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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by ace on August 23, 2004, at 18:51:05
In my never ending quest to rid myself of OCD, me and my doctor have agreed to give Nortriptyline a go. We have both seen some clinical trials wher Nortyptiline has been added to Anafranil, thus squashing OCD. I have a few qstns kids....
1. With Nardil- Suggestions have been made that it can safely be added concurrently with the Nardil....or should I lower right down to 15mg, skip a day, then start Nortryptyline, and the next day back to Nardil??
2. reboxetine (another NE booster) caused me depression...obv\iously there is major differences between Nortryptyline and rebox, but can anyone forsee another return of depression.
3. Dosage...My doc, and I agree, believes the main problem with TCA's is dosage...most people have their dosage too LOW. does 60mg Nardil + 75mg Nortryptiline seem adequate?
4. Anyone with experience of this drug, for anything, please give me all details!!!!!!
Thanks so much dudes and dudettes!!!Ace!
Posted by zeugma on August 23, 2004, at 19:15:02
In reply to Nardil + Nortriptyline - urgent qstns!!!, posted by ace on August 23, 2004, at 18:51:05
ace,
i would guess that of the most effective AD's of all time, both nortriptyline and Nardil would be high on the list. Nortrip got me out of a wasting depression so severe that i was little more than a skeleton. I agree about the dosage- you need to have plasma work done with this med. SLS has reported serotonin syndrome on this combination, however, and I have seen conflicting reports as to its serotonergetic potency. It is definitely less dangerous than Anafranil, but that may not be saying much. Scott has personal experience with this combo, and with similar ones, and he may be able to give more concrete info.
By the way, i think it is wholly admirable that you are sticking to Nardil tenaciously... i feel the same way about nortriptyline, although it does make life more complicated in some ways. There's nothing like relief from depression, and i am of the opinion that pdocs too often see these meds as interchangeable sets of receptor affinities and so forth, and so miss the element of the idiosyncratic and unknown that suffuses all we know of the brain... best of luck, z
Posted by Glydin on August 23, 2004, at 21:22:32
In reply to Re: Nardil + Nortriptyline - urgent qstns!!! » ace, posted by zeugma on August 23, 2004, at 19:15:02
I am wishing you luck and, and, and to remind you of your previous words ---- SLOWLY, SLOWLY, SLOWLY with additions. I just have geniune concern for you and want you get to and stay in a good place.
I care how our resident kangaroo hops!!(smile)
Posted by Sad Panda on August 23, 2004, at 23:56:33
In reply to Nardil + Nortriptyline - urgent qstns!!!, posted by ace on August 23, 2004, at 18:51:05
> In my never ending quest to rid myself of OCD, me and my doctor have agreed to give Nortriptyline a go. We have both seen some clinical trials wher Nortyptiline has been added to Anafranil, thus squashing OCD. I have a few qstns kids....
>
> 1. With Nardil- Suggestions have been made that it can safely be added concurrently with the Nardil....or should I lower right down to 15mg, skip a day, then start Nortryptyline, and the next day back to Nardil??
>
> 2. reboxetine (another NE booster) caused me depression...obv\iously there is major differences between Nortryptyline and rebox, but can anyone forsee another return of depression.
>
> 3. Dosage...My doc, and I agree, believes the main problem with TCA's is dosage...most people have their dosage too LOW. does 60mg Nardil + 75mg Nortryptiline seem adequate?
>
>
> 4. Anyone with experience of this drug, for anything, please give me all details!!!!!!
>
>
> Thanks so much dudes and dudettes!!!
>
> Ace!
>Hi Ace,
1. Do you know which P450 enzyme metabolises Nardil? I know that Nardil inhibits it's own metabolisim & Nortriptyline uses 2D6. If there is no clash, I would leave the Nardil doseage alone. Nort is a weak SRI, I don't think this would be a problem. Hyperthermia is the deadly part of serotonin syndrome, taking a 5-HT2A antagonist counters this, so extra Zyprexa would be good as an antidote if you suspect SS, discuss it with your doctor of course. Nort is a moderate 5-HT2A antagonist too, so it's kind of self protecting.
2. I don't know.
3. I just had my first Nort plasma level today. I am currently at 125mg, guess I will find out in a couple of days what my plasma level is.
4. I had transient headaches & impotence when I started it, the headaches lasted a few days, the impotence lasted a couple of weeks. Start Nort with the doseages spread a bit, but later you can take it all in one hit because it has an average half life of 36 hours, YMMW of course. Nort might lower your BP & is likely to cause you some orthostatic hypotension, but it hasn't for me. (I am obese with high blood pressure). It will slow your bowel down, which is good for me & one of the reasons I went for Nort instead of Rebox.
Cheers,
Panda.
Posted by ace on August 24, 2004, at 1:27:15
In reply to Re: Nardil + Nortriptyline - urgent qstns!!! » ace, posted by zeugma on August 23, 2004, at 19:15:02
> ace,
>
> i would guess that of the most effective AD's of all time, both nortriptyline and Nardil would be high on the list. Nortrip got me out of a wasting depression so severe that i was little more than a skeleton. I agree about the dosage- you need to have plasma work done with this med. SLS has reported serotonin syndrome on this combination, however, and I have seen conflicting reports as to its serotonergetic potency. It is definitely less dangerous than Anafranil, but that may not be saying much. Scott has personal experience with this combo, and with similar ones, and he may be able to give more concrete info.
>
> By the way, i think it is wholly admirable that you are sticking to Nardil tenaciously... i feel the same way about nortriptyline, although it does make life more complicated in some ways. There's nothing like relief from depression, and i am of the opinion that pdocs too often see these meds as interchangeable sets of receptor affinities and so forth, and so miss the element of the idiosyncratic and unknown that suffuses all we know of the brain... best of luck, zThanks so very much for your well-wishes. It's great that Nortipt works well for you....have you ever tried Nardil???
