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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by georgia52 on June 4, 2008, at 13:21:12
My son has been taking Nortryptylin at a low dose for anxiety and has improved. He had to change docs because of insurance and the new doc was shocked he was taking this drug. He said it was very old and that there were better ones. He suggested Lexapro. I'm wondering why he wouldn't increase the dose of Nortryptylin instead of changing to a drug with more side effects and withdrawal problems? My son also takes Ritalin at a very low dose situationally. The doc seems to allude that he should increase the dose of that too but he's doing fine on the dose and rarely has to take any at all. I'm confused.
Posted by torachan on June 4, 2008, at 13:55:24
In reply to Nortryptylin, posted by georgia52 on June 4, 2008, at 13:21:12
I'm taking Nortyptiline for anxiety just like your son. If your son is anything like me with regards to anxiety, and in general an edgy personality, he'd best stay away from Lexapro. Just my advice. I gave Lexapro a good shot, but it is far too activating for an anxiety disorder. I've heard it being touted as the best SSRI for anxiety, but I don't put much stock in these reports. I go on subjective experience, and although what works for me may not work for another in the same boat, I can guarantee you I have a classic case of anxious personality, anxiety disorder, whatever you want to call it, that sprung from panic attacks, which in my opinion in and of itself leaves no doubt that a real underlying anxiety disorder is present. By the way, I've been on a benzodiaxepine ever since the panic attacks, and that drug stopped the attacks dead in their tracks, but long term use is wearing thin on me so I'm looking elsewhere to rid myself of benzo dependence.
The reason why your son's doctor is leery of prescribing the TCA is due to, I believe, not just the higher side effect profile, but the financial issues at hand. Also, doctors by nature want to believe in the advance of science, but if an older drug works better than a newer drug for a particular person, which they do, than most doctors, not all, will follow the creed of their occupation; to treat the patient appropriately to improve their quality of life while weighing the risks and benefits. By the way, the TCA's side effects are exaggerated just a little.
Posted by Marty on June 4, 2008, at 14:27:42
In reply to Re: Nortryptylin, posted by torachan on June 4, 2008, at 13:55:24
"If it's not broken, dont fix it."
/\/\arty
Posted by Marty on June 4, 2008, at 14:33:12
In reply to Re: Nortryptylin » torachan, posted by Marty on June 4, 2008, at 14:27:42
BTW, Wikipedia has this to say on the Nortriptyline article:"It should however be noted, that the co-administration of Tricyclic Antidepressants and stimulant ADD medications is highly inadvisable. Due to the blocking effect such medications have on both norepinephrine and serotonin, the stimulant properties of ADD medications can be severely potentiated, resulting in a risk of hypertension, tachycardia and central overstimulation."
http://en.wikipedia.org/wiki/Nortriptyline
Maybe it's what is frightning your sons doc. I think it's psychopharmaceutical paranoia. That said if you keep the Nortriptyline MAYBE you should NOT allow the doc to INCREASE the stimulant.
/\/\arty
Posted by jms600 on June 4, 2008, at 16:56:53
In reply to Re: Nortryptylin » Marty, posted by Marty on June 4, 2008, at 14:33:12
Hi
I have read - a number of times - that Seroxat is the best SSRI for anxiety. It certainly helped me. Trouble is I found it to be the most sedating out of all the SSRIs. This is not the case with everyone though, so it may be worth trying if you have to go to an SSRI.
Posted by Phillipa on June 4, 2008, at 17:32:39
In reply to Re: Nortryptylin, posted by jms600 on June 4, 2008, at 16:56:53
True if it ain't broken don't fix it but agree don't raise the ritalin. Can you print the article and bring it to the doc? Good luck Phillipa
Posted by johnj on June 4, 2008, at 18:30:07
In reply to Nortryptylin, posted by georgia52 on June 4, 2008, at 13:21:12
What dose is your son taking. I can attest that it is very good for anxiety as I took it in the past. If your son is doing well and in therapy I don't understand why a doc would change meds. TCA's have some side effects but I would rather have dry mouth and constipation than anxiety and sexual dysfunction. Personally, I would get a second opinion.
