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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by kiwi on April 13, 2000, at 23:41:31
Dear Med-heads,
(Please don't reply to my Email addr)
I'm taking:
1200mg Lithium
125mg Nortriptyline (aka Pamelor)
1.5mg ClonazepamWithout the Lithium I swing wildly from being very
depressed to being very agitated (and still depressed).
So, I think the Lithium is helping.I feel a bit agitated at this level of
Nortriptyline, and a bit depressed at 100mg
Nortriptyline. I just can't find the right balance.But I worry constantly about what these meds are
doing to my body: Nortriptyline causes increased
heart rate, Lithium is bad for the liver (and
gives me severe diarrhea about twice a week).Comments?
Posted by Scott L. Schofield on April 18, 2000, at 20:56:39
In reply to Meds advice: Lithium + Nortriptyline, posted by kiwi on April 13, 2000, at 23:41:31
Hi kiwi.
I really don't have much to say. I just didn't want you to think that you were being neglected for having body-odor or something. Sometimes people's attentions are drawn to "hot" issues like the one dealing with malevolent posts. Also, I don't think many people have much experience with tricyclics to be able to offer you any comments.
> Dear Med-heads,
>
> (Please don't reply to my Email addr)
>
> I'm taking:
> 1200mg Lithium
> 125mg Nortriptyline (aka Pamelor)
> 1.5mg ClonazepamFor what condition(s) are you taking these for?
Why was nortriptyline chosen?> I feel a bit agitated at this level of
> Nortriptyline, and a bit depressed at 100mg
> Nortriptyline. I just can't find the right balance.125mg of nortriptyline is normally considered to be a high dosage. People can differ in the way they metabolize drugs, so there are no hard rules as to what dosage is appropriate for all individuals. A blood test should help you figure out whether you should adjust the dosage. Nortriptyline is the best studied of the tricyclics with respect to therapeutic blood levels. It has demonstrated a "therapeutic window". Not only can blood levels be too low, but they can also be too high.
Example:
- 25mg = no response
- 50mg = good response
- 75mg = loss of responseI would recommend that you determine your blood level of nortriptyline and adjusting the dosage until levels fall within the established therapeutic range.
If your doctor has decided that tricyclics are the way to go, you may consider trying desipramine if nortriptyline proves unsatisfactory. There seems to be a negative association between these two drugs with respect to antidepressant response. If nortriptyline works, it is less likely that desipramine will; if desipramine works, it is less likely that nortriptyline will. Although this only represents a trend seen in statistics, it certainly offers a rationale for trying desipramine or one of the other tricyclics.
Tricyclics are very effective, and are often overlooked. But there are plenty of alternatives.
> Without the Lithium I swing wildly from being very
> depressed to being very agitated (and still depressed).
> So, I think the Lithium is helping.> But I worry constantly about what these meds are
> doing to my body: Nortriptyline causes increased
> heart rate,I have not seen anything that would suggest that tricyclics produce any long-term irreversible effects on the cardiovascular system.
> Lithium is bad for the liver
I am not sure that it is. I do know that it can be hard on the kidneys, and that it can affect thyroid function. Thyroid tests should be performed every now and then.
> (and gives me severe diarrhea about twice a week).Ouch. Sorry.
> Comments?
Perhaps you will get more feedback if you provide a better description of your symptoms, any diagnoses that have been proposed, and an idea of what treatments you have already tried.
Good luck.
Posted by bob on April 20, 2000, at 0:03:08
In reply to Re: Meds advice: Lithium + Nortriptyline, posted by Scott L. Schofield on April 18, 2000, at 20:56:39
Geez! Sorry kiwi -- I can't believe I missed this post (and thanks to Scott for chiming in).
I've been on nortrip for quite some time and, like Scott said, it's the only TCA with a well-defined therapeutic window. You should definitely get a blood test done to see if you're hitting that window.
I've been at 150mg/day of nortrip and it has worked well for me, but needs augmentation. I'm also on 1mg of clonazepam for panic disorder ... sounds familiar, perhaps?
While on zoloft, my pdoc had me try lithium to augment that med -- I couldn't tolerate more than 450mg/day on it ... it really stirred up my nerves! Maybe folks out there who are more familiar with mood stabilizers can say something about the side effect profiles of lithium versus neurontin or whatever else there is out there. I'm just curious about it, because you didn't say what you're taking the clonazepam for. Perhaps its not so much the nortriptyline level but the lithium level that's causing the agitation, and maybe a different mood stabilizer would be better ... just tossing out an idea.
As for what nortrip can do to you long term -- it was a minor concern of my gp's wrt cardiac function. Every four months or so he does an ekg to check out how the ticker's working, but he hasn't seen a single thing in over a year to concern him one bit.
good luck!
bob[ps. I just switched today from nortrip to desipramine ... it's supposed to work for OCD/anxiety as well as for depression (if you can believe what it says on those drug store info sheets -- hey Cam! where do the chains get the data for those sheets anyway?) ... my pdoc and I are also hoping that it's a little less sedating.]
Posted by Cam W. on April 20, 2000, at 0:15:23
In reply to Re: Meds advice: Lithium + Nortriptyline, posted by bob on April 20, 2000, at 0:03:08
(if you can believe what it says on those drug store info sheets -- hey Cam! where do the chains get the data for those sheets anyway?)
bob - From their lawyers.
Every psychiatrist I know hates them - alarmist descriptions of the side effects of meds...."This drug may cause an anaphylactic reaction and you may die without prompt medical treatment." - What the hell is that?
- Cam W.
Posted by ChrisK on April 20, 2000, at 7:55:56
In reply to Meds advice: Lithium + Nortriptyline, posted by kiwi on April 13, 2000, at 23:41:31
Kiwi,
Sorry I missed this too. I've been taking Nortrip for a couple of years and it has helped a great deal. There has been the dry mouth and constipation but I'd rather go through that than through the bad depression.
I take a low dose which may help you out. I am 6 feet and 250 pounds and take 100 mg of Nortrip/day.
In the past I have taken Lithium with Immiprimine. It did nothing for me. I think if you are getting SOME benefit from your current meds that you should look at changing your doses. It may actually be that you can get by with lower doses.
Lastly, You may want to think about one of the antipsychotics like Zyprexa or Risperdol. They are very safe to use as augmentors to antidepresants. They can act as well as a mood stabilizer like Lithium. If the Lithium is helping please monitor your blood levels and be upfront to your doctor that you may want to change to something else.
Lithium has helped a lot of people - don't be afraid to suggest a dose adjustment or a new med.
Chris
This is the end of the thread.
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