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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by inanimate peanut on July 10, 2010, at 16:28:15
Well, I just took my first nortriptyline. I took my Parnate early this morning at about 9am to space them out. My BP before starting the nortriptyline was 104/71 and I took 10mg. I'll monitor my BP every 15 min or so. Is there anything besides blood pressure that I should be attuned to? Here's hoping that nortriptyline is the magic ingredient!
This makes my meds:
Nortriptyline
Parnate
Geodon
Lamictal
Topamax
Mirapex
Perphenazine
Ambien
Seroquel
Levothyroxine
FIsh Oil
N-Acetyl Cysteine
Co Q10
Vitamin D
Emergen C
Multi
Posted by Phillipa on July 10, 2010, at 16:37:39
In reply to Nortriptyline day 1, posted by inanimate peanut on July 10, 2010, at 16:28:15
Good luck. Two mood stabalizers and two antipsychotics? Didn't realize you were on so many meds. Phillipa. How you feeling now?
Posted by inanimate peanut on July 10, 2010, at 16:45:52
In reply to Re: Nortriptyline day 1 » inanimate peanut, posted by Phillipa on July 10, 2010, at 16:37:39
The topamax does nothing for mood control-- it stuck around for weight management. Oh, I forgot to add that we just add amantadine for weight-- i haven't even taken it yet. the seroquel also does nothing for mood and is there for sleep only. I am on a ton of meds, most of which do just barely enough to keep them around. I'm hoping if the nortriptyline puts me to sleep i can get rid of the seroquel!
Posted by ed_uk2010 on July 10, 2010, at 18:16:15
In reply to Nortriptyline day 1, posted by inanimate peanut on July 10, 2010, at 16:28:15
> Nortriptyline
> Parnate
> Geodon
> Lamictal
> Topamax
> Mirapex
> Perphenazine
> Ambien
> Seroquel
> LevothyroxinePeanut,
This is only my opinion, which I am stating out of concern for your health - it is not a criticism of you or your doctor.......
I think your medication regimen is overcomplicated and could potentially be simplified whilst at the same time improving your mental and physical health.
It is very unusual to be on three different antipsychotics (Seroquel, perphenazine and Geodon) at the same time, is there a definite reason for this? Also, since antipsychotics are dopamine antagonists and Mirapex is a dopamine agonist, this combination does not seem logical.
I understand that you're taking Topamax to control your weight. This can be problematic. Topamax can cause serious adverse effects such as kidney stones in the long term. There is also a risk of psychiatric side effects. Reducing your antipsychotic medication might help to reduce your weight and allow you to stop Topamax. If weight loss medication is still necessary, orlistat (Xenical) might help. It is generally a safe med but it does tend to cause diarrhoea.
Regarding the nortriptyline, the dose should be increased very gradually under the supervision of your psychiatrist. EKG monitoring might be advisable since you are taking several medications in combination which can occasionally cause arrhythmias in their own right: nortriptyline, perphenazine and Geodon.
