Posted by Bob on January 25, 2013, at 12:06:47
In reply to Re: Dr Ken Gillman on - SLS » Bob, posted by SLS on January 24, 2013, at 19:09:48
> It would be a good idea to get a blood level of nortriptyline if you haven't already done so. It is possible to take too much as well as too little.
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> Just a few ideas:
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> Desipramine might be worth trying in place of nortriptyline. It is substantially more potent as a NE reuptake inhibitor. It is possible that you would need a 5-HT2a antagonist, too, when attempting to substitute for the nortriptyline. A very low dose of Risperdal or one of the other AAPs could serve this purpose. Hmm... Adding Remeron to desipramine or nortriptyline would be an interesting alternative. It would be a way to get the 5-HT2a antagonism and shift NE into overdrive. Sedation is a problem at lower dosages, so you might want to go up to at least 45 mg/day.
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> - ScottHey Scott,
Thank you for the suggestions, your advice is always welcome. I am in a situation in my life these days where med changes are extremely difficult unfortunately, and are accompanied by a significant period of thought and planning. I have always had to taper carefully and slowly no matter what I take as I am more sensitive to meds and med changes than just about anyone I've ever discussed this with.
I too have thought about desipramine due to it's similarity with nortriptyline, but it's the differences that have me worried. I'm concerned that desipramine may be missing something that is helping me with the nortriptyline since there have been so many failures with other other drugs. The other idea I've been toying with lately is to change the sertraline to another SSRI - maybe Lexapro or something similar?
The mirtazapine certainly sounds like a good idea, in theory at least. The pharmacology seems to be comprehensive with a lot of different mechanisms/receptors being affected.
Bob
poster:Bob
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URL: http://www.dr-bob.org/babble/20130124/msgs/1036466.html