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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by morganator on December 22, 2009, at 22:33:48
I may have asked this question already but I can't remember. Has anyone experienced anxiety relief on Nortriptyline?
Blueaberry, do you think a medication like Nortriptyline can cause the same changes/damage to the brain that SSRIs can?
Also, I'm bipolar and was amazingly able to function at a fairly high level and feel pretty darn good for a very long time on Zoloft alone. Should I be concerned that adding Nortriptyline to a smaller dose of Zoloft or other SSRI would destabilize me and make me more anxious and even less focused than I already am? I do take Depakote but it really does not seem to help me like it did when I was first hospitalized 2 years ago. Maybe taking depakote would protect me from becoming too agitated. I'm on 1500 mg now and I feel pretty agitated and anxious. One thing I am not concerned about is becoming hypomanic for a while. As long as I was functioning well and didn't have this awful anxiety, a little hypomania would be welcome and I am aware of what's going on with me enough that I could control it somewhat. It's feeling good that I care most about.
Posted by ace on December 23, 2009, at 3:24:02
In reply to Nortriptyline questions, posted by morganator on December 22, 2009, at 22:33:48
> I may have asked this question already but I can't remember. Has anyone experienced anxiety relief on Nortriptyline?
Hey, I am pretty sure this caused increase anxiety in me...however, I combined this with Nardil.
> Blueaberry, do you think a medication like Nortriptyline can cause the same changes/damage to the brain that SSRIs can?Can I answer this? I think I will, hehe
No, I feel the TCA's are MUCH safer and benign than the SSRI cash cows.
Only problem- Doc'd tend to prescribe them far too less a dose.
> Also, I'm bipolar and was amazingly able to function at a fairly high level and feel pretty darn good for a very long time on Zoloft alone. Should I be concerned that adding Nortriptyline to a smaller dose of Zoloft or other SSRI would destabilize me and make me more anxious and even less focused than I already am? I do take Depakote but it really does not seem to help me like it did when I was first hospitalized 2 years ago. Maybe taking depakote would protect me from becoming too agitated. I'm on 1500 mg now and I feel pretty agitated and anxious. One thing I am not concerned about is becoming hypomanic for a while. As long as I was functioning well and didn't have this awful anxiety, a little hypomania would be welcome and I am aware of what's going on with me enough that I could control it somewhat. It's feeling good that I care most about.
>
>
Posted by bleauberry on December 23, 2009, at 18:20:39
In reply to Nortriptyline questions, posted by morganator on December 22, 2009, at 22:33:48
Everything is experimental and no one is an expert. That said, I can offer what I believe.
I only took 5mg Nortriptyline. It helped noticeably with social comfort, social ease, and general anxiety. The first few nights I had some heart palpitation, disturbed sleep, and waking anxiety, which all subsided within days. Then I entered a new comfort zone which was better than where I had been prior to Nortriptyline.
I believe Nortriptyline is far more complicated in its functions that anyone knows. We generally think of it as a NRI, maybe a weak NSRI, with a little bit of antihistamine anticholinergic stuff. I think it does a ton more than that which we don't even have a clue of.
Why do I say that? Because it relieves migraines amazingly. It relieves Lyme pains, arthritis pains, all kinds of pains, remarkably. It actually helps to heal nerve damage from MS. It is a very helpful med for those with autoimmune diseases...MS, Lupus, Lyme, mercury/lead burden, amalgam illness. It helps sleep, while not being an outright sedative. It reduces the desire for cigarettes. It is clearly doing a whole lot more than what we know it does. NRI mechanism alone cannot explain all those things. Because no other NE drug can duplicate as reliably what Nortriptyline does.
Damage to the brain from SSRIs? Well, in the real world, we know it happens. In the laboratory world of white coats, it is called a quackery idea. Debates on both sides. There is clinical evidence, but not biological evidence. Not because it doesn't exist, but because it hasn't been explored. Some believe it, some don't. I do.
No explanation, though I would roughly guess that artificically increasing only one neurotransmitter dramatically at the expense of the others HAS to have repurcussions down the road. I'm sure the truth involves a whole lot more than that. Genetic coding, receptor shape, density, and function change. Stuff like that.
So would adding Nortriptyline worsen that? My instinct says no, it would do the opposite. It would restore and repair it. It would equalize the imbalance, in addition to all the other mysteriously beneficial stuff Nortriptyline seems to do. I favor the idea. If it is such a benefit to so many people with all kinds of nervous system disorders and diseases, something good is going on. Pure logic, but no reasoning. That's just how I feel.
Agitation as I see it, as my doctor sees it, is too high of a dose too fast. Simple as that. If agitation is induced even at a tiny miniscule custom dose, that is probably not a good sign, but for sure would take at least 3 days to see how it plays out.
Depakote. I don't know. It actually worsened agitation for me. Caused insomnia. Felt like an apathetic lethargic stimulant, if that makes any sense.
