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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by Skeletor on November 8, 2020, at 10:35:10
>>>Currently on low dose nortriptyline (10mg) but not sure if that's the med for me<<<
A few days ago I added 10mg of Nortriptyline to my present 7.5 mg of Escitalopram to help with IBS, Anxiety and Depression. I figured my target dose of the Nortriptyline would probably be 25 mg, but right now I can hardly handle 10 mg: It makes me feel lethargic, sedated and drowsy. I sleep 12 hours / day. I feel kinda spaced out in the head, somewhat slow and forgetful in the hand.
On the plus side: It enhances my appetite and that is great! It gives me good sleep! It relaxes my muscles. It also seems to diminish my restless legs.
Will those negative side effects diminish? I want to try 25 mg, but I am afraid of even more sedation and sleepiness. Do 10 mgs seem like a ridiculously low dose? I am worried about sedation! Will it become more sedating when I get past 10 mg...?
Posted by Skeletor on November 8, 2020, at 10:44:59
In reply to Currently on low dose Nortriptyline but not sure.., posted by Skeletor on November 8, 2020, at 10:35:10
I forgot to mention it: very vivid dreams!
Posted by undopaminergic on November 8, 2020, at 11:37:50
In reply to Currently on low dose Nortriptyline but not sure.., posted by Skeletor on November 8, 2020, at 10:35:10
> >>>Currently on low dose nortriptyline (10mg) but not sure if that's the med for me<<<
>
> A few days ago I added 10mg of Nortriptyline to my present 7.5 mg of Escitalopram to help with IBS, Anxiety and Depression. I figured my target dose of the Nortriptyline would probably be 25 mg, but right now I can hardly handle 10 mg: It makes me feel lethargic, sedated and drowsy. I sleep 12 hours / day. I feel kinda spaced out in the head, somewhat slow and forgetful in the hand.
>
> On the plus side: It enhances my appetite and that is great! It gives me good sleep! It relaxes my muscles. It also seems to diminish my restless legs.
>
> Will those negative side effects diminish? I want to try 25 mg, but I am afraid of even more sedation and sleepiness. Do 10 mgs seem like a ridiculously low dose? I am worried about sedation! Will it become more sedating when I get past 10 mg...?
>Intuitively, you would think the side effects are dose-related, and, indeed, that 10 mg/day is almost a ridiculously low dose. A quick Google search suggests the maximum recommended dose to be 150 mg, and the usual adult dose to be 25 mg 3-4 times daily.
Wikipedia reports there are substantial differences between individuals in terms of nortriptyline metabolism. Your symptoms suggest you may be a poor metaboliser.
It's not really possible to predict whether your side effects will diminish, or whether your dose is adequate for an antidepressant response. What can be said with certainty, on the other hand, is that your current dose is sufficient to have a powerful effect on you.
I suggest you wait and see before you increase the dose, given the substantial adverse effects you're experiencing.
-undopaminergic
Posted by undopaminergic on November 8, 2020, at 11:39:33
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by Skeletor on November 8, 2020, at 10:44:59
> I forgot to mention it: very vivid dreams!
I wish I had that. Dreaming is the best part of sleep.
-undopaminergic
Posted by Skeletor on November 8, 2020, at 12:30:55
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by undopaminergic on November 8, 2020, at 11:37:50
> > >>>Currently on low dose nortriptyline (10mg) but not sure if that's the med for me<<<
> >
> > A few days ago I added 10mg of Nortriptyline to my present 7.5 mg of Escitalopram to help with IBS, Anxiety and Depression. I figured my target dose of the Nortriptyline would probably be 25 mg, but right now I can hardly handle 10 mg: It makes me feel lethargic, sedated and drowsy. I sleep 12 hours / day. I feel kinda spaced out in the head, somewhat slow and forgetful in the hand.
> >
> > On the plus side: It enhances my appetite and that is great! It gives me good sleep! It relaxes my muscles. It also seems to diminish my restless legs.
> >
> > Will those negative side effects diminish? I want to try 25 mg, but I am afraid of even more sedation and sleepiness. Do 10 mgs seem like a ridiculously low dose? I am worried about sedation! Will it become more sedating when I get past 10 mg...?
> >
>
> Intuitively, you would think the side effects are dose-related, and, indeed, that 10 mg/day is almost a ridiculously low dose. A quick Google search suggests the maximum recommended dose to be 150 mg, and the usual adult dose to be 25 mg 3-4 times daily.
>
> Wikipedia reports there are substantial differences between individuals in terms of nortriptyline metabolism. Your symptoms suggest you may be a poor metaboliser.
>
> It's not really possible to predict whether your side effects will diminish, or whether your dose is adequate for an antidepressant response. What can be said with certainty, on the other hand, is that your current dose is sufficient to have a powerful effect on you.
>
> I suggest you wait and see before you increase the dose, given the substantial adverse effects you're experiencing.
>
> -undopaminergic
>I always suspected that I might be a slow metabolizer at various CYP450-enzymes. I got strong effects from lowish SSRI dosages (37,5mg Sertralin, 5mg Escitalopram) and could barely tolerate higher dosages of SSRIs, e.g. 100mg Sertraline was brutal in terms of side effects... unbearbale.
