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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Sad Panda on August 27, 2004, at 12:29:28
Hi All,
I am taking Effexor XR 150mg/day & Nortriptyline 125mg/day, got my blood test results & my Nort plasma level is only 75ng/ml. These last few days I have seemed to lose interest in nearly everything & can't seem to stick to one thing. I don't know if I unfocused or just fuzzy from the antimuscarinic side effects. Anyone know does it pass?
Cheers,
Panda.
Posted by SLS on August 27, 2004, at 13:04:32
In reply to Nortriptyline - paradoxial reaction?, posted by Sad Panda on August 27, 2004, at 12:29:28
> Hi All,
>
> I am taking Effexor XR 150mg/day & Nortriptyline 125mg/day, got my blood test results & my Nort plasma level is only 75ng/ml. These last few days I have seemed to lose interest in nearly everything & can't seem to stick to one thing. I don't know if I unfocused or just fuzzy from the antimuscarinic side effects. Anyone know does it pass?
>
> Cheers,
> Panda.
>Gosh, 125mg of nortriptyline seems rather high to have a blood level of only 75 ng/ml. I guess you must be an extensive metabolizer. Have you had any evidence of this with other TCAs? Maybe you are taking too much.
- Scott
Posted by zeugma on August 27, 2004, at 19:47:29
In reply to Nortriptyline - paradoxial reaction?, posted by Sad Panda on August 27, 2004, at 12:29:28
how did you feel on lower dosages of nortriptyline? With the Effexor the therapeutic window may be altered.
Posted by Sad Panda on August 28, 2004, at 2:54:35
In reply to Re: Nortriptyline - paradoxial reaction? » Sad Panda, posted by SLS on August 27, 2004, at 13:04:32
Hi Scott & Z,
Thanks for your interest. :)
When I started Nort, I noticed that it pushed my Effexor plasma levels up a bit, so I dropped down from 225mg to 150mg. I really needed to only drop 37.5mg, but they don't have them here.
Initially, I found Nort to be alerting, like something was pushing my eyes open that little bit extra, but that feeling quickly dissipated & I now feel nothing now when I take 125mg in one handfull. It has been anxiolytic for me, slowed my anxious bowel down a little & I occasionally get mild orthostatic hypotension. It just hasn't energized me like high dose Effexor did. I am going to go up to 175mg, & if that doesn't work, I am going to ask for a trial of Parnate.
Cheers,
Panda.
Posted by SLS on August 28, 2004, at 6:57:01
In reply to Re: Nortriptyline - paradoxial reaction?, posted by Sad Panda on August 28, 2004, at 2:54:35
> Hi Scott & Z,
>
> Thanks for your interest. :)
>
> When I started Nort, I noticed that it pushed my Effexor plasma levels up a bit, so I dropped down from 225mg to 150mg. I really needed to only drop 37.5mg, but they don't have them here.
>
> Initially, I found Nort to be alerting, like something was pushing my eyes open that little bit extra, but that feeling quickly dissipated & I now feel nothing now when I take 125mg in one handfull. It has been anxiolytic for me, slowed my anxious bowel down a little & I occasionally get mild orthostatic hypotension. It just hasn't energized me like high dose Effexor did. I am going to go up to 175mg, & if that doesn't work, I am going to ask for a trial of Parnate.
>
> Cheers,
> Panda.
>
Good luck, Panda. It sounds like a plan.
- Scott
Posted by Racer on August 28, 2004, at 15:12:17
In reply to Re: Nortriptyline - paradoxial reaction?, posted by Sad Panda on August 28, 2004, at 2:54:35
OK, it's been almost 20 years since I took Nort, and I can't remember anything much in detail -- including my eventual dosage -- but I remember two things about it enough to pass them on:
1. For me, it didn't work until the pdoc added a 'recommendation' for a bunch of L-tryptophan tablets to augment it. (Between the two of them, I was taking 14 tablets, as closely as I can recall. I think 6 of the L-tryp and 8 of the Nort. -- don't ask what strength, can't remember.)
2. The doctor was perplexed by the blood work -- I'm 5'9", small boned, and was about 110# at the time, so she didn't expect to have to prescribe very high a dose to get me into the therapeutic window. It finally did happen, though, once we added enough. It's the only TCA that didn't provide me unexpected close up views of the carpet, though, and -- while the weight gain from it was devastating -- it did do its job once it got to the right mix.
Sorry I can't really help more, but at least you know that you're not alone in taking forever to get to the right dose for you...
Good luck!
Posted by KaraS on August 28, 2004, at 19:11:28
In reply to Re: Nortriptyline - paradoxial reaction?, posted by Sad Panda on August 28, 2004, at 2:54:35
> Hi Scott & Z,
>
> Thanks for your interest. :)
>
> When I started Nort, I noticed that it pushed my Effexor plasma levels up a bit, so I dropped down from 225mg to 150mg. I really needed to only drop 37.5mg, but they don't have them here.
Panda,Is it legal in Australia to import the 37.5 from elsewhere with a prescription? If so, I can give you a recommendation.
