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Re: TRICYCLICS: Is there a best one? SLS

Posted by zeugma on August 17, 2004, at 14:33:56

In reply to Re: TRICYCLICS: Is there a best one? zeugma, posted by SLS on August 16, 2004, at 23:13:58

Since you experienced positive results from combining a therapeutic dosage of nortriptyline with a high dosage of Effexor, would you say that in theory (I know this a hard question) it would be better to simply get onto a stable dosage of nortriptyline, seeing that it has a well-established window AND that the efficacy of AD's is presumed to lie in monoaminergic effects; and that adding Effexor is simply a second-best maneuver, since, presumably, it's just doing more of what nortriptyline is presumably doing?

I know that when I added Strattera, I eventually became severely dysphoric. This was due, I now think, to the unadvertised effects of its metabolite on the kappa opioid receptor. The experience I had was seriously disillusioning, because my pdoc seemed to put more trust in the unproven new drug than in the reliable alternative (an experience that has occurred to me before, with many other pdocs, and which has given me a thorough cynicism about the state of psychiatry as a branch of medicine). Anyaway, if nortriptyline's efficacy is mediated through reuptake inhibition, wouldn't adding another inhibitor make the therapeutic window irrelevant? Or is it possible that nortriptyline has a therapeutic mechanism that is as yet unidentified?




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