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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by theo on August 30, 2008, at 18:02:37
Didn't there used to be a Psychiatric Drug Chart at this link? http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.html
Posted by SLS on August 30, 2008, at 20:14:57
In reply to Psychiatric Drug Chart?, posted by theo on August 30, 2008, at 18:02:37
> Didn't there used to be a Psychiatric Drug Chart at this link? http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.html
Please try:
http://www.slschofield.com/medicine/psychiatric_drugs_chart.html
- Scott
Posted by mav27 on August 31, 2008, at 1:48:24
In reply to Re: Psychiatric Drug Chart?, posted by SLS on August 30, 2008, at 20:14:57
Hope its ok to tack this question onto this thread but after looking at that chart i was just wondering, it mentions clonazepam as being used for bipolar disorder amongst other things.. what would be the usual dose range if being used for this?
> > Didn't there used to be a Psychiatric Drug Chart at this link? http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.html
>
> Please try:
>
> http://www.slschofield.com/medicine/psychiatric_drugs_chart.html
>
>
> - Scott
Posted by SLS on August 31, 2008, at 5:24:51
In reply to Re: Psychiatric Drug Chart? » SLS, posted by mav27 on August 31, 2008, at 1:48:24
> Hope its ok to tack this question onto this thread but after looking at that chart i was just wondering, it mentions clonazepam as being used for bipolar disorder amongst other things.. what would be the usual dose range if being used for this?
For stubborn manias, giving clonazepam 2-4mg/day in addition to mood stabilizers can put the fire out. I found it very helpful when combined with lithium, even though lithium monotherapy was all but worthless.
- Scott
Posted by theo on September 1, 2008, at 9:49:38
In reply to Re: Psychiatric Drug Chart?, posted by SLS on August 30, 2008, at 20:14:57
Thanks. By the way, are you still taking Nortriptyline? I know you take a combo, but how would you explain it's action for you. Mood brightening, clear headed or on the foggy side? Activating or calming?
Posted by SLS on September 1, 2008, at 10:13:46
In reply to Re: Psychiatric Drug Chart? » SLS, posted by theo on September 1, 2008, at 9:49:38
> Thanks. By the way, are you still taking Nortriptyline? I know you take a combo, but how would you explain it's action for you. Mood brightening, clear headed or on the foggy side? Activating or calming?
Hi Theo.
For me, nortripyline is mood brightening and head-clearing. I find it calming. Steven Stahl believes that adding nortriptyline to an SSRI makes for a more effective treatment than SSRI alone. The thing about nortriptyline is that it can be difficult to establish the right dosage. One can feel fine at 100mg and crash at 150mg. This is what is know as a therapeutic window. Fortunately, there are blood tests to help determine the concentration of nortriptyline. Most people target 75mg and do fine with that. Others will need to go to 100mg or higher. The blood test helps you as a guide, but not an absolute therapeutic index. The therapeutic range of blood concentrations for nortriptyline has been determined to be 50-150ng/ml.
My current treatment:Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
NAC (N-acetylcysteine)
Fish Oil
- Scott
Posted by theo on September 1, 2008, at 10:20:07
In reply to Re: Psychiatric Drug Chart?, posted by SLS on September 1, 2008, at 10:13:46
Do you take Nortriptyline as a single dose at bedtime or morning?
Also, didn't see Deplin in your combo. Did you stop it? Honestly for me, I don't know if it's worth the extra $60.00/month.
Posted by SLS on September 1, 2008, at 13:00:47
In reply to Re: Psychiatric Drug Chart? » SLS, posted by theo on September 1, 2008, at 10:20:07
> Do you take Nortriptyline as a single dose at bedtime or morning?
You can take a single dose of nortriptyline before bed. Personally, I like to think that a more even blood level throughout the day makes sense. I take 50mg in the morning and 100mg before bed.
> Also, didn't see Deplin in your combo. Did you stop it? Honestly for me, I don't know if it's worth the extra $60.00/month.I discontinued Deplin mainly because it was disturbing my sleep. I was having vivid nightmares and would end up throwing myself off the bed and onto the floor. I also would talk very loudly and yell occasionally. My neighbors are not too happy with me.
So far, I don't think I have suffered any deterioration in my depressive condition. If I go back to Deplin, I would take 1/2 pill a day (3.75mg).
