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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by morganator on December 6, 2009, at 1:25:32
I am currently taking 150mgs of Zoloft, 2.5 mgs Zyprexa, and 1000 mgs of Depakote. I am still experiencing some fairly heavy depression and extreme anxiety. I am going to have a hard time expressing what I really feel like though. Basically I feel like I've had a minor lobotomy.
A year and a half ago if I took 150 to 200 mgs of Zoloft it was too much for me. Then again, I was not on the other meds. Now, I feel like I can go as high as 200 and I start feeling better but I begin to get an awful constant ache in my brain. I've had a fairly consistent headache for much of this past year. Part of me wonders if being put under general anesthesia 4 times in one year did any damage to my brain. I just feel a lot of constant pressure in my head and I cannot seem to find my way out of the fog. I know this could be severe anxiety.
I will get plenty of sleep, get a little exercise, hang out with friends, and still find my self yawning all day and night. I have definitely lost something in the past year and a half that I am desperate to get back. You can even see it on my face, I look like a zombie as my eyes are expressionless and my pupils are dilated.
Could adding Nortriptyline to Zoloft help me? Can Nortriptyline help with anxiety? I've tried wellbutrin and it makes my body tremble.
If I take Nortrityline does it have to be taken at night or can I try taking it in the morning? Your responses will be much appreciated.
Morgan
Posted by bleauberry on December 6, 2009, at 5:58:33
In reply to Interested in Nortriptyline, posted by morganator on December 6, 2009, at 1:25:32
I don't know, forgive me in advance please for taking a purely logical view that is off the path from how we normally think...
You're doing real bad on three different meds. So why take them? The body and nervous system are being subjected to chemical assault that is not providing significant benefit. I don't see the logic in continuing with that. I also don't see the logic in adding yet one more chemical to the cocktail, as if that one molecule is going to somehow magically make everything work and all problems disappear. Once in a blue moon it happens, but honestly I wouldn't place any money bets on it.
Better bet. Replace the meds with other ones through a well structured non-hurried weaning and cross taper strategy.Any antipsychotic no matter what dose has the potential to cause that "minor lobotomy" feeling. Add 1000mg of depakote on top of that to nearly guarantee it. Not to mention the flood of serotonin from high dose zoloft.
The headache would most likely be viewed by most people as a side effect. Considering how long it has been happening and the consistency, I see it differently. While I agree with you there is likely a different cause, anesthesia is not it.
The problem with depression and anxiety is that there are biological causes of them that are hard or impossible to identify. Many of these causes have nothing to do with the brain. They are elsewhere in the body but directly impact the brain. Psychiatry helps tens of thousands of people regain their lives. But a major weakness is its narrow scope...the other thousands of people will be limited in how much benefit they get from psych meds. You are probably one of those. The cause is elsewhere.
I believe you can find benefit in the psychiatric toolbox. But it is almost 99% unlikely to happen with the meds you are currently taking. And though it would maybe take months or years, I think today is the day you should start researching what things cause depression, so that someday you can pinpoint your own problem and treat it, rather than merely relying on psych drugs to "maybe" mask the symptoms of it.
My two cents.
I guess you could try adding Nortriptyline. It is a good med. I found it to be an incredibly effective pain reliever and if your experience is anything like mine, it should erase those headaches in short order. Even at a mere 5mg I was painfree from all Lyme pains and headaches.
I think you should consider a complete overhaul of the drugs you are taking. I see zero logic in keeping drugs onboard that are not doing goodness.
As I said in the beginning, my views take realistic view based on reality and logic, so forgive me if that is outside the bounds of conventional forum thinking.
> I am currently taking 150mgs of Zoloft, 2.5 mgs Zyprexa, and 1000 mgs of Depakote. I am still experiencing some fairly heavy depression and extreme anxiety. I am going to have a hard time expressing what I really feel like though. Basically I feel like I've had a minor lobotomy.
>
> A year and a half ago if I took 150 to 200 mgs of Zoloft it was too much for me. Then again, I was not on the other meds. Now, I feel like I can go as high as 200 and I start feeling better but I begin to get an awful constant ache in my brain. I've had a fairly consistent headache for much of this past year. Part of me wonders if being put under general anesthesia 4 times in one year did any damage to my brain. I just feel a lot of constant pressure in my head and I cannot seem to find my way out of the fog. I know this could be severe anxiety.
>
> I will get plenty of sleep, get a little exercise, hang out with friends, and still find my self yawning all day and night. I have definitely lost something in the past year and a half that I am desperate to get back. You can even see it on my face, I look like a zombie as my eyes are expressionless and my pupils are dilated.
