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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by ATHEOI on December 5, 2008, at 5:45:35
Hello I have been reading this site since thew late 90's but never posted but now I have a question well two actually.
First Im taking 100mg of nortriptyline and I am debating augmenting 600mg of lithium with it. I just recently about three weeks ago started to take nortriptyline and it has been the best AD I have every taken and Ive taken a bunch. I have experienced no weight gain and have lossed about 5 pounds, the only side effects I have noticed are dry mouth which is getting better and a slight sedation which is good for sleep. I would like to add 600mg of lithium for mood stabilization so does anyone have experience or advice for a TCA with low dose lithium?
My second question is I saw that lithium is listed as having an interaction with Nortrip, so does anybody have any information on what it might be and how severe is this interaction is?
Thanks
ATHEOI
Posted by Phillipa on December 5, 2008, at 10:41:32
In reply to nortriptyline and lithium, posted by ATHEOI on December 5, 2008, at 5:45:35
Welcome to babble. No personal experience with these meds . But there is a drug checker on google. It lists possible interactions with any meds you type in. Hopefully soon someone will answer your thread. Best of luck to you. Phillipa
Posted by azalea on December 5, 2008, at 13:16:14
In reply to nortriptyline and lithium, posted by ATHEOI on December 5, 2008, at 5:45:35
Epocrates Interaction Check indicates "Caution advised: combo may increas risk of CNS, neurotoxic adverse effects even at therapeutic levels (mechanism unknown)"
Perhaps another mood stabilizer such as Lamictal?
> My second question is I saw that lithium is listed as having an interaction with Nortrip, so does anybody have any information on what it might be and how severe is this interaction is?
>
> Thanks
> ATHEOI
Posted by JadeKelly on December 11, 2008, at 20:33:42
In reply to Re: nortriptyline and lithium » ATHEOI, posted by azalea on December 5, 2008, at 13:16:14
> Epocrates Interaction Check indicates "Caution advised: combo may increas risk of CNS, neurotoxic adverse effects even at therapeutic levels (mechanism unknown)"
>
> Perhaps another mood stabilizer such as Lamictal?
>
> > My second question is I saw that lithium is listed as having an interaction with Nortrip, so does anybody have any information on what it might be and how severe is this interaction is?
> >
> > Thanks
> > ATHEOIHi ATHEOI,
I agree with azalea,
I, too, am struggling with which to augment Parnate with. My gut is telling me Lamictal. It just seems that Lamictal will work a little better on depression. You have to go slow cause of the rash thing, but when you've been depressed for a while, better to get it right. I'd run the lithium/nortrip contraindication by your PDoc/Doc.
Good luck with your choice,
~Jade
>
>
Posted by desolationrower on December 12, 2008, at 0:58:21
In reply to Re: nortriptyline and lithium, posted by JadeKelly on December 11, 2008, at 20:33:42
They wouldn't have a pharmacodynamic interaction...i don't think any pharmacokinetic interaction, although i don't really keep up on those, but it shouldn't prevent taking both, since they both have better results if you check serum levels, so you might as well check them.
-d/r
Posted by JadeKelly on December 14, 2008, at 14:10:10
In reply to Re: nortriptyline and lithium, posted by desolationrower on December 12, 2008, at 0:58:21
> They wouldn't have a pharmacodynamic interaction...i don't think any pharmacokinetic interaction, although i don't really keep up on those, but it shouldn't prevent taking both, since they both have better results if you check serum levels, so you might as well check them.
>
> -d/rHi d/r,
Showing off again with your fancy words, haha. Some of us be common folk round here. So, I'm at 9 1/2 weeks Parnate, 10 days 50mg. I deserve a party. No augment yet but I'm going to have to as my mood is pretty decent, fatigue is killer.
~Nortriptyline (how was this safe again?)
~Lamictal (causes fatigue)
~Lithium (have some, must not have liked)
~Seroquel (have for son)
~Abilify (have for son, didn't use)
~Strattera (brother's, how come never see this on board?******This is one I want******
~RITALIN-took it safely for years, this would work wonders for kind of mental and physical fatigue I have, is there a PDoc in the US that would scribe this? Seems others find ways. Do you think its safe with 50-60mg Parnate?