Again, thanks so much and take good care
Ace
Posted by ace on August 24, 2004, at 1:31:13
In reply to Re: Nardil + Nortriptyline - urgent qstns!!!, posted by Glydin on August 23, 2004, at 21:22:32
> I am wishing you luck and, and, and to remind you of your previous words ---- SLOWLY, SLOWLY, SLOWLY with additions.
EXACTLY!!!! I am going to be very careful and sensible, because Ace wants to be a happy boy!!
I just have geniune concern for you and want you get to and stay in a good place.
God Bless You! Thanks so very much for that comment and your sentiments. Thankfully right now, I am a happy little Ace again!!
>
> I care how our resident kangaroo hops!!(smile)Ha ha....well, he USED to hop but because of all the weight gain he walks like a 90 y/o man now!!!
Seriously, I have gained Sooooo much weight, but me and my doc are working on a diet and exercise schedule to get those pounds off, so the girls start giving me the eye again!!!!!!
Once again, God Bless, and you take good care of yourself!
Ace....(Andrew)
Posted by ace on August 24, 2004, at 1:34:28
In reply to Re: Nardil + Nortriptyline - urgent qstns!!! » ace, posted by Sad Panda on August 23, 2004, at 23:56:33
>
> Hi Ace,
>
> 1. Do you know which P450 enzyme metabolises Nardil?Yes, but my brain is being a real bum today and wont let me remember!!
I know that Nardil inhibits it's own metabolisim & Nortriptyline uses 2D6. If there is no clash, I would leave the Nardil doseage alone. Nort is a weak SRI, I don't think this would be a problem. Hyperthermia is the deadly part of serotonin syndrome, taking a 5-HT2A antagonist counters this, so extra Zyprexa would be good as an antidote if you suspect SS, discuss it with your doctor of course. Nort is a moderate 5-HT2A antagonist too, so it's kind of self protecting.
All good advice...thanks so much, I'm printing this post out...
> 2. I don't know.
>
> 3. I just had my first Nort plasma level today. I am currently at 125mg, guess I will find out in a couple of days what my plasma level is.
>
> 4. I had transient headaches & impotence when I started it, the headaches lasted a few days, the impotence lasted a couple of weeks. Start Nort with the doseages spread a bit, but later you can take it all in one hit because it has an average half life of 36 hours, YMMW of course. Nort might lower your BP & is likely to cause you some orthostatic hypotension, but it hasn't for me. (I am obese with high blood pressure).When you say obese, how many kg are you??
It will slow your bowel down, which is good for me & one of the reasons I went for Nort instead of Rebox.
>
> Cheers,
> Panda.
Thanks so much Panda! Much appreciated as always, look after yourself...Ace
Posted by Sad Panda on August 24, 2004, at 2:43:23
In reply to Re: Nardil + Nortriptyline - urgent qstns!!! » Sad Panda, posted by ace on August 24, 2004, at 1:34:28
> When you say obese, how many kg are you??
>180kg, morbidly obese :/
Cheers,
Panda.
Posted by SLS on August 24, 2004, at 7:33:21
In reply to Nardil + Nortriptyline - urgent qstns!!!, posted by ace on August 23, 2004, at 18:51:05
I experienced the beginnings of serotonin syndrome when attempting to add nortriptyline to Nardil 75mg. Symptoms included severe hypotension and altered mental status. Although not as severe as my reaction to the addition of imipramine to Nardil, it was nonetheless worrying.
I agree that it is the hyperpyrexia that is the most serious of the features of SS. I did not experience this with either TCA. I did experience muscle rigidity, though. Serious enough. However, these things resolved pretty quickly upon skipping a few doses of TCA, so you might be able to titrate nortriptyline CAUTIOUSLY to challenge your system in such a way that will allow you to abort treatment should SS appear.
Good luck. I wouldn't necessarily discourage you from attempting the combination. Just don't swallow 75mg of nortriptyline for your first dose!
- Scott
Posted by zeugma on August 24, 2004, at 18:08:26
In reply to Re: Nardil + Nortriptyline - urgent qstns!!! » zeugma, posted by ace on August 24, 2004, at 1:27:15
Thanks so very much for your well-wishes. It's great that Nortipt works well for you....have you ever tried Nardil???
No, never tried Nardil. I have thought about it, because I also have social anxiety and phobias, but Klonopin is pretty good with the social anxiety and I think that if something works,to stick with it if at all possible; and I know full well that I'm in that set of the population that is going to have to take an AD indefinitely. So, nortriptyline it is, until it either stops working or another reason makes me discontinue (I hope not- I am trying to maintain my health, eat well, exercise, etc., so I can stay well enough to stay on the TCA. Not being depressed is very motivating!).
Again, thanks so much and take good care
Ace>
You're welcome, and good luck with nortrip or whatever you try (and listen to Scott's advice!)
z
Posted by luther on August 26, 2004, at 6:54:43
In reply to Nardil + Nortriptyline - urgent qstns!!!, posted by ace on August 23, 2004, at 18:51:05
Interesting Concept. I have taken Anafranil and it should work for OCD by its self. I really wouldn't add another A/D to it with its side effects. Personally I think it works for SAD as well if one can tolerate the side-effects. I know it works on all 3 neurotransmitters. I would not add anything to it, could be very dangerous due to the higher incidence of seizures. Personally I would be afraid to add any A/D to Nardil though I have read that it can be done in some litterature. Good Luck!
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