Posted by inanimate peanut on July 10, 2010, at 19:11:32
In reply to Re: Nortriptyline day 1, posted by ed_uk2010 on July 10, 2010, at 18:16:15
I agree that my med regimen is one total mess. I definitely need to stay on the Parnate. That is the only thing I am certain of on my med regimen. I think I need to stay on the Geodon since I'm pretty certain it's what's controlling the mixed states and it may have a barely perceptible impact on the depression. I would honestly be willing to try to go without the Geodon except I have a strange thing that once I go off a med, it no longer works for me anymore, so I don't get to experiment like that. I would like to decrease the Geodon as it's making my hair fall out. Mirapex, although competing with Geodon, does help my motivation and anhedonia some, so I am slow to give it up. The rest of my meds are ridiculous-- seroquel is for sleep but I don't even think it works anymore because I went off it for awhile and things generally don't work when I go off of them and then back on them. Perphenazine is for sleep. Topamax is for binge eating, which xenical wouldn't necessarily help with. We just added amantidine, so maybe we'll be able to get rid of the topamax. I'm not sure if it even works anymore. I don't think lamictal works anymore but am too scared to get off of it just in case it is doing something. I've just burned myself so many times in the past by stopping a med and then not having it work when I went back on it that I stay on everything for fear of what they might have been doing won't work again if I go back on them. AAAAAAHHHHH! It is so frustrating. I just have to keep piling meds on meds because I can't risk getting rid of any meds because I have very few options left and I'm only 30. I did have a recent EKG which was fine. I can't even get any tests for the nortriptyline because my doc refuses to prescribe it. I have to hide it from her for risk that she'll stop prescribing parnate if she knows I'm on it. She thinks it's too dangerous despite the lovely journal articles I so carefully prepared for her. I think it's dangerous too, which is why I now have permanent BP cuff marks on my arms and readings every quarter hour for the past 3 hours after taking 10mg Nortriptyline. I hope the blood tests aren't too important, because I have no way to get those. Yes, I know I should do this under the care of a psychiatrist and that would be lovely. I made a deal with myself that I would try all the other ideas with my psychiatrist first and save this as a last resort and here I am. It's my responsibility now. Yes, I understand that my entire case is a "what not to do" of psychiatry. I really appreciate your concern, so I hope that this doesn't come across like I don't. I'm just frustrated and don't know how to make it better. If the nortriptyline helps me sleep and I can at least get off the perphenazine and seroquel, that's at least one step. I'm just so frustrated with it all right now. Thanks for caring, though. I appreciate it.
Posted by Phillipa on July 10, 2010, at 20:16:12
In reply to Re: Nortriptyline day 1, posted by inanimate peanut on July 10, 2010, at 19:11:32
Peanut seriously I'm also worried as Ed does know his meds. Anyway you would or could be hospitalized during this trial. You say you're living alone should you be alone at this time? Love Phillipa
Posted by inanimate peanut on July 10, 2010, at 20:46:47
In reply to Re: Nortriptyline day 1 » inanimate peanut, posted by Phillipa on July 10, 2010, at 20:16:12
The doctors at the hospitals wouldn't prescribe this either. TCA/MAOI combos, despite the strong evidence to the contrary, are still considered too dangerous. This is my last ditch effort. I put this up on a shelf several months ago when I wanted to do it and said that I would try everything else first. I've tried everything else. This is my chance to feel normal. You better believe I am being more careful than I have ever been (spent all afternoon taking my BP and reading about how to recognize serotonin syndrome), but I am doing this and unfortunately have to do it alone. I appreciate your caring more than you know, but I just don't feel like I have any other choice. I took 10mg at 4:11-- BP every 15 min since have never been over 120/80, temp steady and never over 97 degrees (I run low), and no agitation or other strange feelings. I have friends that are "on call" to take me to the hospital at the slightest hint of a symptom! I promise, Philipa, I'm taking good care of myself. Thanks so much for caring, but desperate people unfortunately must do desperate things.
Posted by atypical on July 10, 2010, at 21:23:45
In reply to Re: Nortriptyline day 1, posted by inanimate peanut on July 10, 2010, at 19:11:32
ipeanut,
My best wishes for your mental health as well. A question for you, and pardon me if I missed a posting which already answered this question, but: where did you get the nortriptyline from if your doctor(s) won't prescribe it in the first place?
atypical
Posted by morgan miller on July 10, 2010, at 23:29:07
In reply to Re: Nortriptyline day 1, posted by atypical on July 10, 2010, at 21:23:45
It was ordered online from on overseas pharmacy.
Posted by polarbear206 on July 11, 2010, at 7:24:20
In reply to Re: Nortriptyline day 1, posted by ed_uk2010 on July 10, 2010, at 18:16:15
> > Nortriptyline
> > Parnate
> > Geodon
> > Lamictal
> > Topamax
> > Mirapex
> > Perphenazine
> > Ambien
> > Seroquel
> > Levothyroxine
>
> Peanut,
>
> This is only my opinion, which I am stating out of concern for your health - it is not a criticism of you or your doctor.......
