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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by PeterMartin on October 26, 2023, at 3:38:31
Been on Marplan and Lamictal now for over a decade - they've helped me a lot. However it's been up and down a lot since the start of the pandemic. Doc and I decided to give ritalin another go back then, which helps but overtime always loses effects for me and is tough to get away from.
Anyway, I know SLS always talks about NTP+Nardil being a great combo so a small dose trial NTP on top of Marplan has always been in the back of my head. I'd given desipramine a try as an adjunct in 2021 and my response to that was way different....seating profusely was Ultimately the side effect the forced me off after only a couple weeks.
I have a doc appt tomorrow and that marks one month on NYP (10mg but 20mg for the 2nd/3rd week). I was pretty sure I was going to stop taking it around the time I was supposed to bump up to 25......instead I did and I'm feeling a lot more motivated when I'm not totally buried w anxiety.If anyone has any positive NTP stories if be cool to hear them.
Posted by SLS on October 29, 2023, at 23:02:47
In reply to Nortriptyline addition (25mg) seems to help......, posted by PeterMartin on October 26, 2023, at 3:38:31
I am taking the following:
Nardil: 90 mg/day
Nortriptyline: 100 mg/day
Lamotrigine: 300 mg/day
Lithium: 450 mg/day (Increased from 300 mg/day)My comment is that you don't treat the dosages of MAOI + TCA when combined any different than each alone. In other words if you needed 150 mg/day of nortriptyline to produce a maximal effect in monotherapy, you will likely need 150 mg/day of nortriptyline when combined with a MAOI. Likewise, your dosage of MAOI does not have to be adjusted when nortriptyline is added to it.
This has been my personal expereince and the strategy used by aggressive doctors.
If this doesn't apply to you, then start nortriptyine at 25 mg/day and titrate gradually.
The TCAs to stay from are imipramine and clomipramine - SRI being the culprit. Doxepin and trimipramine might be safe to combine with a MAOI, too. Nortriptyline has the mildest side-effects, and makes me feel better than desipramine does. I find nortriptyline to be more anhedonic.
- Scott
Posted by SLS on October 30, 2023, at 17:26:54
In reply to Re: Nortriptyline addition (25mg) seems to help...... » PeterMartin, posted by SLS on October 29, 2023, at 23:02:47
Sorry.
A lack of proofreading.
I found nortriptyline to be a better anti-anhedonic than is desipramine. Your experience might end up being just the opposite, of course. Desipramine feels harsh to me and left me feeling "wired" and accelerated my heart-rate far more than nortriptyline.
I don't know if this is helpful, but for me, desipramine feels more like methylphidate, while nortriptyline feels more like amphetamine. However, if you fail to respond to one, you might yet respond to the other.
- Good Luck
Posted by PeterMartin on November 3, 2023, at 12:47:19
In reply to Nortriptyline addition (25mg) seems to help - Oops, posted by SLS on October 30, 2023, at 17:26:54
> Sorry.
>
> A lack of proofreading.
>
> I found nortriptyline to be a better anti-anhedonic than is desipramine. Your experience might end up being just the opposite, of course. Desipramine feels harsh to me and left me feeling "wired" and accelerated my heart-rate far more than nortriptyline.
>
> I don't know if this is helpful, but for me, desipramine feels more like methylphidate, while nortriptyline feels more like amphetamine. However, if you fail to respond to one, you might yet respond to the other.
>
>
> - Good LuckAppreciate your insight! Yea we tried a small dose of Desipramine about a year ago and I couldn't tolerate it. My heart-rate got too quick, and I got very hot/started sweating at room temperature. I only took it for a couple weeks due to that.
So far Nort has been pretty easy w/ the side effects now being 6ish weeks into my small dose adjunct trial. Constipation is my main issue mainly because other meds I take cause it also...
Thanks a lot also for clarifying on "anti-anhedonic" (vs. the typo) in your earlier post. I was about to comment and ask on that ha. One of the main features of my depression/BP when I have bad days/weeks at this point is inability to pick up things I enjoy (and still WANT to enjoy). I find it's a common symptom in this day and age per groups on Reddit/Discord......
I'm hoping I can stay low on NPT and have it just reignite some of the waned Marplan/Lamictal benefits - I've been on those for 13+yrs now.
This is the end of the thread.
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