> Initially, I found Nort to be alerting, like something was pushing my eyes open that little bit extra, but that feeling quickly dissipated & I now feel nothing now when I take 125mg in one handfull. It has been anxiolytic for me, slowed my anxious bowel down a little & I occasionally get mild orthostatic hypotension. It just hasn't energized me like high dose Effexor did. I am going to go up to 175mg, & if that doesn't work, I am going to ask for a trial of Parnate.
>
> Cheers,
> Panda.
>Also, if the higher dose of Effexor was working for you, why did you go off of it? Was it because of blood pressure? If so, would it be possible to treat that instead or is that considered too dangerous?
Kara
Posted by Sad Panda on August 29, 2004, at 10:57:21
In reply to Re: Nortriptyline - paradoxial reaction?, posted by SLS on August 28, 2004, at 6:57:01
> > Hi Scott & Z,
> >
> > Thanks for your interest. :)
> >
> > When I started Nort, I noticed that it pushed my Effexor plasma levels up a bit, so I dropped down from 225mg to 150mg. I really needed to only drop 37.5mg, but they don't have them here.
> >
> > Initially, I found Nort to be alerting, like something was pushing my eyes open that little bit extra, but that feeling quickly dissipated & I now feel nothing now when I take 125mg in one handfull. It has been anxiolytic for me, slowed my anxious bowel down a little & I occasionally get mild orthostatic hypotension. It just hasn't energized me like high dose Effexor did. I am going to go up to 175mg, & if that doesn't work, I am going to ask for a trial of Parnate.
> >
> > Cheers,
> > Panda.
> >
>
>
> Good luck, Panda. It sounds like a plan.
>
>
> - Scott
>
>Thanks Scott :)
How have you been getting on lately?
Cheers,
Panda.
Posted by Sad Panda on August 29, 2004, at 11:02:26
In reply to Memory is the second thing to go... » Sad Panda, posted by Racer on August 28, 2004, at 15:12:17
> OK, it's been almost 20 years since I took Nort, and I can't remember anything much in detail -- including my eventual dosage -- but I remember two things about it enough to pass them on:
>
> 1. For me, it didn't work until the pdoc added a 'recommendation' for a bunch of L-tryptophan tablets to augment it. (Between the two of them, I was taking 14 tablets, as closely as I can recall. I think 6 of the L-tryp and 8 of the Nort. -- don't ask what strength, can't remember.)
>
> 2. The doctor was perplexed by the blood work -- I'm 5'9", small boned, and was about 110# at the time, so she didn't expect to have to prescribe very high a dose to get me into the therapeutic window. It finally did happen, though, once we added enough. It's the only TCA that didn't provide me unexpected close up views of the carpet, though, and -- while the weight gain from it was devastating -- it did do its job once it got to the right mix.
>
> Sorry I can't really help more, but at least you know that you're not alone in taking forever to get to the right dose for you...
>
> Good luck!
>
>Hi Racer,
I think I was just going through a rough patch last week, kind of like a down mood that a normal, unmedicated person would experience I guess. :)
Cheers,
Panda.
Posted by Sad Panda on August 29, 2004, at 11:14:43
In reply to Re: Nortriptyline - paradoxial reaction? » Sad Panda, posted by KaraS on August 28, 2004, at 19:11:28
> Panda,
>
> Is it legal in Australia to import the 37.5 from elsewhere with a prescription? If so, I can give you a recommendation.
>
>
>
> Also, if the higher dose of Effexor was working for you, why did you go off of it? Was it because of blood pressure? If so, would it be possible to treat that instead or is that considered too dangerous?
>
> Kara
>
>Hi Kara,
I don't know if it's legal or not, however, I can't afford them anyhow.
I found 300mg of Effexor activating, but it had a horrible effect on my brain, ie, I would be driving along in my car wondering where I was going, so I had to stop it. I'm guessing that I had too much serotonin. My blood pressure did increase by 10/10, but you would expect it too when NE comes in to play. I actually turned down an offer to try Reboxetine purely because it should push blood pressure up, which I can't afford to happen & choose to try Nort instead.
Cheers,
Panda.
Posted by SLS on August 30, 2004, at 7:22:29
In reply to Re: Nortriptyline - paradoxial reaction? » SLS, posted by Sad Panda on August 29, 2004, at 10:57:21
Hi Panda.
> How have you been getting on lately?Things have been tolerable. I have to finesse the dosage of Lamictal for it to be of net benefit. Too low and I don't get enough of an antidepressant effect from it. At the higher dosage necessary to glean the most benefit from, I get the stupids. It really impairs my ability to remember, learn new things, and figure things out. A little brain fog too. I go between 150mg and 200mg.
Over the past week, I have been feeling a little better than I would normally (that's a paradoxical use of that word, isn't it). I don't know whether to attribute that to Cymbalta, or to the rebound improvement I always get whenever I discontinue a tricyclic. Of course, I'm hoping for the former, but expecting the latter. It's not really pessimism so much as realism based on past experiences. I have only been taking 60mg of Cymbalta for a few days, so I really shouldn't expect anything positive anyway. With regards to side effects, the only thing I am experiencing is some episodic sleepiness. It's not serious enough for me to call it somnolence. Although the slight improvement in my condition is welcome, I am apprehensive that it won't lead to remission and won't last. I guess that's part of the game.
- Scott
This is the end of the thread.
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