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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by polarbear206 on July 22, 2009, at 10:44:45
Question for you about Nortip. I take 300mg of effexor and would like to cut dose in half, and add nortrip. Reason is d/t sexual side effects of effexor. P-doc gave me 10mg caps to start off with and can take up to 3. I knew from the get-go that I would need a higher dose, more like 100mg with the 150 effexor. Been down the wellbutrin road and it caused increased anxiety and anger. Your thoughts.
Thanks, PB
Posted by SLS on July 22, 2009, at 15:07:23
In reply to Calling SLS, posted by polarbear206 on July 22, 2009, at 10:44:45
> Question for you about Nortip. I take 300mg of effexor and would like to cut dose in half, and add nortrip. Reason is d/t sexual side effects of effexor. P-doc gave me 10mg caps to start off with and can take up to 3. I knew from the get-go that I would need a higher dose, more like 100mg with the 150 effexor. Been down the wellbutrin road and it caused increased anxiety and anger. Your thoughts.
Hi.You are doing everything right in the way you are bringing nortiptyline on board. It is an interesting notion that one can reduce the need for Effexor by bringing in a NE reuptake inhibitor to make up the difference. One can argue that the high dosage of Effexor is necessary only to establish enough NE reuptake inhibition to produce the therapeutic response, and that the 5-HT reuptake inhibition is exceeding what is necessary. It makes sense.
You should, of course, consider this an experiment. Based upon my own experience, though, my first reaction is to say that if you absolutely need to take no less than 300mg of Effexor to obtain a response, adding nortriptyline won't change that. Since I have been known to be wrong from time to time :-), you might as well run your experiment to see what happens.
Effexor 300mg and nortriptyline 75mg treated me pretty well, all things considered. It was only a partial improvement, though. If my doctor had been smart enough at the time, he would have had me take a test for nortriptyline blood levels. I really needed to take twice as much. Perhaps I would have attained remission were I to have taken 150mg.
If your doctor will allow you to continue to take 300mg of Effexor while you titrate the nortriptyline, I would first establish a therapeutic dosage of the nortriptyline. Then, you can begin to reduce the Effexor gradually. With a little luck, perhaps you won't need any Effexor at all. And if you do, I hope your hypothesis is correct and that you are able to cut the Effexor dosage down low enough to reduce side effects.
I really hope this works for you. Please apprise us of your progress. I'll keep my fingers crossed for you.
- Scott
Posted by polarbear206 on July 22, 2009, at 19:31:29
In reply to Re: Calling SLS » polarbear206, posted by SLS on July 22, 2009, at 15:07:23
> > Question for you about Nortip. I take 300mg of effexor and would like to cut dose in half, and add nortrip. Reason is d/t sexual side effects of effexor. P-doc gave me 10mg caps to start off with and can take up to 3. I knew from the get-go that I would need a higher dose, more like 100mg with the 150 effexor. Been down the wellbutrin road and it caused increased anxiety and anger. Your thoughts.
>
>
> Hi.
>
> You are doing everything right in the way you are bringing nortiptyline on board. It is an interesting notion that one can reduce the need for Effexor by bringing in a NE reuptake inhibitor to make up the difference. One can argue that the high dosage of Effexor is necessary only to establish enough NE reuptake inhibition to produce the therapeutic response, and that the 5-HT reuptake inhibition is exceeding what is necessary. It makes sense.
>
> You should, of course, consider this an experiment. Based upon my own experience, though, my first reaction is to say that if you absolutely need to take no less than 300mg of Effexor to obtain a response, adding nortriptyline won't change that. Since I have been known to be wrong from time to time :-), you might as well run your experiment to see what happens.
>
> Effexor 300mg and nortriptyline 75mg treated me pretty well, all things considered. It was only a partial improvement, though. If my doctor had been smart enough at the time, he would have had me take a test for nortriptyline blood levels. I really needed to take twice as much. Perhaps I would have attained remission were I to have taken 150mg.
>
> If your doctor will allow you to continue to take 300mg of Effexor while you titrate the nortriptyline, I would first establish a therapeutic dosage of the nortriptyline. Then, you can begin to reduce the Effexor gradually. With a little luck, perhaps you won't need any Effexor at all. And if you do, I hope your hypothesis is correct and that you are able to cut the Effexor dosage down low enough to reduce side effects.
>
> I really hope this works for you. Please apprise us of your progress. I'll keep my fingers crossed for you.
>
>
> - ScottThanks Scott. I really appreciate your knowledge and input. You are a great asset to this community. :)
Posted by floatingbridge on July 24, 2009, at 2:05:51
In reply to Re: Calling SLS » polarbear206, posted by SLS on July 22, 2009, at 15:07:23
Polarbear, please let us know how this goes for you. And Scott, am
I drawing a sound assumption, that nortriptyline can help effexor withdrawal?fb
Posted by SLS on July 24, 2009, at 6:01:35
In reply to Re: Calling SLS » SLS, posted by floatingbridge on July 24, 2009, at 2:05:51
> Polarbear, please let us know how this goes for you. And Scott, am
> I drawing a sound assumption, that nortriptyline can help effexor withdrawal?If it does help, I would guess that it would be barely perceptible. I think the main aspect of Effexor pharmacology that produces the withdrawal phenomenon is serotonin reuptake inhibition (SRI), for which nortriptyline is weak at best.
If you anticipate having to withdraw from an SRI, you might be able to use low-dosage Depakote 250-500mg. Another drug sometimes used to mitigate withdrawal is Benedryl (diphenhydramine). I have seen Periactin (cyproheptadine) reported to be of benefit.
Personally, I have used a flexible-dosing strategy to discontinue Effexor and benzodiazepines without the need for taking any other drugs. It involves taking a small but sufficient amount of drug only when the withdrawal symptoms appear. Towards the end of tapering, I will dose 3-4 times a day by biting off small pieces of a tablet. If you are using capsules, you can pour out the granules and estimate. You don't have to be exact. It actually takes some practice to wait for the very beginnings of withdrawal symptoms and take some medication as soon as they emerge. There is no reason to suffer. The idea is to be flexible with your dosing as the brain is accommodating to change rather than to stick to an arbitrary taper schedule. What you can do is to plan a fixed taper schedule in the beginning and then become more flexible once you reach the point of having withdrawal symptoms emerge.
I am vulnerable to withdrawal symptoms. I suffer most of the common effects, including the "brain zaps". They feel like lightning going of inside your head. I also experience anxiety, ataxia, tremulousness, etc. Now, I have learned how to discontinue Effexor 300mg in two weeks. Of course, taking Depakote or even Trileptal (two anticonvulsants) would be easier.
You might want to go over to the Withdrawal board and ask questions there. The board is relatively inactive, but you never know what will turn up.
- Scott
Posted by polarbear206 on July 24, 2009, at 14:37:42
In reply to Re: Calling SLS » SLS, posted by floatingbridge on July 24, 2009, at 2:05:51
> Polarbear, please let us know how this goes for you. And Scott, am
> I drawing a sound assumption, that nortriptyline can help effexor withdrawal?
>
> fbWill do :)
This is the end of the thread.
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