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Re: Interested in Nortriptyline... Side Effects? » cache-monkey

Posted by zeugma on February 18, 2005, at 7:35:07

In reply to Interested in Nortriptyline... Side Effects?, posted by cache-monkey on February 16, 2005, at 18:21:33

Oh, and BTW I'm an intermediate CYP-2D6 metabolizer, which should increase the ratio of nortrip. to its metabolites, if this makes a difference for side effects.>>

This might mean that the lower end of the dosing spectrum (i.e. 50 rather than > or = 100 mg/day) might be more effective, as nortriptyline has a much longer half-life than its active metabolite, and would be expected to accumulate more quickly. I'm a pretty rapid metabolizer of nortriptyline, and I get subtherapeutic effects at 50 mg, and less than optimal effects at 75 mg. It will be pretty clear what the therapeutic window will be for you, as the difference is dramatic in terms of mood (there are also differential effects on various functions: see below).

Nortriptyline is much more anti-muscarinic than 10-hydroxynortriptyline, so it might cause more s/e than the metabolized product. I think there is growing recognition of the importance of metabolizer status when it comes to psychotropics: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14618296

As far as the other concerns you had: nortriptyline is good for motivation/anhedonia, but its effects are fairly subtle and very dose-dependent (e.g. I lapse back into depression when my dose goes below 75 mg/day; on the other hand motivation increased almost immediately when I started at 20 mg/day, suggesting that it has differential effects on these components of affect/behavior). I have found it better for motivation than for anhedonia, for what that's worth.

I also have ADD, so can address your concern about attention as well. It does have an effect, but it is somewhat obscured by the antihistaminic effects, and is not comparable to a pure NRI like atomoxetine in this respect. On the other hand nortriptyline is a far more tolerable and effective antidepressant. I have had to augment the nortrip with various stimulants to gain improvements in attention, and this has been a difficult process, as TCA's and stimulants interact in some very undesirable ways, and I also am not very stimulant-responsive.

-z



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