Posted by mav27 on June 4, 2008, at 21:48:10
In reply to Re: Nortryptylin » georgia52, posted by johnj on June 4, 2008, at 18:30:07
> What dose is your son taking. I can attest that it is very good for anxiety as I took it in the past. If your son is doing well and in therapy I don't understand why a doc would change meds. TCA's have some side effects but I would rather have dry mouth and constipation than anxiety and sexual dysfunction. Personally, I would get a second opinion.
Interesting.. for me Nortriptyline caused the worst anxiety and medium level sexual dysfunction.
Posted by georgia52 on June 5, 2008, at 8:25:38
In reply to Re: Nortryptylin » Marty, posted by Marty on June 4, 2008, at 14:33:12
Thanks everyone for the info so far. I'm learning!
Posted by johnj on June 5, 2008, at 8:52:46
In reply to Re: Nortryptylin » johnj, posted by mav27 on June 4, 2008, at 21:48:10
Maybe for you, but her son is doing better on it so why change?
What dose were you on and for how long? Were you on it long enough for it to smooth out or did you dump it to fast or ramp up too fast? How do you respond to ssri's?
Posted by georgia52 on June 5, 2008, at 8:59:26
In reply to Re: Nortryptylin » mav27, posted by johnj on June 5, 2008, at 8:52:46
My son is on 20 mgs of Nortriptylin and 5-10 of Ritalin. The new doc put him on Lexapro 2.5 and will move up to. 5.0 and so on. I know that is a low dose of Nortriptylin. He is not keen on the side effects of Lexapro and hasn't really had any on the TCA. Thanks everyone.
Posted by johnj on June 5, 2008, at 9:09:19
In reply to Re: Nortryptylin, posted by georgia52 on June 5, 2008, at 8:59:26
Keep in mind that if he doesn't do well the nort is something you can go back to. I still would reconsider. The new flavor is not always the best flavor. good luck
johnj
Posted by mav27 on June 6, 2008, at 2:46:46
In reply to Re: Nortryptylin » mav27, posted by johnj on June 5, 2008, at 8:52:46
Yeah i didn't mean anyone should change, i just found it amusing how we had such opposite reactions to it.
I built up to 150mg over about 3 months and was on it for 5 months all up... it just got worse and worse to the point i was a jittery mess.
SSRi's are the devil... they turn me into a zombie. I'm treated best so far by imipramine, reboxetine, nardil and parnate, anything else doesn't like me.
> Maybe for you, but her son is doing better on it so why change?
>
> What dose were you on and for how long? Were you on it long enough for it to smooth out or did you dump it to fast or ramp up too fast? How do you respond to ssri's?
Posted by Racer on June 8, 2008, at 14:52:41
In reply to Nortryptylin, posted by georgia52 on June 4, 2008, at 13:21:12
> He had to change docs because of insurance and the new doc was shocked he was taking this drug. He said it was very old and that there were better ones.
Well, he's half right, and the other half is more opinion than fact. Nortriptyline is part of a very old class of drug, the tricyclic antidepressants. They've been around since about the late 50s. Lexapro is a member of the SSRI class, which is considerably newer. For many people, the benefit of SSRIs over TCAs is actually the more tolerable side effect profile of the SSRIs. (Keep in mind -- many people here have had a different experience of these medications. I'm talking about overall, on average, for people who are not treatment resistant.)
It sounds as though your son was responding to nortriptyline, but I'm wondering why you asked about increasing the dose? Was he not finding it entirely effective? If so, increasing the dose might have increased side effects, and wouldn't necessarily have offered more effectiveness. On the other hand, nortriptyline has a known therapeutic window, which can be checked by testing blood levels. If your son was in that window, there wouldn't be a good reason to increase the dose.
And I would wonder a lot about increasing the Ritalin, if your son is doing well on a low dose PRN.
Honestly, I wonder if your new doctor isn't making changes either because he feels as though he needs to make changes to justify his fees, or perhaps because he isn't familiar enough to be comfortable with this medication protocol. It's worth asking him why he's making these changes, and what the reasoning behind them is.
Good luck.
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