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Dr. Bob is Robert Hsiung, MD,
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Posted by Tomatheus on September 26, 2015, at 16:34:20
In reply to Re: My doc presribed nortriptyline. Wish me luck., posted by Lamdage22 on September 26, 2015, at 5:08:52
Thank you for your response, Lamdage. Again, I wish you the best of luck with nortriptyline -- as a treatment for the depression that you've been experiencing.
Tomatheus
Posted by Lamdage22 on September 26, 2015, at 22:37:53
In reply to Re: @SLS whats the word on nortriptyline? » Lamdage22, posted by SLS on September 26, 2015, at 14:38:22
Is Nortriptyline less likely to produce a psychotic reaction than MAOI?
I am a bit worried.
Posted by SLS on September 27, 2015, at 0:27:09
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 26, 2015, at 22:37:53
> Is Nortriptyline less likely to produce a psychotic reaction than MAOI?
>
> I am a bit worried.In my experience, MAOIs are more likely than nortriptyline to produce psychosis. Almost any antidepressant can cause a switch into mania for people who are bipolar, though. Given your diagnosis, it is good to have a healthy respect for these medications. If I were in your situation, I would continue with your nortriptyline trial. Try to be patient with both therapeutic response and side effects. Many side effects lessen with time. Raising the dosage gradually will help. If you feel a need to stop taking it, please call your doctor first and tell him about your concerns. I imagine you are scared.
Nortriptyline has some pluses and minuses. The pluses include a high rate of success, little or no sexual side effects, and a low probability of pooping-out. Since people tend to gain weight rather than lose weight, begin managing your diet now. You might feel a little foggy-brain at first, but that should disappear. The plus is that you will not experience the apathy, emotional numbness, and amotivation that SSRIs can cause.
People often respond to 75 mg/day. Rapid metabolizers need more. It is not unusual to need 150 mg/day. Use blood tests to help determine what kind of metabolizer you are. It probably makes sense to get a blood test before moving higher than 75 mg/day. I guess it depends on how much experience your doctor has with this drug. He might feel confident in his ability to titrated without blood tests.
Try not to be too scared of the elevated heart rate.
- Scott
Posted by Lamdage22 on September 27, 2015, at 0:44:41
In reply to Re: @SLS whats the word on nortriptyline? » Lamdage22, posted by SLS on September 27, 2015, at 0:27:09
Thanks so much Scott.
It is probably superstition, but i have a good feeling with this. It would seem only fair if this works for me.
I dont know if i will experience much additional weight gain since i am on Seroquel Zyprexa and Metformin.
Posted by Lamdage22 on September 27, 2015, at 1:08:38
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 27, 2015, at 0:44:41
No, i will not abort this trial early. I woke up early-ish (7AM) today which is not a bad sign. Also it will be good for my bowel movements if i get some "constipation" in there. Metformin softens that stuff big time.
You know what, Scott? When i further reduce my antipsychotics, i could get on 300-400 mg Lithium like you. (With the help of Metformin against the weight gain). Have you ever tried to lower the Lithium dosage? Does your current dosage give you more effect than a low dosage like, say 50mg? I am asking because i wonder if higher dose lithium would give me any benefits beyond cutting out suicidal thoughts. Currently it only curbs suicidal thoughts. Nothing more and nothing less. Its a pie in the sky though because i will need significant amounts of time to wein off of the antipsychotics further.
Ha, i love me some english sayings.
What do you think?
Posted by SLS on September 27, 2015, at 7:15:15
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 27, 2015, at 1:08:38
> No, i will not abort this trial early. I woke up early-ish (7AM) today which is not a bad sign. Also it will be good for my bowel movements if i get some "constipation" in there. Metformin softens that stuff big time.
>
> You know what, Scott? When i further reduce my antipsychotics, i could get on 300-400 mg Lithium like you. (With the help of Metformin against the weight gain). Have you ever tried to lower the Lithium dosage? Does your current dosage give you more effect than a low dosage like, say 50mg? I am asking because i wonder if higher dose lithium would give me any benefits beyond cutting out suicidal thoughts. Currently it only curbs suicidal thoughts. Nothing more and nothing less. Its a pie in the sky though because i will need significant amounts of time to wein off of the antipsychotics further.
