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Re: Depression switch to anxiety. Starting Effexor. phidippus

Posted by SLS on October 20, 2017, at 21:51:42

In reply to Re: Depression switch to anxiety. Starting Effexor., posted by phidippus on October 16, 2017, at 16:45:58

Hi, Eric.

Sorry I didn't get to this post sooner.

> Tell me about nortryptaline.

1. Selective (not specific like desipramine) NE reuptake inhibitor.
2. 5-HT2a antagonist.
3. Narrow therapeutic dosage window. If you feel wonderful at 75 mg/day, you might return to feeling horrible at 100 mg/day. For me 100 mg/day is ideal. At 150 mg/day, the benefits I obtained at 100 mg/day disappeared. The reference range for effective NOR blood levels is 50 to 150 ng/mL. However, this is to be used as a guideline to help steer clinical decisions.
4. Milder with regard to side effects than most other TCA, including desipramine.
5. I find NOR to be more pleasant and a better mood-brighter than DMI.
6. Somnolence might appear early, but can disappear quickly.

Scientists do not understand the totality of what nortriptyline does and how it is different from any other antidepressant drug. Clinicians must rely on empirical observations seen in clinical trials and in private practice. Why should DMI work better than NOR for some people and vice-versa? All I can say is that Effexor worked better for me when NOR was added. I guess one could make the argument that this is easily explained by the complementarity of Effexor's SRI to nortriptyline's NRI. I don't know.

> Abilify and I have a strange relationship. It got me out of a bad psychotic episode in 2008 and was onboard for awhile. It seems to do its job, but lately when I try to take it I feel weird, maybe a little over stimulated. It definitely is not as tranparent as the Invega.

Sometimes, I allow a drug to make me feel weird at first and see where it goes. These are enormously powerful drugs in the brain, and one should expect to feel somehow different when first starting one. You might find that you feel even more weird the second time around.

> I take Invega primarily to reduce OCD symptoms.

Do you think that Abilify would reverse this improvement, even if Invega remained on board?

> It also keeps me from becoming hypomanic.

I think that Abilify has done this for me in that I have not had a manic reaction to medication since beginning it 15 years ago.

Does Wellbutrin make things worse for you?

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw




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