>
> I think your medication regimen is overcomplicated and could potentially be simplified whilst at the same time improving your mental and physical health.
>
> It is very unusual to be on three different antipsychotics (Seroquel, perphenazine and Geodon) at the same time, is there a definite reason for this? Also, since antipsychotics are dopamine antagonists and Mirapex is a dopamine agonist, this combination does not seem logical.
>
> I understand that you're taking Topamax to control your weight. This can be problematic. Topamax can cause serious adverse effects such as kidney stones in the long term. There is also a risk of psychiatric side effects. Reducing your antipsychotic medication might help to reduce your weight and allow you to stop Topamax. If weight loss medication is still necessary, orlistat (Xenical) might help. It is generally a safe med but it does tend to cause diarrhoea.
>
> Regarding the nortriptyline, the dose should be increased very gradually under the supervision of your psychiatrist. EKG monitoring might be advisable since you are taking several medications in combination which can occasionally cause arrhythmias in their own right: nortriptyline, perphenazine and Geodon.Very good advice.
Posted by inanimate peanut on July 11, 2010, at 9:46:28
In reply to Re: Nortriptyline day 1, posted by atypical on July 10, 2010, at 21:23:45
Hong Kong-- I don't think I'm actually allowed to say the pharmacy on here. It was recommended to me by another babbler that had used it before. Yes, I am aware of the dangers of using overseas pharmacies.
Posted by inanimate peanut on July 11, 2010, at 10:02:01
In reply to Re: Nortriptyline day 1, posted by polarbear206 on July 11, 2010, at 7:24:20
> > > Nortriptyline
> > > Parnate
> > > Geodon
> > > Lamictal
> > > Topamax
> > > Mirapex
> > > Perphenazine
> > > Ambien
> > > Seroquel
> > > Levothyroxine
> >
> > Peanut,
> >
> > This is only my opinion, which I am stating out of concern for your health - it is not a criticism of you or your doctor.......
> >
> > I think your medication regimen is overcomplicated and could potentially be simplified whilst at the same time improving your mental and physical health.
> >
> > It is very unusual to be on three different antipsychotics (Seroquel, perphenazine and Geodon) at the same time, is there a definite reason for this? Also, since antipsychotics are dopamine antagonists and Mirapex is a dopamine agonist, this combination does not seem logical.
> >
> > I understand that you're taking Topamax to control your weight. This can be problematic. Topamax can cause serious adverse effects such as kidney stones in the long term. There is also a risk of psychiatric side effects. Reducing your antipsychotic medication might help to reduce your weight and allow you to stop Topamax. If weight loss medication is still necessary, orlistat (Xenical) might help. It is generally a safe med but it does tend to cause diarrhoea.
> >
> > Regarding the nortriptyline, the dose should be increased very gradually under the supervision of your psychiatrist. EKG monitoring might be advisable since you are taking several medications in combination which can occasionally cause arrhythmias in their own right: nortriptyline, perphenazine and Geodon.
>
> Very good advice.I agree that it's all very good advice. I just feel very stuck right now. I'm doing the best I feel I can under the circumstances. I'm going to try to get off the perphenazine and seroquel and I'm thinking more seriously about the Topamax (I just don't know what else to do for binge eating). I'll try to get another EKG based on being on the perphenazine and the Geodon, but I doubt that will be enough for my doc to order it. The only reason they did the EKG before is to prep me for ECT. As for the nortriptyline, that's all on me. That can't be helped. I've tried with my doc until I've got no other articles and no other arguments and I've got to give it a try. I have no other options right now.
Posted by janejane on July 11, 2010, at 10:30:57
In reply to Re: Nortriptyline day 1, posted by inanimate peanut on July 11, 2010, at 10:02:01
Hi Peanut. :-) Is your BP still OK on day 2? Have you taken additional doses? Thanks for keeping us worried folks updated.
Posted by inanimate peanut on July 11, 2010, at 12:52:35
In reply to still doing OK? » inanimate peanut, posted by janejane on July 11, 2010, at 10:30:57
My BP from day 1 stayed fine until bed. I haven't taken my day 2 dose yet. I have a Bible Study at 3pm so I was going to take it after that. I will keep everyone posted how that goes. It shouldn't be any different from yesterday as I plan on doing the 10mg again.