If you are in doubt of whether Deplin is helping or not, you can simply discontinue it for a week or so. There is no need to titrate back to 7.5mg should you discover you still need Deplin in your treatment regime. I have become suspicious that the initial response to Deplin fades gradually over time such that it is unnoticeable.
Regarding NAC, I first had as a goal to use this substance to prevent and possibly reverse the cell death that comes with affective disorders, especially bipolar disorder. I wanted to take NAC as an antioxidant and anti-apoptotic. I then stumbled over a blinded study of NAC as a treatment for bipolar depression. The results of the study were that NAC after 8 weeks produced a significant reduction in depression scores. The study used 2000mg per day (1000mg b.i.d.). I am starting out at 1200mg and will move up to 1800mg if positive results aren't imminent.
- Scott
Posted by theo on September 1, 2008, at 13:46:35
In reply to Re: Psychiatric Drug Chart? » theo, posted by SLS on September 1, 2008, at 13:00:47
Wow, I'm glad you shared this response. I've been very angry and having violent dreams about a week after starting Deplin. I called Pamlab and can't remember the guys name but he even suggested just taking half a pill because 7.5mg can cause severe agitation. I've recently stopped it (yesterday) because I was getting so agitated I couldn't control it, especially mid afternoon after taking it about 7:00am. My wife was even asking me what was up.
> I discontinued Deplin mainly because it was disturbing my sleep. I was having vivid nightmares and would end up throwing myself off the bed and onto the floor. I also would talk very loudly and yell occasionally. My neighbors are not too happy with me.
>
> So far, I don't think I have suffered any deterioration in my depressive condition. If I go back to Deplin, I would take 1/2 pill a day (3.75mg).
>
> If you are in doubt of whether Deplin is helping or not, you can simply discontinue it for a week or so. There is no need to titrate back to 7.5mg should you discover you still need Deplin in your treatment regime. I have become suspicious that the initial response to Deplin fades gradually over time such that it is unnoticeable.
>
> Regarding NAC, I first had as a goal to use this substance to prevent and possibly reverse the cell death that comes with affective disorders, especially bipolar disorder. I wanted to take NAC as an antioxidant and anti-apoptotic. I then stumbled over a blinded study of NAC as a treatment for bipolar depression. The results of the study were that NAC after 8 weeks produced a significant reduction in depression scores. The study used 2000mg per day (1000mg b.i.d.). I am starting out at 1200mg and will move up to 1800mg if positive results aren't imminent.
>
>
> - Scott
Posted by Bob on September 1, 2008, at 14:06:51
In reply to Re: Psychiatric Drug Chart?, posted by SLS on September 1, 2008, at 10:13:46
> > Thanks. By the way, are you still taking Nortriptyline? I know you take a combo, but how would you explain it's action for you. Mood brightening, clear headed or on the foggy side? Activating or calming?
>
> Hi Theo.
>
> For me, nortripyline is mood brightening and head-clearing. I find it calming. Steven Stahl believes that adding nortriptyline to an SSRI makes for a more effective treatment than SSRI alone. The thing about nortriptyline is that it can be difficult to establish the right dosage. One can feel fine at 100mg and crash at 150mg. This is what is know as a therapeutic window. Fortunately, there are blood tests to help determine the concentration of nortriptyline. Most people target 75mg and do fine with that. Others will need to go to 100mg or higher. The blood test helps you as a guide, but not an absolute therapeutic index. The therapeutic range of blood concentrations for nortriptyline has been determined to be 50-150ng/ml.
>
>
> My current treatment:
>
> Nardil 90mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 20mg
> NAC (N-acetylcysteine)
> Fish Oil
>
>
> - Scott
Scott,Did you find Nortriptyline to be somewhat foggy upon initial startup and then it would clear up later? I'm trying to titrate up and it is making me fatigued, slightly sedated, and kinda confused and a little out of it.
When you say some people crash at certain doses of Nortriptyline, what type of crash are you referring to specifically? A depression like before treatment with the drug, or a crash where there's no energy?
Bob
Posted by SLS on September 1, 2008, at 14:32:15
In reply to Re: Psychiatric Drug Chart? » SLS, posted by Bob on September 1, 2008, at 14:06:51
> > > Thanks. By the way, are you still taking Nortriptyline? I know you take a combo, but how would you explain it's action for you. Mood brightening, clear headed or on the foggy side? Activating or calming?
> >
> > Hi Theo.
