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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by schleprock on May 12, 2012, at 20:26:03
I've been lurking around this forum on and off over the last few years, but now I could really use some help!
I suffer from chronic anxiety\depression, and have been on nortriptyline for the past 20 years (started at 200mg; the last 10 years I'd alternate between 100\150mg every other night). The first 17 years I was relatively stable, but things began to unravel when an interim psychiatrist I was briefly seeing convinced me to try switching me over to 1200mg of lithium. Unfortunately, the only results of this very brief "experiment" were me suffering uncharacteristically severe panic attacks. The lithium was stopped, and I was put on clonazepam (initially 1 and 1/2 mgs, I think) and atenolol (12.5 mg) to control the anxiety.
To get to the point, I felt like crap on the extra medications (to the point were I'd rarely go outside), gradually weaned myself off of them, and finally started to feel pleasantly normal for the first six months without them. Then about two months ago I suffered a severe panic attack in the middle of the night, then two weeks later the slightly more typical persistant, lingering anxiety and depression.
Since then, I've tried upping my nortriptyline dosage from the nightly alternating of 100\150mg to a steady 150mg (I employed a similar strategy when I was briefly only taking 100mg and began to experience issues.), and a brief return to atenolol, which only seemed to worsen the depression. For the past couple of weeks I've seemed to be suffering from a cycling, off and on depression, not unlike how I remember feeling just before I've started taking nortriptyline. I felt great the first few days of the atenolol, but now the depression is returning and I'm starting to get worried!
My biggest fear is that now the nortriptyline has just stopped working for me, and I'm really paranoid about switching over to something else! In a few days I'll be seeing my present psychiatrist, and I was hoping I could get some suggestions for what my best options are. I think I'd be more comfortable either augmenting (or increasing) my current med or switching only to another tricyclic (after my first year of nortriptyline I tried switching over to prozac, but had to quickly go back.) I'd even consider going back to clonazepam if it would help with the depression. I'm hoping that someone out there has had a similar experience and found a successful solution.
Posted by Phillipa on May 13, 2012, at 9:49:47
In reply to HELP! My anti-depressant is going on strike!, posted by schleprock on May 12, 2012, at 20:26:03
Only meds that stop working. Phillipa
Posted by Lou Pilder on May 13, 2012, at 11:33:13
In reply to HELP! My anti-depressant is going on strike!, posted by schleprock on May 12, 2012, at 20:26:03
> I've been lurking around this forum on and off over the last few years, but now I could really use some help!
>
> I suffer from chronic anxiety\depression, and have been on nortriptyline for the past 20 years (started at 200mg; the last 10 years I'd alternate between 100\150mg every other night). The first 17 years I was relatively stable, but things began to unravel when an interim psychiatrist I was briefly seeing convinced me to try switching me over to 1200mg of lithium. Unfortunately, the only results of this very brief "experiment" were me suffering uncharacteristically severe panic attacks. The lithium was stopped, and I was put on clonazepam (initially 1 and 1/2 mgs, I think) and atenolol (12.5 mg) to control the anxiety.
>
> To get to the point, I felt like crap on the extra medications (to the point were I'd rarely go outside), gradually weaned myself off of them, and finally started to feel pleasantly normal for the first six months without them. Then about two months ago I suffered a severe panic attack in the middle of the night, then two weeks later the slightly more typical persistant, lingering anxiety and depression.
>
> Since then, I've tried upping my nortriptyline dosage from the nightly alternating of 100\150mg to a steady 150mg (I employed a similar strategy when I was briefly only taking 100mg and began to experience issues.), and a brief return to atenolol, which only seemed to worsen the depression. For the past couple of weeks I've seemed to be suffering from a cycling, off and on depression, not unlike how I remember feeling just before I've started taking nortriptyline. I felt great the first few days of the atenolol, but now the depression is returning and I'm starting to get worried!
