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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by papillon2 on May 30, 2012, at 9:20:22
I have been on the same dose of Nortriptyline (100mg) since August/September but over the past 1.5 months I've experienced a rapid worsening of side effects - severe constipation, urinary retention, moderately increased hunger/appetite, worsening dry eyes and what looks like massive weight gain but is not really showing much on the scales -- my abdomen in particular is blown up like a massive balloon and physically hurts. I seriously look pregnant but I'm not (meanwhile my back looks emaciated and my ribs are more prominant, WTF?). The blimp effect worsens as the day goes on. Went to GP yesterday and have been prescribed Movicol, but all it's doing so far is causing massive rumbling in my intestines and more gas.
Has anyone ever experienced a sudden worsening of side effects on Nortriptyline? I don't understand what the hell is happening to me. I noticed the packaging has changed recently (same generic, just a differently shaped box) -- could a different batch be the problem?
On top of it I feel profoundly depressed. Back to spending all day in bed. Can't be bothered doing anything, including showering. Suicidal ideation high (but am safe). Adverse to going out in public not just because it involves doing something but also because I'm so repulsive and don't want to have contact with anyone. Adverse to answering the phone. When I do go out for groceries (only reason to go out besides dr appointments) I'm like a deer in headlights, confused and can't make decisions. It takes a ridiculous amount of time to do anything. And I'm being ripped to shreds by ED thoughts (not surprising given my body is being taken over by aliens. Metaphorically speaking. I'm not delusional).
I feel like stopping Nortriptyline and throwing in the towel. But I'm acutely aware that any other treatment options are worse. Doxepin (fat, zombified and dietary/med restrictions which will make my allergies flare), ECT (more memory and cognitive problems) and Epilim (fat, bald and hormonally screwed) is what's being offered. In any case, I'm probably just not trying hard enough. I'm just a fat f***ing failure.
Depression sucks. Treatment sucks. Blah blah whinge moan. But back to my original question -- has anyone experienced a sudden worsening of side effects? None of this makes sense. Even my GP is confused.
Signed Papillon the Fail Whale
Posted by g_g_g_unit on May 30, 2012, at 9:36:47
In reply to Sudden worsening of Nortriptyline side effects, posted by papillon2 on May 30, 2012, at 9:20:22
>Doxepin (fat, zombified and dietary/med >restrictions which will make my allergies flare), >ECT (more memory and cognitive problems) and Epilim >(fat, bald and hormonally screwed) is what's being >offered.
Sorry to hear things have taken a turn for the worse, p.
Why only those three options? What about Clomipramine? MAOIs?
Posted by Phillipa on May 30, 2012, at 10:15:16
In reply to Re: Sudden worsening of Nortriptyline side effects » papillon2, posted by g_g_g_unit on May 30, 2012, at 9:36:47
I'm sorry also. Did you doc suggest any reason? Phillipa
Posted by bleauberry on May 30, 2012, at 17:07:26
In reply to Sudden worsening of Nortriptyline side effects, posted by papillon2 on May 30, 2012, at 9:20:22
Well, this is just my opinion, ok.
Whenever a med makes things worse....doesn't matter when....right away, early, later, months, whatever....then one way or the other it has gone sour. Maybe it did too much of what it was desired to do and went too far creating a new imbalance. Maybe it took a while to build up in the bloodstream. Maybe it took a while to cause some brain adjustments which happened to be undesirable ones. Ya know? Stuff can go wrong at any time.
I am not a fan of nortriptyline monotherapy but I am a big fan of combo therapy using it. Such as with zoloft or prozac. The missing link of serotonin could explain everything that is happening with you right now and mere addition of a small dose of ssri could help with all that.
The urinary retention is bad. Might seem like a nuisance, but it can turn much more nasty than a nuisance. Much worse problems down the road....many months, couple years. So you either have to abandon all meds that cause that to happen or else you will have to take flomax or similar to combat it.
Posted by papillon2 on May 30, 2012, at 20:20:40
In reply to Re: Sudden worsening of Nortriptyline side effects » papillon2, posted by g_g_g_unit on May 30, 2012, at 9:36:47
> >Doxepin (fat, zombified and dietary/med >restrictions which will make my allergies flare), >ECT (more memory and cognitive problems) and Epilim >(fat, bald and hormonally screwed) is what's being >offered.
>
> Sorry to hear things have taken a turn for the worse, p.
>
> Why only those three options? What about Clomipramine? MAOIs?I don't know why those three. Taking a MAOI was discussed in the same sentence as Doxepin but they never said which one.
