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Re: Psychiatric Drug Chart? Bob

Posted by SLS on September 1, 2008, at 14:32:15

In reply to Re: Psychiatric Drug Chart? SLS, posted by Bob on September 1, 2008, at 14:06:51

> > > Thanks. By the way, are you still taking Nortriptyline? I know you take a combo, but how would you explain it's action for you. Mood brightening, clear headed or on the foggy side? Activating or calming?
> >
> > Hi Theo.
> >
> > For me, nortripyline is mood brightening and head-clearing. I find it calming. Steven Stahl believes that adding nortriptyline to an SSRI makes for a more effective treatment than SSRI alone. The thing about nortriptyline is that it can be difficult to establish the right dosage. One can feel fine at 100mg and crash at 150mg. This is what is know as a therapeutic window. Fortunately, there are blood tests to help determine the concentration of nortriptyline. Most people target 75mg and do fine with that. Others will need to go to 100mg or higher. The blood test helps you as a guide, but not an absolute therapeutic index. The therapeutic range of blood concentrations for nortriptyline has been determined to be 50-150ng/ml.
> >
> >
> > My current treatment:
> >
> > Nardil 90mg
> > nortriptyline 150mg
> > Lamictal 200mg
> > Abilify 20mg
> > NAC (N-acetylcysteine)
> > Fish Oil
> >
> >
> > - Scott
> Scott,
> Did you find Nortriptyline to be somewhat foggy upon initial startup and then it would clear up later?

Yes. When I first tried nortriptyline, it knocked me out at 25mg. I slept for hours during the day. I guess there was a sort of "muckiness" to my cognition. I felt very fatigued. Now, I don't even know that I'm taking the stuff. All of that soporific and cognitive haziness disappeared within two weeks. I would suggest sticking it out with nortriptyline and titrate at a rate that you can tolerate. There's no rush. (I guess there is always a rush to escape misery.) Patience very often pays off.

> When you say some people crash at certain doses of Nortriptyline, what type of crash are you referring to specifically?

I guess it feels much like a relapse being close to unmedicated baseline. I never purposely went up so high in dosage that I would experience moving beyond the window. I am probably a P450 2D6 rapid metabolizer. Most people take 75mg as compared to my 150mg.

Good luck with your treatment. You are experiencing exactly what I would expect from someone trying nortriptyline for the first time.

- Scott




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