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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by ChicagoKat on September 29, 2012, at 16:07:38
I am becoming hesitant about adding Nortryptiline to Nardil b/c I know Nortryp. hits NE receptors hard, which can lead to an increase in anxiety in those predisposed to it, which I am. In fact, I think that is why Ritalin ended up causing me so much anxiety that I can no longer use it.
So I wondered if either of you, or anyone else for that matter, had any suggestions of ADs that are safe with MAOIs but that hit NE less.
Thanks for any ideas.
Kat
Posted by phidippus on September 29, 2012, at 17:16:39
In reply to Jono and/or SLS, posted by ChicagoKat on September 29, 2012, at 16:07:38
Just wait and see what the Nardil does alone, then reassess whether you need to add something else.
Eric
Posted by SLS on September 29, 2012, at 18:12:18
In reply to Jono and/or SLS, posted by ChicagoKat on September 29, 2012, at 16:07:38
> I am becoming hesitant about adding Nortryptiline to Nardil b/c I know Nortryp. hits NE receptors hard, which can lead to an increase in anxiety in those predisposed to it, which I am. In fact, I think that is why Ritalin ended up causing me so much anxiety that I can no longer use it.
>
> So I wondered if either of you, or anyone else for that matter, had any suggestions of ADs that are safe with MAOIs but that hit NE less.
>
> Thanks for any ideas.
> Kat
My only worthwhile advice at this juncture is not to get "too smart". Nortriptyline can reduce anxiety when it hits the right targets for some people. It does antagonize 5-HT2a receptors. Even desipramine can reduce anxiety if the anxiety is integral to the depressive disorder being treated. If you have never tried a tricyclic before, you might consider trying nortriptyline first and add the Nardil afterwards if necessary. Doing things in the reverse order is counseled against, although I have never seen a compelling argument for this. I have added a tricyclic to ongoing MAOI treatment a few times without sequelae.Parnate is more forgiving with respect to side effects, especially when combined with a tricyclic. The combination of Nardil with a TCA can produce increased hypotension and urinary retention.
I am not smart enough to predict how you will react to any of these treatments. You might experience few if any side effects with combining Nardil and nortriptyline. Then again, nortriptyline might increase your anxiety. I really don't know. Adding Wellbutrin to Nardil sounds interesting. It should be safe. Some people here have tried it. I have added Wellbutrin to ongoing Parnate treatment. Of course, some people do experience intolerable anxiety and irritability with Wellbutrin monotherapy.
- Scott
Posted by ChicagoKat on September 29, 2012, at 19:58:03
In reply to Re: Jono and/or SLS » ChicagoKat, posted by phidippus on September 29, 2012, at 17:16:39
> Just wait and see what the Nardil does alone, then reassess whether you need to add something else.
>
> EricThat's what I'm tending to think I will do. Thanks Eric.
Kat
Posted by jono_in_adelaide on September 29, 2012, at 20:56:59
In reply to Re: Jono and/or SLS » phidippus, posted by ChicagoKat on September 29, 2012, at 19:58:03
Kat, nortriptyline tends to reduce anxiety, rather than cause it (5HT2 effects), however, you might want to see iff nardil alone gets you to full remission (you're aiming for remission, not just improvement)
If it doesnt, Nortriptyline 75mg/day is a sensible add on and is unlikely to cause anxiety.... it releivesandiety and panic for most patients..... just dont push the dose through the roof. Otherwise, doxepin or trimipramine are tricyclics that dont hit noradrenalin particularly, but they are more sedating and less robust as antidepressants.
Given your history of repeated treatment failiures, I think you need to be prepared to push the envelope a little in order to get well..... if you try nortriptyline and its intolorable, of course you should stop, but i wouldnt write it off just becaise it MIGHT cause sode effects
Posted by SLS on September 29, 2012, at 22:47:00
In reply to Re: Jono and/or SLS » phidippus, posted by ChicagoKat on September 29, 2012, at 19:58:03
> > Just wait and see what the Nardil does alone, then reassess whether you need to add something else.
> >
> > Eric
>
> That's what I'm tending to think I will do. Thanks Eric.
> KatOh. I apologize. I thought you had already tried Nardil monotherapy.
If you do decide to add nortriptyline, I recommend that you start at 10 mg/day taken at night and titrate very gradually so that you don't trigger autonomic side effects. Hypotension and urinary retention can ruin things. Of course, you could try using Florinef and Urecholine to remediate these two side effects respectively.