Posted by europerep on July 11, 2010, at 13:30:13
In reply to Nortriptyline day 1, posted by inanimate peanut on July 10, 2010, at 16:28:15
I guess the point is also that there are so many molecules which all concentrate in the same brain regions, that they'll interaffect each other so much that you actually aren't able to say whether a med you added is responsible for an effect, or its interactions, etc.. I don't mean to hit on you, I see that you are in a desperate situation, and I can understand you I believe, but I would be surprised if such a chaotic regimen could ever work.. how bad are you feeling currently, compared to the worst point where you were lately? if there is no huge difference, then I would really say drop at least some of the meds you are taking - you say you believe they hardly do anything, and you are obviously already feeling very bad - so that nortriptyline plus parnate can actually do its work.. I am sure none of the studies you found had patients with other meds being taken, other than maybe a sleeping agent, and you will not reproduce their results like this.. sorry, but I think if everyone on here and their psychiatrists could find ONE consensus, it's that the number of meds should be as low as possible, and maybe 3 is already too much..
also, I would suggest having a fixed time at which you take the nortriptyline. like 3PM, not something afternoonish.. that way the daily blood level will be more steady, which might be essential for a rapid onset and good efficacy..
good luck!
Posted by ed_uk2010 on July 11, 2010, at 13:39:05
In reply to Re: Nortriptyline day 1, posted by inanimate peanut on July 10, 2010, at 19:11:32
>I agree that my med regimen is one total mess. I definitely need to stay on the Parnate. That is the only thing I am certain of on my med regimen. I think I need to stay on the Geodon since I'm pretty certain it's what's controlling the mixed states and it may have a barely perceptible impact on the depression. I would honestly be willing to try to go without the Geodon except I have a strange thing that once I go off a med, it no longer works for me anymore, so I don't get to experiment like that. I would like to decrease the Geodon as it's making my hair fall out.
OK, stick with the Geodon for now. If the nortriptyline helps your depression, perhaps you could consider a small reduction in your Geodon dose.
>Mirapex, although competing with Geodon, does help my motivation and anhedonia some, so I am slow to give it up.
I get the impression that most people find that the motivational benefits of Mirapex tend to 'poop out' after a while. I'm not sure that it's a good med to take long term (except for Parkinson's disease). I think you should review whether you still need Mirapex once the nortriptyline kicks in.
>The rest of my meds are ridiculous-- seroquel is for sleep but I don't even think it works anymore because I went off it for awhile and things generally don't work when I go off of them and then back on them. Perphenazine is for sleep.
I think you should consider tapering them both if your doctor agrees. You should probably wait until your nortriptyline dose is stable because if you make too many changes at once you won't know 'what's doing what'.
>Topamax is for binge eating, which xenical wouldn't necessarily help with. We just added amantadine, so maybe we'll be able to get rid of the topamax.
Amantadine can cause psychiatric adverse effects in its own right. I think you should manage the binge eating by reducing the use of drugs which contribute to it eg. Seroquel. Combining amantadine with antipsychotics is controversial. Adding more drugs to deal with drug side effects can lead to more problems than it solves.
>I don't think lamictal works anymore but am too scared to get off of it just in case it is doing something.
Stick with it for now. At least it's normally well tolerated, especially at doses less than 200mg per day.
>I have to hide it from her for risk that she'll stop prescribing parnate if she knows I'm on it.
I honestly think that you have to tell her. Once she sees that you are 'still alive' on the combination, she might be willing to prescribe nortriptyline herself.
>I hope the blood tests aren't too important, because I have no way to get those.
Most psychiatrists do not do nortriptyline levels.
Perhaps in a few weeks you're psych meds could be........
Parnate
Nortriptyline
Geodon
Lamictal
Ambien
Posted by morgan miller on July 11, 2010, at 14:10:08
In reply to Re: Nortriptyline day 1, posted by ed_uk2010 on July 11, 2010, at 13:39:05
Good advice...
