![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by UGottaHaveHope on January 30, 2007, at 2:14:43
That was encouraging Scott to hear that your meds are doing well for you. I always meant to ask you: What is your diagnosis? Bipolar? Depression? Anxiety? If it's the latter two, I may try to copycat you with my pdoc. Thanks
>>>>>
My goal is full remission. I think I may be lucky enough to have found my magic pills. We'll see.
Currently:
Nardil 75mg
nortriptyline 150mg
Lamictal 100mg
Topamax 100mg
Abilify 10mg
Posted by SLS on January 30, 2007, at 6:01:38
In reply to Q for SLS, posted by UGottaHaveHope on January 30, 2007, at 2:14:43
> That was encouraging Scott to hear that your meds are doing well for you. I always meant to ask you: What is your diagnosis? Bipolar? Depression? Anxiety? If it's the latter two, I may try to copycat you with my pdoc. Thanks
As best as we can tell, I am bipolar. I have had occasional severe psychotic episodes as reactions to specific medications if administered a certain way. There are other attributes of my illness that are consistent with bipolar disorder, too.I know how compelling it is to try to reproduce a treatment that is found to be effective for someone else. Perhaps you would respond to the Nardil and nortriptyline without the need for the anticonvulsants and antipsychotic. It has been the traditional wisdom to start the tricyclic first. If you have never been on nortriptyline, it is worth trying as monotherapy, anyway. If this treatment is ineffective, you can then add the Nardil using a gradual titration. You must reach a minimum dosage of 60mg for the trial to be considered adequate.
1/2 pill - 3 days
15mg - 1 week
30mg - 1 week
45mg - 3 weeks
60mg - 3-6 weeks
75mg - 3-6 weeksI'm still in the middle of experimenting with my dosage of nortriptyline. I am very surprised to discover that I might need 200mg/day. I might be a rapid metabolizer. I'm not going to bother with blood levels, though. At this point, I'm so close, I'd rather do it clinically.
For you, I would recommend setting 75mg as your initial target dosage of nortriptyline. You might want to start at 25mg, though. It can be sedating in the beginning, so you might want to taking it at night. For me, this soporific (sleep-producing) effect disappeared completely. I now take it in the morning. After being at 75mg for 2 weeks, you might then want to get a blood level. Nortriptyline is a funny drug. You can respond to 75mg and then lose the response at 100mg. Blood levels help to guide you on finding the right dosage. The therapeutic range is considered to be 50-150ng/ml.
What do you think?
- Scott
> My goal is full remission. I think I may be lucky enough to have found my magic pills. We'll see.
>
> Currently:
>
> Nardil 75mg
> nortriptyline 150mg
> Lamictal 100mg
> Topamax 100mg
> Abilify 10mg
Posted by Phillipa on January 30, 2007, at 10:12:20
In reply to Q for SLS, posted by UGottaHaveHope on January 30, 2007, at 2:14:43
Sorry to butt in but are you going off the ENSAM? Love Phillipa
Posted by ed_uk on January 30, 2007, at 14:26:09
In reply to Re: Q for SLS, posted by SLS on January 30, 2007, at 6:01:38
Hi Scott
I'm very pleased to hear that you're doing better. Have you become accustomed to Nardil's side effects now? ....urinary retenion, fainting etc.
>I am very surprised to discover that I might need 200mg/day.
Are you starting to doubt whether nortriptyline has a therapeutic window?
Ed
Posted by stargazer on January 31, 2007, at 0:58:16
In reply to Re: Q for SLS » SLS, posted by ed_uk on January 30, 2007, at 14:26:09
SLS, Nice to have your "dosing schedule" and "how to" advice for Nardil and/or Nortrip handy if and when I need another plan.
Nardil was the first drug I repsonded to when I first sought medication relief for my deprssion in 1987 after 2-3 years of "therapy" with no improvement. I was only on 15 mg BID, so if I tried Nardil again, I would know to go up as high as 60 mg before calling it done.
As far as I remember, I only tried Elavil once and was very uncomfortable with the SE's of dry mouth and pupil dilitation.
Do you believe it makes sense for me to start with Nortrip too or go directly to Nardil since I had a response,even though it was many light years ago.
Thanks for your "recipe", I'll keep it handy if I need to test it out. I'm currently in a holding pattern with Emsam waiting on a referral with another pdoc since I have lost much time to incomplete remissions and my depression is becoming more resilient to any treatment short of trying the big guns, which I refuse...Stargazer
Posted by UGottaHaveHope on January 31, 2007, at 2:26:42
In reply to Re: Q for SLS, posted by SLS on January 30, 2007, at 6:01:38
Scott: Man thanks so much for sharing your info. You are a true gentlemen and make this board what it is. Thanks.
My Q is this: Do you think that med combo would work for GAD first and then depression. I do not have bipolar. Let me know if you think it is worth a try.
Posted by SLS on January 31, 2007, at 8:21:24
In reply to Re: Q for SLS - SLS - SLS, posted by UGottaHaveHope on January 31, 2007, at 2:26:42
> Scott: Man thanks so much for sharing your info. You are a true gentlemen and make this board what it is. Thanks.
>
> My Q is this: Do you think that med combo would work for GAD first and then depression.Excellent thinking.
Nardil should work for both. My guess is that you would experience a slight prosocial or anxiolytic effect earlier than an antidepressant effect.
> I do not have bipolar. Let me know if you think it is worth a try.
I have started a MAOI first and then added the TCA afterwards on several occasions without adverse effect.
Yes, I do think it is worth a try. I can't think of any reason why Nardil + TCA would be specific for bipolar disorder. As for which TCA to choose, I emphatically suggest that the only two that you consider are nortriptyline and desipramine. These are the drugs least likely to produce serotonin syndrome or autonomic side effects.
- Scott
Posted by UGottaHaveHope on January 31, 2007, at 13:20:00
In reply to Re: Q for SLS - SLS - SLS » UGottaHaveHope, posted by SLS on January 31, 2007, at 8:21:24
Scott, right now I am on week four of an Emsam trial. Emsam definitely gives me a little boost of extra energy, but I am not sure if that is a good thing with anxiety as my primary issue.
Have you taken Emsam? If so, what did you notice as the difference between Emsam and Nardil? If you didn't take it, what would predict is the difference? I know you know these meds, and could predict.
I once asked my doc about taking Imipramine. He's very aggressive with drugs, but said he didn't want to give me that one because it can cause heart problems. Are those other TCAs you mentioned safe to take?
Thanks for all of your help!
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.