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Re: Nortriptyline Augmentation..Questions » JohnX2

Posted by Ritch on May 3, 2002, at 0:13:01

In reply to Re: Nortriptyline Augmentation..Questions » Ritch, posted by JohnX2 on May 2, 2002, at 22:41:44

> Hi Mitch,
>
> I've been toying with the idea of adding in low dose
> Nortriptyline to me Lamictal+Serzone+Klonopin.
>
> I bumped the Serzone dose to upper limits and dropped
> topamax on a hunch that this would stabilize me and
> still be anti-depressant. The Serzone generally doesn't
> induce hypomania and helps with myofacial pain.
>
> Unfortunately I am still feeling a bit of atypical
> depression symptoms.
>
> I always wake up in the morning feeling like crap.
>
> Do you think a Nortriptyline add on would help with
> A) pscyhomotor agitation (ADD or hypomania...?)
> B) atypical depression symptoms
> C) myofacial pain
>
> I have found that anti-cholinergic medicines also
> help with my pain.
>
> -John


Hi John,

Well, the good part about adding on nortriptyline (just an opinion), *might* be further reduction of the myofacial pain (or at least not aggravate it). Also, I found it to be generally helpful for inattentive/limbic ADD-type symptoms. You mentioned that anticholinergics seem to help. Also in some of your previous posts you mentioned chlortrimeton? helping as well. You are going to get an NE reuptake blockade+anticholinergic+antihistaminic action with the nortrip. with a mild sedative feeling (that's what I noticed anyhow).

Ok, here's the possible *bad* stuff that might happen. It might trigger dysphoria (TCA's in bipolars), I got it with doxepin and desipramine, but not with amitriptyline or nortriptyline.

Another possible minus: TCA's generally aren't looked at as meds helpful for "atypical depression". If you had it combined with Serzone+Lamictal that could likely be a very different story.

And yet another *possible* minus: TCA's are going to play around with liver enzymes and Serzone is already doing that. Plasma levels of Serzone and TCA will be changed (possibly a bunch) from the add-on. So, that will make how you subsequently feel difficult to attribute to what meds.

The psychomotor agitation thing? All you can do is try it and see what happens.

Wow, feeling like crap when you get up every day...It makes me wonder whether it is meds? What is the *timing* of your doses? If you take a truckload of one med at bedtime-but little or none during the day-that might be a possible culprit. You might try to spread out *everything* evenly throughout the day, and then see how you are feeling *all* day long.

hope this helps,

Mitch


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