And now I read that the dosage range for nortriptyline when used to treat depression is generally 75 - 150 mg/day. JESUS F CHRIST.... xD ^^
It is my hope that at higher dosages Nortriptyline becomes more pro-noradrenergic and less sedating. H1-saturation and desensitization should occur at fairly low dosages.
Posted by Skeletor on November 8, 2020, at 12:31:34
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by undopaminergic on November 8, 2020, at 11:39:33
> > I forgot to mention it: very vivid dreams!
>
> I wish I had that. Dreaming is the best part of sleep.
>
> -undopaminergic
>Unless you have sh*tty dreams ^^ ;=)
Posted by Skeletor on November 8, 2020, at 12:32:35
In reply to Currently on low dose Nortriptyline but not sure.., posted by Skeletor on November 8, 2020, at 10:35:10
>
> somewhat slow and forgetful in the hand.
>Head, not hand ;=)
Typo!
Posted by undopaminergic on November 9, 2020, at 6:50:13
In reply to Re: Currently on low dose Nortriptyline but not sure.. » undopaminergic, posted by Skeletor on November 8, 2020, at 12:31:34
> > > I forgot to mention it: very vivid dreams!
> >
> > I wish I had that. Dreaming is the best part of sleep.
> >
> > -undopaminergic
> >
>
> Unless you have sh*tty dreams ^^ ;=)I have no dreams I wish I hadn't. Sure, most of them are useless, some of them are just dumb, and some of them make you wake up, but I don't mind. Indeed, nightmares are the most exciting, and therefore a nice contrast to my apathetic everyday life. You can also try to interpret them, speaking of which, I stole Freud's briefcase in one particularly memorable dream.
-undopaminergic
Posted by undopaminergic on November 9, 2020, at 6:52:49
In reply to Re: Currently on low dose Nortriptyline but not sure.. » undopaminergic, posted by Skeletor on November 8, 2020, at 12:30:55
>
> It is my hope that at higher dosages Nortriptyline becomes more pro-noradrenergic and less sedating. H1-saturation and desensitization should occur at fairly low dosages.
>Good point. It's worth a try. What's the worst that can happen? Wasting a day sleeping?
-undopaminergic
Posted by Skeletor on November 9, 2020, at 10:55:11
In reply to Currently on low dose Nortriptyline but not sure.., posted by Skeletor on November 8, 2020, at 10:35:10
Last night was strange: my esophagus and stomach was sore and kinda "burning", I had bouts of hot flashes and dry mouth in the morning. O_o
Bot otherwise I feel quite motivated... kinda
Will my teeth rot away due to dry mouth?
Posted by undopaminergic on November 9, 2020, at 11:10:39
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by Skeletor on November 9, 2020, at 10:55:11
>
> Will my teeth rot away due to dry mouth?It's mainly a matter of acidity. With less saliva to dilute it, it takes longer for the pH to return to neutral after a meal. You can try xylitol.
It's notable that you are experiencing prominent anticholinergic symptoms at such a low dose. But, anticholinergics can be powerful antidepressants, so take it as a promising sign. They say medications without side effects don't work...
-undopaminergic
Posted by Skeletor on November 9, 2020, at 11:21:32
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by undopaminergic on November 9, 2020, at 11:10:39
> >
> > Will my teeth rot away due to dry mouth?
>
> It's mainly a matter of acidity. With less saliva to dilute it, it takes longer for the pH to return to neutral after a meal. You can try xylitol.
>
> It's notable that you are experiencing prominent anticholinergic symptoms at such a low dose. But, anticholinergics can be powerful antidepressants, so take it as a promising sign. They say medications without side effects don't work...
>
> -undopaminergic
>Yeah, having those side effects at only 10mg is really scary... and they say that 50mg is minimum in Depression :D ^^
I probably should test my CYP-450 genes.
I am using xylitol as sugar-replacement and in chewing-gums.
Posted by Skeletor on November 9, 2020, at 11:23:04
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by undopaminergic on November 9, 2020, at 6:52:49
> >
> > It is my hope that at higher dosages Nortriptyline becomes more pro-noradrenergic and less sedating. H1-saturation and desensitization should occur at fairly low dosages.
> >
>
> Good point. It's worth a try. What's the worst that can happen? Wasting a day sleeping?
>
> -undopaminergicTrue.
Posted by Skeletor on November 9, 2020, at 11:43:29
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by Skeletor on November 9, 2020, at 10:55:11
(I've been thinking about trying Aripiprazole ("Abilify"), in case Nortriptyline won't work)
Posted by undopaminergic on November 9, 2020, at 12:29:42
In reply to Re: Currently on low dose Nortriptyline but not sure.. » Skeletor, posted by Skeletor on November 9, 2020, at 11:43:29
> (I've been thinking about trying Aripiprazole ("Abilify"), in case Nortriptyline won't work)
>Probably the only reason aripiprazole sometimes works for depression is that it acts primarily as a dopamine direct agonist at low doses. I strongly recommend you try pramipexole instead, because it acts as an agonist at all doses.
