Posted by SLS on January 13, 2016, at 21:26:14
In reply to Re: Parnate shame » SLS, posted by Bob on January 13, 2016, at 14:49:26
> I am currently on: nortriptyline (200mg/day), lithium (about 225mg/day), aripiprazole (2mg/day). I also had a low dose of Brintellix in the mix until recently. I'm thinking I may have to add it back in as I have a lot of aches and pain along with a generally less favorable mood. I removed it due to apathy and fatigue as well as sexual side effects (the latter of which are still largely present unfortunately).
That is a lot of nortriptyline - perhaps too much to allow for a therapeuric response. There is a therapeutic window for nortriptyline. Let's say that you found 75 mg/day to work well. At some point, you decide to increase the dosage to see whether or not you can obtain an even better response. You might actually lose the response entirely at 100 mg/day. For me, 100 mg/day works better than 150 mg/day.
In the ancient past, when TCA were added to MAOI on rare occasions, it was recommended that one start the TCA first. Of course, you are now in a position to do that. You would have to discontinue the Brintellix, though.
Before you go there, I would consider adding Cymbalta first and retain the nortriptyline once you determine the best dosage for you. Perhaps the aches and pains indicate that you are a Cymbalta responder. I don't know. Certainly, Cymbalta really is uniquely well-suited for treating aches and pains.
> If you don't mind me asking, what is your current
Currently:
Parnate 80 mg/day
desiipramine 300 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 10 mg/day
prazosin 30 mg/dayI've been taking 300 mg/day of desipramine for a few weeks. It feels like I am beginning to respond to it. 250 mg/day was not enough. I felt kind of strange for about a week once I reached 300 mg/day. I toughed it out because it reminded me of how I felt just before remitting using a combination of Parnate 60 mg/day + desipramine 150 mg/day It is interesting that I should need more of both drugs 28 years later. Age? Years of illness? Number of drug exposures?
- 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:1085235
URL: http://www.dr-bob.org/babble/20151225/msgs/1085368.html