>
> Ha, i love me some english sayings.
>
> What do you think?I have not tried dosages of lithium below 300 mg/day for any length of time. I am reluctant to make any changes right now. I need to allow things to stabilize since increasing Parnate to 120 mg/day without jumping up and down in dosage. From what I understand, even 100 mg/day of lithium can help prevent Alzheimers Dementia. For sure, 450 mg/day is too much for me. At that dosage, I experience dysphoria and flat affect.
If I were in your position, I would make the addition of nortriptyline the only change you make. Hopefully, you will find the right dosage, respond, and stabilize. If you still feel like you would like to adjust your other drugs, you will be able to more accurately evaluate the need for each one and its optimal dosage. This might take some time to accomplish, but if you are feeling well, what's the rush?
Have you ever heard of a supplement called resveratrol? Nobody seems to know much about it.
Good luck.
- Scott
Posted by Lamdage22 on September 27, 2015, at 8:28:15
In reply to Re: @SLS whats the word on nortriptyline? » Lamdage22, posted by SLS on September 27, 2015, at 7:15:15
No i have not tried resveratrol!
You?
Posted by SLS on September 27, 2015, at 9:07:48
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 27, 2015, at 8:28:15
> No i have not tried resveratrol!
>
> You?I bought some yesterday. I'll probably start it next week. Theoretically, it might be helpful for depression. In the 1980s, I followed the development of an antidepressant drug called rolipram. I believe it is sold in Japan only. Rolipram acts sort of like an MAOI does, but for the second messenger, cAMP. It is what's known as a phosphodiesterase-4 inhibitor, and prevents the breakdown of cAMP. Resveratrol may have some anti-aging properties.
http://www.ncbi.nlm.nih.gov/pubmed/22304913
- Scott
Posted by Lamdage22 on September 28, 2015, at 2:38:41
In reply to Re: @SLS whats the word on nortriptyline?, posted by SLS on September 27, 2015, at 9:07:48
Scott,
can it be ordered from overseas?
Is it safe?
Posted by SLS on September 28, 2015, at 6:33:37
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 28, 2015, at 2:38:41
> Scott,
>
> can it be ordered from overseas?I'm not sure. I would think so. It is not a drug and is not bound by FDA regulations. This is the stuff that comes from red grape skins. Resveratrol is fairly expensive locally.
> Is it safe?
Resveratrol has been studied pretty extensively in humans and in lab animals at high dosages. I have not yet seen anything that would lead me to believe that it is at all dangerous. I don't know what the ideal dosage of resveratrol is yet. I think the minimum is 500 mg/day. I have seen 2000 mg/day.
I guess you have already read that resveratrol reduces depressive reactions to stress in rats. I like the idea that it increases BDNF and cAMP.
- Scott
Posted by SLS on September 28, 2015, at 6:41:31
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 28, 2015, at 2:38:41
Both resveratrol and the drug, rolipram, are PDE4 inhibitors that increase cAMP. I should add that as an antidepressant, rolipram by itself is not terribly effective. I am hoping that resveratrol is helpful as an augmenter.
I might be reaching. I don't have reason to be tremendously optimistic, but I think it is worth a try.
- Scott
Posted by Lamdage22 on September 28, 2015, at 8:22:21
In reply to Re: @SLS whats the word on nortriptyline? » Lamdage22, posted by SLS on September 28, 2015, at 6:41:31
Good luck.
Most of the supplements i bought disappointed me.
The next thing i will do is check if i have that nmda receptor encephalitis.
Posted by Lamdage22 on September 28, 2015, at 9:51:44
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 28, 2015, at 8:22:21
I wish i could speed up the process with Nortiptyline!
Posted by Lamdage22 on September 28, 2015, at 11:30:26
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 28, 2015, at 9:51:44
is it possible that i feel worse initially?
Posted by Lamdage22 on September 28, 2015, at 13:57:21
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 28, 2015, at 9:51:44
is it possible that i feel worse initially?
Posted by SLS on September 28, 2015, at 16:09:47
In reply to I feel kind of weird though.., posted by Lamdage22 on September 28, 2015, at 13:57:21
> is it possible that i feel worse initially?
