I would then raise the dosage again. In other words, I found myself in a situation of dosage escalation. In the end, I profit as much at 80 mg/day as I did at 120 mg/day.
After giving it some thought, I have decided to continue with desipramine 300 mg/day for now, along with Parnate 80 mg/day.
> Curious as to your experience being on both desipramine and nortryptiline.
If the question is which of the two drugs is best, the answer is whichever of the two produces a *true* robust and global antidepressant response. Many people respond to one drug and not the other. Unfortunately, a great many people do not respond fully to either drug, but plateau at some point short of remission.
I have been a partial responder to both desipramine and nortriptyline when combined with a MAOI. Nortriptyline seems to be smoother and is more of a "mood brightener" than desipramine. It produces a more pleasant feeling. Desipramine feels harsh by comparison. It is strangely energizing early in treatment, and can make you feel tense or wired. These things mitigate over time. So, if I am to remain a partial responder to both drugs, I would take nortriptyine. But obtaining a partial response is not my goal. I am remaining on desipramine, hoping that I will achieve full remission with it.
I am acting on the premise that it is going to take months rather than weeks to respond to any treatment. After being on desipramine for over four months, I began to feel better and better. It had been a very gradual improvement, but it was measurable. Just as I was feeling the onset of a true antidepressant effect, I contracted a systemic infection. It's always something. I guess I'm one of those people who experience an exacerbation of depression or a relapse in association with such an infection. It caused a true setback. It was if I relapsed. I thought that desipramine had pooped-out on me. I even questioned whether or not I ever responded to it at all. After all, I felt better for only a few days before getting sick. I began to believe that switching back to nortriptyline was my best move if I were to be stuck with a partial response. I decided that staying with desipramine was the logical more.
Your sources of information are wrong regarding the dosages of desipramine to be used in depression. I am intimately familiar with TCAs. In my estimation, the dosage of desipramine to be used for mild depression is 50-100 mg/day; moderate depression 125-200 mg/day; severe depression 200-300 mg/day. These are not absolutes, of course, but they help as a guidelines. When in doubt, use a blood test as a guideline. Dosages between individuals can vary according one's rate of metabolizing the drug. For me, 300 mg/day is the minimum that produces a stable improvement. I don't do as well at 250 mg/day. 300 mg/day should be enough according to a blood test and the observed clinical improvement.
Do whatever you can get on desipramine. Start low and go slow. I started at 50 mg/day, but your doctors might not be comfortable starting that high. 25 mg/day should be low enough as an initial dosage. If your doctors want to start at 10 mg/day, I couldn't fault them. If your doctors insist on EKG tests or close monitoring of blood pressure in the beginning, I think it would be worth it.
* The dosages of nortriptyline to be used are roughly 50% of those of desipramine. I think that the risk of cardiac toxicity is lower with nortriptyline.
** The dosage of a TCA must be cut by 50% when combined with Prozac, Paxil, or Wellbutrin. The same is true in geriatric patients.
What will be your criteria for choosing between desipramine and nortriptyline?
I'll be happy to answer any more question if I can.
--------------------------------------------
My current treatment regime:
Parnate 80 mg/day
desipramine 300 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 10 mg/day--------------------------------------------
- Scott
Posted by uncouth on March 8, 2016, at 19:39:29
In reply to Re: Nortriptyline weight gain? » Uncouth, posted by SLS on March 7, 2016, at 22:45:42
Scott, thanks so much for the useful remarks. I don't want to hijack this thread so I posted a new post:
http://www.dr-bob.org/babble/20160306/msgs/1086919.html
Reading between the lines, it sounds like you have heard outstanding things about desipramine from others, or your pdoc, enough to keep you committed to it? 300mg seems a very high dose.
Posted by SLS on March 8, 2016, at 21:08:35
In reply to Re: Nortriptyline weight gain? » SLS, posted by uncouth on March 8, 2016, at 19:39:29
> Scott, thanks so much for the useful remarks. I don't want to hijack this thread so I posted a new post:
>
> http://www.dr-bob.org/babble/20160306/msgs/1086919.html
>
> Reading between the lines, it sounds like you have heard outstanding things about desipramine from others, or your pdoc, enough to keep you committed to it? 300mg seems a very high dose.For desipramine, 300 mg/day is high, but not above the maximum recommended dosage. Start low and go slow to keep everyone happy. I can't see you responding to anything less than 150 mg/day, even when combined with Parnate. Actually, it doesn't appear to me that the dosage of desipramine should be adjusted at all when combined with Parnate.
- Scott
Posted by linkadge on March 9, 2016, at 19:37:23
In reply to Re: Nortriptyline weight gain? » linkadge, posted by J Kelly on March 6, 2016, at 8:37:45
I have taken zyprexa. I took 5mg for a few months and then 2.5 mg for a few more months.
