Posted by WhatToDoNext on August 6, 2008, at 12:12:07
In reply to Just back from doc....questions?, posted by ricker on August 5, 2008, at 12:51:10
Rick, I'm not sure what the plan is.....
Made my way up to 75mg Nortriptyline (25mg three times per day), Still on the Zoloft at 50mg.
Klonopin 1mg twice/day, Xanax XR 1mg twice / day
Today, I'm feeling a little more anxious than yesterday, but still much better than I've been. I'd say, yesterday, overall I felt about 60% better from my current baseline before the Nortriptlyine. Today, I'd give it a 40%. I am titrating up quickly, so perhaps the anxiety I'm feeling today is related to the quick titrate.
I can tell you that the constant uncomfortable feeling I had in my chest and throat is still gone. Didn't wake up all flabergasted like I normally do.
Anyway, the plan is to get me well so I can get back to work. So, I think we will titrate based on my response. I'm gonna hang here at 75mg for a few days, then go to 100mg and stay there till my next Pdoc appt, which is next Thursday. I'm staying on the Zoloft at 50mg/day for right now, but I think if the Nortriptyline works well for me, I will try and ditch the Zoloft as it never did anything for me.
Like I said in my previous post, I don't think I have a Serotonin problem based on lack of effect from the SSRI's and the supplemental 5-HTP I was taking. I appears that my problem may be all Norepinephrine reuptake.
The truth is, I don't care how I get better, so long as I get better. Nortriptyline covers you on both sides (i.e. Serotonin reuptake inhibition and Norepi reutake inhibition). Thats why I say, at some point, the Zolft should go away.
The therapeutic dose of Nortriptyline is 50-150mg per day, so starting at 50mg is a good idea. I would ditch the Lamictal if I were you as it doesn't appear to be helping you. I tried it, as they said I may be Bipolar II. I was on it for a few months at 200mg and got no response, so I just weaned off it. I guess I'm not Bipolar....lol
Your idea of more Zoloft and less Nortriptyline doesn't sound good to me. If your gonna take the Nortriptyline, you should take it at the range I wrote above. Zolfot is a great drug if you have a Serotnin problem, but if it's Norepinephrine, than the Nortriptyline should be the beeter med for ya. I believe the ration is 3:2 on Norepi & Serotonin, so your inhibiting the reuptake at higher levels with the Nortriptyline than Zoloft or any other SSRI or SNRI.
Remember, the pharmaceutical co.'s make money off new drugs and new Patents. Nortriptyline was used many years back as a first line treatment for depression and anxiety disorders as well as the other Tricyclics. Older Psychiatrists still use them as first line treaments, but the younger Docs stick with the SSRI's, as they get tons of free samples and drug reps coming in and pushing these meds. Plus, the media sells the drugs too.
I look at it kind of like putting toothpaste on a bee sting, or any old fashion home remedy. They still work and are still available.
The 5-HTP I spoke about can be bought over the counter in any health food store. It converts to Serotonin and crosses the blood brain barrier. So instead of taking an SSRI and faking the brain it has more Serotonin, you can take 5-HTP and actually have more Serotonin and wouldn't need an SSRI.
No one pushes 5-HTP. Again, no patent, and no money to be made by the drug co.'s . My pdoc didn't even know about 5-HTP. Look it up if you don't know about it.
K.I.T.
Steve
poster:WhatToDoNext
thread:844323
URL: http://www.dr-bob.org/babble/20080805/msgs/844565.html