Psycho-Babble Medication Thread 1116085

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Need advice...nortriptyline

Posted by jay2112 on July 24, 2021, at 15:31:23

Hi everyone:

Well, I am on a combo of Effexor, Remeron, and nortriptyline. Have been for over a month.

Now, I am, I guess, 'mild' asymptomatic, with a major reduction in my cPTSD (complex PTSD) symptoms, in particular a reduction in consistent crying, and extreme vegetative symptoms. As well as startle effect, and freezing behaviour.

But, I DID, when started notrip, go out for regular tasks (reduced agoraphobia) and felt less pain (I am anemic, and can't take iron suppliments because of kidney disease.) But now, a month later, I am having increased pain, apathetic symptoms (like on an SRI), anhedonia has returned, and increased diarrhea (despite notrip's anticholinergic properties..also like an SRI symptom). I have to mention, these effects are above and beyond my original Rx of Effexor and Remeron, which I have been on, in a combo, for over 5 years. (Sorry, I forgot to mention that I am also on Vyvanse, for over 11 years.)

The notriptyline isn't even giving me the bottom end boost it did when I was on fluoxetine for over 10 years. That is what I am looking for, that 'anti-lethargic' feeling I got from nortriptyline. It gave me the boost sort-of like (but smoother) that I got from Vyvanse.

Take-away: should I boost the nortriptyline (which I did, recently, with only major caffeine-like jitters, which I *absolutely HATE*.) or add some other kind of norepinephrine/dopamine boosters?
One of the problems,which I hate, and think contributes to tolerance and failure of many drugs, is downregulation of the receptors.

Should I possibly try a small amount of l-tyrosine, or l-phenylalanine, (d-phenylalanine didn't make any difference in the past.)? I am honestly looking for complementary alternatives, as I have tried about 98 percent of psychiatric Rx's available in Canada. *Note...I have also tried increasing all of these doses, as well as dropping one med at a time for a minimum of 4-6 weeks, with mostly nasty side-effects.



Re: Need advice...nortriptyline

Posted by linkadge on July 25, 2021, at 12:21:49

In reply to Need advice...nortriptyline, posted by jay2112 on July 24, 2021, at 15:31:23

How much nortriptyline are you on?

You could try reducing the remeron a bit, and increase the nortriptyline. You might also try reducing the effexor (depending on the dose you're on).



Re: Need advice...nortriptyline

Posted by SLS on July 29, 2021, at 1:50:22

In reply to Need advice...nortriptyline, posted by jay2112 on July 24, 2021, at 15:31:23


Nortriptyline is a rather strange tricyclic. Unlike the others, it displays a therapeutic dosage window. For instance, someone might respond very well at 75 mg/day. However, increasing the dosage to 100 mg/day causes the person to relapse.

A blood test can help guide the choice of dosage. Usually, the range of blood levels is 50-150 ng/mL. This is a guide rather than than a precise value. When I was tested at 150 mg/day, my blood level was 153 ng/mL. I felt pretty crappy. The assumption was that moving down to 100 mg/day would put me at a more effective blood level. After playing around continuously with my dosage of Nardil for months in order to maintain a robust response, I stumbled upon a hint that I might be taking too much. When I reduced the dosage of nortriptyline from 100 mg/day to 50 mg/day, everything changed and I am experiencing a more robust and consistent response at steady dosages.

Another way doctors dosed nortriptyllne without blood tests was to use two separate ranges.

People tend to respond to either 50-75 mg/day or to 150 mg/day. So, if 50-75 mg/day doesn't help after 4 weeks, one might titrate rapidly to 150 mg/day.

- Scott

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