Indeed, pramipexole is the only drug I ever tried that was (temporarily) effective against anhedonia.
-undopaminergic
Posted by Skeletor on November 9, 2020, at 12:46:25
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by undopaminergic on November 9, 2020, at 12:29:42
> > (I've been thinking about trying Aripiprazole ("Abilify"), in case Nortriptyline won't work)
> >
>
> Probably the only reason aripiprazole sometimes works for depression is that it acts primarily as a dopamine direct agonist at low doses. I strongly recommend you try pramipexole instead, because it acts as an agonist at all doses.
>
> Indeed, pramipexole is the only drug I ever tried that was (temporarily) effective against anhedonia.
>
> -undopaminergic
>Pramipexole sure is interesting, but difficult to come by... most doctors especially in Germany are afraid of full dopamine agonists ^^
Imho Aripiprazole is interesting because it is pro-dopaminergic at low dosages (2 mg) and it exhibits 5HT2-antagonist-properties AND it isn't a strong antihistamine. But yeah, your mileage may vary.
Low dosage of Olanzapine is also interesting, but strong antihistamine... ^^
What is your current regimen?
Posted by ed_uk2010 on November 9, 2020, at 16:09:20
In reply to Currently on low dose Nortriptyline but not sure.., posted by Skeletor on November 8, 2020, at 10:35:10
It's completely normal to feel drowsy when starting nortriptyline, even at low doses.
You're going to have to give it a couple of weeks to see whether it wears off.
Posted by Skeletor on November 9, 2020, at 16:13:00
In reply to Re: Currently on low dose Nortriptyline but not sure.. » Skeletor, posted by ed_uk2010 on November 9, 2020, at 16:09:20
> It's completely normal to feel drowsy when starting nortriptyline, even at low doses.
>
> You're going to have to give it a couple of weeks to see whether it wears off.Thanks. I will do that! ;=)
Did you take Nortriptyline and or Amitriptyline in the past?
Posted by undopaminergic on November 10, 2020, at 0:11:03
In reply to Re: Currently on low dose Nortriptyline but not sure.. » undopaminergic, posted by Skeletor on November 9, 2020, at 12:46:25
>
> Pramipexole sure is interesting, but difficult to come by... most doctors especially in Germany are afraid of full dopamine agonists ^^
>
> Imho Aripiprazole is interesting because it is pro-dopaminergic at low dosages (2 mg) and it exhibits 5HT2-antagonist-properties AND it isn't a strong antihistamine. But yeah, your mileage may vary.
>
> Low dosage of Olanzapine is also interesting, but strong antihistamine... ^^
>
> What is your current regimen?Sulpiride 150 mg, clozapine 350 mg, cariprazine 1.5 mg, lamotrigine 200 mg, and most importantly, trimipramine 150 mg.
Clozapine is particularly useless in my experience. Sulpiride was even better than a stimulant when I first tried it, but this effect disappeared after some week or so. Cariprazine may be slightly activating, and I recommend it over aripiprazole. Lamotrigine seems to do nothing. Trimipramine is the best drug I've ever tried that is classified as an antidepressant.
-undopaminergic
Posted by Skeletor on November 10, 2020, at 19:24:02
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by undopaminergic on November 10, 2020, at 0:11:03
> Trimipramine is the best drug I've ever tried that is classified as an antidepressant.
>
> -undopaminergic
>That is interesting. Many people are quite satisfied with Trimipramine albeit it doesn't exhibit any Reuptake-Properties...
F*CK knows how these drugs work O_o
Posted by Skeletor on November 11, 2020, at 15:41:16
In reply to Currently on low dose Nortriptyline but not sure.., posted by Skeletor on November 8, 2020, at 10:35:10
Today's poop was really hard to pass... O_o
Posted by ed_uk2010 on November 13, 2020, at 18:36:37
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by Skeletor on November 11, 2020, at 15:41:16
> Today's poop was really hard to pass... O_o
Nortriptyline can be constipating yeah, take a stool softener.
And yes, I've taken amitriptyline.
Posted by Skeletor on November 14, 2020, at 5:27:33
In reply to Re: Currently on low dose Nortriptyline but not sure.. » Skeletor, posted by ed_uk2010 on November 13, 2020, at 18:36:37
>
> And yes, I've taken amitriptyline.
>
>How was your experience?
Posted by ed_uk2010 on November 14, 2020, at 10:21:44
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by Skeletor on November 14, 2020, at 5:27:33
> >
> > And yes, I've taken amitriptyline.
> >
> >
>
> How was your experience?It was too anticholinergic, although the drowsiness does reduce over time.
Typically, nortriptyline is more tolerable.
Posted by Skeletor on November 15, 2020, at 8:36:14
In reply to Re: Currently on low dose Nortriptyline but not sure.., posted by ed_uk2010 on November 14, 2020, at 10:21:44
Not sure what to make of it.
One the one hand, it kinda gives me a motivational push, but on the other hand I feel dysphoric and "out of it". It also f*cks with my teeth enamel...
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