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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by cache-monkey on February 16, 2005, at 18:21:33
Hey all,
I'm in the process of a change in my med regime. Right now I have Klonopin at 1 mg/day for generalized and social anxiety. (I suspect I'll have to go a little higher, though to get that under control.) I'm just starting Lithium as a mood stabilizer, since there's a strong reason to believe that I have a "soft" BP.
I'd like to add on an anti-depressant. Ideally, this would help with attentional/motivational issues, anhedonia, and (most importantly) help me quit smoking; I've fallen into depression upon every recent quit attempt.
I've tried Wellbutrin before, but it ended up making me kind of more edgy in some ways. I'm thinking about low-dose selegiline, but all of the evidence on its effectiveness is based on somewhat small samples.
Nortriptyline has been suggested to me before on this board. I know it has clinical backing as an aid to smoking cessation, but would it be useful for attention/motivation/anhedonia?
Also, I'd like to know what the most prominent side effects are. (The info on RxList seems to take an everything-that's-ever-been-reported approach.) I'm especially interested in the effects on sexual function and weight.
Oh, and BTW I'm an intermediate CYP-2D6 metabolizer, which should increase the ratio of nortrip. to its metabolites, if this makes a difference for side effects.
Any information is greatly appreciated.
All the best,
cache-monkey
Posted by Sammybabe on February 16, 2005, at 19:43:21
In reply to Interested in Nortriptyline... Side Effects?, posted by cache-monkey on February 16, 2005, at 18:21:33
I've been on Nortriptyline for 2 months now. It has been neutral in terms of weight gain (no effect). The worst effect -- and it gets pretty bad -- is dry mouth. To offset this effect, I take Salagel 3x a day (prescription salivation medicine) and it works out well. Nortriptyline is by far the best med. I've been on in terms of taking me out of a crippling depression. Good luck.,
Posted by Maxime on February 16, 2005, at 21:30:05
In reply to Re: Interested in Nortriptyline... Side Effects?, posted by Sammybabe on February 16, 2005, at 19:43:21
I had the same but I also severe sedation, and was always constipated, plus weight gain.
Maxime
> I've been on Nortriptyline for 2 months now. It has been neutral in terms of weight gain (no effect). The worst effect -- and it gets pretty bad -- is dry mouth. To offset this effect, I take Salagel 3x a day (prescription salivation medicine) and it works out well. Nortriptyline is by far the best med. I've been on in terms of taking me out of a crippling depression. Good luck.,
Posted by Maxime on February 16, 2005, at 21:31:18
In reply to Re: Interested in Nortriptyline... Side Effects?, posted by Sammybabe on February 16, 2005, at 19:43:21
Sammy - was this the first TCA for you or have you been on others and how do they compare?
Maxime
Posted by banga on February 17, 2005, at 0:59:07
In reply to Re: Interested in Nortriptyline... Side Effects? » Sammybabe, posted by Maxime on February 16, 2005, at 21:31:18
I had weight gain on nortyptiline..some dry mouth.
I switched to desipramine, which also primarily acts on norepinephrine, and though initially it caused insomnia and anxiety, that has passed. I think it helps with calrity of thinking and amotivation. And almost no weight gain.
Posted by jay on February 17, 2005, at 14:31:14
In reply to Interested in Nortriptyline... Side Effects?, posted by cache-monkey on February 16, 2005, at 18:21:33
I am on 50 mg on Nortrip a day. But I take a big combo...80 mg's of prozac; 100 mg of topomax; 5oo mg of depakote/epival; 4mg of clonazepam; 2mg of risperdal. The Nortrip I know plays a big part...it takes a few weeks but then you will feel good effects if it works. Good luck...
Jay
Posted by Sammybabe on February 17, 2005, at 19:20:23
In reply to Re: Interested in Nortriptyline... Side Effects? » Sammybabe, posted by Maxime on February 16, 2005, at 21:31:18
Maxine - what does TCA stand for? i was on effexor for years and it did nothing. i LOVED zyprexa but gained 25 pounds (uugh). the pamelor (nortrip) has been the solution for the past few months. and you?
