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Re: Anyone ever augment a TCA with Zoloft or Remeron?

Posted by linkadge on December 27, 2018, at 10:51:14

In reply to Re: Anyone ever augment a TCA with Zoloft or Remeron?, posted by Schlepo on December 26, 2018, at 17:06:04

Hi.
I just wrote a long response and it got erased (arggg).

I was taking lower doses (20-30mg of nortriptyline) and added 7.5-15mg of mirtazapine as my sleep was not good.
There may not be a need to lower the nortriptyline. You could keep this at the current dose and then slowly add a 2nd med. For mirtazapine, I wouldn't take more than 7.5mg to start (perhaps even 3.75mg). For sertaline, I would start with 25mg.
Keep in mind, these two meds could have very different effects

mirtazapine
-----------
- good for sleep, anxiety, and low appetite
- lower risk of sexual dysfunction
- may improve cognition
- higher daytime sedation (especially to start)
- some don't find it as strong on core depression symptoms (although varies quite a bit from person to person)
- may cause weight gain

sertaline
---------
- more activating than mirtazapine
- weight neutral
- good for anxiety / depression
- will cause less daytime sedation
- may cause more sexual dysfunction

If it was a toss up between these two, I might go for sertaline first (unless insomnia, anxiety are predominant, then mirtazapine might be a better choice). TCAs and SSRIs are combined fairly regularly. There is no direct contraindication (as with
MAOIs). If you start the 2nd med slowly and increase slowly, you should be able to catch an interaction. Sertaline can increase the blood level of nortriptyline (usually only to a small extent), so ultimately, you may get away with less nortriptyline. I'm not sure if you are getting theraputic testing for nortriptyline levels. If so, you may want to check the nortripyline levels. Nortriptyline can have more side effects if the level gets too high. However, this may just mean you ultimately need less nortiprtline.

https://www.ncbi.nlm.nih.gov/pubmed/9375595


Linkadge


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