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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by BusuB on March 20, 2014, at 18:02:20
I've been on 10mg Prozac for PD for the last 9.5 weeks and was still having difficulty sleeping and breakthrough anxiety. I'd been taking 50mg Trazodone for the sleep part which was nice but left me incredibly groggy. When I called my pdoc for a refill, he suggested 10mg Nortriptyline, which I've done for the last 3 nights. While I have been sleeping through the night (as predicted by pdoc), I notice that I've been feeling extra edgy lately as if I'd consumed too much caffeine.
Can this be an effect of the Nortriptyline, even at such a low dose? Also, I understand that Prozac slows the metabolism of Nortriptyline to a certain extent, making lower doses more potent. Does anyone know how much more potent Nortriptyline becomes in this instance?
Posted by SLS on March 21, 2014, at 5:03:43
In reply to Adding low dose Nortrityline to Prozac, posted by BusuB on March 20, 2014, at 18:02:20
> I've been on 10mg Prozac for PD for the last 9.5 weeks and was still having difficulty sleeping and breakthrough anxiety.
What about increasing the dosage of Prozac? 20 mg/day is normally the minimum maintenance dose.
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From the Prozac package label:
"Panic Disorder
Initial Treatment In the controlled clinical trials of fluoxetine supporting its effectiveness in the treatment of panic disorder, patients were administered fluoxetine doses in the range of 10 to 60 mg/day [see Clinical Studies].
Treatment should be initiated with a dose of 10 mg/day. After one week, the dose should be increased to 20 mg/day. The most frequently administered dose in the 2 flexible-dose clinical trials was 20 mg/day."
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> I'd been taking 50mg Trazodone for the sleep part which was nice but left me incredibly groggy. When I called my pdoc for a refill, he suggested 10mg Nortriptyline, which I've done for the last 3 nights. While I have been sleeping through the night (as predicted by pdoc), I notice that I've been feeling extra edgy lately as if I'd consumed too much caffeine.
>
> Can this be an effect of the Nortriptyline, even at such a low dose? Also, I understand that Prozac slows the metabolism of Nortriptyline to a certain extent, making lower doses more potent. Does anyone know how much more potent Nortriptyline becomes in this instance?I am under the impression that Prozac doubles the blood concentration of nortriptyline and the other TCAs (P450 2D6). If the ability of nortriptyline to act as a sleep aid disappears, there are other drugs that can be tried. As far as the caffeine effect is concerned, nortriptyline is a powerful drug, even at low dosages. If this is uncomfortable and continues unabated, you will have to look for another drug. Low dosages of doxepin and amitriptyline are often chosen if one would like to stay with TCAs. Remeron is a popular choice, but you will need to remain at a dosage no higher than 30 mg/day. 7.5 - 15.0 mg/day usually works pretty well.
- Scott
Posted by Phillipa on March 21, 2014, at 10:19:39
In reply to Re: Adding low dose Nortrityline to Prozac » BusuB, posted by SLS on March 21, 2014, at 5:03:43
First ad ever when new and only available in gel caps of 20mg. By day three so much panic flushed them down the toilet. I wasn't depressed. It was thought it was good for anxiety at that time. I had been taking .25mg of Xanax and felt great. Never again even though the doc begged me to take it ever three days. If they had had small doses then maybe 2.5mg would have allowed me to experience just high energy as I did on day one. Phillipa
Posted by bleauberry on March 21, 2014, at 10:34:02
In reply to Adding low dose Nortrityline to Prozac, posted by BusuB on March 20, 2014, at 18:02:20
Try 5mg. To do that, empty the capsule, divide the powder into 2 approximately equal size piles. Doesn't have to be exact. Then either load your dose back into an empty size OO gel cap from a health food store, or simply spread it on applesauce or mix in juice. Won't taste good, so swallow quickly.
I was on Nort for a few months. I started at 2.5mg, worked up to 10mg, tried to go higher, ended up at 5mg as my best dose.
Each person is uniquely different, so I do not buy the premise of accepting whatever dosage amounts the industry gives us. The right dose is only found through self discovery, not from a label or a generally accepted consensus. imo
Someone might point out scientific evidence that "suggests" lower doses "may not" be enough. Obviously, those words are not very exact or factual. The right dose is....the right dose that helps you feel the best possible, whatever size that happens to be. Could be 1mg or could be 200mg. Depends on the person.
When I went up to 10mg and higher, I felt what you feel....the over-caffeinated feeling. Actually at those higher doses it worsened my sleep because of the stimulation. Nortriptyline is going to keep more norepinephrine in action, which is in the adrenaline family. Prozac by itself boosts brain levels of norepinephrine quite a bit too. So it is probably the synergy of the two together that is making norepinephrine as sensitive as it is.
Yeah, at this point I would try a lower custom made dose, and eventually as your body adjusts you may be able to go to 10mg and be good with it.
The best sleep I had on 8 years of prozac was when I added low dose zyprexa (5mg). Second best for me was ultra low dose remeron (7mg or less). Third best was Lunesta.
In the meantime, through your journeys, in the weeks and months ahead, study up on herbal approaches to combat these areas:
Antimicrobial (bacterial, fungal, and viral)
Anti-inflammation
Anti-toxinAnd take a really close look at the grocery cart before you buy. You know how it is if you put garbage into a computer program? You get garbage results, right? It is the same thing with the human body. There is so much stuff on the market that is bad for a lot of people, not everyone, but a lot, especially the sick ones, and these things are commonly accepted as being perfectly fine. They absolutely are not. In that category would be things like gluten, corn that does not specify non-gmo, not enough colors in the meal (should be mostly veggies and fruits, the meat is the side dish), and cut down on sugars of all kinds where ever possible.
This stuff is really important because what it all does is pave the path for you to be well without meds at some point in the future. Your psychiatric symptoms, in my opinion, as well as my symptoms and pretty much everyone else here....is because of something wrong in one of the 3 categories I mentioned above. Those are fixable. We don't need to know exactly what is wrong or exactly what we are fixing. It is basically a blanket unmbrella approach that covers a wide range of possibilities. There is no testing or expertise in the world right now to be able to pinpoint these things with any accuracy. But we don't need to.
Hope this helps.
Posted by BusuB on March 21, 2014, at 14:54:26
In reply to Adding low dose Nortrityline to Prozac, posted by BusuB on March 20, 2014, at 18:02:20
Thank you everyone for the input. I guess I'm just getting tired of the med-go-round. I'm on 10 mg of prozac as the pdoc believes I'd better respond to low doses of AD's. Higher doses of AD's give me terrible anxiety it seems. At any rate, just trying to have patience. The nortriptyline doesn't seem to be hitting me as hard today compared to yesterday.
Thanks again.
This is the end of the thread.
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