>
> My biggest fear is that now the nortriptyline has just stopped working for me, and I'm really paranoid about switching over to something else! In a few days I'll be seeing my present psychiatrist, and I was hoping I could get some suggestions for what my best options are. I think I'd be more comfortable either augmenting (or increasing) my current med or switching only to another tricyclic (after my first year of nortriptyline I tried switching over to prozac, but had to quickly go back.) I'd even consider going back to clonazepam if it would help with the depression. I'm hoping that someone out there has had a similar experience and found a successful solution.
>schleproc,
You wrote,[...I could really usse some help..suffer from..anxiety/depression...hoping that someone...has had similar experiance..found a successful solution...].
I am unsure as to if or if not you are wanting to limit responses from members here to those that used the actual drugs that you mention or if {similar} could be a broader term to include anyone's response, even if they did not take the actual drugs mentioneed by you here. So if you could post answers to the following, then I could have the opportunity or not to post a response to what your request could be.
A. I am limiting responses to those that have taken the drugs mentioned
B. I am not limiting response to those that have taken those drugs
C. I have no restrictions to those that would like to post their response here to my post.
Lou
Posted by schleprock on May 13, 2012, at 12:15:52
In reply to Lou's response-initiator restriction » schleprock, posted by Lou Pilder on May 13, 2012, at 11:33:13
> > I've been lurking around this forum on and off over the last few years, but now I could really use some help!
> >
> > I suffer from chronic anxiety\depression, and have been on nortriptyline for the past 20 years (started at 200mg; the last 10 years I'd alternate between 100\150mg every other night). The first 17 years I was relatively stable, but things began to unravel when an interim psychiatrist I was briefly seeing convinced me to try switching me over to 1200mg of lithium. Unfortunately, the only results of this very brief "experiment" were me suffering uncharacteristically severe panic attacks. The lithium was stopped, and I was put on clonazepam (initially 1 and 1/2 mgs, I think) and atenolol (12.5 mg) to control the anxiety.
> >
> > To get to the point, I felt like crap on the extra medications (to the point were I'd rarely go outside), gradually weaned myself off of them, and finally started to feel pleasantly normal for the first six months without them. Then about two months ago I suffered a severe panic attack in the middle of the night, then two weeks later the slightly more typical persistant, lingering anxiety and depression.
> >
> > Since then, I've tried upping my nortriptyline dosage from the nightly alternating of 100\150mg to a steady 150mg (I employed a similar strategy when I was briefly only taking 100mg and began to experience issues.), and a brief return to atenolol, which only seemed to worsen the depression. For the past couple of weeks I've seemed to be suffering from a cycling, off and on depression, not unlike how I remember feeling just before I've started taking nortriptyline. I felt great the first few days of the atenolol, but now the depression is returning and I'm starting to get worried!
> >
> > My biggest fear is that now the nortriptyline has just stopped working for me, and I'm really paranoid about switching over to something else! In a few days I'll be seeing my present psychiatrist, and I was hoping I could get some suggestions for what my best options are. I think I'd be more comfortable either augmenting (or increasing) my current med or switching only to another tricyclic (after my first year of nortriptyline I tried switching over to prozac, but had to quickly go back.) I'd even consider going back to clonazepam if it would help with the depression. I'm hoping that someone out there has had a similar experience and found a successful solution.
> >
>
> schleproc,
> You wrote,[...I could really usse some help..suffer from..anxiety/depression...hoping that someone...has had similar experiance..found a successful solution...].
> I am unsure as to if or if not you are wanting to limit responses from members here to those that used the actual drugs that you mention or if {similar} could be a broader term to include anyone's response, even if they did not take the actual drugs mentioneed by you here. So if you could post answers to the following, then I could have the opportunity or not to post a response to what your request could be.
> A. I am limiting responses to those that have taken the drugs mentioned
> B. I am not limiting response to those that have taken those drugs
> C. I have no restrictions to those that would like to post their response here to my post.
> LouNo, I have no wish to limit the responses in any way. The last sentence was more or less rhetorical, and just seemed like the best way to end the post.
Posted by bleauberry on May 13, 2012, at 17:46:27
In reply to HELP! My anti-depressant is going on strike!, posted by schleprock on May 12, 2012, at 20:26:03
Add rhodiola rosea to it.