I too think that things like seroquel need to be dropped instead of adding another medication for the food binging issues.
I think if you feel well enough soon you should consider joining a gym and adding a exercise to your regular regimen. I find moderate to intense exercise to be most beneficial(for 15 to 20 periods, no longer), but that is just me. Actually the brain healing benefits and appetite suppressing benefits are probably best attained from moderate to intense bursts of exercise. Other benefits for the heart and lungs are also better attained this way.
Posted by ed_uk2010 on July 11, 2010, at 15:50:58
In reply to Re: Nortriptyline day 1 » ed_uk2010, posted by morgan miller on July 11, 2010, at 14:10:08
>I too think that things like seroquel need to be dropped instead of adding another medication for the food binging issues.
True, and once perphenazine (potent dopamine antagonist) has been stopped, Mirapex (dopamine agonist) probably won't be necessary.
Posted by inanimate peanut on July 11, 2010, at 17:39:38
In reply to Re: Nortriptyline day 1 » inanimate peanut, posted by europerep on July 11, 2010, at 13:30:13
The idea is going to be to take Nortriptyline at bedtime. The only reason I take it earlier now is so I'm awake to monitor for any adverse effects. Right now my life kind of dictates when I take it because I have to take it after I am home for the day so I can monitor BP and temp and I like to take it early evening if possible so I have 4-5 good hours to monitor. Once I am stable, I will take it at bedtime so it will always be the same time daily.
Posted by inanimate peanut on July 11, 2010, at 17:50:05
In reply to Re: Nortriptyline day 1 » ed_uk2010, posted by morgan miller on July 11, 2010, at 14:10:08
Amazingly through all this I've kept my job teaching water aerobics. It's not as high-impact as when I used to teach step aerobics but it's still a cardio workout 4 days a week for an hour. I believe I would get worse if I stopped doing this, so I somehow manage to keep it up no matter how badly I feel. I don't get exercise high's anymore, though-- even when I do land exercise and get my heart rate way up, it doesn't change my mood unfortunately.
Posted by inanimate peanut on July 11, 2010, at 20:54:58
In reply to Re: Nortriptyline day 1, posted by inanimate peanut on July 11, 2010, at 17:50:05
20mg Nortriptyline- at 3 hours from dose, all is well BP range 96/55-116/72 and temp range 97.9-98.4 (started higher before dose today, so not higher because of nortrptyline)
Posted by inanimate peanut on July 11, 2010, at 20:58:01
In reply to Re: Nortriptyline day 1, posted by inanimate peanut on July 11, 2010, at 17:50:05
I'm checking my BP every 15 min and temp every hour for the first 3 hours after dosing then both every hour after than until I go to bed. Is that excessive? Do I need to check my BP that often? I don't mind doing it, but I was just wondering how often I need to be checking and for how long. Will the reaction occur within a certain time frame from dosing or can it occur at any time?
Posted by Phillipa on July 11, 2010, at 21:26:00
In reply to Nortriptyline day 2, posted by inanimate peanut on July 11, 2010, at 20:54:58
You went up to 20mg? or did I read it wrong? Phillipa
Posted by Dan_MI on July 12, 2010, at 9:22:24
In reply to am I too careful?, posted by inanimate peanut on July 11, 2010, at 20:58:01
I think it would be impossible for you to be too cautious with what you are attempting. I'm worried for you.
checking my BP every 15 min and temp every hour for the first 3 hours after dosing then both every hour after than until I go to bed. Is that excessive? Do I need to check my BP that often? I don't mind doing it, but I was just wondering how often I need to be checking and for how long. Will the reaction occur within a certain time frame from dosing or can it occur at any time?
Posted by inanimate peanut on July 12, 2010, at 10:35:22
In reply to Re: am I too careful?, posted by Dan_MI on July 12, 2010, at 9:22:24
There are people who add nortriptyline to Parnate all the time. The difference is that I don't have a doc following me. My doc sees me every 2 months anyway, so I'm not sure what the difference would be if she did know.
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