Posted by SLS on July 18, 2004, at 7:54:46
In reply to Re: Zeugma, ADD diagnosis, posted by zeugma on July 18, 2004, at 7:08:00
Hi.
> That backs up what my pdoc told me, that desipramine and nortriptyline are virtually interchangeable in terms of clinical effect.
This is pretty much true. There are two important differences, though. First, there are people who respond to one and not the other. Second, unlike desipramine, the dosages of nortriptyline that someone will respond to for depression will fall within a therapeutic window, outside of which, the quality of response is reduced. It is actually possible to take too much and lose the antidepressant effect. However, the blood levels of nortriptyline are well studied, and the therapeutic range has been established as being between 50-150 ng/mL. Simple blood tests will help with dosing. Most people end up taking 75mg. I don't know how true this is, but at one time, many clinicians felt that if a patient responded well to desipramine, they were less likely to respond to nortriptyline and vice versa. If you don't respond to one, don't rule out the other.
> Muscarinic receptors are associated with the memory deficits of Alzheimer's disease, and anti-muscarinic potency is why the TCA's are called (misleadingly) 'dumb drugs.'
I take imipramine 300mg, and I feel pretty dumb. I know much of my problem is due to the depression itself, and some might even be due to Lamictal 300mg. How would you guess that much imipramine would affect me - or anyone else for that matter? Do you think the negative congnitive effects are exaggerated? I do enter REM early. It bugs the hell out of me to think that a drug is making me dumber than I am to begin with! Damn these illnesses.
>:-(
Regarding sleep, I discovered a little trick a long time ago that helps me from suffering a worsening of depression when I need to catch up on sleep. Regardless of what time you go to bed, wake up at the same time every day, get out of bed, expose yourself to bright light, do anything that will bring yourself to a state of full wakefullness, and then go back to bed and sleep as long as you like. This resets the circadian clock and prevents a phase delay. It usually works for me.
:-)
- Scott
poster:SLS
thread:364549
URL: http://www.dr-bob.org/babble/20040714/msgs/367321.html