>
> Could adding Nortriptyline to Zoloft help me? Can Nortriptyline help with anxiety? I've tried wellbutrin and it makes my body tremble.
>
> If I take Nortrityline does it have to be taken at night or can I try taking it in the morning? Your responses will be much appreciated.
>
> Morgan
Posted by SLS on December 6, 2009, at 6:02:14
In reply to Interested in Nortriptyline, posted by morganator on December 6, 2009, at 1:25:32
> Could adding Nortriptyline to Zoloft help me?
Some doctors are beginning to combine tricyclics with SRIs regularly for treating TRD. Nortriptyline makes a good choice because it has about the mildest side effects and does not usually disturb sleep.
> Can Nortriptyline help with anxiety?
Often, anxiety is a component of, or the result of, a depressive disorder, in which case, it can resolve as the depression resolves. My guess is that the anxiety associated with depression is variable and may depend on one's exposure to psychosocial stress, whether it be situationally or psychologically. I don't think that a tricyclic is very helpful for treating anxiety disorders.
> If I take Nortrityline does it have to be taken at night or can I try taking it in the morning?
I have always taken most of my dosage of nortriptyline in the morning. However, you might need to take it at night as you first initiate treatment, as it can produce transient somnolence. Unlike amitriptyline, I don't find nortriptyline to be at all sedating. I have combined it with Effexor and gleaned substantial benefit. However, it was not enough for me to want to commit to continuing with treatment indefinitely. As it turns out, I was significantly underdosed with nortriptyline. I will return to the combination if I am not happy with my current treatment.
- Scott
Posted by Phillipa on December 6, 2009, at 12:04:22
In reply to Re: Interested in Nortriptyline » morganator, posted by SLS on December 6, 2009, at 6:02:14
Back to the general anesthesia I had it two years ago and that started the wierd meds not working. I was told it's stored in fat tissue. So could it be a factor? Seriously? Phillipa
Posted by RocketMan on December 6, 2009, at 15:50:23
In reply to Interested in Nortriptyline, posted by morganator on December 6, 2009, at 1:25:32
Hey Morgan,
I think you stole my brain :-) We have allot in common and I've been feeling pretty much the same way you describe things. I'm on zoloft 100mg right now, just reduced from 150mg and have reduced zyprexa from 5mg to 2.5mg. Also taking lamictal 100mg and clonazepam 0.5mg/3 day.
I just finished a nortriptyline trial 2 weeks ago, it only lasted 10 days. I experienced terrible insomnia, an increase in my anxiety levels and throw in urine retention/enlarged prostate for good measure. I was taking 25mg at night.
I stopped the nortrip and replaced it with remeron 30mg to get me by until my next p/doc appointment in 2 weeks.I have read good things about nortrip/zoloft augmentation so it may work good for you, just thought I'd share my experience.
Take care, Rick
Posted by Bob on December 6, 2009, at 16:26:21
In reply to Re: Interested in Nortriptyline » morganator, posted by SLS on December 6, 2009, at 6:02:14
> > Could adding Nortriptyline to Zoloft help me?
>
> Some doctors are beginning to combine tricyclics with SRIs regularly for treating TRD. Nortriptyline makes a good choice because it has about the mildest side effects and does not usually disturb sleep.
>
> > Can Nortriptyline help with anxiety?
>
> Often, anxiety is a component of, or the result of, a depressive disorder, in which case, it can resolve as the depression resolves. My guess is that the anxiety associated with depression is variable and may depend on one's exposure to psychosocial stress, whether it be situationally or psychologically. I don't think that a tricyclic is very helpful for treating anxiety disorders.
>
> > If I take Nortrityline does it have to be taken at night or can I try taking it in the morning?
>
> I have always taken most of my dosage of nortriptyline in the morning. However, you might need to take it at night as you first initiate treatment, as it can produce transient somnolence. Unlike amitriptyline, I don't find nortriptyline to be at all sedating. I have combined it with Effexor and gleaned substantial benefit. However, it was not enough for me to want to commit to continuing with treatment indefinitely. As it turns out, I was significantly underdosed with nortriptyline. I will return to the combination if I am not happy with my current treatment.
>
>
> - Scott
Scott,Just as an aside... I did a search for MAOI's with Nortriptyline, and there were countless hits that came up about how you cannot take any Tricyclic with Parnate, or any other MAOI. What does your doctor say about this?