(I don't want to end up with a mind racer like provigil)
OK, so where are you in your Parnate Journey and what are you augmenting with?
Sorry if some of this is repeat, but it all changes! My ONLY complaint is fatigue. Have you have any luck treating residual symptoms? I've been thinking alot about the bad habits that depressed people aquire. I see mine as part of the illness, because they didn't arise until I was fully depressed. So, after I find cure for fatigue, I'll know what I have to work on. Da*m.
Hope to hear from you!
~Jade
Posted by desolationrower on December 14, 2008, at 19:53:25
In reply to Re: nortriptyline and lithium » desolationrower, posted by JadeKelly on December 14, 2008, at 14:10:10
> Hi d/r,
>
> Showing off again with your fancy words, haha. Some of us be common folk round here. So, I'm at 9 1/2 weeks Parnate, 10 days 50mg. I deserve a party. No augment yet but I'm going to have to as my mood is pretty decent, fatigue is killer.
didn't you say it was energy was ok but you felt irritable sometimes? i mabe be confused.> ~Nortriptyline (how was this safe again?)
? - safe for what?
> ~Lamictal (causes fatigue)
for you? some people find it energizing.
> ~Lithium (have some, must not have liked)
> ~Seroquel (have for son)
> ~Abilify (have for son, didn't use)tranquilizers suck
> ~Strattera (brother's, how come never see this on board?
it also sucks, never seems to work for depression, i'd try other nris first
>
> ******This is one I want******
>
> ~RITALIN-took it safely for years, this would work wonders for kind of mental and physical fatigue I have, is there a PDoc in the US that would scribe this? Seems others find ways. Do you think its safe with 50-60mg Parnate?sure plenty safe just start slow. i'd think a short half life drug is more likely to cause a hypertensive crisis than a nri that you keep steady 24/7, but thats a guess
>
> (I don't want to end up with a mind racer like provigil)
>
> OK, so where are you in your Parnate Journey and what are you augmenting with?i have an appointment tomorow, not sure waht he will want to do. I don't know if i'll ask for clonazapm or dexamphetamine or nortriptaline or a dose increase (60->90). I sorta think i need all of that, but docs like 1 change at a time. The parnate helped with mood but so far i have not noticed any anxiolytic effect or greater ability to get things done. when i met him last time im not quite sure what he was thinking of doing, he just raised the 40->60mg parnate. so i'll probably talk about diagnosis, i think the past doctors have thought of the anxiety and apathy as depression related and i don't think thats the case. and saying we could talk about adhd later once i wasn't depressed and then confused when sris made me worse. i didn't notice any difference in parnate dose increase.
>
> Sorry if some of this is repeat, but it all changes! My ONLY complaint is fatigue. Have you have any luck treating residual symptoms? I've been thinking alot about the bad habits that depressed people aquire. I see mine as part of the illness, because they didn't arise until I was fully depressed. So, after I find cure for fatigue, I'll know what I have to work on. Da*m.
>
> Hope to hear from you!
>
> ~Jade
-d/r
Posted by JadeKelly on December 14, 2008, at 22:53:06
In reply to Re: nortriptyline and lithium, posted by desolationrower on December 14, 2008, at 19:53:25
> > Hi d/r,
> >
> > Showing off again with your fancy words, haha. Some of us be common folk round here. So, I'm at 9 1/2 weeks Parnate, 10 days 50mg. I deserve a party. No augment yet but I'm going to have to as my mood is pretty decent, fatigue is killer.
>
>
> didn't you say it was energy was ok but you felt irritable sometimes? i mabe be confused.I can say for SURE I never said energy was OK. And since you seem to be getting away with this word, energy has SUCKED from the beginning of depression and got worse with Parnate.
>
> > ~Nortriptyline (how was this safe again?)
>
> ? - safe for what?Safe as augment and what dose? I think we both said once we were thinking of using it as augment, but TCA's being containdicated with MAOI's, I figured Nort must be special?
>
> > ~Lamictal (causes fatigue)
>
> for you? some people find it energizing.Oh, cool. Didn't know that.
>
> > ~Lithium (have some, must not have liked)
> > ~Seroquel (have for son)
> > ~Abilify (have for son, didn't use)
>
> tranquilizers suckWell, settles that then.