Posted by Maxime on February 17, 2005, at 22:29:00
In reply to Re: Interested in Nortriptyline... Side Effects?, posted by Sammybabe on February 17, 2005, at 19:20:23
Tricyclic Antidepressant.The last med that worked for me was Parnate. It stopped working for some reason which is unusual for Parnate. After trying somewhere between 35 and 40 meds (not all antidepressants - antipsychotics, mood stabilisers) Parnate was a god send. But I since the summer my mood was very low and then it just got worse (I'm bipolar type 2). I'm going through adderall withdrawal now so I haven't started my desipramine. I am really sick right now. But I take two mood stabilisers (trileptal and klonopin) and maybe if I don't kill myself ( I am very suicidal) and get through the withdrawal I will open that bottle of desipramine. But I probably won't take it. I am too scared. And I feel too hopeless.
Maxime
Maxime
Take care of you.
> Maxine - what does TCA stand for? i was on effexor for years and it did nothing. i LOVED zyprexa but gained 25 pounds (uugh). the pamelor (nortrip) has been the solution for the past few months. and you?
Posted by zeugma on February 18, 2005, at 7:35:07
In reply to Interested in Nortriptyline... Side Effects?, posted by cache-monkey on February 16, 2005, at 18:21:33
Oh, and BTW I'm an intermediate CYP-2D6 metabolizer, which should increase the ratio of nortrip. to its metabolites, if this makes a difference for side effects.>>
This might mean that the lower end of the dosing spectrum (i.e. 50 rather than > or = 100 mg/day) might be more effective, as nortriptyline has a much longer half-life than its active metabolite, and would be expected to accumulate more quickly. I'm a pretty rapid metabolizer of nortriptyline, and I get subtherapeutic effects at 50 mg, and less than optimal effects at 75 mg. It will be pretty clear what the therapeutic window will be for you, as the difference is dramatic in terms of mood (there are also differential effects on various functions: see below).
Nortriptyline is much more anti-muscarinic than 10-hydroxynortriptyline, so it might cause more s/e than the metabolized product. I think there is growing recognition of the importance of metabolizer status when it comes to psychotropics: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14618296
As far as the other concerns you had: nortriptyline is good for motivation/anhedonia, but its effects are fairly subtle and very dose-dependent (e.g. I lapse back into depression when my dose goes below 75 mg/day; on the other hand motivation increased almost immediately when I started at 20 mg/day, suggesting that it has differential effects on these components of affect/behavior). I have found it better for motivation than for anhedonia, for what that's worth.
I also have ADD, so can address your concern about attention as well. It does have an effect, but it is somewhat obscured by the antihistaminic effects, and is not comparable to a pure NRI like atomoxetine in this respect. On the other hand nortriptyline is a far more tolerable and effective antidepressant. I have had to augment the nortrip with various stimulants to gain improvements in attention, and this has been a difficult process, as TCA's and stimulants interact in some very undesirable ways, and I also am not very stimulant-responsive.
-z
Posted by cache-monkey on February 18, 2005, at 12:07:29
In reply to Re: Interested in Nortriptyline... Side Effects?, posted by Maxime on February 17, 2005, at 22:29:00
Thanks, all for the info!
No-one's mentioned sexual side effects. Is this just not an issue with Nortrip?
Best,
cache-monkey
Posted by cache-monkey on February 18, 2005, at 12:11:37
In reply to Re: Interested in Nortriptyline... Side Effects? » cache-monkey, posted by zeugma on February 18, 2005, at 7:35:07
Thanks for the other info! Could you please clarify what "anti-muscarinic" means?
Best,
cache-monkey
Posted by zeugma on February 18, 2005, at 17:40:28
In reply to Re: Interested in Nortriptyline... Side Effects? » zeugma, posted by cache-monkey on February 18, 2005, at 12:11:37
> Thanks for the other info! Could you please clarify what "anti-muscarinic" means?
>
> Best,
> cache-monkeyMuscarinic receptors are a species of acetylcholine receptor, and the anti-muscarinic effects of TCA's are held responsible for the 'dumb-drug' effects of the drugs. They are involved in cognition and memory processes. Their blockade is also partly responsible for the constipation/dry mouth side effects. Their blockade also arguably adds to the AD effect.
-z
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