If you were going to make any moves on the meds, then I personally would add something complimentary to nort, which would be zoloft, prozac, or savella. to get a full spectrum approach for both depression and anxiety and covering multiple neurotransmitters not just one. If a total switch were in mind, then I would probably want to go to another TCA with a reputation as good or better than nort, and with the full spectrum, and that would be clomipramine.
But I know nortrirptyline pretty well. I know rhodiola pretty well. I know your symptoms pretty well and how puzzling the whole scenario can look sometimes. That's the stuff rhodiola has good potential for. I have never seen it touted as a mood stabilizer, but honestly I think it's be mood stabilizer out there and I've tried them all except trileptal. Great for anxiety, social anxiety, all kinds of anxieties. Most of its scientific and anecdotal eviidence has been on fatigue and mood. The common side effects people experience are antidepression, antianxiety, and antii insomnia. In other words, if someone starts taking rhodiola because they have a lot of stress in their fast paced world and they need more energy endurance, they will probably get those desired outcomes but it also comes with better mood, calmer more grounded, and improved sleep.
A psychiatrist in NYC and his psychiatrist wife wrote a book called Rhodiola Revolution. I have not read it. Short to the point..,,they couldn't fix her depression or the lingering symptoms of her chrnoic lyme. When they added rhodiola to her meds, she got better. Now he routinely prescribes rhodiola in his psychiatrist office along with meds.
Dosing is tricky. So if you get to that point don't hesitate to ask more about how to dose rhodiola.
Imo, the worst thing to do at this time would be a total switch to some completely different med....ya know, an effexor, cymbalta, lexapro, antipsychotic...20 years is a really long time and your body aint going to let go of that nortriptyline molecule very easily. It's almost part of your body by now, so even if it was doing nothing it could take a long time to wean off it.
Imagining myself in your shoes, my first step would be to start playing with rhodiola with an eye on the longterm so no matter how small my starting dose is it doesn't matter. Very shortly after getting some of that started, I would add in the lowest dose, or even half the lowest dose, of savella. My second choice after savella would be zoloft, third choice prozac, but hopefully savella would add the extra stuff needed that nortriptyline used to be able to do completely on its own, and rhodiola would further fill in the gaps as well as provide a bunch of other benefits.
Ask 10 different doctors and they will all likely have a different idea for you. I'm not a doctor.
Posted by schleprock on May 13, 2012, at 19:28:37
In reply to Re: HELP! My anti-depressant is going on strike!, posted by bleauberry on May 13, 2012, at 17:46:27
Thank you very much for the response, bleauberry. One of my main concerns whether I should augment or switch (and then to which class-)so I take it that switching to another class would be the worst option. I'll have to look into rhodiola, but the phrase "mood stabilizer" makes me think of lithium, and I certainly can't go there again.
Regarding an alternative TCA, I've also heard that desipramine is also supposed to be very similar to nortriptyline.
Also I'm not surprised that you mentioned Zoloft, as my first psychiatrist once suggested I switch over (presumably because it would have been an easier transition to that med than prozac, which we had previously attempted.) I think I've read that it works more like a TCA than other SSRIs, but can't confirm it. I'd certainly consider using it for augmentation.
The supplements I'll have to look into, as I've never really considered going outside the more "traditional" antidepressants before.
Posted by Zyprexa on May 18, 2012, at 0:54:06
In reply to Re: HELP! My anti-depressant is going on strike!, posted by schleprock on May 13, 2012, at 19:28:37
You could stick it out with the meds that used to work see if they come back around to working. Thats what I did with zyprexa. It stoped working while I was on a trial of abilify. I went back on zyprexa and off abilify and the zyprexa seemed weaker in strength, so I uped the dose to double and added anouther AP with similar effect which helped the zyprexa work better. Its been a few years since and I've gotten the zyprexa back down to the original dose of 10mg and seems to work better now. I still take the perphenazine too.
So I guess what I'm saying is stick with the med that worked and hope it works again. Maybe raise the dose. or add something new to the mix.
This is the end of the thread.
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