It helped with sleep and mood stabilization, but I never really gained any weight.
I tend to eat extremely well. So, even if I had increased appetite, I only stockpile things like lentils, kidney beans and rice.
Linkadge
Posted by J Kelly on March 10, 2016, at 6:34:03
In reply to Re: Nortriptyline weight gain?, posted by linkadge on March 9, 2016, at 19:37:23
> I have taken zyprexa. I took 5mg for a few months and then 2.5 mg for a few more months.
>
> It helped with sleep and mood stabilization, but I never really gained any weight.
>
> I tend to eat extremely well. So, even if I had increased appetite, I only stockpile things like lentils, kidney beans and rice.
>
> LinkadgeI wish I was as careful as you are with regards to my diet. When I'm down, I tend to eat whatever "feels" good.
As for Zyprexa, it really helps me with my sleep patterns. In addition I think it has a calming effect. However, the weight gain that comes with it (for me) may end up being a deal breaker :(
Jade
Posted by SLS on March 10, 2016, at 6:50:23
In reply to Re: Nortriptyline weight gain? » linkadge, posted by J Kelly on March 10, 2016, at 6:34:03
> As for Zyprexa, it really helps me with my sleep patterns. In addition I think it has a calming effect. However, the weight gain that comes with it (for me) may end up being a deal breaker :(
Take a look at Saphris (asenapine) as a replacement for Zyprexa. It has both antidepressant and antipsychotic properties. I don't know if it helps with sleep, but it doesn't seem to hurt it. I someone who is doing very well on Saphris and Wellbutrin. She sleeps gets 8 sleep. It shouldn't be sedating. Cognitively, she is as sharp as a tack. She thinks clearly and has lots of productive energy. She has lost the weight she gained on Seroquel and Abilify.
- Scott
Posted by J Kelly on March 10, 2016, at 8:26:02
In reply to Re: Nortriptyline weight gain? » J Kelly, posted by SLS on March 10, 2016, at 6:50:23
> Take a look at Saphris (asenapine) as a replacement for Zyprexa. It has both antidepressant and antipsychotic properties. I don't know if it helps with sleep, but it doesn't seem to hurt it. I someone who is doing very well on Saphris and Wellbutrin. She sleeps gets 8 sleep. It shouldn't be sedating. Cognitively, she is as sharp as a tack. She thinks clearly and has lots of productive energy. She has lost the weight she gained on Seroquel and Abilify.
>
>
> - ScottI took Saphris years ago. I didn't respond well to it but can't recall why. I tried Wellbutrin as well but it made me super anxious.
I would love to be "sharp as a tack". I would welcome a clear thought. Unfortunately that's not in the cards for me when I'm depressed. Which is a problem. How does one do the necessary research and formulate the best plan of attack when in the middle of a brain fog?
Honestly. Its beyond frustrating.
Jade
Posted by J Kelly on March 10, 2016, at 8:40:55
In reply to Re: Nortriptyline weight gain? » J Kelly, posted by SLS on March 10, 2016, at 6:50:23
And as a side note, Scott, I certainly appreciate all the research and thought that goes into your posts. I hope you don't ever feel taken for granted.
I hope you, and all the posters who contribute here, know how much your/their insight means to people who come here for not only an ear, but for answers/strategies/and ideas as well.
I try not to be lazy in educating myself. I wish I had more to offer here. Its just for me, depression robs me of much of my cognitive ability. Nothing sticks :(
Jade
Posted by SLS on March 10, 2016, at 8:52:16
In reply to Re: Nortriptyline weight gain? » SLS, posted by J Kelly on March 10, 2016, at 8:40:55
> And as a side note, Scott, I certainly appreciate all the research and thought that goes into your posts. I hope you don't ever feel taken for granted.
I sometimes wonder. It's hard to tell.
> I hope you, and all the posters who contribute here, know how much your/their insight means to people who come here for not only an ear, but for answers/strategies/and ideas as well.
I hope this is true. I wish I had a better track record for helping people to feel better.
> I try not to be lazy in educating myself. I wish I had more to offer here. Its just for me, depression robs me of much of my cognitive ability. Nothing sticks :(
Yes. I know this very well. Repetition helps.
Thanks, Jade.
- Scott
Posted by Bob on March 11, 2016, at 11:58:53
In reply to Re: Nortriptyline weight gain? » SLS, posted by J Kelly on March 10, 2016, at 8:40:55
> And as a side note, Scott, I certainly appreciate all the research and thought that goes into your posts. I hope you don't ever feel taken for granted.
>
> Jade
I second that! I appreciate Scott's well-informed, thoughtful posts.Bob
This is the end of the thread.
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