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Re: Agitated depression; anxiety bad in morning » dannen

Posted by zeugma on October 28, 2003, at 20:33:35

In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 28, 2003, at 12:37:49

> Viridis or Zeugma. Have either of you experience with having blood plasma levels checked after taking nortriptyline? At what point is this done? I read that one should have this done after being at 75 mg for 7 days. Any guidance.

Dannen,

I had my plasma level taken after a month at 60 mg/ day. The trick with nortriptyline is that people metabolize it at very different rates, hence 60 mg a day could be a high dose for one person (while that's fairly unlikely) but low for many others. The plasma level was 'low,' according to my pdoc, so we raised it to 75 mg a day. The response became stronger at that point.


You'll want to titrate up slowly, because nortriptyline tends to have a lot of side effects, that will mostly go away over time. On the other hand, it is much easier on the stomach than a lot of other AD's, and seems to have some kind of anti-nauseant property, in addition to being a good analgesic (its other main use is in conditions of chronic pain, and further up this board there's discussion of its efficacy in migraines).


I still suffer from anxiety- at this point, I am considering a benzodiazepine such as Klonopin prn, for situations that are especially anxiety-provoking. I have a particularly debilitating form of social anxiety, and TCA's generally don't help this condition. They do lower the anxiety level overall. The sedative effect is subtle at low doses- when I was taking 40 mg, I had to take it at 2 pm to get to sleep by midnight (I am a lifetime insomniac). I can take 75 mg at 8 pm to be in bed by 11. It's also made my sleep more restful. A lot of my morning anxiety came from having such bad sleep that I did not feel like a human being when I woke up.


zeugma


>
> Viridis. Thanks for the information on Xanax and Klonopin. Can one take Klonopin every day, without the risk of needing more (i.e., developing a tolerance)? My sister-in-law takes it 5 days on, 2 days off I think. I knew a priest who got up to 20 mg a day. (Yes, that amount seems impossible, but it is true. He was detoxed at a hospital over several months. A very kindhearted man who get horrible advice from his doctor.)
>
> I need an antidepressant that works for anxiety. My morning anxiety is brutal. The SSRIs did not work, nor any of the newer ADs. So, I am trying nortriptyline as one of the cleaner TCAs and one not as activating as desipramine. Or so I'm told. I start this Thursday, with a very low dose (liquid form).
>
> Thanks. Dannen


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poster:zeugma thread:271647
URL: http://www.dr-bob.org/babble/20031025/msgs/274435.html