![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by johnj1 on April 30, 2009, at 12:05:27
I have been med free for some time but recent stressors triggered anxiety and then OCD, I am pure O. I know you take Nort. and had a question. I started low at 10 mg two days ago. It has helped my physical anxiety a lot but is worsening my sleep. I took 10 for the first time last night and slept off and on for about 5 hours. I didn't feel horrible when I got up and am still ruminating but my anxiety is down. I took another 10 this morning and didn't have a very good morning but feeling better now. I really hate to ruminate and it is about stuff that is very dear to me.
How long do I give the nort to help with sleep? If sleep doesn't improve it isn't much help being on it. Not sure what to do. Thanks
johnj
Posted by SLS on April 30, 2009, at 15:49:34
In reply to Nortryptline SLS, posted by johnj1 on April 30, 2009, at 12:05:27
Hi!
> I have been med free for some time but recent stressors triggered anxiety and then OCD, I am pure O. I know you take Nort. and had a question.
I have never heard of anyone prescribing nortriptyline for insomnia. It is far more norandrenergic than it is serotonergic, and can be activating for some people. If you want to pursue using a tricyclic for sleep, it would be better to try amitriptyline, doxepin, or trimipramine. Of all the tricyclics, trimipramine has the ability to improve sleep architecture (the structure of the different stages). The only problem with trimipramine is that there are no generic manufacturers, so you'll have to pay for the brand name, Surmontil (by Odyssey).
- Scott
Posted by uncouth on April 30, 2009, at 16:30:31
In reply to Re: Nortryptline SLS » johnj1, posted by SLS on April 30, 2009, at 15:49:34
Random followup, since I just switched from Effexor to Nortriptyline....
I know the Serotonin/NE ratios for Effexor at reasonably high dosages are something like 30:1, and for Cymbalta at decent dosages its something like 10:1 if memory serves. And lovely milnacipran is something like 3:1. Right?
And desipramine is essentially 1:infinity, as it doesn't inhibit reuptake of serotonin at all.
But what is Nortryptiline? How does it compare to Effx & Cymbalta and Milnacipran?
Posted by ricker on April 30, 2009, at 16:34:24
In reply to Nortryptline SLS, posted by johnj1 on April 30, 2009, at 12:05:27
I'm thinking clomimpramine, if OCD is your #1 offender. Sleep should improve as well.
Rick
Posted by bleauberry on April 30, 2009, at 16:49:34
In reply to Nortryptline SLS, posted by johnj1 on April 30, 2009, at 12:05:27
I tried Nortriptyline for about 2 weeks at 10mg in the evening. The onset of improved sleep for me was similar to Milnacipran. The first night was restless. Definitely some noradrenergic stuff going on there. Second night not that great, but maybe a little better than the first. Third night seemed better than either of the first two. After that, sleep was very good. I think norepinephrine reuptake has a way at first of being stimulating, but as soon as the feedback loops kick in it calms things down. Assuming a lowish dose of course.
Anyway, I just wanted to comment that for me Nortriptyline worsened sleep for 3 nights and then improved it a lot after that.
Posted by johnj1 on April 30, 2009, at 19:34:00
In reply to Re: Nortryptline SLS » johnj1, posted by bleauberry on April 30, 2009, at 16:49:34
Yes, I have OCD stuff that is terrible. There are times it seems silly and times the anxiety and fears seems so real.
Night hasn't been good. I would do better if I could just let go and let my mind rest. Sigh....
Not sure if I will continue the nort., it just isn't making me feel very good.
I have a very specific OCD thing that is going on and it sucks big time.
Posted by Phillipa on April 30, 2009, at 23:41:17
In reply to Re: Nortryptline, thank you » bleauberry, posted by johnj1 on April 30, 2009, at 19:34:00
Try luvox the generic and a benzo it has always worked for sleep for me. Phillipa pamelor knocked me out.
Posted by desolationrower on April 30, 2009, at 23:43:08
In reply to Re: Nortryptline, thank you » bleauberry, posted by johnj1 on April 30, 2009, at 19:34:00
well i wouldn't really expect nort to help much with OCD. maybe add a very low amount of an ssri, once you've been on the nort for a few weeks to know how it works for you.
Scott - why do you think REM enhancing is good? (other than it being fun; flying and running around escheresque buildings is often the highlite of my day)
-d/r
Posted by bleauberry on May 1, 2009, at 17:11:45
In reply to Re: Nortryptline, thank you » bleauberry, posted by johnj1 on April 30, 2009, at 19:34:00
> Yes, I have OCD stuff that is terrible. There are times it seems silly and times the anxiety and fears seems so real.
Yes, it does seem as real as real can be. I know. It is so weird and kind of scary.
I've never had it longterm. Short term symptoms(a few weeks), I got help from a few things. At one time Cymbalta made it so much worse it was insane. I switched straight over to Zoloft and within two days I was calm and relaxed, all the crap was gone. Years ago either Ativan or Klonopin worked within 24 hours. They got me depressed within 3 days so I couldn't keep taking them. But to shut down an acute OCD thing and have a break from it, those meds worked good.
Antipsychotics would seem appropriate, but in fact made the whole thing worse for me. The OCD, anxiety, and all that related stuff were still just as bad or maybe worse, except that I was also zombified at the same time. Bizarre way to feel.
For longterm continuous treatment, my vote is that one of these would be the best for you:
Clomipramine
Zoloft or Paxil or Luvox + Nortriptyline
Zoloft or Paxil + Amitriptyline
Milnacipran solo, maybe with a smidgen of an SSRI.I believe that in the OCD-anxiety-nervousness-delusional-fear domain, a serotonin med has to be involved for successful treatment. Nortriptyline alone is not going to do that.
In the above scenarios, Zoloft gets first place as a ssri choice due to its least amount of drug interactions with other meds.
>
> Night hasn't been good. I would do better if I could just let go and let my mind rest. Sigh....
>
> Not sure if I will continue the nort., it just isn't making me feel very good.
>
> I have a very specific OCD thing that is going on and it sucks big time.
Posted by johnj1 on May 1, 2009, at 17:28:18
In reply to Re: Nortryptline, thank you » johnj1, posted by bleauberry on May 1, 2009, at 17:11:45
Thank you for the suggestions, your are very kind.
I have tried luvox, even at low doses it wired me too much and paxil made me feel like I was in another universe, very scary. seroquel caused akathisa and I felt that way on paxil too. I am very med sensitive so I have to be careful. Benzo's depress me so there isn't much left. I tried NAC and it really helped, but gave me a headache so glutamate is involved for sure.
I can see that my way of thinking causes a lot of the problems. For example, I like women, like most men but when I notice a woman I initially am interested and admire them. But then I feel horrible guilt because I am married. Then I start to think horrible thoughts like it is rude to my wife, that maybe it means I don't love her enough, etc., and the anxiety mounts. Today, I looked at that and laughed because it is not true. I do that with SOOOO many things. I read way more into than what is really there. It is dumb, but seems real at times. My good friend said he does the same thing and even fantasize but it is just that, don't worry about it. But I do, and it sucks. Work I do the same, over think. So basically, I cause my own problems. I wish I knew how to stop it. I watched Dr. Steven Phillipson videos on OCD and was shocked. It is me!
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.