Posted by Ritch on May 3, 2002, at 11:01:44
In reply to Re: Nortriptyline Augmentation..Questions » Ritch, posted by JohnX2 on May 3, 2002, at 2:58:42
> Hi Mitch,
>
> Thanks for the long well thought out reply.
>
> As far as feeling like crap in the morning, this has
> always been a problem with me. I usually need caffeine
> or substantial excersize to get out of it. I think it
> is an indicator of atypical depression (worse in morning,
> better later in day)?
John, is your sleep interrupted or light? I find the feeling like crap in the morning thing generally is a result of crummy sleep the night before.
>
> I've noticed that increasing my lamictal dose a bit
> and the higher dose Serzone is substantially alleviating
> the psychomotor agitation. However I still have some
> myofacial pain (which may be alleviated by lowering lamictal).
> And I get "SSRI" apathy syndrome..I feel very numb
> emotionally. I can ride this out and maybe it will wear
> off?
It sounds like you have found the "sweet spot" of 150mg for Lamictal, IMO. I have found that "SSRI Apathy" is a desired state when you *need* to take that kind of medication. I have doubts about that sort of thing "wearing away", unlike some of the physical side effects, but now it seems that even the physical sfx are more persistent than once thought (while taking the medicine).>
> Well, sounds like nortrip add-on might be a tough sell.
> Unless I swapped out Serzone for nortrip. I would need
> to have good evidence that nortrip would erase the
> myofacial pain.
It wouldn't hurt to ask. If he says: "No, we will have to drop the Serzone if you want to try nortriptyline" or "I don't want you on any tricyclics", then you can just tell him to forget the idea. If he agrees to it, you just need to give the NT a couple of weeks, if it is making things worse (in any way) then just ditch the stuff and resume your pre-trial combination.
>
> Adderall helped my myofacial pain. It seems medicines that
> can increase dopamine in an area of the brain called the
> prefrontal cortex alleviate my myofacial pain (the dopamine
> counteracts acetylcholine that induces muscle contraction).
> The dopamine release is gated by serotonin 5-ht2 receptors.
> Blocking those receptors increases dopamine.
> The prefrontal cortex extends into the frontal cortex.
> Its thought that the "negative psychosis" (emotional blunting)
> seen in schizophrenia is caused by a hypodopaminergic state
> in these brain areas. Serzone blocks that 5-ht2a receptor
> and decreases serotonin firing..I believe this helps release
> more dopamine. Zoloft,fyi, makes things *really* bad.
Yes, that is probably why the Serzone settles down agitation. If I take regular SSRI's (of any kind) I start puttering and pacing around all over (even though I don't *feel* anxious). I tried Serzone before and I noticed how different that it was-I could sit still and watch an entire TV program (30 minutes) in one sitting (which *is* a big accomplishment-hypomania or not). Zoloft does "get into your motor circuits" in a big way. I get restless legs even in my sleep, and lots of jaw clenching. It sounds like jaw clenching is something you probably want to avoid. You might ask him about a 10mg nortriptyline add-on and see what happens. I *think* that Serzone will inhibit CYP2D6 (which is what will metabolize NT), which should raise NT levels (Sunnelly, MedLib?) Interesting what you say about Adderall. I get left hand tremor when I am taking Depakote (which I am taking 250mg at bedtime now). When I went through my dexedrine trial a few weeks back I noticed the hand tremor went away! That is a little spooky (Parkinsons'-wise).
>
> I'm still balking on lithium for some reason. But I feel
> I need some sort of add-on and Serzone is a tough med
> to work with drug-interaction wise.
>
> Oh, I'll see how this goes over the next few days and
> then crater to lithium (which may change the whole face
> of the ballgame, I bet).
>
> Thanks,
> John
The lithium might be a better add-on than NT if you can tolerate it. I personally, *like* taking about 450mg of lithium a day, it is just my GI tract doesn't like it.good luck,
Mitch
poster:Ritch
thread:104434
URL: http://www.dr-bob.org/babble/20020503/msgs/104925.html