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Re: Is anyone now taking or has taken a TCA? Results? Mtom

Posted by SLS on September 23, 2021, at 9:58:15

In reply to Re: Is anyone now taking or has taken a TCA? Results? SLS, posted by Mtom on September 21, 2021, at 12:46:42

Hi, Rose.


> > I can't stress enough how critical it is stay within *your* individual dosage window for nortriptyline. Using blood tests to determine an effective dosage isn't always reliable. The recommended range of blood concentrations is 50-150 ng/mL. That's a pretty wide spread. At 150 mg/day of nortriptyline, my concentration was 153 ng/mL. My doctor moved it down to 100 mg/day. I discovered that I did not maintain a consistent antidepressant response until the dosage was dropped to 75 mg/day. 50 mg/day proved to be too low, as I began to relapse at that dosage. I might get a blood test for informational purposes.
> > - Scott
>
> That's interesting. I'm sure a read a paper recently that discussed how both too low a dose of TCA AND too high a dose were ineffective for depression. That would make things tricky with a lot of experimentation and time. I'm going to try to find it again...


The only TCA for which a hard dosage window has been demonstrated is nortriptyline.

My first robust response to an antidepressant, albeit for less than two weeks, was imipramine at a dosage of 150 mg/day. Upon the failure to retain an antidepressant response at that dosage, I was gradually titrated up to 300 mg/day. Later, I would try 75 mg/day without success.

In 1987, I responded to treatment robustly for a period of six months before mania emerged and the drugs were discontinued. I was being treated with a combination of Parnate 60 mg/day + desipramine 125 mg/day. Parnate monotherapy produced a brief, mild improvement for less than a week. I don't recall with certainty the dosage used, but I think it was 50 mg/day.

The second treatment I responded to for a period of months without relapse has been is my current drug regime. I am still responding well to it.

Nardil - 75 mg/day
nortriptyline - 75 mg/day
lamotrigine - 300 mg/day
lithium - 300 mg/day

Not bad for only four drugs.


- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

 

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