- Scott
Posted by ChicagoKat on September 30, 2012, at 10:11:09
In reply to Re: Jono and/or SLS, posted by jono_in_adelaide on September 29, 2012, at 20:56:59
> Kat, nortriptyline tends to reduce anxiety, rather than cause it (5HT2 effects), however, you might want to see iff nardil alone gets you to full remission (you're aiming for remission, not just improvement)
>
> If it doesnt, Nortriptyline 75mg/day is a sensible add on and is unlikely to cause anxiety.... it releivesandiety and panic for most patients..... just dont push the dose through the roof. Otherwise, doxepin or trimipramine are tricyclics that dont hit noradrenalin particularly, but they are more sedating and less robust as antidepressants.
>
> Given your history of repeated treatment failiures, I think you need to be prepared to push the envelope a little in order to get well..... if you try nortriptyline and its intolorable, of course you should stop, but i wouldnt write it off just becaise it MIGHT cause sode effectsThanks so much Jono! You've settled it for me. I will try the Nortryptiline with the Nardil. Like you said, I can always stop it if I have bad effects. And you're right, I do need to push the envelope a bit. I thought I was getting better, but just this morning I found myself crying, and I'm trying not to b/c it is my husband's birthday and I don't want to make him feel bad. I had kinda decided I was gonna ask you guys about wellbutrin, but since you say that nortryp. actually helps anxiety, that's what I'll stay with. And then I don't have to bug you guys again after you have helped me SO very much :) And, to be quite honest, It was mostly wishful thinking on my part that I could tolerate wellbutrin b/c I want to lose weight. My husband is on it (he suffers much milder depression than I do) and he has lost SEVENTY pounds while being on it. And it's not liike he tries; he eats like a horse, eats way more than I do - though I will admit that he eats healthier than I do - and he doesn't exercise, but the weight has just melted off, like it's a metabolic thing from the wellbutrin. And I had read that it can have that effect. Fortunately, he could stand to lose the weight, but now he is at a perfectly normal weight, but if he loses anymore he will look anorexic! But, sigh, wellbutrin is really not for me; I've tried it 3x, and each time it has made me so agitated I've wanted to scream.
Thanks again for the much-needed advice, and I'm sorry as usual for the long post; I just don't seem to be able to help myself. How are you feeling these days? I am hoping better.
All my best,
Kat
Posted by ChicagoKat on September 30, 2012, at 10:20:03
In reply to Re: Jono and/or SLS » ChicagoKat, posted by SLS on September 29, 2012, at 22:47:00
> > > Just wait and see what the Nardil does alone, then reassess whether you need to add something else.
> > >
> > > Eric
> >
> > That's what I'm tending to think I will do. Thanks Eric.
> > Kat
>
> Oh. I apologize. I thought you had already tried Nardil monotherapy.
>
> If you do decide to add nortriptyline, I recommend that you start at 10 mg/day taken at night and titrate very gradually so that you don't trigger autonomic side effects. Hypotension and urinary retention can ruin things. Of course, you could try using Florinef and Urecholine to remediate these two side effects respectively.
>
>
> - ScottThanks Scott, I will take your advice about the dosage. And I'm not too worried about hypotension; I can't WAIT to be off my antihypertensives, and I'm quite prepared to deal with orthostatic hypotension. But if it does get too bad, I will again take your advice and ask my pdoc about adding Florinef. Thanks again! OH - and read the post I just sent in answer to Jono, it talks about wellbutrin, and I seem to remember you are on that, or you were, and I'm curious to see if you had the same experience! Thanks again. You guys are the greatest. I hope you are feeling better, I really do.
All my best,
Kat
Oh, and urinary hesitation doesn't bother me too much. I had plenty of it when I was on Elavil. I turn on the faucet and I sit and wait, and sit and wait some more, and pick at my head as you've most likely read is a bad habit of mine, and eventually: success!! :D
Posted by jono_in_adelaide on September 30, 2012, at 17:44:53
In reply to Re: Jono and/or SLS » SLS, posted by ChicagoKat on September 30, 2012, at 10:20:03
Welbutrin would be another very good option Kat - it would cause les autonomioc side effects with nardil, and would be well worth considering (though it lacks Nortriptylines activity at the 5HT2 receptor which can releive anxiety to some degree)
I'd say try one or the other, and if you dont get the response you want, then flip over and try the other one, both are great antidepressants.Remember, start low - go slow
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