Posted by Scott L. Schofield on April 18, 2000, at 20:56:39
In reply to Meds advice: Lithium + Nortriptyline, posted by kiwi on April 13, 2000, at 23:41:31
Hi kiwi.
I really don't have much to say. I just didn't want you to think that you were being neglected for having body-odor or something. Sometimes people's attentions are drawn to "hot" issues like the one dealing with malevolent posts. Also, I don't think many people have much experience with tricyclics to be able to offer you any comments.
> Dear Med-heads,
>
> (Please don't reply to my Email addr)
>
> I'm taking:
> 1200mg Lithium
> 125mg Nortriptyline (aka Pamelor)
> 1.5mg ClonazepamFor what condition(s) are you taking these for?
Why was nortriptyline chosen?> I feel a bit agitated at this level of
> Nortriptyline, and a bit depressed at 100mg
> Nortriptyline. I just can't find the right balance.125mg of nortriptyline is normally considered to be a high dosage. People can differ in the way they metabolize drugs, so there are no hard rules as to what dosage is appropriate for all individuals. A blood test should help you figure out whether you should adjust the dosage. Nortriptyline is the best studied of the tricyclics with respect to therapeutic blood levels. It has demonstrated a "therapeutic window". Not only can blood levels be too low, but they can also be too high.
Example:
- 25mg = no response
- 50mg = good response
- 75mg = loss of responseI would recommend that you determine your blood level of nortriptyline and adjusting the dosage until levels fall within the established therapeutic range.
If your doctor has decided that tricyclics are the way to go, you may consider trying desipramine if nortriptyline proves unsatisfactory. There seems to be a negative association between these two drugs with respect to antidepressant response. If nortriptyline works, it is less likely that desipramine will; if desipramine works, it is less likely that nortriptyline will. Although this only represents a trend seen in statistics, it certainly offers a rationale for trying desipramine or one of the other tricyclics.
Tricyclics are very effective, and are often overlooked. But there are plenty of alternatives.
> Without the Lithium I swing wildly from being very
> depressed to being very agitated (and still depressed).
> So, I think the Lithium is helping.> But I worry constantly about what these meds are
> doing to my body: Nortriptyline causes increased
> heart rate,I have not seen anything that would suggest that tricyclics produce any long-term irreversible effects on the cardiovascular system.
> Lithium is bad for the liver
I am not sure that it is. I do know that it can be hard on the kidneys, and that it can affect thyroid function. Thyroid tests should be performed every now and then.
> (and gives me severe diarrhea about twice a week).Ouch. Sorry.
> Comments?
Perhaps you will get more feedback if you provide a better description of your symptoms, any diagnoses that have been proposed, and an idea of what treatments you have already tried.
Good luck.
poster:Scott L. Schofield
thread:29938
URL: http://www.dr-bob.org/babble/20000411/msgs/30502.html