>
> > ~Strattera (brother's, how come never see this on board?
>
> it also sucks, never seems to work for depression, i'd try other nris firstYeah, just had it so...geuss not.
>
> >
> > ******This is one I want******
> >
> > ~RITALIN-took it safely for years for add, this would work wonders for kind of mental and physical fatigue I have, is there a PDoc in the US that would scribe this? Seems others find ways. Do you think its safe with 50-60mg Parnate?
>
> sure plenty safe just start slow. i'd think a short half life drug is more likely to cause a hypertensive crisis than a nri that you keep steady 24/7, but thats a guess
>
> >
> > (I don't want to end up with a mind racer like provigil)
> >
> > OK, so where are you in your Parnate Journey and what are you augmenting with?
>
> i have an appointment tomorow, not sure waht he will want to do. I don't know if i'll ask for clonazapm or dexamphetamine or nortriptaline or a dose increase (60->90). I sorta think i need all of that, but docs like 1 change at a time. The parnate helped with mood but so far i have not noticed any anxiolytic effect or greater ability to get things done. when i met him last time im not quite sure what he was thinking of doing, he just raised the 40->60mg parnate. so i'll probably talk about diagnosis, i think the past doctors have thought of the anxiety and apathy as depression related and i don't think thats the case. and saying we could talk about adhd later once i wasn't depressed and then confused when sris made me worse. i didn't notice any difference in parnate dose increase.I didn't get that little burst i've gotten with each increase when I went from 40 to 50, BUT, its been 10 days on 50mg and I feel the best I've felt since I started all this. Its a little transient, but I here thats to be expected as a/d effect increases (I still have a shi*ty day now and then like anyone else) Again tho, even euphoria wouldn't pay the bills and clean the house. I gotta get back to work. Your Doc would prescribe dexamphetamine? What, he's your brother? Best buddy? My Doc would laugh in my face. Just out of curiosity, how do you explain to said Pdoc that this makes sense? I'd like to use similar language when asking for ritalin. I'm totally serious.
>
> >
> > Sorry if some of this is repeat, but it all changes! My ONLY complaint is fatigue. Have you have any luck treating residual symptoms? I've been thinking alot about the bad habits that depressed people aquire. I see mine as part of the illness, because they didn't arise until I was fully depressed. So, after I find cure for fatigue, I'll know what I have to work on. Da*m.
> >
> > Hope to hear from you!
> >
> > ~Jade
>
>
> -d/r
>
Posted by ATHEOI on December 15, 2008, at 1:55:04
In reply to Re: nortriptyline and lithium » desolationrower, posted by JadeKelly on December 14, 2008, at 22:53:06
I'm glad to hear that the parnate is helping with the deppresion. I have been taking dextroamphetamine for several years to treat ADD and day time drowsiness caused by medications. I have seen over five different doctors and none of them have had a problem prescribing it to treat these syptoms. Just be honest with the doctor, explain how parnate is working very well but you are having problems with the increased day time drowsiness which mkakes it hard to focus and your having problems with concentration. Tell the doctor you have been treated in the past for these syptoms associated with ADHD and that ritalin/dexedrine were the only medications that fully alleviated your symptoms and you would like to try taking it again. Also mention that the drowsiness and inability to focus are making it extremely difficult to seek a job. Just be firm and persistant with the doctor that this is the path you want to take.
Let us know how your appointment goes
Posted by desolationrower on December 15, 2008, at 2:13:17
In reply to Re: nortriptyline and lithium » desolationrower, posted by JadeKelly on December 14, 2008, at 22:53:06
Well i think i have attention deficit inattentive, and AMP is the best treatment; probably not any l-amp since thats more likly to raise blood pressure. I don't even know why i shouldn't have it, becasue its scheduled, or i'm on an MAOI, or what? i mean i suppse i approach more from "so i still have adhd symptoms, can we talk about that today"
-d/r
Posted by JadeKelly on December 15, 2008, at 9:03:56
In reply to Re: nortriptyline and lithium, posted by desolationrower on December 15, 2008, at 2:13:17
Hi d/r,
I don't know, I thought AMP was stronger than ritalin, maybe it is. But you should have whatever you want. Your the boss. Well, I think explaining to PDoc like ATHAOI said will be your best shot. For me its true. I can't work without it, PDoc knows I'm ADD, thats how I met him. Can you record your appt so I can memorize it for mine? Good Luck in your quest!