I could be convinced into taking Parnate, MAYBE, but only if I could continue taking my anti-histamine. I don't think it's indicated for melancholic depression though? My current funk seems situational but it isn't the usual for me.
Clomi... hasn't been discussed. Wiki says it can induce schizophrenia. Anyone know what the incidence of that is? With an uncle with schizophrenia I'm not sure I want to risk it... :s
Posted by papillon2 on May 30, 2012, at 20:24:16
In reply to Re: Sudden worsening of Nortriptyline side effects, posted by Phillipa on May 30, 2012, at 10:15:16
> I'm sorry also. Did you doc suggest any reason? Phillipa
No, only that Nortriptyline would likely be causing the constipation and that the constipation is likely causing the urinary retention. So we're treating with Movicol and seeing if the urinary problem remains afterwards.
Man, I feel like a hippo.
Posted by papillon2 on May 30, 2012, at 20:33:24
In reply to Re: Sudden worsening of Nortriptyline side effects, posted by bleauberry on May 30, 2012, at 17:07:26
> Well, this is just my opinion, ok.
>
> Whenever a med makes things worse....doesn't matter when....right away, early, later, months, whatever....then one way or the other it has gone sour. Maybe it did too much of what it was desired to do and went too far creating a new imbalance. Maybe it took a while to build up in the bloodstream. Maybe it took a while to cause some brain adjustments which happened to be undesirable ones. Ya know? Stuff can go wrong at any time.Yeah, you're right. Thanks for that.
> I am not a fan of nortriptyline monotherapy but I am a big fan of combo therapy using it. Such as with zoloft or prozac. The missing link of serotonin could explain everything that is happening with you right now and mere addition of a small dose of ssri could help with all that.Should have mentioned my full cocktail:
Nortriptyline 100mg
Lamictal 200mg
Melatonin 4mg
Aspirin, anti-histamine, supplements.All docs I've seen in Australia are against mixing more than one anti-depressant together due to the risk of seretonin syndrome. So my chances of adding an SSRI are slim to none!
Out of interest though, do you know if SSRIs ever work in conjunction with other meds if they don't help you by themselves? My track record with SSRIs isn't good.
> The urinary retention is bad. Might seem like a nuisance, but it can turn much more nasty than a nuisance. Much worse problems down the road....many months, couple years. So you either have to abandon all meds that cause that to happen or else you will have to take flomax or similar to combat it.Yeah, my GP mentioned I might have to drop back to 75mg or cease Nortriptyline entirely if the urinary problem doesn't go away. Will look into Flomax.
Thanks Bleau
Posted by Phillipa on May 30, 2012, at 20:59:08
In reply to Re: Sudden worsening of Nortriptyline side effects » Phillipa, posted by papillon2 on May 30, 2012, at 20:24:16
I'm sorry truly am but I'm not sure how constipation effects or causes urinary retention? Phillipa
Posted by g_g_g_unit on May 31, 2012, at 1:20:05
In reply to Re: Sudden worsening of Nortriptyline side effects, posted by papillon2 on May 30, 2012, at 20:20:40
> > I could be convinced into taking Parnate, MAYBE, but only if I could continue taking my anti-histamine. I don't think it's indicated for melancholic depression though? My current funk seems situational but it isn't the usual for me.
Oh, my apologies. I didn't think to question the flavor of your affliction. I'm not sure how interchangeable the MAOIs re: melancholic vs. atypical depression. I know there is a thread in the archives titled "Parnate not good for melancholic" or something along those lines . .
>
> Clomi... hasn't been discussed. Wiki says it can induce schizophrenia. Anyone know what the incidence of that is? With an uncle with schizophrenia I'm not sure I want to risk it... :sStrange, I was under the impression Clomipramine blocked D2, which should help psychotic conditions?
Posted by g_g_g_unit on May 31, 2012, at 1:58:04
In reply to Re: Sudden worsening of Nortriptyline side effects » papillon2, posted by g_g_g_unit on May 31, 2012, at 1:20:05
p.s. I don't know if you've already been on Epilim, but I personally hated it -- I felt dulled, stuporous etc.
I don't know if you're in a position to self-medicate, but if I suffered from melancholic depression, I'd totally capitalize on the chance to try Stablon (via mailorder). Since I have atypical depression, it just exacerbated my symptoms, but I hear it should work for melancholic.