Bob
Posted by morganator on December 6, 2009, at 18:00:05
In reply to Re: Interested in Nortriptyline, posted by bleauberry on December 6, 2009, at 5:58:33
Thanks bleauberry. I actually have experienced these issues when I was totally off medications about 15 months ago. I agree that depakote and zyprexa, while controlling potential mania from recurring, are not helping me actually feel better.
I am just upset that I ever stopped Zoloft the first time around in 2007. I didn't feel great all the time on it but I was always able to sleep and take naps and when I worked out there was potential to feel great. After being off Zoloft for the first time in 7 or 8 years and the perfect storm of circumstances/stresses coming together(including abusing my already injured body working for my friends moving company during my summers off at the elementary school-for the first time in my life I was loosing my sense of physical well being and it was happening very quickly), I was sent into a brief major depression followed by a major mixed episode in which I could not sleep for more that 2 or 3 hours a night. Since then I have been on 12 different medications. My brain feels like a train wreck. When I was trying to be off medication over a year ago I began to experience weird things like nose tingling. I feel like I opened pandora's box a few years ago and there is no turning back.
I'm not sure if I will ever be the same. And I swear, the lack of proper chemical production in my brain is being felt in muscle function at times.
Posted by morganator on December 6, 2009, at 18:02:44
In reply to Re: Interested in Nortriptyline » morganator, posted by SLS on December 6, 2009, at 6:02:14
Thanks Scott
Posted by morganator on December 6, 2009, at 18:07:03
In reply to Re: Interested in Nortriptyline, posted by Phillipa on December 6, 2009, at 12:04:22
Yeah I deeply regret having surgery for many reasons. And if I did, I should have insisted on local anesthesia.
Posted by morganator on December 6, 2009, at 18:10:13
In reply to Re: Interested in Nortriptyline » morganator, posted by RocketMan on December 6, 2009, at 15:50:23
Thanks Rick. How are you feeling now? Yeah I may have to try Lamictal again but I don't think I can handle going very high. God I miss when I just took Zoloft. I mean, I still felt medicated sometimes and I was thirsty a lot but it was sooo much better than what I have experienced over this past year and a half.
Posted by RocketMan on December 6, 2009, at 18:24:26
In reply to Re: Interested in Nortriptyline » RocketMan, posted by morganator on December 6, 2009, at 18:10:13
The last 3 months have been hell....depression 90% of the day with some anxiety sprinkled in for good measure. Ya, 9 years ago all I took was zoloft 100mg and I was fine. The last 2 years seems like a merry-go-round of trials and failures. When I took my first dose of zyprexa 6 months ago, I thought I hit the jackpot.... that lasted about a month. Chronic lethargic mood and my life seems to be just a matter of existence, no pleasure. And I can only tolerate 100mg of lamictal, any higher and I get extremely irritable? I often question why I'm still taking the bloody stuff considering I'm depressed more often than not??
Anyway, good luck with your treatment and let us know how things work out.Take care, Rick
Posted by morganator on December 6, 2009, at 18:36:19
In reply to Re: Interested in Nortriptyline, posted by bleauberry on December 6, 2009, at 5:58:33
>I believe you can find benefit in the psychiatric toolbox. But it is almost 99% unlikely to happen with the meds you are currently taking. And though it would maybe take months or years, I think today is the day you should start researching what things cause depression, so that someday you can pinpoint your own problem and treat it, rather than merely relying on psych drugs to "maybe" mask the symptoms of it.
I agree with much of what you say. I've already decided that I may have to stop taking all the meds I am on even though I have had times when I have felt better. I believe there are underlying causes in my emotional psyche combined with the fact that I am bipolar, combining to cause much of my depression and anxiety. Currently my body is a wreck, I have no job or career, I wasted a ton of talent, and I feel totally lost at 37 years old. Because I feel such a mess in so many ways, I don't feel strong in the way I used to be, enabling me to maybe wait tables and meet new friends and restart my life. I don't have the focus or energy to go back to school for something I am passionate about. I live in a state of fear for the future and feel a great amount of loss in a short period of time. I have no escape. I cannot play my bass or drums like I used to because of my carpal tunnel issues. Every surgery I had this past year and a half left me worse off than before. I would have been better off just keeping on moving and working out and maybe getting lots of platelet plasma therapy. I wake up and get out of bed and feel like I have the body of a 70 year old. I have failed at so much, including taking care of myself, which has always been so important to me.
