Posted by bleauberry on May 13, 2012, at 17:46:27
In reply to HELP! My anti-depressant is going on strike!, posted by schleprock on May 12, 2012, at 20:26:03
Add rhodiola rosea to it.
If you were going to make any moves on the meds, then I personally would add something complimentary to nort, which would be zoloft, prozac, or savella. to get a full spectrum approach for both depression and anxiety and covering multiple neurotransmitters not just one. If a total switch were in mind, then I would probably want to go to another TCA with a reputation as good or better than nort, and with the full spectrum, and that would be clomipramine.
But I know nortrirptyline pretty well. I know rhodiola pretty well. I know your symptoms pretty well and how puzzling the whole scenario can look sometimes. That's the stuff rhodiola has good potential for. I have never seen it touted as a mood stabilizer, but honestly I think it's be mood stabilizer out there and I've tried them all except trileptal. Great for anxiety, social anxiety, all kinds of anxieties. Most of its scientific and anecdotal eviidence has been on fatigue and mood. The common side effects people experience are antidepression, antianxiety, and antii insomnia. In other words, if someone starts taking rhodiola because they have a lot of stress in their fast paced world and they need more energy endurance, they will probably get those desired outcomes but it also comes with better mood, calmer more grounded, and improved sleep.
A psychiatrist in NYC and his psychiatrist wife wrote a book called Rhodiola Revolution. I have not read it. Short to the point..,,they couldn't fix her depression or the lingering symptoms of her chrnoic lyme. When they added rhodiola to her meds, she got better. Now he routinely prescribes rhodiola in his psychiatrist office along with meds.
Dosing is tricky. So if you get to that point don't hesitate to ask more about how to dose rhodiola.
Imo, the worst thing to do at this time would be a total switch to some completely different med....ya know, an effexor, cymbalta, lexapro, antipsychotic...20 years is a really long time and your body aint going to let go of that nortriptyline molecule very easily. It's almost part of your body by now, so even if it was doing nothing it could take a long time to wean off it.
Imagining myself in your shoes, my first step would be to start playing with rhodiola with an eye on the longterm so no matter how small my starting dose is it doesn't matter. Very shortly after getting some of that started, I would add in the lowest dose, or even half the lowest dose, of savella. My second choice after savella would be zoloft, third choice prozac, but hopefully savella would add the extra stuff needed that nortriptyline used to be able to do completely on its own, and rhodiola would further fill in the gaps as well as provide a bunch of other benefits.
Ask 10 different doctors and they will all likely have a different idea for you. I'm not a doctor.