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Re: Bipolar and constipation Jay2112

Posted by SLS on December 30, 2022, at 9:41:46

In reply to Re: Bipolar and constipation undopaminergic, posted by Jay2112 on December 29, 2022, at 23:26:59

> > > Ok, a not so lovely topic...buttttt...All of these meds cause me major constipation, and as long as I take Omega 3's, every 3-4 days I swallow a good size laxative, do my jobbers, and I feel *amazing*!! Otherwise, I am bunged up for over a week sometimes, and I find my mental health deteriorates. I have tracked this in my journal, and it's true....this is always the same sequence of events. I wish I could get on a long-term antibiotic, with a probiotic, and I wouldn't have this problem! There is one called rifaximin, for IBS, and I am trying to convince my doctor to put me on it.
> > >
> > > Jay
> >
> > I went very rarely (once a week?) when I was on buprenorphine. Opies have that effect. However I also ate less, which I believe is due to kappa-opioid receptor antagonism.
> >
> > -undopaminergic
> >
>
> I have to *go* once every 3-4 days, or else I feel wretched!! My amitriptyline, clonidine, and risperidone certainly can back me up. I use Tylenol 1 (OTC here in Canada) for migraines, regulaly, so that is the nail in the coffin. :(
>
> Jay


If you haven't tried the metabolite of amitryptyline, nortryptyline, you might respond equally well, but avoid the anticholinergic side effects (constipation, cognitive and memory difficulties, elevated heart rate). However, finding the right dosage of nortriptyline can be tricky. It is the black sheep of the tricyclics. It has a true therapeutic window / index. Generally, I see low-dosages (50-75 mg/day) and high-dosages (125-150 mg/day) produce a robust antidepressant response, but nothing in between. *Generally*. A blood test to assay blood concentrations of nortriptyline can be used as a guide, but an absolute index.

The therapeutic range of nortriptyline is currently quoted lies between 70-170 ng/mL. Formerly, it had been 50-150 ng/mL. At 150 mg/day, my blood level of nortriptyline was 153 ng/mL. However, I am a low-dosage responder. It took two years for me to play out a hunch and reduce the dosage of nortriptyline. I am not a high-dosage responder, after all. I am a low-dosage responder. Right now, 75 mg/day is giving me a better quality of mood that is more stable.

If I recall correctly, you are somewhat improved relative to your untreated baseline. What does your current regime comprise?


- 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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poster:SLS thread:1121386
URL: http://www.dr-bob.org/babble/20220917/msgs/1121408.html