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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by iforgotmypassword on July 17, 2008, at 11:08:20
looking at nortriptyline, these are the main benefits i think i am looking for:
-NE reuptake inhibition: off and on i noted higher awareness and feeling a much better mental grasp on my visual field on atomoxetine (Strattera), and desipramine is probably the drug i responded best to (unfortunately not in a remission-like sense, but it was an improvement.)
5HT-2 antagonism: wikipedia says 5-ht2a may impair the orbitofrontal cortex, and then on the orbitofrontal cortex it mentions it's role in decision making, a huge problem with me relating to executive function and feeling i have a lack of voluntary control over my behaviour and focus (leading to both paralysis, and other times awkward overactive disinhibition, automatic responses to people based on the stimuli they are providing, not my character) 5-HT2 ACTIVITY MAY ALSO BE WHAT IS CAUSING MY VERY WIERD PERMANENT EXTRAPRAMIDAL SYNDROME. is 5-ht2c antagonism also important, does nortriptyline have affinity (it seems to, i think?)? generally speaking is nortriptyline a strong 5-ht2a/c antagonist? is this a strong part of its action, am i giving *relatively* selective, lower antihitaminergic 5-ht2 antagonism a good shot by trying it?
NOW MY RESERVATIONS, i am scared of these aspects:
SE reuptake inhibition: i respond very strangely to SSRIs and believe i am very sensitive to their antidopaminergic effects, paradoxically causing BOTH akathisia and worsening of apathy and general loss of awareness.
ANTICHOLINERGIC EFFECTS: cognitive function in me is very terrible, and it is very hard to do anything and churn things through my head, especially expressing verbally/typing, this is something i do not want to make worse. aricept helped with fluency i think, what i said i felt had more relation with what i felt and was more relevant and real. i do not want any more blasts to the head.
ANTIHISTAMINE EFFECTS: this is another thing that i believe i do not respond well to, risperidone even gave me a feeling that it was supressing my breathing but i do not know which receptor was doing this. taking things like mirtazapine (Remeron) and antipsychotics (i've taken risperidone and olanzapine (Zyprexa)) generally make me feel more impaired, and the idea that histamine activity may be relevant to ADHD makes me feel uneasy about messing with it again.
GENOTOXICITY: there does not seem to be much on this. i did not know desipramine was genotoxic when i took it, and i took it at the absolute highest dose: 300mg (which is supposed to be a last resort) i do not want the same issue to come up with nortriptyline, again also for important personal reasons i have neglected to properly discuss, despite that i really need input on them.
i also want to know more about alpha-1 adrenoreceptor affinity, which i know nothing about, both whether nortriptyline has it and what that action does. desipramine had it, so i am wondering if it was part of its benefit, or if it is not such a good thing.
i'll end this here because it is long. any input on this would be great. i am trying to actually ACT, and not fear every laboured step i try to make.
Posted by linkadge on July 17, 2008, at 11:57:53
In reply to nortriptyline concerns; NE transporter, 5-HT2 Rs, posted by iforgotmypassword on July 17, 2008, at 11:08:20
Wow theres a lot of comments. One thing to keep in mind is that if you can get a medication which exerts more thereaputic effect than side effects, usually one can adapt.
Nortyptaline is a 5-ht2a/c antagonist and this can improve certain forms of executive dysfunction. It may increase OCD like symptoms though, if they are present. Nortryptaline is a serotonin uptake inhibitor, but most people don't get SSRI degree side effects.
You could combat the anticholinergic side effects (should they become problematic) with oral choline, or perhaps a cholinsterase inhibitor like ginkgo.
You may want to continue to look for discussion of geneotoxicity. The studies I read seemed to think nortrpytaline was not genotoxic. The genotoxic TCA's all had some similarity of structural (was it nitrogen? on one of the rings)
Anyhow. I think its fairly safe and worth a shot. Just go up on it slowly.
Linkadge
Posted by iforgotmypassword on July 18, 2008, at 14:10:28
In reply to nortriptyline concerns; NE transporter, 5-HT2 Rs, posted by iforgotmypassword on July 17, 2008, at 11:08:20
i called my doctor and he is calling it in for me to pick up. he said he will go with the starting dose that is in his book. i had no idea of the starting dose. is there a hint of a favourable response when starting at a starting dose like the relatively immediate effect of desipramine?
does it really need to be taken multiple times per day? i am trying to avoid meds that need to be taken more than once per day and have a delayed benefit or response as my current functioning makes doing anything properly and concentrating extremely difficult.
Posted by zeugma on July 21, 2008, at 8:16:05
In reply to dosing, posted by iforgotmypassword on July 18, 2008, at 14:10:28
Nortriptyline can be dosed once daily (I have always taken it as a single dose in the evening).
Linkadge is correct about the genotoxicity being specific to TCA's that have a nitrogen atom at the apex of the central ring. This includes imipramine, desipramine, and clomipramine (but not amitriptyline, protriptyline, or nortriptyline).
This is the end of the thread.
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