~Jade
PS-you know I'm gonna be pissed if you get yours and I don't get mine
Posted by JadeKelly on December 15, 2008, at 9:21:46
In reply to Re: nortriptyline and lithium, posted by ATHEOI on December 15, 2008, at 1:55:04
> I'm glad to hear that the parnate is helping with the deppresion. I have been taking dextroamphetamine for several years to treat ADD and day time drowsiness caused by medications. I have seen over five different doctors and none of them have had a problem prescribing it to treat these syptoms. Just be honest with the doctor, explain how parnate is working very well but you are having problems with the increased day time drowsiness which mkakes it hard to focus and your having problems with concentration. Tell the doctor you have been treated in the past for these syptoms associated with ADHD and that ritalin/dexedrine were the only medications that fully alleviated your symptoms and you would like to try taking it again. Also mention that the drowsiness and inability to focus are making it extremely difficult to seek a job. Just be firm and persistant with the doctor that this is the path you want to take.
>
> Let us know how your appointment goesSounds good to me, somehow I don't think my Pdoc will go for it. He'll give me most anything I ask for unless its containdicated in his book of possible liabilities. May I ask if you were ever on a MAOI when prescribed AMP? Any problems?
Thanks!
~Jade
>
Posted by desolationrower on December 15, 2008, at 13:16:06
In reply to Re: nortriptyline and lithium » desolationrower, posted by JadeKelly on December 15, 2008, at 9:03:56
> Hi d/r,
>
> I don't know, I thought AMP was stronger than ritalin, maybe it is. But you should have whatever you want. Your the boss. Well, I think explaining to PDoc like ATHAOI said will be your best shot. For me its true. I can't work without it, PDoc knows I'm ADD, thats how I met him. Can you record your appt so I can memorize it for mine? Good Luck in your quest!
>
> ~Jade
>
> PS-you know I'm gonna be pissed if you get yours and I don't get minedoc said i could have a trial on stimulants but he doesn't want to unless i stop taking TCP. >:(
i think he would prefer prescribing atomoxetine but would let me pick. I think its the 'why not see if weaker option works before trying 'dangerous' option that will be more powerful. so we decided to go to 90mg and add clonazapam 2x a week.-d/r
Posted by JadeKelly on December 15, 2008, at 14:49:33
In reply to Re: nortriptyline and lithium, posted by desolationrower on December 15, 2008, at 13:16:06
> > Hi d/r,
> >
> > I don't know, I thought AMP was stronger than ritalin, maybe it is. But you should have whatever you want. Your the boss. Well, I think explaining to PDoc like ATHAOI said will be your best shot. For me its true. I can't work without it, PDoc knows I'm ADD, thats how I met him. Can you record your appt so I can memorize it for mine? Good Luck in your quest!
> >
> > ~Jade
> >
> > PS-you know I'm gonna be pissed if you get yours and I don't get mine
>
> doc said i could have a trial on stimulants but he doesn't want to unless i stop taking TCP. >:(
> i think he would prefer prescribing atomoxetine but would let me pick. I think its the 'why not see if weaker option works before trying 'dangerous' option that will be more powerful. so we decided to go to 90mg and add clonazapam 2x a week.
>
> -d/r
Wow, thats some face. I can relate at the momont actually. So you didn't get the AMP but at least he let you change two things. Is that right? 2mg Klon per week or per day? When is your next appt.? I'm really curious to see how you do on 90mg. I've been going up at 10mg per every few weeks or so. Everyone else goes up 30mg. I think its cause thats what I asked for not knowing any better. I wonder if I should go up 20mg. Been on 50mg for 11 days, but only up from 40mg. Ugghh.Hope you like your new regimen, oh, btw-are you one of those people that gets high on benz? Just curious. I'm on 3mg klon and NEVER got a buzz once.
