Posted by Jay2112 on August 21, 2021, at 0:18:00
In reply to Nortriptyline dosing., posted by SLS on August 17, 2021, at 8:21:06
Hi Scott
Well, I believe you said you were bipolar? I or II?
I am type II, but my psychiatrist and I were talking recently, and the research always seems to point to the addition of a noradrenergic antidepressant, like nortriptyline, utilization, rather than a serotonergic one, to a mood stabilizer. Which you are, sort of, doing...but, like me, you are also using a serotonin based med.Ok...bear with me...I do have a point..lol. (Along with my fragmented sentences.)
Now, I respond extremely well to lithium, which blocks noradrenaline. I tried nortriptyline (Aventyl) a few times, and I eventually had a few psychotic, manic episodes. See, there is a type of mania called dysphoric mania, which is like taking a boiling hot shower just after falling onto a thousand razorblades. Most people think mania is some euphoric spending spree, having sex with strangers, type of thing. I think you likely know what I am getting at. The noradrenaline is a huge factor in mania...but in your case, it could be an anomaly. Or, like many bipolar people, who respond to, say, Wellbutrin, it may not be an anomaly..lol.
So,have you had any type of very negative episodes on the Aventyl? See, I am *also* an anomaly, lol, because I take 60mg of Vyvanse daily, on top of 225mg of Effexor, 600mg of lithium, and 10mg of Abilify. Now, you also take Lamictal, correct?
I mean this with all due respect, but blood levels, as suggested in pharmacology, I think, can be the exception more than the rule. Yes, it may be based on sound research, but the real-world evidence, versus a randomized controlled trial, and their concordance, are being highly recognized in the scientific community. According to the research, you nor I should not be taking high doses of a serotonergic antidepressant, right? And, I should not be taking a stimulant, especially after a psychotic episode.
I think there is also a bit of an art, with the science, is really what I am getting at. And the metric used for the Aventyl is a very general guide. I am honestly not trying to argue...I respect your thoughts greatly. I *hope* that makes sense..lol.
:)Jay
Humans punish themselves endlessly
for not being what they believe they should be.
-Don Miguel Ruiz-
poster:Jay2112
thread:1116455
URL: http://www.dr-bob.org/babble/20210723/msgs/1116548.html