There are many reasons why I experience depression and anxiety the way I do. I have been thoroughly checked out by a very good primary care physician. I have been tested for Lyme Disease using the Western Blot test 3 times. The only thing that concerns me is that I could have some autoimmune disorder. Even if I do, I still have major issues with depression and anxiety that I have always had. My illness is rooted in biological and psychological causes. It has always been this way. I am also a very sensitive person. I find it odd that more people don't take what makes them human into account more often. I believe in the biological factors of the mind and body, but, I also believe in the emotional factors that can effect the biological.
Thanks again Blueaberry, you always give great and insight. I don't mind your approach at all.
Posted by morganator on December 6, 2009, at 18:42:53
In reply to Re: Interested in Nortriptyline » morganator, posted by RocketMan on December 6, 2009, at 18:24:26
Thanks Rick good luck to you also.
Posted by morganator on December 6, 2009, at 18:51:37
In reply to Re: Interested in Nortriptyline » morganator, posted by RocketMan on December 6, 2009, at 18:24:26
Thanks Rick good luck to you also. So are you bipolar??? Did you go undiagnosed for a long time and look back and realize that it all made sense?
The first time I was on an antidepressant I took Prozac. I realize now that I was having a fairly mild to moderate mixed episode. It was amazing though, after 3 weeks I woke up one day, took that little pill, and felt the best I had felt in years. I did have some hypomania, especially in the beginning. For the most part though, Prozac worked very very well. I miss those days and would love to feel good like that again. I was 22 years old so I understand that has much to do with it. Though, just 2 and a half years ago I was going to the gym and feeling great with good energy and stamina. I think the combination of being a few years older with everything I've been through has really left me feeling like a pile of you know what.
Posted by RocketMan on December 6, 2009, at 19:08:12
In reply to Re: Interested in Nortriptyline, posted by morganator on December 6, 2009, at 18:51:37
> Thanks Rick good luck to you also. So are you bipolar??? Did you go undiagnosed for a long time and look back and realize that it all made sense?
I have all the typical earmarks for bipolar 2 although my p/doc is the type not to "label". He prefers the term "mood disorder" as treatment strategies can be similar, whether bipolar or atypical depression. At least that what he tells me?? But yes, not until I started doing my own research on the internet did it all make sense. My mood fits quite nicely into the bipolar spectrum, soft, 2 or nos. Prior to that, in my mind, I was just an irritable person with depression?
> The first time I was on an antidepressant I took Prozac. I realize now that I was having a fairly mild to moderate mixed episode. It was amazing though, after 3 weeks I woke up one day, took that little pill, and felt the best I had felt in years. I did have some hypomania, especially in the beginning. For the most part though, Prozac worked very very well. I miss those days and would love to feel good like that again. I was 22 years old so I understand that has much to do with it. Though, just 2 and a half years ago I was going to the gym and feeling great with good energy and stamina. I think the combination of being a few years older with everything I've been through has really left me feeling like a pile of you know what.
Quite similar to my experience 9 years ago when I first started zoloft. I was a raging lunatic for a week, then I felt like god....quite the narcissist! Long gone are my days of pumping iron at the gym, protein shakes, having that ripped body and feeling like the world was there for the taking!
Geez, now I'm starting to feel really depressed :-(
Posted by morganator on December 6, 2009, at 19:54:58
In reply to Re: Interested in Nortriptyline, posted by RocketMan on December 6, 2009, at 19:08:12
I can totally relate. I feel like the change has happened sooo suddenly for me. I know it has much to do with all the damage, stress and depression. Age plays a role to certain degree but given my genes and looking at the rest of my family, I know I should be feeling much younger, fresh, stronger, and energetic than I am now. Ugh!! It is depressing!!
Morgan
Posted by Phillipa on December 6, 2009, at 21:19:38
In reply to Re: Interested in Nortriptyline, posted by morganator on December 6, 2009, at 19:54:58
Hey you guys are young me the old batty 63 year old is feeling the same. We will get to the bottom of the mystery keep googling til your computers explode!!!! Got that listen to your elders my Kids don't but then they are grown up. Love Phillipa Jan whatever
Posted by morganator on December 6, 2009, at 23:58:14
In reply to Re: Interested in Nortriptyline, posted by bleauberry on December 6, 2009, at 5:58:33
I'm afraid that being on so many meds has left my brain in worse shape that it was before. I think being on zyprexa for the last 6 months has left my brain in worse shape, despite maybe helping with some of my symptoms.
I don't know if I can afford to go through another shift in meds and take the time to clean out. I haven't worked in a year and a half and everyone is pressuring me to get a job. It sucks because I don't think I'm close to really feeling better. Everyone thinks working will help me feel better. I hope it does. This sucks so bad.
This is the end of the thread.
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