Posted by SLS on September 26, 2015, at 14:38:22
In reply to @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 26, 2015, at 10:28:31
> When can i expect to feel something?
>
> Im on 25mg until Thursday 8th. Since this morning.25 mg/day is a good dosage to start at. Some start at 10 mg/day. If you are a nortiptyline "virgin", you might experience somnolence and become very sedated and sleepy. Should this occur, it should wear off in a few days. The usual side effects that apply to most TCAs apply to nortriptyline as well, but are usually significantly milder. Most of them involve anticholinergic/pronoradrenergic: dry mouth, elevated heart rate, sweating, nasal congestion, tremulousness, blurred vision, constipation, urinary retention, etc. You may not get any of these.
My impression is that TCAs work a bit faster than SSRIs. You might feel a small improvement by the end of week 2. A good response will continue to grow so that by the end of week 4, you will be feeling significantly better. With me, I recover mental energy and sex drive before I experience an improvement in interest, motivation, and mood. I find the sex drive thing very interesting. I don't know if this is just idiosyncratic for me, or more generalized.
I wish you luck with nortriptyline. Since you are still taking antipsychotics - particularly Zyprexa - I believe you will be mostly protected from a manic or psychotic reaction that the TCAs sometimes produce. My rare severe MAOI manic reactions are quickly extinguished by using Zyprexa or Depakote. You should be okay.
Be patient with time to improvement, and allow a week or two for startup side effects to mitigate. Elevated heart rate will probably persist, but it is not dangerous. You might have a resting rate of about 110 bpm at first, but this should level off to 80 - 90 bpm. Heart electrical rhythm abnormalities are uncommon, but you might want to get a ECG if you are worried about this.
Because we were just talking about this in another thread, one can have an increase in suicidal ideations with TCAs, although my impression is that this happens less often than with SSRIs. Suicidality can emerge in two scenarios:
1. The drug creates a genuine neurobiological substrate that makes someone "feel" suicidal independent of thought or type of depression. The emergence of anxiety, anger, or impulsivity leaves these people particularly vulnerable.
2. This patient is extremely vegetative at baseline, including anergia, paychomotor retardation, slow thinking, flat affect, and feeling numb to one's surroundings. He is too vegetative to think about, plan, or act on suicidal ideation. They are often content to remain motionless and stare into space. The problem is this. When someone like this is given an effective antidepressant, the first thing that improves is mental energy and an increase in thinking and psychomotor speed. The last things to return are improvements in mood, interest to do things, desire, motivation, and reward. Unfortunately, the increase in mental energy occurs before improved mood and outlook does. What sometimes happens in these cases is that while they still have depressed mood and poor outlook, the mental energy necessary to produce suicidal thoughts and formulate plans appear. This is only a temporary phase in the process of recovery, though. This state can pass in a week, leaving room for the good thoughts and enjoyment that are beginning to emerge.
With either, scenario, the first 3 weeks can be a dangerous time. A good doctor will warn their patients of the possibility that they might feel worse, and monitor them with weekly or biweekly appoints early in treatment.
Good luck.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1082913
URL: http://www.dr-bob.org/babble/20150901/msgs/1082946.html