~Jade
Posted by ATHEOI on December 15, 2008, at 16:40:41
In reply to Re: nortriptyline and lithium, posted by desolationrower on December 15, 2008, at 13:16:06
> Sounds good to me, somehow I don't think my Pdoc will go for it. He'll give me most anything I ask for unless its containdicated in his book of possible liabilities. May I ask if you were ever on a MAOI when prescribed AMP? Any problems?I have never taken a MAOI before so I have no personal experience with the interactions. Hopefully the atomoxetine will work for you but if you decide to try the AMP just start at a really low dose and go from there. If you really want to take AMP you could try a TCA like Nortrip but it sounds like the Parnate is working well so why change unless you have to. Clonazapam is probably my favorite benzo for long term treatment of anxiety issues. Xanax is best for panic attacks and halcion with ambien is best for sleep.
Hope you like your new regimen, oh, btw-are you one of those people that gets high on benz? Just curious. I'm on 3mg klon and NEVER got a buzz once.
Ive never found benzos to be recreational when taken alone.
Posted by JadeKelly on December 15, 2008, at 17:38:59
In reply to Re: nortriptyline and lithium, posted by ATHEOI on December 15, 2008, at 16:40:41
>
> > Sounds good to me, somehow I don't think my Pdoc will go for it. He'll give me most anything I ask for unless its containdicated in his book of possible liabilities. May I ask if you were ever on a MAOI when prescribed AMP? Any problems?
>
> I have never taken a MAOI before so I have no personal experience with the interactions. Hopefully the atomoxetine will work for you but if you decide to try the AMP just start at a really low dose and go from there. If you really want to take AMP you could try a TCA like Nortrip but it sounds like the Parnate is working well so why change unless you have to. Clonazapam is probably my favorite benzo for long term treatment of anxiety issues. Xanax is best for panic attacks and halcion with ambien is best for sleep.
>
> Hope you like your new regimen, oh, btw-are you one of those people that gets high on benz? Just curious. I'm on 3mg klon and NEVER got a buzz once.
>
> Ive never found benzos to be recreational when taken alone.
>Hi ATHEOI,
I'm a little confused.Was this post intended for d/r or for me (Jade)? When you post a message, if you click on the box that says previous poster you can get it to who you want by starting with message to you. Hope that makes sense.
Top paragraph I posted to you? No, I have no desire to add AMP to Parnate (or any MAOI) I'm too chicken for that. I don't want Strattera either, I was just asking d/r what he thought of it and we disgarded the idea. What I DO WANT is Ritalin. I took it for years, know it well, and know that it should clear up this crazy lethargy and fatigue I'm feeling. Maybe not tho. Any ideas? Giving up Parnate is not an option at this time. I've come too far to quit now!! Just need some energy.
I asked d/r about klonopin cause he got some today, I may have asked you also, anyway, I take 3mg per day for nerve pain but never feel anything. Amazing how some people feel on top of the world when they take benzos. They just make me tired, hah.
~Jade
Posted by desolationrower on December 16, 2008, at 0:06:28
In reply to Re: nortriptyline and lithium » desolationrower, posted by JadeKelly on December 15, 2008, at 14:49:33
> Wow, thats some face. I can relate at the momont actually. So you didn't get the AMP but at least he let you change two things. Is that right? 2mg Klon per week or per day? When is your next appt.? I'm really curious to see how you do on 90mg. I've been going up at 10mg per every few weeks or so. Everyone else goes up 30mg. I think its cause thats what I asked for not knowing any better. I wonder if I should go up 20mg. Been on 50mg for 11 days, but only up from 40mg. Ugghh.
>
> Hope you like your new regimen, oh, btw-are you one of those people that gets high on benz? Just curious. I'm on 3mg klon and NEVER got a buzz once.
>
> ~Jade
>
.5mg kpin per day, up to two days per week. the only drugs i am interested in recreationally are ganja and psychedelics. he wanted to go to 75mg but agreed on 90mg.for me the fatigue passed after a week or so. maybe it just takes longer for you.
-d/r
Posted by JadeKelly on December 16, 2008, at 9:09:39
In reply to Re: nortriptyline and lithium, posted by desolationrower on December 16, 2008, at 0:06:28
d/r on psychedelics....now theres a face I dont think I want to see on my screen.
As far as your fatigue passing after one week >:(
~Jade
This is the end of the thread.
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