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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by jono_in_adelaide on May 4, 2011, at 5:51:37
I notice in the data sheet that the recomended dose of nortriptyline is 75-100mg per day, yet traditional wisdom is that most tricyclics need to be taken in a dose of 150mg per day in order to produce a theraputic effect.
Is nortriptyline more potent than amitriptyline and imipramine, or is the datasheet reflecting outdated info from 1964, when it was written?
Posted by SLS on May 4, 2011, at 11:02:22
In reply to Effective Nortriptyline Dose, posted by jono_in_adelaide on May 4, 2011, at 5:51:37
> I notice in the data sheet that the recomended dose of nortriptyline is 75-100mg per day, yet traditional wisdom is that most tricyclics need to be taken in a dose of 150mg per day in order to produce a theraputic effect.
>
> Is nortriptyline more potent than amitriptyline and imipramine, or is the datasheet reflecting outdated info from 1964, when it was written?The datasheet is right. However, it is recommended that one use blood tests to establish a therapeutic dosage. Slow metabolizers might only need 50mg. Rapid metabolizers often need 150mg.
- Scott
Posted by bleauberry on May 6, 2011, at 17:11:52
In reply to Effective Nortriptyline Dose, posted by jono_in_adelaide on May 4, 2011, at 5:51:37
I think the dose someone needs could be anything....lower than suggested doses, within the normal range, or higher than the suggested range. And the only way to find out is a personal trial.
With me the best dose was 5mg. Half of the smallest capsule. Any other size dose didn't feel as good.
I think Nortriptyline has its best advantage when combined with an ssri, preferably zoloft. I feel there is a much improved prognosis on the combo compared to either alone.
I think amitriptyline and imipramine are more potent in the sense they have strong affinity for serotonin receptors. They generally have a reputation of being the two most potent among the TCAs.
Posted by SLS on May 6, 2011, at 21:25:18
In reply to Re: Effective Nortriptyline Dose, posted by bleauberry on May 6, 2011, at 17:11:52
> I think the dose someone needs could be anything
This is a very safe thing to say, but counterproductive.
My suggestions are based upon over 40 years of scientific investigation into the clinical use of nortriptyline as well as my own observations with the drug since 1977. Nortriptyline is the most closely studied of antidepressant drugs regarding measurable therapeutic blood levels.
What do you base your opinion on?
> ....lower than suggested doses, within the normal range, or higher than the suggested range.
This is a very safe thing to say, but counterproductive.
> And the only way to find out is a personal trial.
This is a very safe thing to say, but is stating the obvious.
> With me the best dose was 5mg.
Are you still taking 5mg of nortriptyline? If not, why not?
> I think Nortriptyline has its best advantage when combined with an ssri, preferably zoloft. I feel there is a much improved prognosis on the combo compared to either alone.
What evidence do you have to support your preference for Zoloft over Effexor or Pristiq?
> I think amitriptyline and imipramine are more potent in the sense they have strong affinity for serotonin receptors. They generally have a reputation of being the two most potent among the TCAs.
There is data and opinion to support your contention. However, I don't think any neuroscientist is ready to sign on to a particular explanation for the mechanisms involved in the therapeutics of any one antidepressant drug.
How would you suggest initiating treatment with nortriptyline and finding the optimimum therapeutic dosage?
How quickly can you get someone well if they are a responder to nortriptyline 150mg? Would you start everyone at 5mg as you suggest is effective for you and give this dosage 4 weeks to produce results? After 5mg, where would you go next? 10mg?
How about using science as a guide?
- Scott
Posted by Laney on May 10, 2011, at 10:03:30
In reply to Re: Effective Nortriptyline Dose » bleauberry, posted by SLS on May 6, 2011, at 21:25:18
I myself had to get to 75mg. Nortriptyline along with taking paxil 10mg. to produce a therapeutic result. If it hadn't of made me gain weight the way it did I would still be on it.
Not to mention that I absolutely craved sweets and that went away immediately as well.
Good luck!
Laney
Posted by jono_in_adelaide on May 15, 2011, at 18:24:40
In reply to Re: Effective Nortriptyline Dose, posted by Laney on May 10, 2011, at 10:03:30
I think I'll stick with my current antidepressant cocktail of Zoloft 100mg om and Edronax (reboxetine, NARI) 4mg bd. No weight gain with reboxetine, and no sedation.
Unfortunatly the antidepressants dont help with my panic/anxiety, so I also take Xanax 1mg 2-3 times a day, and risperidone 1mg at bedtime.
Oh for the days when my medicine cabinet consisted of a bottle of ibuprofen, a bottle of cold capsules and some band-aids.
Posted by Laney on May 18, 2011, at 13:35:44
In reply to Re: Effective Nortriptyline Dose, posted by jono_in_adelaide on May 15, 2011, at 18:24:40
I hear you there! :-}
This is the end of the thread.
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