![[dr. bob]](/dr-bob-sm.gif)
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 hansi555 on October 1, 2008, at 3:30:09
Hi all
As some of you would know I started out with 4 months of Remeron but after increasing dose to 60 mg without getting constant relief, Lexapro was added since the last 4 months, I am currently doing 35 mg of Remeron at night and 25 mg Lexapro in the morning.But I have 4 or 5 melancholic features; morning start up problems, early wake ups, lack of apetite, no energy or interest etc. and then it gets better during day time end good in the evenings. When a good period comes it will last one or two weeks, then 2-5 days of depression, then things turn around and get acceptable again.
1 hour after taking Remeron I feel very good and have a lot of appetite but then I get sleepy and wake up the next day w the melancholic features and it starts all over again.
Is it the noraldreline effect I am feeling in the evening?
Lexapro works most of the time but is preventing real joy, especially after increasing dose, and I get these real annoying down periods also.After reading a lot in here, I have now (almost) decided to go for something more powerfull and Nortriptyline seems to be a good choice to me.
But how should I make the transistion from my current combo? And which of the 2 current drugs, if any, should I keep and in what dosages?
Thanks for all your inputs..
Posted by Phillipa on October 1, 2008, at 10:52:05
In reply to How to start up Nortriptyline and combos...?, posted by hansi555 on October 1, 2008, at 3:30:09
That almost sounds like the normal ups and downs of life the way you put it or is it more severe? Phillipa
Posted by Polarbear206 on October 1, 2008, at 15:35:14
In reply to How to start up Nortriptyline and combos...?, posted by hansi555 on October 1, 2008, at 3:30:09
> Hi all
> As some of you would know I started out with 4 months of Remeron but after increasing dose to 60 mg without getting constant relief, Lexapro was added since the last 4 months, I am currently doing 35 mg of Remeron at night and 25 mg Lexapro in the morning.
>
> But I have 4 or 5 melancholic features; morning start up problems, early wake ups, lack of apetite, no energy or interest etc. and then it gets better during day time end good in the evenings. When a good period comes it will last one or two weeks, then 2-5 days of depression, then things turn around and get acceptable again.
>
> 1 hour after taking Remeron I feel very good and have a lot of appetite but then I get sleepy and wake up the next day w the melancholic features and it starts all over again.
> Is it the noraldreline effect I am feeling in the evening?
> Lexapro works most of the time but is preventing real joy, especially after increasing dose, and I get these real annoying down periods also.
>
> After reading a lot in here, I have now (almost) decided to go for something more powerfull and Nortriptyline seems to be a good choice to me.
>
> But how should I make the transistion from my current combo? And which of the 2 current drugs, if any, should I keep and in what dosages?
>
> Thanks for all your inputs..You are obviously having some mild cycling going on. Believe me, I was just like you at one time. An SNRI and a mood stablizer evened me out.
Posted by bulldog2 on October 4, 2008, at 19:18:54
In reply to How to start up Nortriptyline and combos...?, posted by hansi555 on October 1, 2008, at 3:30:09
> Hi all
> As some of you would know I started out with 4 months of Remeron but after increasing dose to 60 mg without getting constant relief, Lexapro was added since the last 4 months, I am currently doing 35 mg of Remeron at night and 25 mg Lexapro in the morning.
>
> But I have 4 or 5 melancholic features; morning start up problems, early wake ups, lack of apetite, no energy or interest etc. and then it gets better during day time end good in the evenings. When a good period comes it will last one or two weeks, then 2-5 days of depression, then things turn around and get acceptable again.
>
> 1 hour after taking Remeron I feel very good and have a lot of appetite but then I get sleepy and wake up the next day w the melancholic features and it starts all over again.
> Is it the noraldreline effect I am feeling in the evening?
> Lexapro works most of the time but is preventing real joy, especially after increasing dose, and I get these real annoying down periods also.
>
> After reading a lot in here, I have now (almost) decided to go for something more powerfull and Nortriptyline seems to be a good choice to me.
>
> But how should I make the transistion from my current combo? And which of the 2 current drugs, if any, should I keep and in what dosages?
>
> Thanks for all your inputs..Nortriptyline is a good adjunct to an ssri. The problem with snri's is you have a fixed ratio to se to ne. By adding nortriptyline to an ssri you get keep adding it until you get the correct ratio that suits you.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.