Posted by psychobot5000 on June 2, 2012, at 0:33:27
In reply to Re: Sudden worsening of Nortriptyline side effects, posted by g_g_g_unit on May 31, 2012, at 1:58:04
> p.s. I don't know if you've already been on Epilim, but I personally hated it -- I felt dulled, stuporous etc.
>
> I don't know if you're in a position to self-medicate, but if I suffered from melancholic depression, I'd totally capitalize on the chance to try Stablon (via mailorder). Since I have atypical depression, it just exacerbated my symptoms, but I hear it should work for melancholic.Stablon is awesome! And often side-effect free! I took it for years, and prefer it to SSRIs or tricyclics.
I don't know your case well, but I thought I'd throw a thought out there: around the time things took a turn for the worse, did you make any other change in medication, or supplementation, perhaps? I'm just wondering if there could have been a metabolic (i.e. liver) interaction that's changed the blood-levels of the nortrip in your system, presumably raising them and causing the increased side-effects. Has your doc taken blood-levels of the medication? Might be worth checking that you're in the therapeutic range.
On an unrelated note, according to wikipedia, nortrip has a reputation for working initially, then stopping, possibly due to some 'toxic' metabolite. However the article does not mention a pattern of side-effects suddenly going out of control like this, so I don't know how useful that is.
Re: schizophrenia, unless you have a parent, brother or sister who has it, I think the benefits of taking something like clomipramine are worth the risks (which likely are not high, in any case). It is the most effective tricyclic. That said, if you don't like SSRIs, that drug may not be the way to go, as its profile is somewhat similar (like a cross between imipramine and an SSRI, with features of both). That said...if doctors there don't like combining antidepressants, clomipramine may be just the thing, since it's almost a combination drug on its own.
MAOis are statistically better than tricyclics for atypical depression, but I'm not aware of any reverse law that indicates they're worse for melancholic depression. Statistically, MAOis are simply the most powerful drugs we have (clomipramine, effexor and remeron are also probably slightly better than SSRIs, according to meta-analyses).
Posted by papillon2 on June 2, 2012, at 10:25:31
In reply to Re: Sudden worsening of Nortriptyline side effects, posted by psychobot5000 on June 2, 2012, at 0:33:27
> I don't know your case well, but I thought I'd throw a thought out there: around the time things took a turn for the worse, did you make any other change in medication, or supplementation, perhaps? I'm just wondering if there could have been a metabolic (i.e. liver) interaction that's changed the blood-levels of the nortrip in your system, presumably raising them and causing the increased side-effects. Has your doc taken blood-levels of the medication? Might be worth checking that you're in the therapeutic range.
Unfortunately there have been no recent med or supplement changes at which to point a finger. Getting another blood level done is a fantastic idea, however. Thank you! :-)
> Re: schizophrenia, unless you have a parent, brother or sister who has it, I think the benefits of taking something like clomipramine are worth the risks (which likely are not high, in any case). It is the most effective tricyclic. That said, if you don't like SSRIs, that drug may not be the way to go, as its profile is somewhat similar (like a cross between imipramine and an SSRI, with features of both). That said...if doctors there don't like combining antidepressants, clomipramine may be just the thing, since it's almost a combination drug on its own.
Re: SSRIs, it's more that those I've tried have never done very much for me. My first, Luvox, either made me catatonic or didn't prevent my depression worsening to that state. The second, Celexa, improved my condition enough for me to be discharged from hospital only to attempt suicide suicide two weeks later. I don't recall any side effects.I hypothesize that I need a good amount of noradrenalin/norepinephrine action. Seretonin alone isn't enough. My depression was treated fairly successfully by Effexor XR for 7 years but then the medication stopped working and/or my depression worsened/morphed. Probably both. I had a reasonable response to Remeron but the side effects (weight gain and related anxiety / threat of ED relapse) were intolerable.
> MAOis are statistically better than tricyclics for atypical depression, but I'm not aware of any reverse law that indicates they're worse for melancholic depression. Statistically, MAOis are simply the most powerful drugs we have (clomipramine, effexor and remeron are also probably slightly better than SSRIs, according to meta-analyses).
I did not mean to suggest that MAOIs are bad for melancholic depression, I have just read that they are better suited to atypical depression.Thank you for weighing in. I'll go get that blood test this week. Last reading was 500ng/mL - top of the therapeutic window.
Posted by creepy on June 8, 2012, at 6:23:54
In reply to Sudden worsening of Nortriptyline side effects, posted by papillon2 on May 30, 2012, at 9:20:22
some people dont do well on TCA's.. severe constipation is something Ive heard about before.
You may even want to consult a gastro doc about it.
This is the end of the thread.
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