In most clinical trials, Depakote had lost its effectiveness fairly quickly...3 months common. When used primarily for seizure control, which is what it is really intended for, along with other antiseizure meds, it can last indefinitely for years. But that's for seizures, not psychiatry.
My take is to avoid as many drugs as possible, but put the focus on dosing strategy of the core meds instead. Each patient is unique and requires a customized approach in terms of starting dose, ending dose, escalation rate (if any), and such. I generally believe it is all too common to start at doses that are too high (usually the minimum dose...yeah, that's too much), and to increase doses at too rapid of a pace, without getting a chance to see what the lower dose will do.
I do not accept commonly held practices with as much blind faith as most people do. That's just me. I allow reason and logic to take part, rather than blindly following the crowd. If the crowd were demonstrating impressive results, that would be different and I would change my tune. But since they don't, I have to ask myself, what is the crowd doing wrong that they so casually without a thought believe to be correct?
I like Nortriptyline. I like Nortriptyline added to Zoloft a lot. The key is to ignore dosing guidelines. Instead, start very low and step up gradually without any hurry.
Depakote 1500mg for that long will be tricky to come off or reduce. It is clearly problematic and needs to be dealt with. Do it slowly in tiny steps. Add-ons to help would be magnesium supplements, test the waters with low-modest lithium, glycine+gaba supplements.
> I may have asked this question already but I can't remember. Has anyone experienced anxiety relief on Nortriptyline?
>
> Blueaberry, do you think a medication like Nortriptyline can cause the same changes/damage to the brain that SSRIs can?
>
> Also, I'm bipolar and was amazingly able to function at a fairly high level and feel pretty darn good for a very long time on Zoloft alone. Should I be concerned that adding Nortriptyline to a smaller dose of Zoloft or other SSRI would destabilize me and make me more anxious and even less focused than I already am? I do take Depakote but it really does not seem to help me like it did when I was first hospitalized 2 years ago. Maybe taking depakote would protect me from becoming too agitated. I'm on 1500 mg now and I feel pretty agitated and anxious. One thing I am not concerned about is becoming hypomanic for a while. As long as I was functioning well and didn't have this awful anxiety, a little hypomania would be welcome and I am aware of what's going on with me enough that I could control it somewhat. It's feeling good that I care most about.
>
>
Posted by morganator on December 24, 2009, at 0:23:07
In reply to Re: Nortriptyline questions, posted by bleauberry on December 23, 2009, at 18:20:39
Thanks Bleauberry,
Yeah I'm just frustrated because I felt so normal on 100 mgs of Zoloft alone for so long. It wasn't until I got off it and had a major mixed episode 6 months later that things seemed to change. Much more was going on at that point emotionally that contributed. But it's funny how you stop something, have a very damaging episode, and go back to it and it just doesn't feel the same anymore.
My doctor right now wants to take things slow and not jump on adding any meds. I'm starting a new job and starting to exercise again. He wants to see how I do with the Depakote and Zoloft. He's all about as few drugs as possible.
I would love to try Nortriptyline, especially if it worked for me at a very low dose. I'm guessing that I might be able to lower the Zoloft from 100mg to say 50 or 25. Zoloft at 100 is not stabilizing me the same way it used to anyway. In the past, if I went down to 50mg, I would get feel agitated and get angry at things I would never get as angry at. It was very odd. Then I would got back up to 100 and everything was fine.
So I wonder if Nortriptyline could potentially help repair all of my nerve damage. I wonder if it doesn't only apply to MS.
I actually wanted to talk to my doctor about getting on a low dose of lithium. Evidently lower doses don't act as well to stabilized mood. I like the idea of being on a low dose but a high dose is not something I would want to do. I think the doctors at the hospital and my doctor now are high on depakote because of the type of mania I experienced in the past. Depakote and zyprexa brought me out of my major mixed mania 2 years ago.
I supplement with l carnitine and folic acid, both of which are depleted by depakote. The l carnitine may actually help protect from liver damage done by depakote.
I don't want to be on depakote or any other medication that I consider to be fairly invasive and toxic. I would love to be on a low dose of prozac or Zoloft along with Nortriptyline and just take some of my supplements that seem to help keep me calm and focused.
We will see. As for now I am feeling somewhat better but still have times when I feel terrible. I need to be back to my old self. I'm going back to a restaurant I worked at 3 years ago and they are expecting the old Morgan. Kinda scary but I need to be tough about this.
Thanks again, your insight and thoughts have been very helpful. Hopefully I will try Nortriptyline and it will help me feel much better at a low dose.
I am also still considering adding SJW to the Zoloft. I was tempted to buy some today but I will listen to my doc for now and wait to do something like that after I speak to him.
You said Kira is most likely the more calming and anxiety reducing of the SJW brands right?
Posted by JohnWatford on April 28, 2016, at 1:22:22
In reply to Re: Nortriptyline questions, posted by bleauberry on December 23, 2009, at 18:20:39
Interesting!! Would you think nortriptylene and lexapro would be a good combination (e.g. why do you think zoloft + nort is good?). Ken Gillman likes that combination too
This is the end of the thread.
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