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Re: nortriptyline + celexa (+ trazodone?) for ocd ibs yeltom

Posted by Sad Panda on July 20, 2004, at 7:58:09

In reply to nortriptyline + celexa (+ trazodone?) for ocd ibs, posted by yeltom on July 19, 2004, at 14:09:24

> I take celexa (40-60 mg) plus trazodone (50 mg) at night for OCD, anxiety, and depression, and recently have had bad IBS (irritable bowel syndrome-alternating diarreah/constipation). The gastroenterologist I saw recommended a low dose of a tricyclic antidepressant. After talking with my psychiatrist, I settled on nortriptyline, thinking that it might be a good way to augment the celexa (which I need) as well as stop the IBS. The idea was to substitute the nortriptyline for the trazodone. I'm just wondering what experiences people have had with this combination. I am having a hard time making the transition. I seem to have become dependent on trazodone to get to sleep. 10 mg of nortriptylene didn't seem to be enough for the IBS (though maybe I didn't give it enough time), but 20 mg seems to leave me with a headache and dizziness in the morning and still doesn't really help me sleep the way trazodone does. (Plus, rather than fixing the ibs, it just seems to change it from diarreah-predominant to constipation-predominant.) Is there anything theoretically wrong with mixing trazodone and nortrip? Seems to make my headache and dizziness worse. Maybe I should try 10 mg or nortrip plus 25 mg of trazodone. Is 10 mg of nortrip enough (in theory) to significantly augment celexa? I could see that being the case with prozac (because of significant p450 enzyme inhibition), but not so much with celexa. Any and all responses appreciated.

Most TCA's are strongly antimuscarinic which produces constipation & they also block 5-HT2A(like Trazodone) which produces a good nights sleep & smoothes out a lot of the problems caused by SSRI's. To replace 50mg of Trazodone you will need roughly 75mg of Nortriptyline which may be too stimulating or you might like it. If you only want sedation, then 25mg of Amitriptyline would make a better swap for 50mg of Traz.

The only thing that can smooth over both diarrhoea & constipation is fiber. :)





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