> >
> > For me, nortripyline is mood brightening and head-clearing. I find it calming. Steven Stahl believes that adding nortriptyline to an SSRI makes for a more effective treatment than SSRI alone. The thing about nortriptyline is that it can be difficult to establish the right dosage. One can feel fine at 100mg and crash at 150mg. This is what is know as a therapeutic window. Fortunately, there are blood tests to help determine the concentration of nortriptyline. Most people target 75mg and do fine with that. Others will need to go to 100mg or higher. The blood test helps you as a guide, but not an absolute therapeutic index. The therapeutic range of blood concentrations for nortriptyline has been determined to be 50-150ng/ml.
> >
> >
> > My current treatment:
> >
> > Nardil 90mg
> > nortriptyline 150mg
> > Lamictal 200mg
> > Abilify 20mg
> > NAC (N-acetylcysteine)
> > Fish Oil
> >
> >
> > - Scott
>
>
> Scott,
>
> Did you find Nortriptyline to be somewhat foggy upon initial startup and then it would clear up later?Yes. When I first tried nortriptyline, it knocked me out at 25mg. I slept for hours during the day. I guess there was a sort of "muckiness" to my cognition. I felt very fatigued. Now, I don't even know that I'm taking the stuff. All of that soporific and cognitive haziness disappeared within two weeks. I would suggest sticking it out with nortriptyline and titrate at a rate that you can tolerate. There's no rush. (I guess there is always a rush to escape misery.) Patience very often pays off.
> When you say some people crash at certain doses of Nortriptyline, what type of crash are you referring to specifically?
I guess it feels much like a relapse being close to unmedicated baseline. I never purposely went up so high in dosage that I would experience moving beyond the window. I am probably a P450 2D6 rapid metabolizer. Most people take 75mg as compared to my 150mg.
Good luck with your treatment. You are experiencing exactly what I would expect from someone trying nortriptyline for the first time.
- Scott
Posted by Bob on September 1, 2008, at 16:17:57
In reply to Re: Psychiatric Drug Chart? » Bob, posted by SLS on September 1, 2008, at 14:32:15
> > > > Thanks. By the way, are you still taking Nortriptyline? I know you take a combo, but how would you explain it's action for you. Mood brightening, clear headed or on the foggy side? Activating or calming?
> > >
> > > Hi Theo.
> > >
> > > For me, nortripyline is mood brightening and head-clearing. I find it calming. Steven Stahl believes that adding nortriptyline to an SSRI makes for a more effective treatment than SSRI alone. The thing about nortriptyline is that it can be difficult to establish the right dosage. One can feel fine at 100mg and crash at 150mg. This is what is know as a therapeutic window. Fortunately, there are blood tests to help determine the concentration of nortriptyline. Most people target 75mg and do fine with that. Others will need to go to 100mg or higher. The blood test helps you as a guide, but not an absolute therapeutic index. The therapeutic range of blood concentrations for nortriptyline has been determined to be 50-150ng/ml.
> > >
> > >
> > > My current treatment:
> > >
> > > Nardil 90mg
> > > nortriptyline 150mg
> > > Lamictal 200mg
> > > Abilify 20mg
> > > NAC (N-acetylcysteine)
> > > Fish Oil
> > >
> > >
> > > - Scott
> >
> >
> > Scott,
> >
> > Did you find Nortriptyline to be somewhat foggy upon initial startup and then it would clear up later?
>
> Yes. When I first tried nortriptyline, it knocked me out at 25mg. I slept for hours during the day. I guess there was a sort of "muckiness" to my cognition. I felt very fatigued. Now, I don't even know that I'm taking the stuff. All of that soporific and cognitive haziness disappeared within two weeks. I would suggest sticking it out with nortriptyline and titrate at a rate that you can tolerate. There's no rush. (I guess there is always a rush to escape misery.) Patience very often pays off.
>
> > When you say some people crash at certain doses of Nortriptyline, what type of crash are you referring to specifically?
>
> I guess it feels much like a relapse being close to unmedicated baseline. I never purposely went up so high in dosage that I would experience moving beyond the window. I am probably a P450 2D6 rapid metabolizer. Most people take 75mg as compared to my 150mg.
>
> Good luck with your treatment. You are experiencing exactly what I would expect from someone trying nortriptyline for the first time.
>
>
> - ScottAs usual, thanks for the great answer Scott.
This is the end of the thread.
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