I prefer your subject line. "feel kind of weird"
Weird is not necessarily a bad thing. Does it feel like a tingly brain fog? If the depression itself is getting worse, I should think that this would be unmistakable to you. In the past, feeling "weird" has sometimes been a prelude to a subsequent therapeutic response for me.
Can you describe what you are experiencing? Try to be objective in your observations and not describe them having already concluded that they are depressive symptoms.
- Scott
Posted by Lamdage22 on September 29, 2015, at 4:46:47
In reply to Re: I feel kind of weird though.., posted by SLS on September 28, 2015, at 16:09:47
Yes kind of a brain fog and some apathy. The apathy may very well be my illness though and not the med.
Spacy might be a good description.
Posted by Lamdage22 on September 29, 2015, at 7:49:05
In reply to Re: I feel kind of weird though.., posted by Lamdage22 on September 29, 2015, at 4:46:47
> Yes kind of a brain fog and some apathy. The apathy may very well be my illness though and not the med.
>
> Spacy might be a good description.I mean spacey.
Posted by SLS on September 29, 2015, at 14:49:49
In reply to Re: I feel kind of weird though.., posted by Lamdage22 on September 29, 2015, at 7:49:05
> > Yes kind of a brain fog and some apathy. The apathy may very well be my illness though and not the med.
> >
> > Spacy might be a good description.
>
> I mean spacey.
>I misspell that word all of the time, especially when a drug makes me feel spacy.
<stupid joke>
Actually, I really do misspell that word. Thanks for the correction.
I hope things are heading in the right direction for you. You have been incredibly frustrated and disappointed, especially in modern psychiatry, that has not yet been able to provide you with an adequate improvement in your conditions.
- Scott
Posted by Lamdage22 on September 30, 2015, at 2:58:31
In reply to Re: I feel kind of weird though.. » Lamdage22, posted by SLS on September 29, 2015, at 14:49:49
I think i have weight gain as a side effect.
Last night i woke up twice and ate loads of cereal.
Posted by Lamdage22 on September 30, 2015, at 3:31:58
In reply to Re: I feel kind of weird though.., posted by Lamdage22 on September 30, 2015, at 2:58:31
I think drugs that make you feel spacy would be awesome;)
I am looking at victoza for weight.
Posted by Lamdage22 on September 30, 2015, at 12:34:03
In reply to Re: I feel kind of weird though.., posted by Lamdage22 on September 30, 2015, at 3:31:58
So how do i do this? I dont want to piss my doctor off, but i also dont want to put on weight. Next appointment is 8th October.
Id put on the weight for a "antidepressant effect pending psychosis" not a "antidepressant with no chance of psychosis".
So nah, i dont want to do this anymore.
I have thought about an anti inflammatory for my tennis elbow.. might get me back into the gym quicker.. The gym and the golf course is a "AD no chance of psychosis". Seems superior to me!
Posted by baseball55 on September 30, 2015, at 18:43:33
In reply to I cant picture myself being on this.25mg=carb crav, posted by Lamdage22 on September 30, 2015, at 12:34:03
> I have thought about an anti inflammatory for my tennis elbow.. might get me back into the gym quicker.. The gym and the golf course is a "AD no chance of psychosis". Seems superior to me!
Hopefully an NSAID will help. But, if it doesn't, there are other ways to get that nice feeling without irritating your elbow - bike-riding, swimming, exercise classes, running, walking a good distance at a good pace. They're not social like golf, but they'll get the heart pumping and leave you with that sweet - wow am I glad I did that - feeling.
Posted by bleauberry on October 2, 2015, at 14:10:47
In reply to My doc presribed nortriptyline. Wish me luck., posted by Lamdage22 on September 25, 2015, at 10:43:27
Nortriptyline is a good drug in my experience, but usually needs to go with an SSRI. You've got effexor. Close enough.
The seroquel and zyprexa can tend to numb out, drown out, or block, any beneficial stuff you get from the other drugs, so it will be hard to feel significant improvement.
Fingers crossed. Hope you get feeling better soon!
Posted by Lamdage22 on October 2, 2015, at 14:27:40
In reply to Re: My doc presribed nortriptyline. Wish me luck., posted by bleauberry on October 2, 2015, at 14:10:47
i reduce them. 100mg Seroquel or 2.5mg Zyprexa every three months.
So far so good!
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