Posted by zeugma on June 10, 2004, at 20:42:55
In reply to Re: Maprotiline or Doxepine? Maprotiline for Burno, posted by rod on June 10, 2004, at 13:54:12
> > I suggest a blood test so you know what level of Nort is your blood does the most good. As you would know Ami metabolises to Nort, so if you were to take some Ami you would have to take less Nort to get the Nort level in your blood the same as before. No matter what TCA you use, you are probably going to have to lower your Nort intake to avoid NE overload.>
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> > Hi, I just want to second Panda's advice to get a plasma level done for nortriptyline. And I agree that if you add any drug that is an NRI, including any TCA, there is an increased possibility that you are going to get counterproductive results from NE overload. I think that some of the symptoms I have experienced recently, including severe fatigue, were due to my simultaneous intake of two NE reuptake inhibitors (nortriptyline and Strattera).
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> > I am currently on 75 mg nortriptyline, 1 mg clonazepam, plus 15 mg buspirone as needed to combat insomnia.
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> Hi
> sure, this can end in counterproductive symptoms due to NE overload. And thank you for caring about me. :)
> But I think its the simplest way to just try out, and see what happens. I mean, what if I know my Nortriptyline plasma level. What does this tell me about the outcome of augmenting with anouther NE reuptake inhibitor (except Amitriptyline). I mean I have *no* cardicac effects from nortrip. or other side effect. they are zero. It just got a bit better than without meds. And if a additonal TCA produces an improvement in my functionality, I take it, if its counterproductive, I quit the newly started one.
> Well, I dont really know which symptoms represent NE overload. Are there specific ones? if so, please tell me.
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> But I will make one the next time I visit my doc. Just out of curiosity.
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> RolandI don't really know, except from my own experience. My blood pressure and vital signs were not affected by my combination, but my fatigue became completely uncontrollable (that may only be the Strattera effect, however). The pertinent question is what the MAP or other NRI would do for you that nortriptyline can't.
Several posters in the archives have pointed out that while nortriptyline has an inverted U-shaped dose response curve, 'open-ended' but otherwise similar TCA's like desipramine don't, and that is one of the great mysteries of psychopharmacology. You could try desipramine and push the dose to 300 mg (under competent supervision, of course). I think it's better, as a principle, to escalate the dosage of a single drug rather than add a similar one simply to get around a glitch in the dose-response curve :)One other note- the curvilinear response pattern for nortriptyline is not tied to cardiac or other side effects. As I said, it's a mystery. It just works less well at higher plasma concentrations, and no one knows if this has anything to do with NE overload, or any known property of the drug. My experience with Strattera was that it seemed to boost the AD effect for a good long time, but wound up bringing back the depression with the added, unendurable fatigue. I did think for a while that I had gotten around the U shape, but I wound up feeling worse than ever :)
poster:zeugma
thread:354847
URL: http://www.dr-bob.org/babble/20040608/msgs/355568.html